Life During Lockdown by Shed13

Life during Lockdown

Findings from the Growing Up in New Zealand COVID-19 Wellbeing Survey PART 1: HEALTH AND WELLBEING

Growing Up in New Zealand:

Life during Lockdown: Findings from the GUiNZ COVID-19 Wellbeing Survey Part 1: Health and Wellbeing Authors Natalie Walker

Kane Meissel

Nandini Dubey

Sarah-Jane Paine

Molly Bergquist

Te Kani Kingi

Stephane Janicot

Seini Taufa

Boyd Swinburn

Avinesh Pillai

Carin Napier

Pat Bullen

Elizabeth Peterson

Karen Waldie

Rebecca Evans

Ashley Smith

Sarah Gerritsen

Clare Wall

Fiona Langridge

Susan Morton

September 2021

Suggested Citation: Walker N, Dubey N, Bergquist M, et al. The GUiNZ COVID-19 Wellbeing Survey: Part 1: Health and Wellbeing. Auckland: Growing up in New Zealand, 2021. ISSN: 2253-251X (online) © Growing Up in New Zealand 2021 Contact details: Professor Boyd Swinburn, Acting Research Director, Growing Up in New Zealand, PO Box 18288, Auckland 1743, Phone +64 9 373 7599 Further information on Growing Up in New Zealand is available at www.growingup.co.nz This report was produced by the University of Auckland with Crown funding managed by the Ministry of Social Development. www.msd.govt.nz The cover image and the image on pg 3 were taken by photographer Shona Dey. They are part of her Lockdown Bubble series which documented families in their neighbourhood during the 2020 Level-4 Lockdown.

Table of Contents Policy Summary................................................................2

3.4.3 A nxiety symptoms during COVID-19, compared to before COVID-19................. 37

3.4.4 C hildren most at risk of poor health and wellbeing...................................................40

Executive Summary..........................................................6 List of Figures....................................................................8 List of Tables.....................................................................9 Glossary.......................................................................... 10 1.

Introduction.............................................................. 11 1.1 COVID-19 in New Zealand.................................... 11 1.2 The impact of COVID-19 on the health and wellbeing of children...........................................12 1.3 The impact of Alert Level 4 (Lockdown) on New Zealand children...........................................12

4. Discussion................................................................43 4.1 Strength in togetherness................................... 43 4.2 Alert Levels 2-4 were very challenging for some children..................................................... 43 4.3 Could the observed changes in depression and anxiety be age-related?............................... 43 4.4 The security of the ‘bubble’...............................44

1.4 Overview of Growing up in New Zealand..............13

4.5 Some children worry a lot about money............44

1.5 Aims of the COVID-19 Wellbeing Survey...............13

4.6 Support children with well-being and developmental concerns...................................44

1.6 The focus of this report.........................................13 2. Methods.................................................................... 14 2.1 Study design........................................................14 2.2 Data collection....................................................14 2.3 Survey questions.................................................14

4.7 Comparison with other COVID-19 studies undertaken in children....................................... 45 5. Strengths and Limitations..................................... 46 5.1 Study strengths..................................................46

2.4 Data analyses......................................................14

5.2 Study limitations................................................46

3. Findings ......................................................................15

6. Future Directions.....................................................48

3.1 Survey respondents............................................15

Acknowledgements....................................................... 49

3.2 Participant characteristics.................................16

References......................................................................50

3.3 Cross-sectional analysis of the COVID-19 Wellbeing Survey.................................................17

APPENDICES....................................................................54

3.3.1 Health status...............................................17

APPENDIX A: Additional detail related to the study methods................................................................. 54

3.3.2 Depression..................................................21

APPENDIX B: Survey questionnaire.................................. 59

3.3.3 Anxiety....................................................... 25

APPENDIX C: Survey response rate.................................. 70

3.4 Longitudinal analysis of the COVID-19 Wellbeing Survey.................................................31

APPENDIX D: Demographic variables...............................71

3.4.1 Health status during COVID-19, compared to before COVID-19......................................31

3.4.2 Depression symptoms during COVID‑19, compared to before COVID-19................... 35

APPENDIX E: Potential predictors of depression and anxiety ..................................................................... 72 APPENDIX F: Other variables of interest to health and mental wellbeing....................................................... 73

Growing Up in New Zealand COVID-19 Wellbeing Survey

Policy Summary Summary In March 2020, the New Zealand Government introduced a four-level COVID-19 alert system, with each level considering the immediate level of risk and outlining the required restrictions that legally had to be followed to minimise the risk of catching and/or spreading COVID-19. As the levels increased, restrictions increased on population movement, travel, and gatherings. The alert levels were Level 1 (Prepare); Level 2 (Reduce); Level 3 (Restrict); and Level 4 (Lockdown). This policy brief draws on findings from a bespoke online COVID-19 Wellbeing Survey delivered early in the first nationwide lockdown in May 2020 when the country was at COVID-19 Alert Levels 2 and 3 and completed by 2,421 children aged 10-11 years participating in the Growing Up in New Zealand longitudinal study. The survey provided the opportunity to: 1) determine the children’s experiences during Alert Levels 2 - 4, including their health and mental wellbeing, schooling, connectedness, media use, and nutrition; and 2) ascertain the level of engagement by the cohort in a bespoke online digital data collection process. This report focusses on the health and mental wellbeing outcomes from the survey and compares the findings to when the children were approximately eight years of age. The report found: • Overall, 83% of children reported ‘very good’ to ‘excellent’ health during COVID-19 Alert Levels 2-3, and approximately 60% had no symptoms associated with depression or anxiety. • There was an improvement in health (since they were eight) in about a third of children, and a general decline in anxiety over time. • There was an increase in the number of children reporting symptoms related to depression, compared to when they were eight years of age. • Clear subgroups of children were disproportionately impacted by the COVID-19 restrictions (both positively and negatively). 2

Growing Up in New Zealand COVID-19 Wellbeing Survey

• The response rate of 42% was reasonably high for a digital survey of this nature especially given no prior update of digital addresses given the unexpected pandemic. The observed changes in mental health seen in this cohort of children may be age-related or could be attributable to the impact of the COVID-19 restrictions. These findings highlight the need to prioritise child mental health and wellbeing during the pandemic and provide appropriate support to families/whānau and their children.

Context Concerns have been raised about the potential impact of the COVID-19 periods of lockdown and restrictions in movement on the health and mental wellbeing of New Zealand children. Children have been identified as a group vulnerable to the psychosocial impacts of the pandemic as they often lack properly developed coping strategies, and emotional reactions may result in them experiencing greater stress and trauma. The social distancing measures implemented as part of the pandemic response in New Zealand limited access to schools and social interactions between children, separated some children from their families and whānau, restricted access to child protection and other social services and restricted access to usual levels of physical exercise, all of which may have negative impacts on children’s physical and mental health. Moreover, children in vulnerable socioeconomic positions and marginalised communities, or children with disabilities may be disproportionately impacted by the pandemic. To determine the impact of the pandemic on New Zealand children, longitudinal information on child health and wellbeing from before the pandemic needs to be compared to information gathered during, and after the pandemic. The Growing Up in New Zealand data used in this report can provide such information. Longitudinal studies involving children during the time of COVID-19 have been undertaken in other countries, however these countries have had a very different journey though the pandemic, compared to New Zealand.

Findings

Positive findings around mental health

Overall, 42% (n=2,421) of the 5,756 eligible children completed the COVID-19 Wellbeing Survey. A higher response rate to the survey was observed for girls, and children with older and more educated mothers. A lower response rate was observed for Māori, Pacific, and Asian children, and children living in rural areas. Cross-sectional and longitudinal analyses were undertaken, adjusting for socio-demographics, predictors of depression and anxiety, and co-variates from the COVID-19 Wellbeing Survey. The outcome measure from the eight-year data collection wave (DCW) was also considered as a potential covariate for the cross-sectional multivariate models.

• Approximately six in every ten children had no clinically significant depressive symptoms or symptoms of anxiety at the time of the survey.

Positive findings around general health • Approximately eight in every ten children reported they had ‘very good’ to ‘excellent’ health at the time of the survey. • One in three children had an improvement in their health since they were eight years of age.

• Compared to European children, there was a decrease in the proportion of Māori and Pacific children with symptoms of depression, from when the children were eight years of age. • Pacific children had significantly lower anxiety scores at the time of the survey, compared to European children. • Children with 5-6 regular positive experiences during Alert level 4, had significantly lower mean anxiety scores, compared to children with no or very few regular positive experiences. • Pacific children, and children who were overweight when they were eight years of age, had a decrease in anxiety from when they were eight to the time of the COVID-19 Wellbeing Survey.

• Asian children and children with two or more wellbeing and development concerns (e.g., disabilities or learning challenges) when they were eight years of age, were more likely to have an improvement in health over time.

PART ONE: HEALTH AND WELLBEING

Findings of concern around general health • Children who were less connected with friends and family outside of the home during Alert Level 4, or at the time of the survey were worried about how much money their family had, or were still undertaking schoolwork at home, were more likely to report poorer health at the time of the survey.

Who was more likely to experience one or more negative changes in their health and wellbeing, from when they were eight years of age to the time of the covid-19 wellbeing survey?

• Children who had obesity when they were eight years of age reported poorer health at the time of the survey, compared to children of normal body size.

2. Children who had a mother with a history of depression.

• 9% of children had a decline in their reported health. • Children who were underweight when they were eight years of age were less likely to report an improvement in health over time, compared to children of normal body size. Findings of concern around mental health • At the time of the survey, girls, children who were worried about how much money their family had, and children with two or more wellbeing and developmental concerns (e.g., disabilities or learning challenges) when they were eight, were more likely to have higher depression and anxiety scores. • At the time of the survey, children who woke frequently during the night when they were eight, had higher anxiety scores than children who didn’t wake during the night. • At the time of the survey, children who had a mother with a history of depression were more likely to have higher depression scores. • Girls, and children who were always or often worried about how much money their family had at the time of the survey, had an increase in depression and anxiety from when they were eight to the time of the COVID-19 Wellbeing Survey. • Having symptoms of depression and anxiety at eight years of age was strongly predictive of having symptoms of depression and anxiety at time of survey.

Implications

Growing Up in New Zealand COVID-19 Wellbeing Survey

1. Girls

3. C hildren who worried about how much money their family had. 4. Children who had highly educated mothers. Who was less likely to experience one or more negative changes over time? 1. C hildren with six or more people in their ‘bubble’ during Alert Level 4 Despite the limited generalisability of the findings, given two thirds of the cohort did not participate in the survey (particularly Māori, Pacific and Asian children, and children living in rural New Zealand), the report provides much needed information to guide development of appropriate strategies and support for New Zealand children and their whānau, both during and post-pandemic. To date, New Zealand has been one of the most successful countries in the world to control the pandemic, achieved through a focus on an ‘elimination’ strategy. However, New Zealanders have still been impacted by the significant economic and social consequences of COVID-19. Although some of the observed findings may be age-related, New Zealand children have not been immune to the impact of the COVID-19 pandemic. Moving forward, child wellbeing and mental health needs to be prioritized, as it remains unknown what the long-term impact of the COVID-19 pandemic will have on children, particularly in those children already showing signs of distress.

Recommendations 1. Acknowledge the observed strength and resilience of children in respect to their health and mental wellbeing, particularly Māori and Pacific children. 2. Provide caregivers with tools and resources to identify early signs of depression and/or anxiety in children, and appropriate pathways for action. For example, offer family-centric services, not just individualised services, as children’s mental health may be impacted by wider stressors within the family. 3. Provide children with age-appropriate tools and resources to identify early signs of depression and anxiety, and appropriate pathways for action. Given the strong shift to ‘online’ education and support because of COVID-19, mobile and virtual mental health support services may be more acceptable and accessible. However, as part of this move it will be important to ensure equitable access to digital technologies for all families with children. Examples of mobile and virtual mental health support services include: • The free SPARX youth online evidence-based mental health programme (www.sparx.org.nz), hosted by the University of Auckland, and funded by the Prime Minister’s Youth Mental Health Project could be more actively promoted to children and young adults. The programme includes an initial screening for depression and anxiety and a referral pathway for children in immediate need of more active support. • Various evidence-based and culturally-tailored mental wellbeing mobile apps designed specifically for children and young people have been reviewed on the New Zealand ‘Health Navigator’ website (www.healthnavigator.org.nz/), including one that focuses on mental wellbeing during COVID-19.

- ‘Whitu’: a culturally-appropriate coping skills app providing ‘seven ways in seven days’ to support the emotional wellbeing of young people during the COVID-19 pandemic, with a focus on depression and anxiety. Development of the app was led by researchers from Psychological Medicine, University of Auckland and co-designed by mental health, e-health, and Māori and Pacific researchers. - ‘Village’: a culturally-appropriate app that aims to reduce youth suicide by encouraging young people to connect with their support networks (referred to as ‘buddies’) if they are thinking about self-harm and suicide. Development of the app was supported by Auckland Savings Bank, the Starship Foundation, and Datacom, with the app currently being evaluated by Auckland District Health Board. 4. Continue to support families to be financially secure and decrease child poverty, e.g., have (real) living wages and increases to benefits, and improve educational opportunities for young women and mothers. 5. Deliver an education campaign alerting parents/ caregivers that their children may significantly worry about money and providing parents/caregivers with strategies for reassuring their children. 6. Investigate what additional resources and support are needed by families with children who have disabilities or learning challenges, to support mental wellbeing should New Zealand move up Alert levels in the future. 7. Investigate how well online teaching environments meet the needs of children who have disabilities or learning challenges during times of Alert Level 3 and 4.

• Other New Zealand-specific apps currently being evaluated in clinical trials (and if successful, may be widely accessible in New Zealand) include: PART ONE: HEALTH AND WELLBEING

Executive Summary The purpose of this report is to provide a snapshot of the health and wellbeing of New Zealand children aged 10-11 years during the early period of the COVID-19 pandemic, and the associated lockdown in 2020. The report presents findings from an opportunistic bespoke COVID-19 Wellbeing Survey of 2421 children from the Growing Up in New Zealand (GUiNZ) longitudinal cohort study. The survey was delivered during COVID-19 Alert Levels 2 (Reduce) and 3 (Restrict) in May 2020, with survey questions related to these Alert Levels or the earlier Alert Level 4 (Lockdown). The survey is one of the largest in New Zealand and the world to date, to explore changes in health and wellbeing in 10-11 year old children from before the time of COVID-19 to during COVID-19. Highlights from the report are provided below.

Strength in the face of adversity

• Children of Pacific ethnicity had a decline in anxiety from when they were eight years of age to the time of the COVID-19 Wellbeing Survey, compared to European children. • Children who had had five to six regular positive experiences during Alert level 4, experienced a decrease in symptoms of anxiety from when they were eight years of age. • Children who were overweight at eight years of age had a decline in anxiety over time, compared to normal weight children. • Being in a bubble during Alert Level 4 (Lockdown) with six or more people was protective of negative health and wellbeing changes over the two DCWs.

The general health of most children was unaffected during COVID-19 Alert Levels 2 and 3 – despite this time bringing significant uncertainty, restrictions in movement, and personal and family stress. Overall, 84% of children reported their current health was ‘very good’ to ‘excellent’, compared to 64% at the eight-year data collection wave. Furthermore, 28% of children had an improvement in their health since they were eight years of age, and there was a general decline in symptoms of anxiety. Additionally:

COVID-19 Alert Levels 2 and 3 were a challenging time for some children.

• Having ‘very good’ to ‘excellent’ health at eight years of age, strongly predicted having ‘very good’ to ‘excellent’ health at the time of the COVID-19 Wellbeing Survey.

• Children who had obesity when they were eight years of age; those who felt less connected with friends and family not living with them during Alert Level 4; those who were more worried about how much money their family had at the time of the COVID-19 Wellbeing Survey; or those who were still undertaking schoolwork at home at the time of the survey were more likely to report poor health.

• Children of Asian ethnicity, or whose mothers reported their child had two or more concerns about their child’s wellbeing and development when they were eight years of age, were more likely to report an improvement in health.

• Māori and Pacific children had a decline in depression over time, compared to European children.

Growing Up in New Zealand COVID-19 Wellbeing Survey

For some children life was more difficult during COVID-19 Alert Levels 2 and 3, with poorer physical and/or mental health at the time of the survey compared to the eight-year data collection wave. Current health was ‘fair’ to ‘poor’ in 3% of children, 41% of children had clinically significant symptoms of depression, and 33% had symptoms of anxiety.

• Girls, children who were more worried about how much money their family had, and children whose mothers reported having two or more concerns about their child’s wellbeing and development when they were eight years of age, were more likely to report symptoms of depression or anxiety at the time of the COVID-19 Wellbeing Survey. • Children were more likely to report symptoms of depression if their mother had a history of depression. • Children were more likely to report symptoms of anxiety if they woke often during the night when they were eight years of age. Looking at the data longitudinally, 9% of children had a deterioration in their self-reported health since they were eight years of age, particularly if they were underweight at the eight-year data collection wave. There was also an increase in symptoms of depression over time in the cohort of children. Furthermore: • Having symptoms related to depression or anxiety when they were eight years of age, strongly predicted the children having symptoms related to depression or anxiety at the time of the COVID-19 Wellbeing Survey.

Looking ahead The findings from this report provide a glimpse into the lives of New Zealand children during the early period of the COVID-19 pandemic in New Zealand, highlighting both the positive and negatives short term impacts of the Government COVID-19 restrictions on their wellbeing. Findings are consistent with what little published research exists on the impact of the pandemic on children. However, the findings are not generalisable to all New Zealand children, given the low survey participation rate (particularly from Māori, Pacific, and Asian children and those living in rural areas which was impacted by not having accurate digital addresses for these groups). Despite this, the findings provide policy stakeholders with information to help guide development of appropriate strategies and support for New Zealand children and their families should New Zealand move into higher COVID-19 Alert Levels in the future. The scheduled GUiNZ 12-year DCW will be important, as it provides the opportunity to not only verify the report findings but also to assess the longer-term impact of the pandemic on the GUiNZ children.

• At the time of the survey, children who woke frequently during the night when they were eight, had higher anxiety scores than children who didn’t wake during the night. • Girls, and children who were always or often worried about how much money their family had, had an increase in depression and anxiety from when they were eight to the time of the COVID-19 Wellbeing Survey.

PART ONE: HEALTH AND WELLBEING

List of Figures Figure 1:

Recruitment summary....................................15

Figure 2:

Ethnicity of respondents................................16

Figure 3: How children felt about their current health..............................................................17 Figure 4: Current health status, by body size at eight years of age............................................18 Figure 5:

Degree of connectedness in the children......19

Figure 6: Current health status, by degree of connectedness...............................................19 Figure 7: Current health status, by material wellbeing concerns........................................20 Figure 8: Current health status, by school attendance.....................................................21 Figure 9:

Boxplot of depression score, by sex.............. 22

Figure 10: Boxplot of depression score, by number of wellbeing and developmental concerns raised at eight years of age............................ 22 Figure 11: Boxplot by depression score, by number of regular positive childhood experiences during Alert Level 4........................................ 23 Figure 12: Boxplot of depression score, by number of maternal depression events.......................... 24 Figure 13: Boxplot of by depression score, by material wellbeing concerns........................................ 24 Figure 14: Boxplot of anxiety score, by ethnicity........... 26 Figure 15: Boxplot of anxiety score, by sex.................... 27 Figure 16: Boxplot of anxiety score, by number of wellbeing and developmental concerns raised at eight years of age............................ 27

Growing Up in New Zealand COVID-19 Wellbeing Survey

Figure 17: Boxplot of anxiety score, by frequency of night waking at eight years of age................. 28 Figure 18: Boxplot of anxiety score, by the number of regular positive childhood experiences during Alert Level 4........................................ 29 Figure 19: Boxplot anxiety scores, by material wellbeing concerns........................................30 Figure 20: Change in health status over time................. 32 Figure 21: Ethnicity, by change in health status over time........................................................ 33 Figure 22: Number of wellbeing and developmental concerns raised at eight years of age, by change in health status over time................. 33 Figure 23: Body size at eight years of age, by change in health status over time.............................. 34 Figure 24: Distribution of depression scores across two data collection waves............................. 35 Figure 25: Distribution of anxiety scores across two data collection waves.................................... 38 Figure 26: Child anxiety levels across the two data collection waves............................................ 39 Figure 27: Children with one or more negative health and wellbeing changes over time..................40 Figure 28: Children at risk of having one or more negative health and wellbeing changes over time.........................................................41 Figure 29: Bubble size during Alert Level 4 (Lockdown).................................................... 42

List of Tables Table 1: Impact of body size at eight years of age on current health status.................................18 Table 2: Impact of connectedness on current health status...................................................19 Table 3: Impact of material wellbeing concerns on current health status.....................................20 Table 4: Impact of number of wellbeing and developmental concerns raised at eight years of age, on depression scores............... 23 Table 5: Impact of number of positive childhood experiences during Alert Level 4 on depression scores......................................... 23

Table 15: Impact of number of wellbeing and development concerns raised at eight years of age, on change in health status over time.................................. 34 Table 16: Impact of body size at eight years of age on change in health status over time............ 34 Table 17:

Ethnicity and depression scores over time... 36

Table 18: Impact of number of positive childhood experiences during Alert Level 4 on depression scores over time......................... 36 Table 19: Impact of material wellbeing concerns on depression scores over time......................... 36

Table 6: Impact of material wellbeing concerns on depression scores......................................... 25

Table 20: Impact of connectedness on depression scores over time............................................ 36

Table 7:

Table 21: Change in depression scores across two data collection waves.................................... 37

Ethnicity and anxiety scores......................... 26

Table 8: Impact of number of wellbeing and development concerns raised at eight years of age, on anxiety scores...................... 28 Table 9: Impact of frequency of night waking at eight years of age, on anxiety scores..................... 29 Table 10: Impact of number of positive childhood experiences during Alert Level 4 on anxiety scores............................................................ 29 Table 11: Impact of material wellbeing concerns on anxiety scores................................................30 Table 12: Child health at the eight-year DCW, as a predictor of health during Alert Levels 2 and 3.............................................................31

Table 22:

Ethnicity and anxiety scores over time......... 38

Table 23: Impact of material wellbeing concerns on anxiety scores over time............................... 38 Table 24: Impact of body size at eight years of age on anxiety scores over time........................... 38 Table 25: Change in anxiety scores across two data collection waves............................................ 39 Table 26: Children most at risk of poor health and wellbeing changes over time..........................41 Table 27: The protective effect of bubble size on health and wellbeing..................................... 42

Table 13: Child’s health status across two data collection waves.............................................31 Table 14: Ethnicity and change in health status over time........................................................ 33

PART ONE: HEALTH AND WELLBEING

Glossary

Term

Definition or translation

ANOVA

Analysis of variance

BMI

Body Mass Index

CES-D-10

Center for Epidemiological Studies Depression Scale

COVID-19

The abbreviated name given to a novel infectious coronavirus

DCW

Data Collection Wave

DHB

District Health Board

GLM

Generalized Linear Model

GUiNZ

Growing Up in New Zealand

IQR

Inter-quartile range

MBIE

Ministry of Business, Innovation and Employment

MSD

Ministry of Social Development

MSLSS

Multidimensional Students Life Satisfaction Scale

NCEA

National Certificates of Educational Achievement

NZDep2013

New Zealand Index of Deprivation 2013

PHQ-9

Patient Health Questionnaire - 9

PROMIS

Patient Reported Outcomes Measurement Information System

SAP

Statistical Analysis Plan

Standard Deviation

USA

United States of America

WHO

World Health Organization

Growing Up in New Zealand COVID-19 Wellbeing Survey

1. Introduction COVID-19 is the name given to disease caused by the coronavirus SARS-CoV2, first identified in Wuhan, China in 2019. As a novel virus for which humans have no pre-existing immunity, the world’s population is highly susceptible to infection. On the 11th March 2020 the World Health Organization (WHO) declared that COVID-19 had become a pandemic (1). As of the 26th May 2021, the number of confirmed cases of COVID-19 worldwide was 167,492,769 with 3,482,907 deaths (21%) (2). As of August 2020, most cases of COVID-19 globally have been reported in adults over 30 years of age, with only 3.7% of cases under 14 years of age (3).

1.1 COVID-19 in New Zealand The first case of COVID-19 in New Zealand was identified on the 28th February 2020 (4). The New Zealand Government’s response to COVID-19 was fast and effective, with border entry measures immediately implemented. In March 2020, the Government introduced a four-level alert system to “manage and minimise the risk of COVID-19 in New Zealand” (5). Each level considered the immediate level of risk and detailed the required restrictions that legally had to be followed by New Zealanders to minimise the risk of catching and/ or spreading COVID-19. A summary of the alert levels is below: (5). • Alert level 1 (Prepare): No restrictions on movement, domestic travel, or gatherings. All educational facilities, public venues and businesses are open. People are encouraged to maintain records to enable contact tracing. • Alert level 2 (Reduce): People can mix with friends and family. Educational facilities, business and public venues can open, but with physical distancing. Gatherings of up to 100 people are permitted. Sport and recreation activities are permitted. Inter-regional travel is permitted. Face coverings are required on public transport and aircraft (with some exemptions). People are encouraged to maintain records to enable contact tracing. • Alert level 3 (Restrict): All people are advised to stay at home in their immediate household unit or ‘bubble’, but the bubble can include external caregivers, close family, or isolated people. Only essential movement is

permitted, but safe recreational activity is allowed in the local area with physical distancing. Children should be schooled at home, but educational facilities can open with limited capacity. Public venues are closed. Businesses can open provided they have no physical interaction with customers. Gatherings of up to ten people are permitted but only for certain events. Interregional travel is restricted. People are encouraged to maintain records to enable contact tracing. • Alert level 4 (Lockdown): All people are advised to stay at home in their immediate household ‘bubble’, except for essential movement, although safe recreational activity is permitted in the local area with physical distancing. All educational facilities, public venues and all businesses must close, except essential services. Gatherings are cancelled and travel is significantly restricted. People are encouraged to maintain records to enable contact tracing. At 11:59pm on the 25th March 2020, in response to a rapid increase in the number of COVID-19 cases in the country, New Zealand moved into Alert Level 4. This lockdown continued until 11:59pm on the 27th April 2021, whereupon the whole country was dropped back to Alert Level 3. At 11:59pm on the 13th May 2020, New Zealand dropped back to Alert Level 2. The COVID-19 Wellbeing Survey discussed in this report was delivered between the 8th - 24th May 2020. On the 7th April 2020, the Ministry of Health confirmed that the New Zealand Government would utilise an ‘elimination’ pandemic strategy, with the goal to eliminate COVID-19 in New Zealand (or reduce numbers to a very low target range) until the availability of a vaccine or effective treatment (6). Furthermore, the Government activated the first three stages of its sixphase pandemic strategy, namely Plan For It (planning and preparedness); Keep It Out (border management); and Stamp It Out (cluster control). Throughout the pandemic strategy there was an explicit focus on prioritising equity at all levels of the COVID-19 response. This focus recognised the potential for COVID-19 to exacerbate pre-existing health inequities and create new health inequities, with an awareness that the elimination strategy control measures would disproportionately impact Māori and Pacific peoples and those experiencing socioeconomic hardship. PART ONE: HEALTH AND WELLBEING

As of the 24th May 2020, there had been 1505 confirmed or probable cases of COVID-19 in New Zealand and 21 COVID-19 related deaths (4). Just over a third of cases (38%) were in people entering New Zealand, or airline crew, having acquired COVID-19 overseas or during the journey to New Zealand, or in people who were exposed to international returnees (i.e., 62% were community acquired cases, which was why New Zealand was at a high Alert Level at this time). Approximately half of all cases (54%, N=808) at this time had been in those aged between 20-49 years, with 10% (N=157) of cases aged 0-19 years (4). The majority (over 70%) of confirmed or probable cases of COVID-19 were European. Overall, 49% (N=733) of all cases had been reported in the Auckland, Waitemata, Counties Manukau and Waikato District Health Board (DHB) regions (4).

1.2 The impact of COVID-19 on the health and wellbeing of children As shown above, children (including infants) can contract COVID-19, but international evidence indicates the severity of acute COVID-19 infection tends to be milder compared to adults (although there are cases that have required hospitalisation, and deaths have been recorded) (7-8). Internationally, concerns have been raised about the secondary negative impacts of COVID-19 on child health and wellbeing (9-10). In addition to the physical health threat of COVID-19 itself, the pandemic and its associated control measures have limited children’s access to their friends, extended family and schools, separated children from their families and whānau, and restricted access to child protection and other social services (9). These factors have the potential to negatively impact the mental health of children (10). Finding from two studies (one cross-sectional: N=1784 (11); one a case-control study: N=252 (12) suggest social distancing or quarantine measures associated with COVID-19 may be associated with an increase in children’s depression symptoms (11), feelings of sadness, fear, nervousness, annoyance and anxiety-related insomnia (12). These findings are supported by a 2013 mixedmethod study (N=398 parents) exploring the psychosocial responses of parents and their children to previous pandemic disasters (13). The study found children placed in isolation and quarantine had a higher risk of developing acute stress disorder, adjustment disorder, grief or post-traumatic stress disorder related to these experiences, compared to children not quarantined (13). Lifestyle changes, psychosocial stress due to home confinement, loss of income, and the mental health impacts of quarantine during a pandemic have the potential to create a vicious circle (14), with decreased opportunity for children to engage in health and wellbeing promoting behaviours. International literature about the impact of COVID-19 on child health and wellbeing may have limited applicability to New Zealand, due to the differing severity of the pandemic in New Zealand, the early strong COVID-19 control measures implemented by Government, and New Zealand’s socio-demographic 12

Growing Up in New Zealand COVID-19 Wellbeing Survey

context. It is therefore important to look at New Zealand specific information on this topic.

1.3 The impact of Alert Level 4 (Lockdown) on New Zealand children Few New Zealand studies have asked children and young people about the impact of COVID-19, particularly Alert Level 4 (Lockdown) on their health and wellbeing. These studies are summarised below: • Youthline undertook an online survey (15) (advertised via Facebook between the 11th – 24th April 2020) of 976 New Zealanders of all ages, of whom 0.2% were under 12 years of age, and 24.8% were aged 12-18 years. The survey found that young people aged 12-18 years were more likely to report that the COVID-19 lockdown had an impact on their mental health, than participants aged ≥25 years. No further data for children/youth under 18 years of age were presented in the Youthline report. Instead, this age group was incorporated under the category “young people <25 years.” • The Ministry of Health undertook a survey, in conjunction with CBG Health Research Limited, of New Zealanders aged ≥15 years who were previous participants in the New Zealand Health Survey and had consented to being recontacted for future research (16). A stratified, multi-stage sampling design was used to select participants. Data were collected via a 10-15 minute phone interview, using Computer Assisted Telephone Interviewing, between 30th March 2020 and the 27th September 2020. Approximately 300 people were interviewed each day. Survey questions focused on the impact of COVID-19 on “health and wellbeing, understanding and compliance of the Alert Level rules” and participants’ financial situation in the past week. Weekly reports were published from the survey, but findings were not presented by age group, so no specific results are available for young people. For the week ending 26th April 2020, 77% of respondents felt their wellbeing was the same as usual or better than usual. Between the 5th and 26th April 2020, 11‑13% of respondents experienced symptoms related to depression (measured using the adapted version of the Patient Health Questionnaire-2) or anxiety (measured using the Generalised Anxiety Disorder-2 questionnaire) in the past week. However, no information was available about whether these people had had symptoms related to depression prior to the lockdown. Between 34-38% of respondents reported feelings of loneliness and isolation “at least a little of the time” during the above lockdown period – again, no information was available about whether these people had had feelings of loneliness and isolation prior to the lockdown. • On the 19th May 2020, when New Zealand was at Alert Level 2, the Office of the Children’s Commissioner launched a national online survey of children and young people aged 8-18 years (17). The survey focussed on current wellbeing (i.e., at Alert level

2), and experiences during Alert Levels 3 and 4. Data were collected over a three-week period, with 1402 respondents (1373 respondents were recruited via 24 schools, and 29 via youth organisations). The sample was predominately European (70%), and approximately 22% were aged 10-11 years of age. Findings from the survey were not presented according to key demographic factors. The survey found many positive effects of being under Alert Levels 3 and 4 for this population, such as more free-time, opportunities for new activities, and independence. However, for some children and young people, significant challenges were experienced “broadening and deepening some already difficult living situations and existing inequities.” Although the above cross-sectional studies provide some information on the impact of COVID-19 on health and wellbeing in children and young people in New Zealand, the findings presented are not very detailed or specific. Furthermore, their design means they are unable to establish any causal relationship between COVID-19 Alert Levels and health and wellbeing in the children. Such a research question is better answered using a longitudinal cohort study design, where health and wellbeing data from before COVID-19 can be compared to health and wellbeing data during the COVID-19 pandemic. New Zealand has such a cohort study — the Growing Up in New Zealand (GUiNZ) longitudinal cohort study. This report aims to address the knowledge gap for New Zealand children by presenting data exploring the impact of the COVID-19 lockdown on the health and wellbeing of children (aged 10-11 years) who had been part of the GUiNZ longitudinal cohort study since they were born (2008-2010).

1.4 Overview of Growing up in New Zealand The GUiNZ longitudinal cohort study recruited a cohort of births via their 6822 pregnant mothers who were living within the Auckland, Counties Manukau, or Waikato DHB regions during pregnancy and who were due to have their babies between 25th April 2009 and 25th March 2010. The subsequent child cohort consisted of 6853 children, whose birth parameters closely aligned to all New Zealand births in 2007 – 2010 (18).

the importance of having in place contingency processes for GUiNZ to potentially engage with the cohort digitally as a primary data collection mode, should face-to-face meetings not be possible. Furthermore, in the future a digital online questionnaire may become routinely used for each DCW. It was also recognised that understanding wellbeing trajectories for the cohort over time would ideally need to capture wellbeing at the time of COVID-19. With these factors in mind, a brief opportunistic online survey (referred henceforth as the ‘COVID-19 Wellbeing Survey’) was designed and delivered to the cohort.

1.5 Aims of the COVID-19 Wellbeing Survey The purpose of the COVID-19 Wellbeing Survey was two-fold. First, the survey provided the opportunity to capture the acute impact of COVID-19 on child wellbeing, with the aim to: 1. Understand the attitudes and feelings of children about schoolwork during Alert Level 4, and their thoughts about returning to school. 2. Understand whether children had access to, and use of, devices during Alert Level 4, and the amount of time they spent on these devices. 3. Determine how engaged children were with activities involving family and friends during Alert Level 4. 4. Determine whether children had any changes in eating behaviours and attitudes toward food during Alert Level 4. 5. Understand what the children liked, or did not like, about Alert Level 4. 6. Understand what the children worried about and were most excited about during Alert Level 4 (Lockdown). 7. Understand how Alert Level 4 impacted the children’s general health and mental wellbeing, particularly: - Whether this impact differed according to demographic variables, and other variables of interest. - Whether their general health and mental wellbeing had changed from when they were eight years of age.

Since its inception, five main data collection waves (DCW) have been completed face-to-face in the home with the GUiNZ cohort (antenatal) and when the children were approximately nine months, 24 months, 54 months, and eight years of age. Between the main face-to-face DCWs, age-specific data has been collected from caregivers, via online electronic questionnaires and telephone interviews.

The survey also provided the opportunity to see how well a child-centred digital engagement process would connect with existing GUiNZ parent-based digital contacts for cohort members, noting that primary contacts for families were residential address-based up until this timepoint.

A sixth in-home DCW was planned for 2020, when the children were approximately 11 years of age. However, the COVID-19 pandemic meant the scheduled preengagement exercise (where participants are contacted as part of routine cohort retention and engagement activities) and the 11-year DCW were delayed until 2021. The pandemic (and associated lockdowns) did highlight

The objectives of this report are to present the findings from the COVID-19 Wellbeing Survey relevant to general health and mental wellbeing (Aim 7). Separate publications focus on school satisfaction, media/ screen time and connectedness (Aims 1-3), eating behaviours and attitudes toward food (Aim 4), and qualitative analysis of free text fields (Aims 5 and 6).

1.6 The focus of this report

PART ONE: HEALTH AND WELLBEING

2. Methods This section provides a brief overview of the methods and data analysis plan used in this study. A full methods section can be found in Appendix A, detailing the study design, ethics approval, data collection process, and survey measures.

2.1 Study design A cross-sectional survey design was utilised. Children were eligible if: the person who had completed the “Mother Questionnaire” at the most recent DCW. the child had taken part in had not withdrawn from the GUiNZ study prior to May 2020; this person had a contact email address; and the child was living in New Zealand at the time of survey distribution. Children whose caregivers had requested that all communications be in Te Reo Māori were ineligible for the survey (n=11), as translation of the survey was unfortunately not possible given time constraints.

2.2 Data collection Email invitations to participate in the survey were generated from the Qualtrics® digital platform and sent to the person who had completed the “Mother questionnaire” at the most recent DCW the child had taken part in (and had not withdrawn prior to May 2020 and had a contact email address). The invitation included an individualised link to the survey, which directed them to a web-based online survey accessible on all devices (computer, tablet, phone). The front page of the survey described the purpose of the questionnaire and gave children the opportunity to accept or decline to participate. Children could complete the survey independently or receive help from a family member if required. To increase compliance with survey completion, a general media campaign promoting the survey to GUiNZ participants was run whilst the survey was live. While koha are typically offered to participants as part of main data collection waves, this was not possible for the COVID-19 Wellbeing Survey.

2.3 Survey questions The COVID-19 Wellbeing Survey consisted of 46 questions in total (see Appendices A and B). Questions were not compulsory, and children could progress to the next section of the questionnaire if they wished to skip any 14

Growing Up in New Zealand COVID-19 Wellbeing Survey

section. The questionnaire asked children about their household ‘bubbles’, feelings, experiences, activities, home and family life, school, current health, media and screen time, connectedness, depressive and anxiety symptoms, and food and drink. This report focuses on the questions about current health and mental wellbeing.

2.4 Data analyses Analyses were undertaken using R (version 4.0 and 4.0.2), R studio and Excel (version 2002 and 2016). All statistical analyses and resulting code for this report have been peer reviewed by an independent member of the GUiNZ Biostatistics team (not involved in the COVID-19 Wellbeing Survey). Standard summary statistics are used to report survey responses across questions pertaining to current health, depression, and anxiety, according to potential predictors of these outcomes (See Appendix A for further detail). A strength of having a longitudinal dataset is the ability to undertake analyses that consider the contribution of early-life experiences for life during COVID-19. Where possible we have approached the longitudinal analyses with the aim of comparing similar measures across time and identifying earlier experiences that are predictive of health, depression, and anxiety during COVID-19. The following sets of covariates have been considered simultaneously for each multivariate model: • Socio-demographics (gender, prioritized ethnicity, socio-economic deprivation, maternal education, maternal age, and rurality) • Predictors of depression and anxiety in children (body size, number of hours of sleep per night, number of times child usually wakes in the night, number of adverse events experienced, maternal depression and oncerns about child health). • Covariates from the COVID-19 Wellbeing Survey (number of people and essential workers in the bubble, number of regular positive events, connectedness during lockdown, school attendance and material wellbeing concerns) In addition, the outcome measure at eight years has also been considered as a potential covariate for the cross‑sectional multivariate models.

3. Findings 3.1 Survey respondents In total, 5756 GUiNZ children were deemed eligible to participate in the COVID-19 Wellbeing Survey. The survey went live on the 8th May 2020. At that time New Zealand was at Alert Level 3, 12 days after stepping down from Alert Level 4. It was originally planned for the live link to remain open for seven days. However, a small number of children declined to participate when they had not meant to do so. Their parents contacted the study team and asked for the children to be re-issued a survey link, which extended the period of data collection. The survey was closed on the 24th May 2020 when New Zealand was at Alert Level 2. Overall, 2421 children completed the COVID-19 Wellbeing Survey giving a response rate of 42%, with 70% of the children completing the survey during Alert Level 3, and 30% completing the survey during Alert level 2 (Figure 1).

Some response bias was identified for the COVID-19 Wellbeing Survey (Appendix C). Specifically, a lower response rate was observed for Māori, Pasifika, and Asian children and those living in rural areas. A higher response rate was observed for girls, and children who had older (>40 years) and more educated mothers (i.e., ≥ Bachelor’s degree). Further detail about the response bias can be found in an additional report on data from the GUiNZ COVID-19 Wellbeing Survey which focused on household bubble size, school satisfaction, connectedness, activities and experiences, media use and screen time (19).

100%

98%

Cumulative percentage

75%

70%

50%

27% 23%

25%

Alert Level 3

Alert Level 2

May 08

May 09

May 10

May 11

May 12

May 13 Date

May 14

May 15

May 16

May 17

May 18

Figure 1: Recruitment summary PART ONE: HEALTH AND WELLBEING

3.2 Participant characteristics Demographic characteristics of the COVID-19 Wellbeing Survey population are detailed in Appendix D. Almost all (99%) participating children were aged 10-11 years, with an equal proportion of boys and girls. The majority (85%) of participating children were living in an urban area, with a higher proportion of children living in areas of low and medium socioeconomic deprivation (38% and 37% respectively, compared to 21% living in areas of high socioeconomic deprivation). Ethnicity data in Figure 2 and Appendix D are presented using prioritised ethnicity and total response ethnicity. Of the Pacific group (total response), the following ethnicities were represented: • Samoan:

53% (n=169)

• Tongan:

26% (n=83)

• Cook Island Māori:

22% (n=71)

• Niuean:

12% (n=38)

• Fijian:

6% (n=18)

• Other:

<1%

Of the Asian group (total response), the following ethnicities were represented: • Chinese:

30% (n=102)

• Indian:

29% (n=99)

• Filipino:

10% (n=33)

• Other:

34% (n=116)

The ‘Other’ category represents ethnicities with less than 10% of children from each population (e.g., Sri Lankan, Korean, Japanese, Cambodian, Vietnamese, etc). Variables explored as potential predictors of depression and anxiety, and other covariates of interest for the COVID-19 Wellbeing Survey population, are summarised in Appendices E and F, respectively.

100% 90%

Percentage

80% 70% 60%

55%

50% 30%

21%

20%

10% 0%

13% 2%

European

Māori

Pacific

Asian

Other

Ethnicity (prioritised) 100% 90%

83%

Percentage

80% 70% 60% 50% 30%

21%

20%

13%

14%

10% 0%

3% European

Māori

Pacific

Ethnicity (total reponse) Figure 2: Ethnicity of respondents 16

Growing Up in New Zealand COVID-19 Wellbeing Survey

Asian

Other

3.3 Cross-sectional analysis of the COVID-19 Wellbeing Survey This section presents the cross-sectional analysis of the COVID-19 Wellbeing Survey general health, depression, and anxiety outcomes, according to various demographic and other variables of interest (some predictive variables are sourced from previous DCWs). Given the response rate to the survey, it is not appropriate to extrapolate these findings to the whole GUiNZ cohort, or all New Zealand children of this age. Therefore, these findings should be considered exploratory only.

Very good; Good; Fair; and Poor. The term ‘health’ was not defined, so some children may have interpreted this word to mean physical health, mental health, or both.

3.3.1 Health status

No association was observed between the following variables and current health status:

Of the 2421 children who undertook the survey, 94% (n=2257) completed the question about their current health. Most (83%, n=1884) children reported that their current health status was ‘excellent’ or ‘very good’ (Figure 3). Less than 3% (n=62) of children reported their health as ‘fair’ or ‘poor’.

KEY FINDINGS AROUND THE CHILDREN’S SELF‑REPORTED HEALTH STATUS WERE:

• The child’s sex, ethnicity, level of socioeconomic deprivation, or whether they lived in an urban or rural area.

• Most children (83%) reported ‘very good’ or ‘excellent’ health.

• The mother’s age, level of education, or whether they had had one or more episodes of depression.

• Children with obesity when they were eight years of age had poorer health at the time of the survey, compared to children of normal body size.

• Whether the mother had any concerns about their child’s wellbeing and development when the child was eight years of age.

• Children who were less connected to friends and family during Alert Level 4 were more likely to report poorer health status, compared to children who were more connected.

• The mother’s report of the number of hours their child typically slept per night, and the frequency of their waking during the night, when the child was eight years of age.

• Children who were always or often worried about how much money their family had, or didn’t know how they felt, were more likely to report poorer health status compared to children who didn’t think about it at all.

• The number of adverse life events the children had experienced by the time they were eight years of age. • The number of people in the child’s bubble during Alert Level 4, or the number of essential workers in the child’s bubble.

• Children who were still undertaking schoolwork at home at the time of the survey (during Alert Levels 2 and 3) were more likely to report poorer health, compared to children who had returned to school.

• The number of positive events experienced by the child during Alert Level 4. However, significant associations were observed between four variables of interest (body size, connectedness, material wellbeing, and school attendance) and current health status, with these associations summarised in the sections below.

Health status refers to the self-reported ‘current’ health of the child, which means findings relate to health status during Alert Levels 2 and 3 (the period during which the survey was delivered). The options provided for reporting current health were: Excellent;

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Percentage Excellent

Very good

Good

Fair

Poor

Figure 3: How children felt about their current health

PART ONE: HEALTH AND WELLBEING

3.3.1.1 Body size and current health status Of the 2421 children who completed the survey, 94% (n=2284) had information available from the eight-year DCW regarding their body size. There was a significant association between body size and health status (Figure 4, Chi-squared P<0.001). Regression analysis identified that children with obesity (as determined at the eight-year DCW) reported significantly poorer health compared to children of normal body size (Table 1).

Body size

Obese Overweight Normal Underweight 0%

10%

20%

30%

40%

50%

60%

70%

80%

100%

90%

Percentage Excellent

Very good

Good

Fair/Poor

Figure 4: Current health status, by body size at eight years of age Table 1: Impact of body size at eight years of age on current health status Current health n

Odds ratio

95% confidence intervals

P value

1343

Ref

Underweight

0.44

0.18 to 1.09

0.074

Overweight

354

0.97

0.78 to 1.22

0.784

Obese

177

0.52

0.38 to 0.71

<0.001

Normal Body Size

3.3.1.2 Connectedness to friends and family and current health status Previous research from the GUiNZ cohort study has identified that family connectedness plays a key role in supporting the health and wellbeing of families and children (20). For this reason, connectedness questions were asked in the COVID-19 Wellbeing Survey, and relate to the Lockdown period (i.e., Alert level 4). Responses to this set of questions were available from 93% of the children (i.e., 2242 of the 2421 children who undertook the survey). The level of connectedness of the children (i.e., faceto-face, telephone or online) with friends or family not living with them during Alert Level 4 was high, with 85% (n=1914) of children categorised as ‘moderately’ or ‘more connected’ (Figure 5). However, 5% (n=113) of children were relatively disconnected with friends and family during the lockdown period (Figure 5).

Growing Up in New Zealand COVID-19 Wellbeing Survey

Number of participants

Every day

100 200 300

Connectedness with friends

A few times a week Weekly

Connectedness Not or almost not connected (N = 113) A little connected (N = 186) Moderately connected (N = 970) More connected (N = 944)

Fortnightly Less than fortnightly Only once or twice

Every day

A few times a week

Weekly

Fortnightly

Less than fortnightly

Only once or twice

Never

Connectedness with family Figure 5: Degree of connectedness in the children

Degree of connectedness

There was a significant positive association between the degree of connectedness and the health status of the child (Figure 6, Chi-squared P<0.001).

More Moderately A little Not/almost not 0%

10%

20%

30%

40%

50%

60%

70%

80%

100%

90%

Percentage Excellent

Very good

Good

Fair/Poor

Figure 6: Current health status, by degree of connectedness Regression analysis found that children who were less connected to friends and family during Lockdown had poorer self-reported health (Table 2). Table 2: Impact of connectedness on current health status Current health

Degree of connectedness

Odds ratio

95% confidence intervals

P value

More connected

831

Ref

Moderately connected

830

0.77

0.64 to 0.94

0.008

A little connected

153

0.74

0.52 to 1.04

0.081

Not or almost not connected

0.62

0.40 to 0.97

0.035

PART ONE: HEALTH AND WELLBEING

3.3.1.3 Concerns around material wellbeing, and current health status Different measures of household material wellbeing exist, utilising various measures of income, wealth and consumption, with poor material wellbeing strongly linked to poor child health (21-22). For example, the Child Wellbeing & Poverty Reduction Group at the New Zealand Department of the Prime Minister and Cabinet define good material wellbeing as ‘having the basics and “a little bit more”’. The group have developed a 24 item Material Wellbeing Index as a measure of the proportion of children who are living in households who meet the threshold of good material wellbeing (23).

survey short. This question asked how often the children worried about how much money their family had, with 94% (2268/2421) of children responding to the question. A significant association was observed between current health status and how often children worried about how much money their family had (Figure 7, Chi-squared p<0.001). A higher frequency of worrying was associated with a lower proportion of children reporting ‘Excellent’ current health. Regression analysis found that children who ‘always’ or ‘sometimes/often’ worried about how much money their family had, or didn’t know how they felt, were more likely to report poorer health status, compared to children that didn’t think about it at all (Table 3).

How often do they worry about money

In the COVID-19 Wellbeing Survey only a single material wellbeing question was used, given the need to keep the Don’t know Never Sometimes Often Always 0%

10%

20%

30%

40%

50%

60%

70%

80%

100%

90%

Percentage Excellent

Very good

Good

Fair/Poor

Figure 7: Current health status, by material wellbeing concerns Table 3: Impact of material wellbeing concerns on current health status Current health

How often the child worries about how much money the family has

Odds ratio

95% confidence intervals

P value

Don’t think about it at all

991

Ref

Sometimes/Often

651

0.58

0.48 to 0.70

<0.001

Always

0.54

0.33 to 0.87

0.011

Don’t know

185

0.56

0.42 to 0.77

<0.001

Growing Up in New Zealand COVID-19 Wellbeing Survey

3.3.1.4 School attendance, and current health facilities could open, but with physical distancing measures in place.

At Level 3, these children likely had parents who were considered essential workers by the Government, and so the children could attend school but with restricted movement and mixing. At Alert Level 2 educational

Children who were still undertaking schoolwork at home in their bubble were significantly more likely to report poorer health, compared to children who had returned to school (OR=0.53, 95% CI 0.30-0.91, p=0.024).

School attendance

Of the 2421 children who undertook the survey, 93% (n=2259) completed the questions related to school attendance. A total of 76 (3%) children had returned to school at the time the COVID-19 Wellbeing Survey was undertaken.

There was a significant association between school attendance and current health status (Figure 8, Chisquared p=0.009).

Returned to school Schooling at home 0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Percentage Excellent

Very good

Good

Fair/Poor

Figure 8: Current health status, by school attendance 3.3.2 Depression KEY FINDINGS AROUND SYMPTOMS OF DEPRESSION IN CHILDREN WERE: • Girls had higher mean depression scores than boys. • Children with two or more wellbeing and developmental concerns when they were eight years old, had higher mean depression scores, compared to children with no such concerns. • More regular positive experiences for children during Alert level 4 was associated with lower mean depression scores. • Children whose mothers had had one or more maternal depression events had higher mean depression scores, compared to children with mothers who had no history of depression. • Children who were always or often worried about how much money their family had, or didn’t know how they felt, had higher mean depression scores compared to children who didn’t think about it at all. The average age of onset of major depressive disorders is typically between the ages of 11 and 14. However, as mentioned in sections 1.2 and 1.3, there is emerging evidence that the COVID-19 pandemic is having a significant impact on the mental wellbeing of children (10-12, 15). For these reasons, children in the COVID-19 Wellbeing Survey were asked about symptoms related to depression. Of the 2421 children who undertook the survey, 90% (n=2178) completed questions on the short form (24) of the CES-DC-10 for measuring depression (25). The questions asked about the ‘past seven days’, so findings

relate to depression symptoms during Alert Levels 2 and 3 given the period of survey delivery. The total scores were right skewed (mean=9.0, SD=5.0; median=8.0, inter-quartile range [IQR]=5-12). No association was observed between the following variables and depression: • The child’s ethnicity, level of socioeconomic deprivation, whether they lived in an urban or rural area, or their body size when they were eight years of age. • The mother’s age or level of education. • The mother’s report of the number of hours their child typically slept per night, and the frequency of their waking during the night, when the child was eight years of age. • The number of adverse life events the children had experienced by the time they were eight years of age. • The number of people in the child’s bubble during Alert Level 4, or the number of essential workers in the child’s bubble. • The degree of connectedness for the child during Alert Level 4. • The child’s attendance at school during Alert Levels 2 and 3. However, significant associations were observed between five variables of interest (sex, mother’s concern about their child’s wellbeing and development, number of positive child experiences during Alert Level 4, maternal depression, and material wellbeing concerns) and symptoms of depression, with these associations summarised in the sections below. PART ONE: HEALTH AND WELLBEING

3.3.2.1 Child’s sex, and symptoms of depression International research indicates a clear sex difference for depression in children and young adults, with 12 year old girls almost two and half times more likely to have a diagnosis of major depression and depression symptoms, than boys (26).

In the COVID-19 Wellbeing Survey, the same sex difference was apparent (Figure 9, p=0.035). Regression analysis identified that the mean CES-DC-10 score was 0.65 points higher in girls, compared to boys (estimate=0.84, 95% CI 0.40-1.27, p<0.001).

CES-DC-10 Score (COVID-19 Wellbeing Survey)

0 Boy (n = 1052) Girl (n = 1125) The middle line represents the median value, the diamond the mean, the ends of the box represent the 25th and 75th percentile, and the ends of each whisker indicate the range. A higher score is indicative of a greater risk of depression.

Figure 9: Boxplot of depression score, by sex 3.3.2.2 Mother’s concern about their child’s wellbeing and development, and symptoms of depression in children Depression in children may depend on whether a child has a disability or not (27-28), or whether they have learning disabilities (29). A significant association was observed between the number of wellbeing and developmental concerns the mother had for their child when they were eight years of age and mean depression scores

in the COVID-19 Wellbeing Survey (Figure 10, p=0.002). Mean CES-DC-10 scores were higher among those who had a higher number of concerns, particularly for children with vision concerns (p=0.018), behavioural or Autistic Spectrum Disorders (p<0.001), or other concerns (p<0.001).

CES-DC-10 Score (COVID-19 Wellbeing Survey)

0 0 (n = 1417)

1 (n = 436) Number of concerns regarding the child’s health

2 or more (n = 158)

The middle line represents the median value, the diamond the mean, the ends of the box represent the 25th and 75th percentile, and the ends of each whisker indicate the range. A higher score is indicative of a greater risk of depression.

Figure 10: Boxplot of depression score, by number of wellbeing and developmental concerns raised at eight years of age 22

Growing Up in New Zealand COVID-19 Wellbeing Survey

Regression analysis identified significantly higher mean depression scores in children with two or more wellbeing and development concerns, with the mean CES-DC-10 score one point higher compared to children with no concerns (Table 4). Table 4: Impact of number of wellbeing and development concerns raised at eight years of age, on depression scores. Mean CES-DC-DC score

Number of wellbeing and development concerns

Odds ratio

95% confidence intervals

P value

None

1245

Ref

One

380

0.33

-0.20 to 0.86

0.225

Two or more

130

1.02

0.16 to 1.87

0.020

3.3.2.3 Number of positive childhood experiences, and symptoms of depression in children Positive childhood experiences have been demonstrated to provide protective effects during times of heightened risk (30). For this reason, the COVID-19 Wellbeing Survey included seven questions related to different aspects of resilience during Alert Level 4: family support, community participation, school connection, contact with friends, feelings of

safety, family cohesion, and having someone to share their feelings with. A significant association was observed between the number of regular (i.e., answering ‘often’ or ‘always’ to the questions) positive childhood experiences at Alert Level 4 and the mean depression scores in the COVID-19 Wellbeing Survey (Figure 11, p<0.001).

CES-DC-10 Score (COVID-19 Wellbeing Survey)

0 0-2 (n = 256)

3-4 (n = 984) Number of positive experiences happening regularly

5-6 (n = 886)

Figure 11: Boxplot of depression score, by number of regular positive childhood experiences during Alert Level 4 Table 5: Impact of number of positive childhood experiences during Alert level 4, on depression scores Mean CES-DC-DC score

Number of regular positive experiences during Alert level 4

Odds ratio

95% confidence intervals

P value

0-2

203

Ref

3-4

818

-1.43

-2.14 to -0.72

<0.001

5-6

734

-2.94

-3.67 to -2.21

<0.001

PART ONE: HEALTH AND WELLBEING

3.3.2.4 Maternal depression and symptoms of depression in children Maternal mental health is a known predictor of depression in children (31). This association was also observed in the COVID-19 Wellbeing Survey, with a significant association seen between a maternal history of depression events and the mean depression scores of children (Figure 12, p<0.001)

Regression analysis identified that children whose mothers had had one or more maternal depression events had a mean CES-DC-10 score one point higher, than children who had mothers with no history of maternal depression (estimate=0.97, 95% CI 0.30-1.64, p=0.005).

CES-DC-10 Score (COVID-19 Wellbeing Survey)

0 0 (n = 1846)

1 (n = 231) History of maternal depression (number of incidences)

2 (n = 37)

Figure 12: Boxplot of depression score, by number of maternal depression events 3.3.2.5 Material wellbeing concerns and symptoms of depression in children As mentioned earlier in the report, poor material wellbeing is strongly linked to poor child health, including poor mental health (21-22). There was a

significant association between mean depression scores and how often children worried about how much money their family had (Figure 13, p<0.001).

CES-DC-10 Score (COVID-19 Wellbeing Survey)

0 Always (n = 85)

Often Sometimes I don’t think about it at all (n = 140) (n = 597) (n = 1130) Worry about how much money your family has (Lockdown)

I don’t know (n = 220)

Figure 13: Boxplot of depression score, by material wellbeing concerns 24

Growing Up in New Zealand COVID-19 Wellbeing Survey

Regression analysis found children who were always, often or sometimes worried about how much money their family had, or didn’t know how they felt, were significantly more likely to have higher depression scores, compared to children that didn’t think about

it at all (Table 6). For example, children who always worried about how much money their family had had a mean CES-DC-10 score 3.07 points higher than children who didn’t think about money at all.

Table 6: Impact of material wellbeing concerns on depression scores Mean CES-DC-DC score

How often the child worries about how much money the family has

Odds ratio

95% confidence intervals

P value

Don’t think about it at all

928

Ref

Don’t know

162

1.33

0.56 to 2.10

<0.001

Sometimes

489

1.66

1.15 to 2.17

<0.001

Often

114

3.02

2.12 to 3.92

<0.001

Always

3.07

1.87 to 4.27

<0.001

3.3.3 Anxiety KEY FINDINGS AROUND SYMPTOMS OF ANXIETY IN CHILDREN WERE: • Pasifika children had significantly lower anxiety scores, compared to European children. • Girls had higher mean anxiety scores than boys. • Children with two or more wellbeing and developmental concerns when they were eight years old, had higher mean anxiety scores, compared to children with no such concerns. • Children who woke frequently during the night (when they were eight) had higher anxiety scores than children who didn’t wake during the night. • Children with five to six regular positive experiences during Alert level 4, had significantly lower mean anxiety scores, compared to children with no or very few regular positive experiences. • Children who were always or often worried about how much money their family had, or didn’t know how they felt, had significantly higher mean anxiety scores. Overall, 90% (2177/2421) of the children in the survey completed questions on the anxiety scale. The question set asked about the ‘past seven days’, so findings relate to anxiety symptoms during Alert Level 2 and 3 given the date of delivery of the survey.

The total scores for the PROMIS Pediatric Anxiety symptoms scale32 were right skewed (mean=45.7, SD=10.0; median=45.0, IQR=37-52). No association was observed between anxiety and: • The child’s level of socioeconomic deprivation, whether they lived in an urban or rural area, or their body size when they were eight years of age. • The mother’s age, level of education, or episodes of maternal depression. • The mother’s report of the number of hours their child typically slept per night when the child was eight years of age. • The number of adverse life events the children had experienced by the time they were eight years of age. • The number of people in the child’s bubble during Alert Level 4, or the number of essential workers in the child’s bubble. • The degree of connectedness for the child during Alert Level 4. • The child’s attendance at school during Alert Levels 2 and 3. However, significant associations were observed between six variables of interest (ethnicity, sex, mother’s concern about their child’s wellbeing and development, positive child experiences during Lockdown, frequency of night waking, and material wellbeing) and anxiety, with these associations summarised in the sections below.

PART ONE: HEALTH AND WELLBEING

3.3.3.1 Ethnicity, and symptoms of anxiety in children Mean anxiety score at the time of the COVID-19 Wellbeing Survey, by ethnicity (prioritised), is shown in Figure 14. Regression analysis identified that Pacific children had a significantly lower risk of anxiety at the time of the COVID-19 Wellbeing Survey, with the average PROMIS score 2.2 points lower than seen in European children (Table 7). 80

PROMIS T Score (COVID-19 Wellbeing Survey)

30 European (n = 1247)

Māori (n = 433)

Pacific (n = 179) Extenally prioritised ethnicity

Asian (n = 267)

Other (n = 50)

Figure 14: Boxplot of anxiety score, by ethnicity

Table 7: Ethnicity and anxiety scores Mean CES-DC-DC score

Ethnicity (Prioritised)

Odds ratio

95% confidence intervals

P value

European

1069

Ref

Māori

346

-0.58

-1.76 to 0.59

0.331

Pacific

114

-2.19

-4.03 to -0.36

0.019

Asian

195

0.85

-0.61 to 2.30

0.254

Other

0.52

-2.47 to 3.52

0.732

3.3.3.2 Child’s sex, and symptoms of anxiety There was a significant association between the child’s sex and mean anxiety scores at the time of the COVID-19 Wellbeing Survey (Figure 15, p<0.001). Regression analysis identified that girls were significantly more likely to have a higher mean anxiety score, with the average PROMIS score two points higher than seen for boys (estimate=1.98, 95% CI 0.902.86, p<0.001).

Growing Up in New Zealand COVID-19 Wellbeing Survey

PROMIS T Score (COVID-19 Wellbeing Survey)

30 Boy (n = 1045) Girl (n = 1131) The middle line represents the median value, the diamond the mean, the ends of the box represent the 25th and 75th percentile, and the ends of each whisker indicate the range. A higher score is indicative of a greater risk of depression.

Figure 15: Boxplot of anxiety score by sex 3.3.3.3 Mother’s concern about their child’s wellbeing and development, and symptoms of anxiety Anxiety in children may depend on whether a child has a disability or not (27-28), or whether they have learning disabilities (29). The COVID-19 Wellbeing Survey found a significant association between the number of wellbeing and developmental concerns the mother had for their child (when measured at the eight-year DCW) and the

mean anxiety scores in the COVID-19 Wellbeing Survey (Figure 16, p=0.008). Mean anxiety scores were higher among those who had a higher number of concerns, particularly for children with behavioural or Autistic Spectrum Disorders (p=0.035), movement, mobility or physical concerns (p=0.014), or other concerns (p=0.017).

PROMIS T Score (COVID-19 Wellbeing Survey)

30 0 (n = 1417)

1 (n = 438) Number of concerns regarding child’s health

2 or more (n = 156)

Figure 16: Boxplot of anxiety score by number of wellbeing and development concerns raised at eight years of age PART ONE: HEALTH AND WELLBEING

Regression analysis identified that children with two or more wellbeing and development concerns had significantly higher mean anxiety scores, with the average PROMIS score almost two points higher than children with no concerns (Table 8). Table 8: Impact of number of wellbeing and development concerns raised at eight years of age on anxiety scores Mean PROMIS score

Number of mother’s concerns

Estimate

95% confidence intervals

P value

No concerns

1248

Ref

One concern

384

0.66

-0.42 to 1.73

0.230

≥2 concerns

131

1.84

0.11 to 3.58

0.037

3.3.3.4 Frequency of night waking, and symptoms of anxiety in children The transition into early adolescence is a period where there are significant changes in hormone levels and emotional and cognitive processing – factors which can influence the various dimensions of sleep and anxiety (33-34). There was a significant association between frequency of night waking in the child at eight years of age, and and mean anxiety scores in the COVID-19 Wellbeing Survey (Figure 17, p<0.001). A higher frequency of night-time

waking was associated with higher mean anxiety scores. Regression analysis found children who woke during the night were significantly more likely to have higher anxiety scores, compared to children that didn’t wake during the night (Table 9). For example, children who were waking two or more times during the night when they were eight years of age, had an mean PROMIS score three and a half points higher than children who didn’t wake during the night.

PROMIS T Score (COVID-19 Wellbeing Survey)

30 None (n = 1507)

1 time (n = 387) 2 or more times (n = 77) Number of times child usually wakes in the night

Figure 17: Boxplot of anxiety score, by frequency of night waking at eight years of age

Growing Up in New Zealand COVID-19 Wellbeing Survey

Table 9: Impact of frequency of night waking at eight years of age, on anxiety scores Mean PROMIS score

Frequency of night walking at age 8

Estimate

95% confidence intervals

P value

Never

1364

Ref

Once

336

1.16

0.03 to 2.29

0.045

Two or more times

3.47

1.06 to 5.88

0.005

3.3.3.5 Number of positive childhood experiences, and symptoms of anxiety in children As mentioned earlier, positive experiences during times of heightened risk (e.g., a strong and nurturing family environment that reinforces feelings of safety) have been demonstrated to have a positive impact on children (30). A significant association was observed between the number of positive childhood experiences during

Alert level 4 and the mean anxiety scores in the COVID-19 Wellbeing Survey (Figure 18, p<0.001). Regression analysis found that children who had five to six regular positive experiences during Alert Level 4 had a mean PROMIS score almost two points lower than children who had only 0-2 regular positive experiences (Table 10).

PROMIS T Score (COVID-19 Wellbeing Survey)

30 0-2 (n = 260)

3-4 (n = 983) Number of positive experiences happening regularly

5-6 (n = 889)

Figure 18: Boxplot of anxiety score, by the number of regular positive childhood experiences during Alert level 4 Table 10: Impact of number of positive experiences during Alert Level 4 on anxiety scores Mean PROMIS score

Number of positive events

Estimate

95% confidence intervals

P value

0-2 events

209

Ref

3-4 events

819

-0.88

-2.30 to 0.55

0.230

5-6 events

735

-1.79

-3.25 to -0.33

0.017

PART ONE: HEALTH AND WELLBEING

3.3.3.6 Material wellbeing, and symptoms of anxiety in children As mentioned earlier in the report, poor material wellbeing is strongly linked to poor child health, including poor mental health (22-23). There was a significant association between material wellbeing and mean anxiety scores in children at the time of the COVID-19 Wellbeing Survey (Figure 19, p<0.001).

Regression analysis found the more frequently children worried about how much money their family had, the higher their anxiety scores were, compared to children that didn’t worry (Table 11). For example, children who often worried about how much money their family had had a mean PROMIS score 6.08 points higher than the children who didn’t worry about money at all.

PROMIS T Score (COVID-19 Wellbeing Survey)

30 Always (n = 85)

Often Sometimes I don’t think about it at all (n = 141) (n = 595) (n = 1130) Worry about how much money your family has (Lockdown)

I don’t know (n = 220)

Figure 19: Boxplot of anxiety score, by material wellbeing concerns Table 11: Impact of material wellbeing concerns on anxiety scores Mean PROMIS score

How often the child worries about how much money the family has

Estimate

95% confidence intervals

P value

Don’t think about it at all

933

Ref

Sometimes

487

4.21

3.18 to 5.25

<0.001

Often

116

6.08

4.25 to 7.90

<0.001

Always

5.93

3.48 to 8.38

<0.001

Don’t know

165

2.89

1.33 to 4.45

<0.001

Growing Up in New Zealand COVID-19 Wellbeing Survey

3.4 Longitudinal analysis of the COVID-19 Wellbeing Survey This section presents the longitudinal analysis of the COVID-19 Wellbeing Survey general health, depression, and anxiety outcomes, according to various demographic and other variables of interest. Questions asked in the COVID-19 Wellbeing Survey are compared to the same questions asked at the eight year DCW, to determine changes over time. Given the response rate to the survey, it is not appropriate to extrapolate these findings to the whole GUiNZ cohort, or all New Zealand children of this age. Therefore, these findings should be considered exploratory only. However, the upcoming GUiNZ 12-year DCW will be important as it will enable the findings presented in this section to be further explored in the full cohort, as the longer term impact of COVID-19 is a key focus in the upcoming DCW. 3.4.1 H ealth status during COVID-19, compared to before COVID-19 KEY FINDINGS AROUND CHANGES IN HEALTH STATUS OVER TIME WERE: • About a third of children had an improvement in health, from when they were eight years old to the time of the COVID-19 Wellbeing Survey, and one in ten children reported a decline in their health. • Children of Asian ethnicity were more likely to report an improvement in health status over time, compared to European children.

• Children with two or more wellbeing and developmental concerns when they were eight years old were more likely to have an improvement in health over time, compared to children with no wellbeing and development concerns. • Children who were underweight when they were eight years of age were less likely to report an improvement in health status over time, compared to children of normal body size. An important question to explore was whether the COVID-19 pandemic and the associated Government restrictions impacted how children felt about their health. To investigate this question the data were compared longitudinally, looking at children who answered this question in both the eight‑year DCW and the COVID-19 Wellbeing Survey. Exploring how children in each category transitioned over time, it’s clear that for some children there was little change in health status between the two surveys. However, movement in health state over time was also observed, with many children transitioning into more positive health states, whilst a smaller proportion of children moved into a more negative health state (Table 12). Logistic regression analysis identified that children with ‘very good’ or ‘excellent’ health at the eight-year DCW, were two to three times more likely to have ‘very good’ or ‘excellent’ health at the time of the COVID-19 Wellbeing Survey, compared to children with ‘Fair/ Poor’ health at the eight-year DCW (Table 13).

Table 12: Child health at the eight-year DCW, as a predictor of health during Alert Levels 2 and 3 Child health in the COVID-19 Wellbeing Survey

Child health at the eight-year DCW

Excellent

Very Good

Good

Fair to Poor

Excellent

367 (64%)

151 (26%)

48 (8%)

<10

Very Good

413 (51%)

287 (36%)

85 (11%)

19 (2%)

Good

278 (43%)

215 (33%)

131 (20%)

24 (4%)

Fair to Poor

42 (37%)

36 (32%)

28 (25%)

<10

Table 13: Child’s health status across two data collection waves Child health in the COVID-19 Wellbeing Survey

Child health at the eight-year DCW

Estimate

95% confidence intervals

P value

Excellent

100

Ref

Very Good

570

1.25

0.84 to 1.88

0.276

Good

711

1.88

1.26 to 2.81

0.002

Fair to Poor

512

2.76

1.82 to 4.19

<0.001

PART ONE: HEALTH AND WELLBEING

Another way to look at health change over time is to consider categorisation into the following three groups: deterioration in health, no change in health, improvement in health, as outlined below: No Change

GOOD

v ro

No Change

e em

rio

e et

ion

Improvement

POOR/FAIR Deterioration

Most children (91%) had an improvement or no change in their health over the two surveys (Figure 20). No association was observed between the following variables and change in health status: • The child’s sex, level of socioeconomic deprivation, or whether they lived in an urban or rural area.

rio

No Change

tio

VERY GOOD/ EXCELLENT

experienced by the time they were eight years of age. • The child’s degree of connectedness with friends and family during Alert Level 4, the number of people in the child’s bubble during Alert Level 4, or the number of essential workers in the child’s bubble. • School attendance during Alert Level 2 and 3

• The mother’s age, level of education, or whether they had had one or more episodes of depression.

• The number of positive events experienced by the child during Alert Level 4.

• The mother’s report of the number of hours their child typically slept per night.

However, three variables (ethnicity, mother’s concerns about the wellbeing and development of their child, and body size) were associated with change in health status. These associations are summarised below.

• The number of adverse life events the children had 100% 90%

Percentage of children

80% 70%

63%

60% 50%

28%

30% 20% 10% 0%

9% Deterioration in health

Figure 20: Change in health status over time 32

Growing Up in New Zealand COVID-19 Wellbeing Survey

No change in health

Improvement in health

3.4.1.1 E thnicity, and change in health status over time. A significant association between ethnicity (prioritised) and change in health status was observed (Figure 21, Chi‑squared p=0.003).

Regression analysis identified children of Asian ethnicity were significantly more likely to report an improvement in health status over time, compared to European children (Table 14).

European

Ethnicity

Māori Pacific Asian Other 0%

10%

20%

30%

40%

50%

60%

70%

80%

100%

90%

Percentage Deterioration in health

No change in health

Improvement in health

Figure 21: Change in health status over time by ethnicity

Table 14: Ethnicity and change in health status over time Change in Health Status

Ethnicity (Prioritised)

Odds ratio

95% confidence intervals

P value

European

1175

Ref

Māori

377

1.04

0.81 to 1.33

0.753

Pacific

125

1.41

0.96 to 2.06

0.082

Asian

224

1.49

1.11 to 2.00

0.009

Other

1.21

0.67 to 2.21

0.551

3.4.1.2 Mothers’ concerns about their child’s wellbeing and development and change in health status over time

Number of concerns

An association was observed between the number of concerns mothers had about their child’s wellbeing and development and a change in children’s health status (Figure 22, Chi-squared p=0.007), particularly learning concerns (Chi-squared p=0.002).

Regression analysis found children with two or more wellbeing and development concerns were more likely to have an improvement in health, compared to children with no wellbeing and development concerns (Table 15).

Two or more concerns One concern No concerns 0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Percentage Deterioration in health

No change in health

Improvement in health

Figure 22: Mothers’ concerns about their child’s wellbeing and development and change in health status over time PART ONE: HEALTH AND WELLBEING

Table 15: Impact of number of wellbeing and development concerns raised at eight years of age on change in health status over time Change in Health Status

Number of wellbeing and development concerns

Odds ratio

95% confidence intervals

P value

None

1377

Ref

One

423

1.17

0.94 to 1.47

0.163

Two or more

145

1.65

1.16 to 2.35

0.005

3.4.1.3 Body size, and change in health status A significant association was observed between body size at eight years of age, and a change in children’s health status over time (Figure 23, Chi-squared p=0.012). Regression analysis found children who were underweight were significantly less likely to have an improvement in health state over time (Table 16).

Body size

Obese Overweight Normal Underweight 0%

10%

20%

30%

40%

50%

60%

70%

80%

100%

90%

Percentage Deterioration in health

No change in health

Improvement in health

Figure 23: Change in health status over time by body size at eight years of age

Table 16: Impact of body size at eight years of age on change in health status over time Change in Health Status n

Odds ratio

95% confidence intervals

P value

1396

Ref

Underweight

0.38

0.15 to 0.99

0.048

Overweight

361

1.25

0.98 to 1.59

0.068

Obese

168

1.08

0.77 to 1.52

0.639

Normal Body size

Growing Up in New Zealand COVID-19 Wellbeing Survey

3.4.2 Depression symptoms during COVID-19, compared to before COVID-19. A key question to explore is whether the COVID-19 pandemic and the associated Government restrictions, increased feelings of depression in this cohort of children, compared to before the pandemic (i.e., when they were eight years of age). KEY FINDINGS AROUND CHANGES IN SYMPTOMS OF DEPRESSION OVER TIME WERE:

- Girls - Children who were always or often worried about how much money their family had or didn’t know how they felt. • The following groups of children experienced a decrease over time in the symptoms of depression: - Māori and Pacific children. - Children who had three of more positive experiences during Lockdown. - Children who were less connected with friends and family during Lockdown.

200

0.100

150

0.075

Mean = 1.85

Density

Frequency (N = 2071)

• Approximately 60% of children had no clinically significant symptoms of depression at the time of the COVID-19 Wellbeing Survey, compared to approximately 70% without clinically significant symptoms of depression when the children were eight years of age.

• There was an increase over time in the number of children experiencing symptoms of depression, particularly in:

100

0.050

0.025

0.000 0

2 4 6 8 10 12 14 16 18 20 22 24 26 Centre for Epidemiological Studies Depression Scale (CES-DC-10 Score) Collection wave Lockdown survey 8-year DCW

-20

20 -10 0 10 Difference in scores (CES-DC-10 Score) Lockdown - DCW8

Figure 24: Distribution of depression scores across two data collection waves 3.4.2.1 Depression scores as continuous data

for which there was a significant change included:

Looking at the depression scores longitudinally, the distribution of depression scores shifted to the right in those children who completed both the eight-year DCW and the COVID-19 Wellbeing Survey (Figure 24). This shift indicates an increase over time in the number of children experiencing symptoms associated with depression.

• Girls: A greater increase in depression scores over time was observed for girls, compared to boys (estimate=1.20, 95% CI 0.66 – 1.74, p<0.001).

Mean scores for the CES-DC-10 scale increased over the two data collection waves (eight-year DCW: mean=7.18, SD=4.44, median=6; compared to COVID-19 Wellbeing Survey: mean=9.04, SD=4.96, median=8 respectively, t test p<0.001). Linear regression analysis identified that having symptoms associated with depression at the eight-year DCW was predictive of having symptoms associated with depression at the time of the COVID-19 Wellbeing Survey (estimate=0.21, 95% CI=0.16-0.26, p<0.001). Subgroups

• Māori and Pasifika children: A significant decrease in depression scores over time was observed for these children, compared to European children (Table 17). • Children who had three of more positive experiences during Alert Level 4: A decrease in depression scores over time was observed for these children, compared to children who had less than three positive experiences (Table 18). • Children who worried about how much money their family had: A greater increase in depression scores over time was observed for these children, compared to children who didn’t worry about money (Table 19). PART ONE: HEALTH AND WELLBEING

Table 17: Ethnicity and depression scores over time Mean CES-DC-10 Score

Ethnicity (Prioritised)

Estimate

95% confidence intervals

P value

European

1106

Ref

Māori

354

-0.99

-1.73 to -0.25

0.009

Pacific

115

-1.50

-2.66 to -0.33

0.012

Asian

219

-0.63

-1.48 to 0.23

0.150

Other

-1.04

-2.90 to 0.81

0.270

Table 18: Impact of number of positive childhood experiences during Alert Level 4 on depression scores over time Mean CES-DC-10 Score

Number of regular positive events

Estimate

95% confidence intervals

P value

0-2 events

219

Ref

3-4 events

839

-1.40

-2.28 to -0.53

0.002

5-6 events

775

-2.11

-3.01 to -1.21

<0.001

Table 19: Impact of material wellbeing concerns on depression scores over time Mean CES-DC-10 Score

How often the child worries about how much money the family has

Estimate

95% confidence intervals

P value

Don’t think about it at all

973

Ref

Don’t know

179

1.28

0.36 to 2.21

0.007

Sometimes

501

1.25

0.62 to 1.88

<0.001

Often

115

2.29

1.16 to 3.42

<0.001

Always

2.14

0.67 to 3.61

0.004

Children who were less connected with friends and family during Alert Level 4, also had a decrease in depression scores over time, compared to children who were more connected (Table 20). This finding appears counter-intuitive but can be explained by the fact that the least connected children had a higher mean depression score at the eight-year DCW (mean=8.6), compared to the most connected children (mean=6.9).

The mean depression score increased over time in the most connected children (from 6.9 to 8.8 at the time of the COVID-19 Wellbeing Survey) but declined for those who were not or almost not connected (from 8.6 to 8.5 at the time of the COVID-19 Wellbeing Survey). This finding suggests that the mental health of children who were highly connected was impacted more by Alert Level 4.

Table 20: Impact of connectedness during Lockdown on depression scores over time Change in Health Status

Degree of connectedness

Estimate

95% confidence intervals

P value

More connected

788

Ref

Moderately connected

821

0.24

-0.33 to 0.81

0.412

A little connected

149

-0.62

-1.65 to 0.42

0.242

Not or almost not connected

-1.67

-3.09 to -0.25

0.021

Growing Up in New Zealand COVID-19 Wellbeing Survey

Sensitivity analysis, where item DS5 (“I felt like something good was going to happen”) of the CES-DC 10 scale was removed to increase the robustness of the scale at both DCWs, had no impact on the overall findings. 3.4.2.2 Depression scores as categorical data The CES-DC-10 scores can also be looked at categorically, i.e., where a score <10 suggests no significant depressive symptoms and a score ≥10 suggests clinically significant depressive symptoms (Table 21). Overall, 59% of children in the COVID-19 Wellbeing Survey scored below 10, compared to 72% of children at the eight-year DCW. Some children did not change the category they were in over time, that is: • Almost two-thirds of children with a CES-DC-10 score

< 10 at the eight-year DCW where in the same category at the time of the COVID-19 Wellbeing Survey. • Approximately a half of children with a CES-DC-10 score ≥ 10 at the eight-year DCW where still in the same category at the time of the COVID-19 Wellbeing Survey. However, 37% of children had a decline in mental health over time, transitioning from a low CES-DC-10 score at the eight-year DCW into a state of having clinically significant depressive symptoms (i.e., CESDC-10 scores ≥ 10) at the time of the COVID-19 Survey. Almost half of the children had an improvement in their mental health, transitioning from a high CES-DC 10 score (suggestive of clinically significant depressive symptoms) at the eight-year DCW into a better mental state at the time of the COVID-19 Wellbeing Survey.

Table 21: Change in depression scores across two data collection waves Depression scores in the COVID-19 Wellbeing Survey

Depression scores at the eight-year DCW

CES-DC 10 score < 10 n (%)

CES-DC 10 score ≥ 10 n (%)

CES-DC 10 score: <10

945 (63.4%)

546 (36.6%)

CES-DC 10 score: ≥10

271 (46.7%)

309 (53.3%)

3.4.3 A nxiety symptoms during COVID-19, compared to before COVID-19 Another key question to explore is whether the COVID-19 pandemic and the associated Government restrictions, increased feelings of anxiety in this cohort of children, compared to before the pandemic (i.e., when they were eight years of age). KEY FINDINGS AROUND CHANGES IN SYMPTOMS OF ANXIETY OVER TIME WERE: • Approximately 70% of children had no clinically significant symptoms of anxiety, compared to approximately 60% when the children were eight. • There was a decrease over time in the number of children experiencing symptoms associated with anxiety, particularly in: - Pacific children. - Children who were overweight when they were eight years of age. • The following groups of children experienced an increase over time in the symptoms associated with anxiety: - Girls. - Children who were always or often worried about how much money their family had or didn’t know how they felt.

3.4.3.1 Anxiety scores as continuous data Looking at the data longitudinally, the distribution of anxiety scores shifted to the left in those children who completed both the eight-year DCW and the COVID-19 Wellbeing Survey (Figure 25). This shift indicates a decrease over time in the proportion of children experiencing symptoms associated with anxiety. Mean PROMIS scores at the two data collection waves declined over time (eight-year DCW: mean=48.18, SD=9.70, median 48; compared to COVID-19 Wellbeing Survey: mean=45.73, SD=10.01, median 45 respectively, t test p<0.001). Linear regression analysis identified that having symptoms associated with anxiety at the eight-year DCW was predictive of having symptoms associated with anxiety at the time of the COVID-19 Wellbeing Survey (estimate=0.26, 95% CI=0.21-0.31, p<0.001). Subgroups where there was a significant change in anxiety scores over time included: • Girls: Anxiety scores increased over time, compared to boys (estimate=1.55, 95% CI 0.50 – 2.60, p=0.004). • Pacific children: Anxiety scores decreased by three points over time, compared to European children (Table 22) . • Children who worried about how much money their family had: Anxiety scores increased by three to four points over time, compared to children who didn’t worry about money (Table 23). • Children who were overweight: Anxiety scores decreased by one and half points over time, compared to children of normal body weight (Table 24). PART ONE: HEALTH AND WELLBEING

Mean = -2.41 0.09

300 250

Density

Frequency (N = 2069)

350

200 150

0.06

100

0.03

50 0.00

-50

32 39 43 47 50 52 55 57 60 62 65 67 70 72 75 79 84 Pediatric Anxiety Symptoms Scale (PROMIS T Score) Collection wave Lockdown survey 8-year DCW

-25 0 25 Difference in scores (PROMIS T Score) Lockdown - DCW8

Figure 25: Distribution of anxiety scores across two data collection waves Table 22: Ethnicity and anxiety scores over time Mean PROMIS scores

Ethnicity (Prioritised)

Estimate

95% confidence intervals

P value

European

1138

Ref

Māori

364

-0.93

-2.39 to 0.53

0.210

Pacific

124

-3.27

-5.55 to -0.99

0.005

Asian

220

0.81

-0.89 to 2.50

0.349

Other

-2.66

-6.15 to 0.83

0.135

Table 23: Impact of material wellbeing concerns on anxiety scores over time Mean PROMIS scores

How often the child worries about how much money the family has

Estimate

95% confidence intervals

P value

Don’t think about it at all

1001

Ref

Don’t know

182

3.31

1.48 to 5.14

<0.001

Sometimes

519

3.18

1.95 to 4.41

<0.001

Often

123

3.81

1.63 to 5.99

<0.001

Always

3.16

0.24 to 6.08

0.034

Table 24: Impact of body size at eight years of age on anxiety scores over time Mean PROMIS scores n

Estimate

95% confidence intervals

P value

1355

Ref

Underweight

-2.48

-7.48 to -2.52

0.331

Overweight

347

-1.50

-2.88 to -0.12

0.033

Obese

167

-0.92

-2.86 to 1.02

0.353

Normal Body size

Growing Up in New Zealand COVID-19 Wellbeing Survey

3.4.3.2 Anxiety scores as categorical data The PROMIS scores can also be looked at categorically, i.e., where scores ≤50 indicate no anxiety, scores of 51‑55 indicate ‘mild’ symptoms of anxiety, scores of 56-65 indicate ‘moderate’ symptoms of anxiety, and scores ≥66 indicate ‘severe’ symptoms of anxiety. Using these categories, more than half of the children in both the eight-year DCW and the COVID-19 Wellbeing Survey had no symptoms of anxiety (Figure 26). The proportion of children with symptoms associated with anxiety decreased between the two data collection waves, with severe anxiety reported by less than 5% of children. Some children did not change the anxiety category they were in between the two data collection waves (Table 25). For example,

• 76% of children with no symptoms of anxiety at the eight-year DCW still had no symptoms of anxiety at the time of the COVID-19 Wellbeing Survey. • 25% of children with moderate anxiety at the eight‑year DCW still had moderate anxiety at the time of the COVID-19 Wellbeing Survey. However, other children had an increase in anxiety symptoms over time, while others had a decline (Table 25). For example, • 10% of children with no symptoms of anxiety at the eight-year DCW had moderate anxiety at the time of the COVID-19 Wellbeing Survey. • 53% of children with severe anxiety at the eight-year DCW had no symptoms of anxiety at the time of the COVID-19 Wellbeing Survey.

100% 90%

Percentage of children

80%

67%

70% 60%

59%

50% 30%

17%

20%

15%

10% 0%

4% No anxiety

Mild anxiety

Moderate anxiety

Severe anxiety

Anxiety measured using the PROMIS scale 8 year DCW

COVID Wellbeing Survey

Figure 26: Child anxiety levels across the two data collection waves

Table 25: Change in anxiety scores across two data collection waves Anxiety at the time of the COVID-19 Wellbeing Survey

Anxiety at the time of the eight-year DCW

No anxiety n (%)

Mild anxiety n (%)

Moderate anxiety n (%)

Severe anxiety n (%)

No anxiety

922 (75.7%)

143 (11.7%)

126 (10.3%)

27 (2.2%)

Mild anxiety

230 (63.9%)

62 (17.2%)

57 (15.8%)

11 (3.1%)

Moderate anxiety

185 (47.2%)

92 (22.3%)

105 (25.4%)

21 (5.1%)

Severe anxiety

41 (52.6%)

11 (14.1%)

21 (26.9%)

<10

PART ONE: HEALTH AND WELLBEING

3.4.4 Children most at risk of poor health and wellbeing KEY FINDINGS: • The following children were most at risk of having one or more negative changes in health and wellbeing over the two DCWs. - Girls. - Children with mothers who had one or more episodes of depression. - Children who were always or often worried about how much money their family had or didn’t know how they felt.

Based on findings presented in this report, there is a group of children who have had negative changes in their health and wellbeing outcomes from the eight‑year DCW to the time of the COVID-19 Wellbeing Survey. Some children have only had one negative change (e.g., an increase in symptoms of depression), some have had two (e.g., an increase in symptoms of depression and anxiety), while 70 children (5%) have experienced three negative changes, i.e., an increase in symptoms associated with depression and anxiety, plus a deterioration in their health (Figure 27).

- Children who had highly educated mothers. • However, children who had six or more people in their bubble during Alert level 4 were less likely to report one or more negative changes over the two DCWs.

Increase in CES-DC score

552 (39.9%) 47 (3.4%)

527 (38.1%) 70 (5.1%)

Increase in PROMIS score

137 (9.9%) 11 (0.8%)

41 (3.0%) Deterioration of health status

Figure 27: Children with one or more negative health and wellbeing changes over time

Growing Up in New Zealand COVID-19 Wellbeing Survey

The children who were significantly more likely to report a higher number of negative changes over the two DCWs were (Figure 28, Table 26): • Girls. • Children whose mother had a history of depression. • Children who worried about how much money their family had. • Children who had mothers with a bachelor’s degree or higher. Gender Boy Girl History of Maternal depression (number of incidences) 0 1 2 Worry about how much money the family has I don’t think about it Sometimes Often Always No secondary school qualification Sec school/NCEA 1-4 Diploma/Trade cert/ NCEA 5-6 Bachelor’s degree

Mother education

Higher degree 0%

10%

20%

30%

40%

50%

60%

70%

80%

100%

90%

Number of negative changes in outcomes 0

Figure28: Children at risk of having one or more negative health and wellbeing changes over time Table 26: Children most at risk of poor health and wellbeing changes over time Negative health and wellbeing outcomes n

Odds ratio

Boy 936 Ref Sex 1.42 Figure 27: Children with oneGirl or more negative health and wellbeing 1019 changes over time

95% confidence intervals

P value

1.20 to 1.67

<0.001

0 1 or 2

1712 243

Ref 1.42

1.11 to 1.82

0.006

How often the child worries about how much money the family has

Don’t think about it at all Don’t know Sometimes/Often Always

1032 188 664 71

Ref 1.65 1.67 1.76

1.24 to 2.20 1.39 to 2.00 1.11 to 2.79

<0.001 <0.001 0.016

Mother’s education

No secondary schooling Secondary school/ NCEA 1-4 Diploma/Trade Cert/NCEA 5-6 Bachelor’s degree Higher degree

58 322 491 612 472

Ref 1.46 1.58 1.69 1.96

0.86 to 2.49 0.94 to 2.66 1.01 to 2.84 1.17 to 3.32

0.163 0.083 0.046 0.011

Episodes of maternal depression

PART ONE: HEALTH AND WELLBEING

3.4.4.1 The protective effect of bubble size Children participating in the COVID-19 Wellbeing Survey were asked to provide information about their bubbles during Alert Level 4. Most children (90%, n=2065) reported having between three and six people in their bubble, including themselves (Figure 29). Pasifika and Māori children were, on average, more likely to have a greater number of people in their bubble.

Children who had six or more people in their bubble during Alert Level 4 were significantly less likely to report one or more negative changes over the two DCWs, compared to children who had 2-3 people in their bubble (Table 27).

50%

Percentage

40%

Ethnicity - Total response

European 35.2% 29.5%

30% 20%

13.9%

10%

5.8%

1.2%

3.6%

2.1% 1%

1.8%

5 (1.5)

Māori

5.5 (2)

Pacific

6 (2.2)

Asian

4.8 (1.4)

Other

4.5 (1.1)

0% 2

6 7 8 Bubble size

6 8 2 4 Average number of people in bubble (incl SD)

Figure 29: Bubble size during Alert Level 4

Table 27: The protective effect of bubble size on health and wellbeing Change in Health Status

Number of people in the child’s bubble

Estimate

95% confidence intervals

P value

2 or 3 people

138

Ref

4 or 5 people

1282

0.82

0.59 to 1.13

0.216

6 or more people

535

0.67

0.47 to 0.95

0.023

Growing Up in New Zealand COVID-19 Wellbeing Survey

4. Discussion This study aimed to explore the impact of governmentmandated COVID-19 restrictions on the health and mental wellbeing of children in the GUiNZ longitudinal cohort study, and whether this impact differed by specific demographic variables or had changed since the last DCW (undertaken when the children were eight years of age). The survey was delivered during Alert Levels 2 and 3, with survey questions pertaining to that time-period, or to Alert Level 4. A total of 2421 children participated in the survey, representing 42% of the invited GUiNZ cohort.

4.1 Strength in togetherness • Overall, most children who completed the survey reported their current health was ‘very good’ to ‘excellent’, and approximately 60% of children had no clinically significant symptoms of depression or anxiety. • One in three children had an improvement in their health since they were eight years of age and there was a general decline in the number of children with symptoms of anxiety, particularly in Pasifika children and children who were overweight. • There was also an observed decline in symptoms of depression in Māori and Pasifika children over the two time periods. • Being in a bubble during Alert level 4 (Lockdown) with six or more people was protective of negative health and wellbeing changes over the two DCWs. BEST THINGS ABOUT LOCKDOWN

“Reading, eating healthy stuff, bonding with my family.”

4.2 A lert Levels 2-4 were very challenging for some children • Having obesity, being less connected with friends and family outside of the home, worrying about how much money the family had, and still undertaking schoolwork at home were predictive of poorer health at the time of the survey. • Children who were underweight were more likely to report a decline in health from when they were eight years of age. • There was also a group of children that had one or more negative changes in their health and mental wellbeing over time. This combination of negative changes was more likely to be seen in girls, children who had a mother with a history of depression, children who worried about how much money their family had, and children who had well educated mothers. WORST THING ABOUT LOCKDOWN

“Feeling like I’m eating too much, parents not having money, arguing with parents” 4.3 Could the observed changes in depression and anxiety be age-related? The observed changes in depression (increasing over time) and anxiety (decreasing over time) in this cohort of children may be age-related. The prevalence of depression and anxiety is known to increase with age, with the average age of onset of major depressive disorders occurring between 11 to 14 years of age (35). Thus any increase in depression symptoms between eight and 11 years of age may represent children manifesting their first symptoms of a depressive disorder, particularly in children where there is a family history of depression (31). Anxiety disorders tend to present during early childhood, with a gradual increase in prevalence with age and clear sex differences in prevalence (35) (i.e., higher in girls, but with no difference by sex in age of onset) (36).

PART ONE: HEALTH AND WELLBEING

Furthermore, certain anxiety disorders are more common in early childhood (e.g., separation anxiety, social anxiety, and specific phobias), but can resolve with time (36-37). The observed increase in depression, and decrease in anxiety, may therefore reflect the known prevalence trends of these disorders in childhood. Despite the above, it’s important to remember that the survey had low participation by Māori, Pacific, and Asian children, and children living in rural areas of New Zealand. Children who did not participate in the survey may have been those experiencing the social and environmental stressors (such as poverty, bullying, etc) known to be determinants of depression and anxiety. WORST THING ABOUT LOCKDOWN

“My mum has to go to work and people might make my mum get sick and I will be sad” 4.4 The security of the ‘bubble’ Previous research has shown a higher prevalence of depression and anxiety in New Zealand Māori and Pacific children, compared to other ethnic groups (38), and a higher prevalence of depression and anxiety in children who were overweight or with obesity, compared to children who are normal weight (39). However, the COVID-19 Wellbeing Survey found the opposite, with a significant reduction in depression for Māori and Pacific children, and a significant reduction in anxiety for Pacific children and children who were overweight. There are several possible explanations for these findings. First, the average size of each household ‘bubble’ at the time of the survey (not including the child) was bigger for Pacific and Māori children, than for European children. Māori and Pacific peoples tend to be strongly connected to their culture and to others socially (40), so one could postulate that being around more people in the family unit/ bubble meant there were more people around to assist with household tasks, look after the children, and offer the children a sense of security and connection, thereby helping to reduce symptoms of depression and anxiety. A review on anxiety and depression in Pacific youth found strong family connections and faith were protective factors for depression and anxiety (41). Furthermore, for Pacific youth, particularly Samoan youth, the cultural concept of ‘le va’ (“an interconnecting space that connects people together, nurturing positive relationships between them”) (41) appears protective of mental health. As mentioned earlier, it’s important to note that the survey had low participation by Māori and Pacific children, and non-engaged children may have been those experiencing social and environmental stressors that can impact mental wellbeing. 44

Growing Up in New Zealand COVID-19 Wellbeing Survey

Second, bullying is a known risk factor for depression and anxiety (42), and high rates of bullying have previously been noted in Pacific children in the GUiNZ study (compared with European children) (43). Furthermore, bullying is also higher in children who are overweight or obese (42). It’s therefore possible that being at home during COVID-19 Alert Level 3 meant children were not exposed to bullying at school, potentially resulting in less depression and anxiety. BEST THINGS ABOUT LOCKDOWN

“Spending time with grandparents after we combined bubbles.” 4.5 Some children worry a lot about money A significant finding from the COVID-19 Wellbeing Survey was that children who worried about how much money the family had reported poorer health and more symptoms of depression and anxiety at the time of the survey, compared to when they were eight. These findings may be explained by the children reflecting the emotional change within the family environment due to the significant economic and social impact Alert Levels 3 and 4 had on many New Zealand families. For example, a New Zealand survey (N=3000) undertaken during Alert Level 4 found 34% of households were experiencing significant financial difficulty, 10% had missed a rent or mortgage payment, and 41% of survey respondents were feeling anxious about their financial situation (44). Another New Zealand survey undertaken during this period (N=2002) focused on the impact of work status, job and income loss, and work-family conflict on family functioning and wellbeing during lockdown (45). Approximately half of working parents reported an increase in family demands, despite “work time demands among those who continued working remaining unchanged”. Such work-family conflict was associated with more partner conflict, less supportive partners, a decline in parental role satisfaction, more negative emotions, and less positive emotions. WORST THING ABOUT LOCKDOWN

“I sometimes get worried that we will run out of money and have to sell our home.” 4.6 Support children with well-being and developmental concerns Another subgroup of interest in the COVID-19 Wellbeing Survey were children whose mothers reported wellbeing and developmental concerns for them at the eight-year DCW. This group of children had better health but were more likely to have depression and anxiety at

the time of the COVID-19 Wellbeing Survey, compared to when they were eight. Similar findings were reported in a cross-sectional study (N=64) of Polish youth and young adults with development disorders, which found that family stresses because of COVID-19 lockdowns predicted the severity of depression in girls (46). It’s therefore possible that because these children had wellbeing and developmental concerns their family paid close attention to their health needs, particularly during high stress times. However, as mentioned above, many children were exposed to family stress because of COVID-19 related financial and work-life challenges (35) (including families who had children with wellbeing and developmental concerns). Symptoms of depression and anxiety in this higher-needs population of children may reflect this exposure. WHAT IT’S LIKE IN LOCKDOWN

“All the children with disabilities shouldn’t be forgotten. I have autism and I want to make sure those families are getting help to” 4.7 Comparison with other COVID-19 studies undertaken in children The finding in the COVID-19 Wellbeing Survey that the majority of children rated themselves as having ‘good’ to ‘excellent’ health is aligned with the findings from an audit from Starship Children’s Hospital in Auckland, which found the lowest number of child trauma admissions in the past five years during Alert Level 4 (47). Restriction of population movement during Alert Levels 3 and 4 meant less traffic on the roads, less activity out of the home environment, and closer supervision of children given caregivers were not away from home, thereby reducing the risk of physical harm. International research supports the finding that for some children their health deteriorated during the time of COVID-19 related restrictions (48-49). Reasons for a decline in health are likely multifaceted, and can include becoming unwell with COVID-19 (at the time of the COVID-19 Wellbeing Survey, 157 COVID-19 cases in New Zealand were children aged 0-19 years) (4), a preexisting health condition becoming worse, or increased food insecurity (potentially related to COVID-19 related job losses for caregivers and associated financial insecurity) (35) resulting in poorer nutrition and poorer health in children who are underweight (50). Certainly in New Zealand there is evidence that the COVID-19 lockdowns have exacerbated the existing food insecurity problem, with an increase in the distribution of food parcels and Special Needs Grants issued for food by the Ministry of Social Development (51). Emerging

international research also indicates many children had an increase in unhealthy food practices (such as eating more unhealthy food, and/or eating more frequently), and an increase in sedentary behaviour, during periods of COVID-19 related confinement, with resulting weight gain (50). Research also suggests unhealthy food consumption may have a depressive effect (52). A decline in health could also be related to experiencing violence and/or abuse through spending a longer time in a home environment with pre-existing family vulnerabilities (e.g., family dysfunction, economic hardship, poor mental health, alcohol dependence, etc) and/or new family stresses (e.g., COVID-19 related job losses, financial insecurity, increased alcohol consumption, etc). Certainly, both nationally and internationally there have been reports of adults increasing their alcohol consumption during periods of lockdown (53-54), and people experiencing family violence during periods of lockdown (53, 55-56). Relatively little published information is available on the trajectory of mental health in children and young people from before to during the COVID-19 pandemic. Information that does exist is broadly consistent with that observed in the GUiNZ COVID-19 Wellbeing Survey, and is summarised below: • A study of 248 children (aged 13-16 years, 82% Caucasian, 79% mid to high socioeconomic status) from an urban area in New South Wales, Australia found a significant increase in both depression and anxiety symptoms from the 12 months leading up to lockdown (i.e., 2019), and two months into a lockdown (5-14th May 2020) (57) Key predictors for poor mental health included being female, having COVID-19 related worries, decreased life satisfaction, experiencing online learning difficulties, and increased conflict with parents. Factors that were protective of poor mental health included feeling socially connected during the lockdown period and adhering to the Government orders to stay at home. • A study of 1339 children (aged 9-18 years) from 12 longitudinal studies (10 from the USA, one from the Netherlands, and one from Peru) found a significant increase in depression, but not anxiety, symptoms from before the COVID-19 pandemic to during the first six months of the pandemic (58). A greater decline in mental health was observed for multiracial children, and those children under more strict ‘lockdown’ restrictions. • A study of 168 children (aged 8-12 years) in England found a significant increase in depression, but not anxiety, symptoms from before the COVID-19 lockdown to during the Lockdown (59). L ongitudinal studies from the UK (60-61) and Canada (62) have also observed a decline in the mental health in adults, from before the COVID-19 pandemic to during the pandemic. PART ONE: HEALTH AND WELLBEING

5. Strengths and Limitations 5.1 Study strengths This survey is the first in New Zealand, and one of the largest in the world, to explore the impact of COVID-19 on the health and wellbeing of children aged 10-11 years of age, in comparison to their health and wellbeing before COVID-19. The prospective longitudinal design of the study provides a temporal framework to assess causality, with adjustment for known confounders, as well as the ability to calibrate the findings to the baseline generalisable cohort (despite the lower response rate). Previous New Zealand research on the health and wellbeing of children at the time of the pandemic has been crosssectional in design and therefore unable to attribute any causal relationship to the pandemic. Given the longitudinal design, comprehensive data were available for many variables of interest from previous DCWs, meaning recall bias was minimised. The timing of the survey meant the acute impact of COVID-19 Alert Levels 3 and 4 was captured, with information on the long-term impact of COVID-19 on the GUiNZ children and families/whānau to be determined in future DCWs. The survey strongly reflects the views of girls, and children who had older (>40 years) and more educated mothers (i.e., ≥ Bachelor’s degree), given the higher participation rate of these groups in the survey. The survey is also the first time an online DCW has been utilised with children in the GUiNZ cohort, with the 42% response rate considered high for a digital survey of this nature (63). Furthermore, most children completed all questions in the survey. The response rate applies to children who were able to engage in the survey if their parental primary contact agreed and provided the children with access to a connected device. Once the

Growing Up in New Zealand COVID-19 Wellbeing Survey

children are ≥16 years of age, parental consent will no longer be required, and so response rates to any future digital surveys may increase (particularly given this cohort of children are ‘digital natives’, having grown-up in a highly connected world). The response rate and lessons learnt from delivering this survey online provides valuable information to inform strategies for contingency planning should future DCWs require electronic data capture (e.g., if future COVID-19 lockdowns prohibit faceto-face data capture for the upcoming 12-year DCW).

5.2 Study limitations The study had several limitations that should be considered when interpreting the findings. These limitations relate to four areas: generalisability, reporting bias, the validity of the depression and anxiety instruments, and multiple tests of significance. • Generalisability: Five aspects of the study limit the generalisability of the survey findings to the greater survey cohort, and New Zealand children of this age in general. First, 11 children were excluded from participating in the survey because their caregivers had requested that all communications to the children be in Te Reo Māori, limiting the generalisability of the survey findings to this subgroup of children. Unfortunately, the GUiNZ team did not have the resources during Alert Level 4 to provide a translated survey within the limited time available to launch the survey. As an important sub-group of the Māori cohort, the GUiNZ team did not want to offend these families by sending them an English-only survey and risk having the families withdraw from the cohort study. The team therefore made the difficult decision to not invite these children to complete the COVID-19 Wellbeing Survey. Second, almost two thirds of the

cohort did not participate in the survey, with underrepresentation from Māori, Pacific, and Asian children, and children living in rural areas of New Zealand. Based on the eight-year DCW, the study team were aware that valid contact details were unavailable for some families for the COVID-19 Wellbeing Survey. However, given the opportunistic nature of this survey there was no time and resources available to address this issue. The team made the decision to continue with the survey, whilst acknowledging that the sample would not be representative. Third, it was anticipated that some non-response would be due to digital inequity, that is a lack of access to devices to access the internet to complete the online survey, or lack of access to, or consistent access to, the internet. Fourth, the children were unfamiliar with the Qualtrics survey platform, which proved challenging for some children (e.g., the survey links expired after a certain time). Finally, some children in the COVID-19 Wellbeing Survey, and in the eight-year DCW, did not answer all survey questions, although the degree of nonresponse was very low indicating that in general the cohort children were willing and able to participate in a primary digital data collection process. • Reporting bias: Various issues may have introduced reporting bias into the study. First, face-to-face interviews were used for the eight-year DCW, compared to a remote, self-completed online survey for the COVID-19 Wellbeing Survey. This difference in data collection method may have impacted the quality and reliability of results and may have led to differential attrition within population subgroups not seen in the overall response rates. Second, how the children interpreted the meaning of the phrase ‘current health’ is unknown. Some may have interpreted the word to mean physical health,

mental health, or both in the definition. Third, survey questions in the COVID-19 Wellbeing Survey, and all previous DCWs, were not compulsory to complete, so certain questions have more missing data than others. Missing data for the variables presented in this report ranged from 0.3% to 10.1%. Fourth, data are self-reported and therefore subject to some degree of bias. For example, more objective measures of general health, depression and anxiety may not align with the self-reported measures, and some questions may be impacted by social desirability bias. Finally, some linked variables from the eight-year DCW may have changed over time, and thus may not be the same at the time of the COVID-19 Wellbeing Survey, for example, socioeconomic deprivation, rurality, and number of adverse life events experienced by the child. • Validity of the depression and anxiety instruments: The instrument used to measure depression (and the score cut-off of ≥10) has not been validated in children aged 10-11 years, although it has been validated in youth aged 13-17 years (64-66). The internal consistency of the depression score was also not reliable for the COVID-19 Wellbeing Survey cohort, although it was for the eight-year DCW. Similarly, the instrument used to measure anxiety has not been validated in a New Zealand population, and the score cut-offs have not been validated in children aged 10-11 years. For the above reasons, the results of the depression and anxiety analyses are suggestive-only and require validation. • Multiple tests of significance: Multiple tests of significance were undertaken, increasing the risk of type 1 error, that is finding a significant relationship where none exists.

PART ONE: HEALTH AND WELLBEING

6. Future Directions This survey was administered rapidly and opportunistically during the time of an unexpected global pandemic and an associated brief acute lockdown period. The advantage of the survey was that it utilised an existing cohort of children with well-characterised demographic, health, and wellbeing information. The intent of the survey was to capture a snapshot of life during this high stress time, through the eyes of the children themselves and provide a measure of wellbeing that could augment the longitudinal wellbeing trajectory information. It will be important that future GUiNZ DCWs continue to assess the on-going and long-term impact of the COVID-19 pandemic on the health and wellbeing of children in New Zealand.

Growing Up in New Zealand COVID-19 Wellbeing Survey

Acknowledgements GUiNZ is indebted to the continued commitment of all the child and family participants in the study. Fitting an ongoing involvement with GUiNZ into your busy lives is a significant undertaking; we acknowledge your trust and recognise our responsibility to safeguard the time, honesty, and information you have shared with us. The authors of this report are members of the GUiNZ team: the Foundation Director (Professor Susan Morton), Named Investigators (Professor Clare Wall, Professor Karen Waldie, Associate Professor Elizabeth Peterson, Dr Kane Meissel, Dr Pat Bullen), Associate Professor Natalie Walker, Nandini Dubey (Medical Student), Senior Research Fellows (Dr Sarah Gerritsen, Dr Carin Napier), Research Fellows (Dr Fiona Langridge, Dr Rebecca Evans), Research Assistants (Molly Bergquist, Ashley Smith), Biostatisticians (Avinesh Pillai, Stephane Janicot), Pacific Theme Lead (Dr Seini Taufa), Māori Theme Leads (Dr Sarah-Jane Paine and Professor Te Kani Kingi) and Research Director (Professor Boyd Swinburn). The authors acknowledge that the content of this report is informed by experts in the specific research domains and themes for GUiNZ, and feedback from the Ministry of Social Development and Ministry of Education. Further information regarding the expert advisory team and study design is available on our website: www.growingup.co.nz This report would not be possible without the efforts of all those involved in the wider GUiNZ team to get the survey out into field. We acknowledge specifically: Annette Gohns (General Manager), Rina Prasad (Lead Data Manager), Anushree Kedia (Data Manager), Cherie Lovell (Field Operations Manager), and Saraid Black and Kirsty Jones (Communications Managers), Amelia Willems (Research Delivery Manager), and Davanti Consulting Limited.

We thank the key funders of GUiNZ who not only contribute to the study’s sustainability but help to ensure that the information from our families contributes evidence to inform the policy environment in New Zealand. We thank the initial funders of GUiNZ, in particular the Ministry of Social Development, supported by the Health Research Council of New Zealand and the University of Auckland. Many Government agencies contribute to the ongoing sustainability and utility of GUiNZ. We acknowledge and thank the Ministry of Social Development for management of the Crown funding of GUiNZ and acknowledge further funding and support received from the Ministries of Health and Education, as well as Te Puni Kōkiri, the Ministries of Justice and Business, Innovation and Employment, the Ministry for Pacific Peoples, the Ministry for Women, the Departments of Corrections and Labour, the New Zealand Police, Sport New Zealand and the Office of the Health and Disability Commissioner. We also acknowledge the support of the Office of the Children’s Commissioner, Housing New Zealand, the Office of Ethnic Communities, Statistics New Zealand, and the Treasury. Finally, GUiNZ acknowledges the ongoing support and advice provided by the University of Auckland and Auckland UniServices Limited, as well as the advisory and governance groups of the study including all Named Investigators, the Steering Group, Policy Forum, our Expert Scientific Advisory Group, our Kaitiaki Group, our Pasifika Advisory Group, and our Data Access Committee. Further information about the GUiNZ team, governance and design of this longitudinal study is available on our website: https://www.growingup.co.nz/

PART ONE: HEALTH AND WELLBEING

References 1. World Health Organization. Coronavirus disease 2019 (COVID-19) Situation Report - 51. 2020. World Health Organization, Geneva 2. World Health Organization. WHO Coronavirus (COVID-19) Dashboard. World Health Organization, Geneva. https://covid19.who.int/ 3. World Health Organization. Coronavirus disease 2019 (COVID-19) Situation Report - 198. August 2020. World Health Organization, Geneva 4. Ministry of Health. COVID-19: Case demographics. Ministry of Health, Wellington. https://www.health. govt.nz/our-work/diseases-and-conditions/covid19-novel-coronavirus/covid-19-data-and-statistics/ covid-19-case-demographics 5. Ministry of Health. COVID-19: Current Cases. Ministry of Health, Wellington. https://www.health. govt.nz/our-work/diseases-and-conditions/covid19-novel-coronavirus/covid-19-data-and-statistics/ covid-19-current-cases 6. Baker M, Wilson N, Anglemyer A. Successful Elimination of Covid-19 Transmission in New Zealand. New England Journal of Medicine, 2020; 383 (8). 7. Götzinger F, Santiago-García B, Noguera-Julián A, et al. COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study. Lancet Child & Adolescent Health, 2020; 4 (9):653-61. 8. Swann OV, Holden KA, Turtle L, et al. Clinical characteristics of children and young people admitted to hospital with COVID-19 in the United Kingdom: prospective multi-centre observational cohort study. British Medical Journal, 2020; 370. m3249. doi: 10.1136/bmj.m3249 9. Fore HH. A wake-up call: COVID-19 and its impact on children’s health and wellbeing. Lancet Global Health, 2020;(20):19–20. 10. Liu JJ, Bao Y, Huang X, Shi J, Lu L. Mental health considerations for children quarantined because of COVID-19. Lancet Child & Adolescent Health, 2020 May;4(5):347–9. 50

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11. Xie X, Xue Q, Zhou Y, Zhu K, Liu Q, Zhang J, et al. Mental Health Status among Children in Home Confinement during the Coronavirus Disease 2019 Outbreak in Hubei Province, China. JAMA Pediatrics, 2020;7:1–3. 12. Saurabh K, Ranjan S. Compliance and Psychological Impact of Quarantine in Children and Adolescents due to COVID-19 Pandemic. Indian Journal of Pediatrics, 2020; 87(7):532-6. 13. Sprang G, Silman M. Posttraumatic stress disorder in parents and youth after health-related disasters. Disaster Medicine and Public Health Preparedness, 2013; 7(1): 105–10. 14. Wang G, Zhang Y, Zhao J, Zhang J, Jiang F. Mitigate the effects of home confinement on children during the COVID-19 outbreak. Lancet, 2020;395(10228):945–7. 15. Youthline COVID-19 Research: Report of Results. 2020. https://www.youthline.co.nz/surveyresults. html 16. Ministry of Health, COVID-19 Health and Wellbeing Survey. Ministry of Health, Wellington https://www. health.govt.nz/our-work/diseases-and-conditions/ covid-19-novel-coronavirus/covid-19-resourcesand-tools/covid-19-health-and-wellbeing-survey 17. Office of the Children’s Commissioner. Life in Lockdown: Children and young people’s views on the nationwide COVID-19 level 3 and 4 lockdown between March and May 2020. Office of the Children’s Commissioner, Wellington, November 2020. ISBN 978-0-473-54970-1 18. Morton SMB, Ramke J, Kinloch J, et al. Growing Up in New Zealand cohort alignment with all New Zealand births. Australian and New Zealand Journal of Public Health, 2015;39(1):82–7. 19. Bergquist-O’Sullivan M, et al. GUiNZ COVID-19 Wellbeing Survey: Part 2: Education. Ministry of Education, Wellington 2021.

20. Jose PE, Stuart J, Pryor J, Ja N. The influences of social connectedness on behaviour in young children: A longitudinal investigation using GUiNZ data. Ministry of Social Development. August 2019. 21. Ministry of Social Development. Rapid Evidence Review: The impact of poverty on life course outcomes for children, and the likely effect of increasing the adequacy of welfare benefits. Ministry of Social Development, Wellington. December 2018. 22. Statistics New Zealand. Measuring child poverty: Material hardship. Statistics New Zealand, Wellington, 2019. https://www.stats.govt.nz/ methods/measuring-child-poverty-materialhardship. 23. Child Wellbeing & Poverty Reduction Group. Material Wellbeing. Child Wellbeing & Poverty Reduction Group, Department of the Prime Minister and Cabinet, Wellington 2021. 24. Andresen EM, Malmgren JA, Carter WB, Patrick DL. Screening for Depression in Well Older Adults: Evaluation of a Short Form of the CES-D. American Journal of Preventive Medicine, 1994 Mar;10(2):77– 84. 25. Bradley KL, Bagnell AL, Brannen CL. Factorial Validity of the Center for Epidemiological Studies Depression 10 in Adolescents. Issues in Mental Health Nursing, 2010 May 7;31(6):408–12 26. Salk RH, Hyde JS, Abramson LY. Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms. Psychological Bulletin, 2017; 143(8), 783–822. 27. Mammarella IC, Ghisi M, Bomba M, et al. Anxiety and depression in children with nonverbal learning disabilities, reading disabilities, or typical development. Journal of Learning Disabilities. 2016; 49(2):130-9. 28. Whitney DG, Shapiro DN, Peterson MD, Warschausky SA. Factors associated with depression and anxiety in children with intellectual disabilities. Journal of Intellectual Disability Research, 2019; 63: 408–17.

31. Spence SH, Najman JM, Bor W, O’Callaghan MJ, Williams GM. Maternal anxiety and depression, poverty and marital relationship factors during early childhood as predictors of anxiety and depressive symptoms in adolescence. Journal of Child Psychology and Psychiatry, 2002; 43: 457-69. 32. Irwin DE, Stucky B, Langer MM, et al. An item response analysis of the pediatric PROMIS anxiety and depressive symptoms scales. Quality of Life Research. 2010 May 7;19(4):595–607. 33. Goldstone A, Javitz HS, Claudatos SA, et al. Sleep Disturbance Predicts Depression Symptoms in Early Adolescence: Initial Findings from the Adolescent Brain Cognitive Development Study. Journal of Adolescent Health, 2020; 66(5): 567-74, 34. McMakin DL, Alfano CA. Sleep and anxiety in late childhood and early adolescence. Current Opinion in Psychiatry, 2015; 28(6): 483-9. 35. Merikangas KR, Nakamura EF, Kessler RC. Epidemiology of mental disorders in children and adolescents. Dialogues of Clinical Neuroscience, 2009;11(1):7–20. 36. Merikangas KR., Avenevoli S. Epidemiology of mood and anxiety disorders in children and adolescents. In: Tsaung MT, Tohen M, eds. Textbook in Psychiatric Epidemiology, 2nd Edition. New York, NY: Wiley- Liss, 2002:657–704. 37. Masi G, Mucci M, Millepiedi S. Separation Anxiety Disorder in Children and Adolescents. CNS Drugs, 2001;15(2):93–104 38. Fleming T, Tiatia-Seath J, Peiris-John R, Sutcliffe K, Archer D, Bavin L, Crengle S, Clark T. (2020). Youth19 Rangatahi Smart Survey, Initial Findings: Hauora Hinengaro / Emotional and Mental Health. The Youth19 Research Group, The University of Auckland and Victoria University of Wellington, New Zealand. 39. Rankin J, Matthews L, Cobley S, et al. Psychological consequences of childhood obesity: psychiatric comorbidity and prevention. Adolescent Health, Medicine and Therapeutics, 2016; 7: 125-46. 40. Kukutai T, Prickett K, Atatoa-Carr P, Rata A. Poipoia te kākano kia puawai. Family structure, family change and the wellbeing of tamariki Māori. Ministry of Social Development, July 2020

29. Livingston EM, Siegel LS, Ribary U. Developmental dyslexia: emotional impact and consequences. Australian Journal of Learning Difficulties, 2018; 23:2, 107-35.

41. Tucker-Masters L, Tiatia-Seath J. Reviewing the literature on anxiety and depression in Pacific youth: a fresh perspective. New Zealand Medical Student Journal, 2017; 25: 24-8.

30. Sanders J, Munford R, Thimasarn-Anwar T, Liebenberg L. Validation of the Child and Youth Resilience Measure (CYRM-28) on a sample of atrisk New Zealand youth. Research on Social Work Practice, 2017; 27(7):827-40.

42. Thompson I, Hong JS, Lee M, Prys NA, Morgan JT, Udo-Inyang I. A review of the empirical research on weight-based bullying and peer victimisation published between 2006 and 2016. Educational Review, 2020; 72 (1): 88-110. PART ONE: HEALTH AND WELLBEING

43. Morton S, Walker C, Gerritsen S, et al. Growing Up in New Zealand: a longitudinal study of New Zealand children and their families. Now we are eight. Auckland. Growing Up in New Zealand, August 2020. 44. Galicki C. Impact of COVID-19 on financial wellbeing: Key findings from a national survey. Commission for Financial Capability, May 2020

56. Perez-Vincent SM, Carreras E, Gibbons MA, Murphy TE, Rossi MA. COVID-19 lockdowns and domestic violence: evidence from two studies in Argentina. Inter-American Development Bank. July 2020.

45. Prickett KC, Fletcher M, Chapple S, Doan N, Smith C. (2020). Life in lockdown: The economic and social effect of lockdown during Alert Level 4 in New Zealand. Wellington, New Zealand: Victoria University of Wellington.

57. Magson NR, Freeman JYA, Rapee RM, et al. Risk and Protective Factors for Prospective Changes in Adolescent Mental Health during the COVID-19 Pandemic. Journal of Youth and Adolescents, 2021; 50: 44–57.

46. Michal G, Lukasz K. Symptoms of anxiety and depression in students with developmental disabilities during COVID-19 lockdown in Poland. Frontiers in Psychiatry, 2021; 12: 319 47. Hamill JK, Sawyer MC. Reductions of childhood trauma during COVID-19 Level 4 lockdown in New Zealand. Australian and New Zealand Journal of Surgery, 2020; 90 (7-8): 1242-3. 48. Patrick SW, Henkhaus LE, Zickafoose JS, et al. Wellbeing of parents and children during thee COVID-19 pandemic: a national survey. Pediatrics, 2020; 146(4): e2020016824. 49. United Nations. Policy Brief: The impact of COVID-19 on children. United Nations. 15th April 2020. 50. Zemrani, B., Gehri, M., Masserey, E. et al. A hidden side of the COVID-19 pandemic in children: the double burden of undernutrition and overnutrition. International Journal of Equity Health, 2021; 20, 44. 51. Child Poverty Action Group. Aoteaora, Land of the long wide bare cupboard. Part 6: Food Insecurity in New Zealand. Child Poverty Action Group, June 2020. 52. Kulkarni AA, Swinburn BA, Utter J. Associations between diet quality and mental health in socially disadvantaged New Zealand adolescents. European Journal of Clinical Nutrition, 2015; 69:7983. 53. Every-Palmer S, Jenkins M, Gendall P, et al. Psychological distress, anxiety, family violence, suicidality, and wellbeing in New Zealand during the COVID-19 lockdown: A cross-sectional study. PLoS ONE, 2020; 15(11): e0241658. 54. Sallie SN, Ritou V, Bowden-Jones H, et al. Assessing International Alcohol Consumption Patterns During Isolation from the COVID-19 Pandemic Using an Online Survey: Highlighting Negative Emotionality Mechanisms. British Medical Journal Open, 2020; doi: 10.1136/bmjopen-2020-044276 52

55. Bradbury-Jones C, Isham L. The pandemic paradox: The consequences of COVID-19 on domestic violence. Journal of Clinical Nursing, 2020; 29 (1314): 2047-9

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58. Barendse M, Flannery JE, Cavanagh C, et al. Longitudinal Change in Adolescent Depression and Anxiety Symptoms from Before to During the COVID-19 Pandemic: A Collaborative of 12 Samples from 3 Countries. PsyArXiv, 2021. February 3. doi:10.31234/osf.io/hn7us. 59. Bignardi G, Dalmaijer ES, Anwyl-Irvine AL, et al. Longitudinal increases in childhood depression symptoms during the COVID-19 lockdown. Archives of Disease in Childhood, 2020. doi: 10.1136/ archdischild-2020-320372 60. Kwong ASF, Pearson RM, Adams MJ, et al. Mental health before and during the COVID-19 pandemic in two longitudinal UK population cohorts. British Journal of Psychiatry, 2020 Nov 24:1-10. 61. Daly M, Sutin A, Robinson E. Longitudinal changes in mental health and the COVID-19 pandemic: Evidence from the UK Household Longitudinal Study. Psychological Medicine, 2020; 1-10. 62. Racine N, Hetherington E, McArthur BA, et al. Maternal depressive and anxiety symptoms before and during the COVID-19 pandemic in Canada: a longitudinal analysis. The Lancet Psychiatry, 2021; 8 (5): 405-15. 63. Blumenberg C, Barros AJD. Response rate differences between web and alternative data collection methods for public health research: a systematic review of the literature. International Journal of Public Health, 2018; 63: 765-73. 64. Bradley KL, Bagnell AL, Brannen CL. Factorial Validity of the Center for Epidemiological Studies Depression 10 in Adolescents. Issues in Mental Health Nursing, 2010; 31:6, 408-12. 65. Cartierre N, Coulon N, Demerval R. Analyse confirmatoire de la version courte de la Center for epidemiological studies of depression scale (CES-D10) chez les adolescents. L’Encephale, 2011;37:273–7.

66. Kilburn, K., Prencipe, L., Hjelm, L. et al. Examination of performance of the Center for Epidemiologic Studies Depression Scale Short Form 10 among African youth in poor, rural households. BMC Psychiatry, 2018; 18: 201. 67. Huebner ES, Gilman R. An Introduction to the Multidimensional Students’ Life Satisfaction Scale. Social Indicators Research, 2002;60(1):115–22. 68. Rowe EW, Kim S, Baker JA, Kamphaus RW, Horne AM. Student personal perception of classroom climate: Exploratory and confirmatory factor analyses. Educational and Psychological Measurement. 2010;70(5):858–79. 69. DeWalt DA, Gross HE, Gipson DS, et al. PROMIS pediatric self-report scales distinguish subgroups of children within and across six common pediatric chronic health conditions. Quality of Life Research, 2015;24(9):2195–208. 70. Northwestern University. PROMIS Reference Populations. 2020 Jul 10. p. 1–7.

71. PROMIS Score Cut Points. Northwestern University. Available from: https://www.healthmeasures.net/ score-and-interpret/interpret-scores/promis/ promis-score-cut-points 72. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 1987; 150: 782-86. 73. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 2001 Sep 16(9):606-13. 74. McKay MT, Cannon, M, Chambers D. et al. Childhood trauma and adult mental disorder: A systematic review and meta-analysis of longitudinal cohort studies. Acta Psychiatrica Scandinavica, 2021; 143: 189-205. 75. de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bulletin of the World Health Organization, 2007; 85(9): 660-7

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APPENDICES APPENDIX A: Additional detail related to the study methods.

This appendix describes the study design, data collection process, and survey questions in more detail than in the main body of the report.

Study design An electronic survey (the COVID-19 Wellbeing Survey) was designed and distributed to all eligible children in the GUiNZ cohort via an emailed link to their parent’s email address (the parent was identified as the person who had completed the “Mother questionnaire” at the most recent DCW the child had taken part in). Children were deemed eligible if their parent had not withdrawn from the GUiNZ study prior to May 2020, the primary caregiver had a contact email address, and the cohort child was living in New Zealand at the time of survey distribution. Children who solely communicated in Te Reo Māori (n=11) were ineligible for the survey, as translation of the questionnaire was unfortunately not possible given time constraints associated with the need to distribute the survey during the lockdown period. Additional data have been sourced from previous GUiNZ DCWs to contribute additional demographic variables and variables that enable longitudinal analyses.

Ethics approval Ethical approval for the survey was obtained from the Northern B Health and Disability Ethics Committee on the 29th April 2020 under the expedited COVID-19 related research pathway (NTY/08/06/055 AM15).

Data collection The survey was designed in-house by members of the GUiNZ research team, and the Ministry of Business, Innovation and Employment (MBIE)-funded ‘Our Voices’ research team. The Qualtrics® digital platform was used for the survey, as it met the security and storage 54

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requirements of the University of Auckland. Davanti Consulting Limited were engaged to assist with getting the survey prepared in the platform, and to develop an engaging interface for the children completing the survey. GUiNZ had an existing relationship with Davanti via the ‘Our Voices’ research project. The data collection process was undertaken in collaboration with the GUiNZ research team. The GUiNZ data management team was responsible for integrating the data into the GUiNZ data management system, after receiving the export files from Davanti. The survey was also emailed to the GUiNZ pilot group - ‘Leading Light: Rōpū Pīata’. This group normally experience the data collection measures before the GUiNZ cohort and provide feedback to guide data collection strategies. However, in this instance, given the time pressure to get the survey into field during the lockdown period, the Leading Light group were engaged at the same time as the main cohort, with a focus on trialling the electronic connections and digital responses from this group. Results from this group were excluded from the main analyses given significant differences in key demographic variables from the main cohort (e.g., being 6-15 months older, and challenges in comparing consistent outcomes for this group over time).

Summary of survey questions The survey consisted of 46 questions (Appendix B). Questions were not compulsory. The following information was collected in the survey (note: although findings for only certain questions are provided in this report, all survey questions are presented in this section for context). • Age: in years (Questions 3-4 in the survey). Other demographic variables were available from previous GUiNZ DCWs.

• COVID-19 ‘Bubbles’: (Questions 5-14 in the survey). The term ‘bubble’ is used to describe a household unit which is self-isolating. During the COVID-19 Level 4 (Lockdown) people in New Zealand were instructed to stay at home only with those in their bubble and restrict contact with other bubbles. Questions asked: How many people were living in the household at the time of the survey; How many bubbles the child was in at the beginning of lockdown and if more than one, how often they moved between bubbles (Every day; Every week; Less often); Who was in each bubble (their relationship with the child, their age, whether they lived with the child before lockdown; whether they looked after the child, and whether they had to leave the bubble to work somewhere else). • Positive childhood experiences: (Question 15 in the survey). Children were asked how often during lockdown they had: Felt able to talk to someone about their feelings; Felt their family supported them in this time; Participated in community activities within their bubble; Felt connected to school/ kura; Felt able to keep in touch with friends; Felt safe and protected in their home; and Felt worried about how people in their home were getting on. Each statement had six options for answering (Never; Almost never; Sometimes; Often; Always; I don’t know). These seven questions were adapted from the Positive Childhood Experiences Score, but the wording was changed slightly to suit 10-11 year olds (the original scale was used for 18 year olds). The Positive Childhood Experiences Score was adapted from four subscales included in the validated “Child and Youth Resilience Measure–28”. • Material wellbeing: (Question 16 in the survey). Children were asked how often they worried about how much money their family had, with six options available for answering (Always; Often; Sometimes; I never think about it all; I don’t know). • Family, play and safety: (Question 17 in the survey). Children were also asked about how much they agreed with the following statements: My parents (or the people who look after me) listen to me; We have a good time together as a family; In my bubble there are enough places to play or to have a good time; and I feel safe when I am out and about in the area I live in. Each statement had six options for answering (I do not agree; Agree a little bit; Agree somewhat; Agree a lot; Agree totally; I don’t know). • School satisfaction: (Questions 18-20 in the survey). Children who were currently still doing schoolwork at home in their bubble were asked how often the following statements were true: I look forward to doing school-work in my bubble; I like school work in my bubble; School work in my bubble is interesting; I wish I didn’t have to do schoolwork while in my

bubble; There are many things about school in my bubble that I like; I enjoy the school activities I do in my bubble; I am looking forward to going back to how school was before we had lockdown; I am worried about missing out on my usual schoolwork while we are in lockdown. Children who had gone back to school were asked the same questions but were asked to reflect back to the time when they were still doing schoolwork at home in their bubble (questions were framed in the past tense). The questions were derived from the Multidimensional Students Life Satisfaction Scale (MSLSS) (67), specifically the six items with the highest factor loadings from the originally 8-item MSLSS, as identified by Rowe et al (68). Each statement had five options for answering (0= Never; 1= Sometimes; 2 = Often; 3 = Almost always; I don’t know). People who answered “I don’t know” were assigned a ‘data missing’ status for the statement. A school satisfaction score was then derived for each participant by summing the responses for each item (after reverse coding of negatively worded questions) then dividing by the total number of questions. Higher scores are associated with higher school satisfaction, and the scores are used as a continuous scale with no defined cut-off. • Current health: (Question 21 in the survey). Children were asked how their health was right now, with five options provided for answering (Excellent; Very good; Good; Fair; Poor). The same question was asked in eight-year DCW. • C urrent media use: (Questions 22-27 in the survey). Children were asked about their current access to the internet, and whether they had access to a device during lockdown (including types of devices, whether these devices had access to a camera, and what activities they used these devices for). Children were also asked whether they currently belonged to, or used, any social media sites. • Connectedness: (Questions 28-33 in the survey). Children were asked whether they had any contact with friends outside of their family, or family not living with them, during lockdown, and if so what type of contact and how frequent this contact was (Everyday; A few times a week; Weekly; Fortnightly; Less than fortnightly; Only once or twice). • Screen time: (Questions 34-35 in the survey). Children were asked about their screen time during lockdown, on a school day and the weekends (defined as hours per day spent on screens, including schoolwork). • Depression: (Question 36 in the survey). The validated 10-item short form (24) of the Center for Epidemiological Studies Depression Scale (CES-D-10) (22) was used to determine depressive symptoms PART ONE: HEALTH AND WELLBEING

in the past seven days. Each question had a 4-point Likert scale for answering (0 = Not at all; 1 = A little; 2 = Some; 3 = A lot). A total score was then calculated by summing the score of all items, after reverse coding of the two positive affect statements (‘I felt like something good was going to happen’ and ‘I was happy’). Total scores can range between 0 and 30, with higher total scores indicating a greater risk of depressive symptoms (scores of ≥10 are indicative of clinically significant depressive symptoms) (25). The same question set was asked in eight-year DCW. • Anxiety: (Question 37 in the survey). The validated 10-item short form of the PROMIS Pediatric Anxiety Symptoms Scale (32) was used to determine anxiety in the past seven days. This question set was also asked in the eight-year DCW. Each item was scored on a 5-point Likert scale (0 = Never; 1 = Almost Never; 2 = Sometimes; 3 = Often; 4 = Almost always). A total score was calculated by summing the score of all items. The total score was then translated to a T-score, using a score translation table that had been generated based on item-response theory. The standardised T-score has a mean score of 50 (Standard Deviation [SD]=10) for the reference population, derived from the ‘general population’ (based on the 2000 General USA census) and a clinical sample of chronically ill children (69-70) Scores >50 therefore lie above the reference population mean, and scores <50 are below the reference population mean. Interpretation of the T scores was based on the ‘Interpreting PROMIS T scores’ diagram (71). Scores of 51-55 indicate ‘mild’ symptoms of anxiety. Scores of 56-65 indicate ‘moderate’ symptoms of anxiety. Scores ≥66 indicate ‘severe’ symptoms of anxiety. The same question set was asked in eight-year DCW. • Activities during lockdown: (Question 38 in the survey). Children were asked how often they did the following activities with the people in their bubble during the lockdown: Reading books together; Watching television/movies together; Talking about feelings or issues; Singing a song, playing music, or doing some other musical activity; Drawing a picture or doing another art/craft activity; Homework and/or school work or talking about homework or school work; Outdoor sporting activities together; Baking or cooking together; Doing chores or housework together; Eating a meal together. Each question had six options for answering (Never/ Almost never; Once a week; Several times a week; Once a day; Several times a day; I don’t know). • Food and drink during lockdown: (Questions 39-41 in the survey). Children were asked which of the following statements were true about the food and drinks they had during the lockdown: I eat more food than before; I eat more often during the day than before (more meals and snacks); I eat more 56

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fruit than before; I eat more vegetables than before; I eat more potato chips, chocolate, biscuits, cake or lollies than before; I drink more fizzy drink than before; I drink more water than before; I eat a greater variety (different types) of food than before. Each statement had six options for answering (I do not agree; Agree a little bit; Agree somewhat; Agree a lot; Totally agree; I don’t know). Two additional questions were asked around what the child liked most about the food in their bubble, and what foods they missed most in their bubble. Both questions had a free text option for answering. • Feelings during lockdown: (Questions 42-46 in the survey). The last questions of the survey asked what the child felt had been the best thing for them about being in lockdown, plus what had been the hardest, and what they had most worried about. The child was also asked what they were most excited for/about when lockdown was over. Finally, the child was asked if there was anything else they wanted to share with other people about what it was like to be in lockdown for them. All five questions had a free text option for answering.

Variables of interest All analyses in this report relate to current health and mental wellbeing (depression and anxiety), with the data looked at cross-sectionally and longitudinally according to demographic variables and other variables of interest. Linked demographic variables Additional data were sourced from previous GUiNZ DCWs to contribute additional demographic variables to the cross-sectional and/or longitudinal analyses. • Sex: Boy or girl as assigned at birth, based on data from the 6-week DCW. • Age: Although the child’s age was asked in the survey, the quality of the data was not high. Age was therefore calculated using the child’s date of birth (as recorded at the 6-week DCW), and the date each child participated in the the COVID-19 Wellbeing Survey (as per the date stamp within the online survey). • Child’s ethnicity: was as reported by the mother at the 54-month DCW. Missing values of ethnicity at the 54-month DCW were replaced by the child’s ethnicity reported by the mother at the 9-month DCW. Ethnicity was externally prioritised based on StatsNew Zealand Level 1 ethnicity groupings in the following order of priority: Māori, Pacific, Asia, Middle Eastern/Latin American/African, Other or European, if used as an explanatory variable. ‘Total response’ ethnicity was also coded based on StatsNew Zealand Level 1 ethnicity groupings (Māori, Pacific, European, Asian, Other).

• Socioeconomic deprivation: was based on the New ZealandDep2013 index of socioeconomic deprivation, which was populated by data from the eight-year DCW. Participants were grouped into one of four categories: Low deprivation (1-3); Medium deprivation (4-7), High deprivation (8-10); Missing. • Rurality: was calculated using the residential address from the eight-year DCW for mothers and grouped as: Urban; Rural; Missing (coded using the 2013 set of meshblock boundaries defined by Statistics New Zealand). Linked predictors of child wellbeing and/or mental health • Maternal age: was calculated using the mother’s date of birth (as reported at the antenatal DCW), and the date each child participated in the the COVID-19 Wellbeing Survey (as per the date stamp within the online survey). Adjusted analysis used maternal age as a categorical variable grouped as one of seven categories: ≤30 years; 31-35 years; 36-40 years; 41-45 years; 46-50 years; >50 years; Missing. • Maternal education: was calculated using the mother’s report of their education level at the Antenatal DCW. Participants were grouped into one of the six categories: No secondary school qualifications; secondary school/ NCEA 1-4; Diploma/Trade Certificate/NCEA 5-6; Bachelor’s degree; Higher degree; Missing. • Maternal mental health: Maternal mental health is a known predictor of depression in children (31). The number of episodes of maternal depression were based on data from the 9-month DCW (where depression was measured using the Edinburgh depression scale, with a score ≥12 indicating a depressive event) (72), and the eight-year DCW (where maternal mental health was measured using the Patient Health Questionnaire 9, with a score >14 indicating a depressive event) (73). • A dverse child experiences: Adverse life events are defined as negative experiences or trauma that a child may have while growing up, such as death of a close family member or friend, divorce or separation of parents, conflict between parents, experience of a natural disaster, serious physical illness or injury, moving house or country, etc. Such experiences are a predictor of depression in children (74). The number of adverse life events experienced by the child was based on the mother’s self-report of such events at the eight-year DCW. • Persistent sleep problems: Changes in hormone levels and emotional and cognitive processing during early adolescence can impact sleep duration and quality, subsequently impacting mental health

(33-34). Persistent sleep problems were measured in two ways in the GUiNZ database, based on data from the eight-year DCW, namely: 1) Mother’s report of the ‘number of hours their child typically sleeps per night’ (grouped as: ≤8 hours; 9 hours; 10 hours; ≥ 11 hours); and 2) frequency of nighttime waking (none, once, two or more times). • Body size: Being overweight or obese in childhood can predict depression and anxiety in later life.39 For this reason the depression and anxiety outcomes in the COVID-19 Wellbeing Survey were adjusted for body size, based on the WHO Body Mass Index (BMI) age and sex-specific z-scores (75), for data from the eight-year DCW (based on a normalised transformation or a smoothed version of the reference data). Respondents were grouped as: Underweight; Normal weight; Overweight; Obese. • C hild disability: Depression and anxiety in children may depend on whether a child has a disability or not (27-28). There are various measures of disability used in the GUiNZ DCWs. For this report the question asked of mothers at the eightyear DCW was used, specifically mothers were asked if they had areas of concern about their child’s wellbeing and development, in relation to vision, hearing, speech, growth/development, behaviour etc. Based on these data children were grouped in two ways, depending on the analysis to be undertaken and numbers available: - Number of concerns regarding the child’s health: O; 1; 2 or more; Did not respond; Missing. - No concerns; Vision concerns; Hearing/Speech concerns; Behavioural/Autistic Spectrum Disorders; Learning difficulties; Movement/ Mobility/Physical concerns; Other; Missing. • Depression: was based on the data from the CES-D-10 (24-25), collected from children in the eight-year DCW. • Anxiety: was based on data from the PROMIS Pediatric Anxiety symptoms scale (32), collected from children in the eight-year DCW. • Current health: was based on current health data collected from children in the eight-year DCW. The question was worded the same as in the COVID-19 Wellbeing Survey, and had the same choices for answering. Other variables of interest from the COVID-19 Wellbeing Survey Connectedness, bubble size (and if the bubble included essential workers), number of regular positive childhood experiences during Lockdown (‘regular’ defined as answering ‘often’ or ‘always’ to the questions), and whether the child had returned PART ONE: HEALTH AND WELLBEING

to school at the time of the survey (possible if their caregivers were essential workers) were also explored, as these variables may predict health and mental wellbeing. Essential workers included medical professionals, residential facility staff, border security, some education staff, building/construction workers, and those working in primary industries. A variable of ‘connectedness during lockdown’ was developed, and categorised as below: • Not or almost not connected: The child responded that they connected with both friends and family fortnightly or less. • A little connected: The child responded that they connected with either friends or family only one or twice or less than fortnightly. • Moderately connected: The child responded that they connected with either friends or family a few times a week or more. • More connected: The child responded that they connected with both friends and family a few times a week or more each.

Data analyses Prior to analysis, data cleaning was undertaken, response bias was assessed, and scales were checked for reliability. Analyses were undertaken using R (version 4.0 and 4.0.2), R studio and Excel (version 2002 and 2016).

Response rate Overall response rates for the survey sample were compared to the cohort invited to undertake the survey, and included response rates by sex, ethnicity, socioeconomic deprivation, rurality, maternal age, and mother education.

Cross-sectional analyses Standard summary statistics were used to report on demographic variables, predictors of depression and anxiety, current health, depression, and anxiety. The current health status outcomes of ‘Fair’ and ‘Poor’ were collapsed into one category (Fair/Poor) to ensure adequate numbers were present in categories for analysis. Bar charts and/or box and whisker plots are used to show current health status, CES-DC and PROMIS scales by key variables. One-way ANOVA was used to establish the effect of the potential covariates on the

Growing Up in New Zealand COVID-19 Wellbeing Survey

continuous outcomes. Chi-squared tests were used to examine the relationship between the potential covariates and the categorical/ordinal outcomes. Multivariate regression models were used to identify the determinants of current health and the CES-DC and PROMIS scales from the COVID-19 Wellbeing Survey. The aims of these models were to: • Identify the socio-demographic subgroups who were the most at-risk of depression/ anxiety and quantify the average impact of thesecharacteristics on the outcomes. • Quantify the average effect of the main predictors of depression and anxiety in children on the outcomes from the COVID-19 Wellbeing Survey. These variables were also used as control variables. The outcome value at the eight-year DCW was also considered as a potential covariate for the multivariate models.

Longitudinal analyses Comparisons were made among participants having available outcome data at both the eight-year DCW and the COVID-19 Wellbeing Survey. Density plots were produced to show the distribution of current health status, and the CES-DC and PROMIS scales, at the eight-year DCW and the COVID-19 Wellbeing Survey. Only children who had complete data for current health status, and the CES-DC and PROMIS scales, in both the eight-year DCW and the COVID-19 Wellbeing Survey were used in the longitudinal analysis of current health status. A multivariate regression model was used to identify the determinants of the changes in current health and the CES-DC and PROMIS scales over time. The aim of this model was to identify profiles or subgroups of children for whom significant changes in outcomes occurred between the eight-year DCW and the COVID-19 Wellbeing Survey. For the ordinal current health outcome, change over time was measured by the transitions from the eight-year DCW to the COVID-19 Wellbeing Survey. For the continuous CES-DC and PROMIS scales, changes over time were measured by the difference in scales between the eight-year DCW and the COVID-19 Wellbeing Survey. Sensitivity analyses were undertaken for the CES-DC scale, first using all 10 items and then removing item DS5 (“I felt like something good was going to happen”) to increase the robustness of the scale at both DCWs (i.e., the eight-year DCW and COVID-19 Wellbeing Survey).

APPENDIX B: Survey questionnaire Child Questionnaire Growing Up in New Zealand University of Auckland Email: contact@growingup.co.nz www.growingup.co.nz NOTE: The question numbers below are as they appear in the online survey but are not visible to the children.

Introduction Welcome to this Growing Up in New Zealand special survey to find out more about your experience of the Covid-19 “lockdown”.

Q1 Are you happy to take part in this special Growing Up in New Zealand survey? You can say yes or no. Select the option below. Yes

You have been a part of Growing Up in New Zealand since you were born and that means you’re in a special position to help us understand what it is like for New Zealand children to be living through these strange times. By helping us with this survey, you’re speaking on behalf of lots of New Zealand children. You’re making a real difference and your voice and experience can help decision-makers to improve lives for all Kiwi children and families now and in the coming months. The survey is short and easy. We’re going to ask you some questions about the past few weeks when we’ve all had to stay at home in our “bubbles” to help stop the spread of Covid-19. Lots of people have called this “lockdown” or “Level 4”. Your “bubble” is the people you’ve been sharing your home or homes with over this time. In this survey, there are no right or wrong answers. We want to hear what you think and feel. All of your answers will be kept private. We will ask for your name, but this will not be kept with the information you provide. You might want to ask an older family member to help you fill in the survey. It’s totally fine to do this. Please start the survey and pick the answer that best fits with how you think or feel. We want to know what matters to you. You can skip any questions you don’t want to answer by clicking on the NEXT button.

No → Go to END OF QUESTIONS and to the Closing statement Q2

What is your full name?

When is your birthday?

(Day) (Month) Q4

How old are you today in years?

Q5 How many people are living in the house you are in right now? Number of children – including you (aged less than 18) Number of adults (18 or over)

Total

Q6 At the beginning of lockdown (in level 4) did you have more than one bubble? Yes No

PART ONE: HEALTH AND WELLBEING

Q7 If yes, At the beginning of lockdown (in level 4), how many bubbles did you have?

Q8 If yes, During the highest level of lockdown (level 4), approximately how often did you move between bubbles? Every day Every week Less often Tell us about the people in your bubble Q9 Type the names of the other people in your level 4 bubble (don’t include yourself) (Choose up to 10)

Q10 Who they are to you? (e.g. mum, dad, aunty, brother etc.)

Q11 How old are they? – if you know (if you are not sure you can guess)

Q12 Tick the box if they lived with you before the level 4 lockdown?

Q13 Did they have to leave the house to go to work somewhere else during level 4 lockdown? (You can choose more than one. It is okay if you don’t select one)

Q14 Who has looked after you in lockdown? (You can choose more than one. It is okay if you don’t select anyone)

My family and local neighbourhood Q15 How often during lockdown have you: (Choose the best one for each line)

Never

Felt able to talk to someone about your feelings Felt your family supported you in this time Participated in community activities within your bubble (e.g. teddy bear hunt, Easter egg hunt, online church/mosque activities etc, online arts or cultural events e.g ballet, theatre, Waiata) Felt connected to school/kura Felt able to keep in touch with friends Felt safe and protected in your home Felt worried about how people in your home were getting on

Growing Up in New Zealand COVID-19 Wellbeing Survey

Almost never

Sometimes

Often

Always

I Don’t know

Q16 How often do you worry about how much money your family has? (Choose the answer that is closest too how you feel) Always Often Sometimes I don’t think about it at all I don’t know Q17 How much do you agree with the following? (Choose one for each line)

I do NOT agree

Agree a little bit

Agree Agree a lot somewhat

Totally agree

I don’t know

Almost always

I don’t know

My parents (or the people who look after me) listen to me We have a good time together as a family In my bubble there are enough places to play or to have a good time I feel safe when I am out and about in the area I live in

Never

Sometimes

Often

I look forward to doing school work in my bubble I like school work in my bubble School work in my bubble is interesting I wish I didn’t have to do school work while in my bubble There are many things about school in my bubble that I like I enjoy the school activities I do in my bubble I am looking forward to going back to how school was before we had lockdown I am worried about missing out on my usual school work while we are in lockdown

PART ONE: HEALTH AND WELLBEING

Q20 If 18.2, when you were doing school in your bubble, how often were the following statements true? (Choose one for each line)

Never

Sometimes

Often

Almost always

I don’t know

I looked forward to doing school work in my bubble I liked school work in my bubble School work in my bubble was interesting I wished I didn’t have to do school work while in my bubble There were many things about school in my bubble that I liked I enjoyed the school activities I did in my bubble I looked forward to going back to how school was before we had lockdown I was worried about missing out on my usual school work while we were in lockdown

Media use Q22 Do you have internet at home? (Tick one only) Yes No (go to next section) I don’t know Q23 Do you have a device that you can use during lockdown?

Child will select from the list pulled through from previous question and tick if the device has a camera Q26 Do you belong or use any sites listed below? (Select as many as you use) None

Yes

Facebook

Messenger

Q24 What device have you been using during lockdown? (you can choose more than one) Tablet (e.g. an iPad) Laptop or Computer TV Smartphone (e.g. an iPhone or a Samsung Galaxy) Gaming console (e.g. Xbox, PSP or Playstation) Music player (e.g. iPod) Kindle or other eReader Smart watch (e.g. fitbit) A virtual reality headset Something else (list here): I don’t know 62

Q25 Do any of your devices have a camera? (pull through answers from previous questions)

Growing Up in New Zealand COVID-19 Wellbeing Survey

Houseparty Reddit Tik Tok Instagram Snapchat Twitter WhatsApp YouTube Hangouts Something else? List them here:

Q21 How would you say your health is right now? (Choose one only)

Q27 During lockdown, how often have you been doing the following things using a screen-based device? (Choose the best one for each line)

Every day

Excellent

Several times a week

Very good

About once a week

Good

Fair

Poor

About once a month

Hardly ever / never

I don’t know

School work and homework Making phone calls or video calls e.g. Skype/ Facetime Sending and receiving emails Using social media (e.g. TikTok, Snapchat) Instant messaging (e.g. WhatsApp, iMessage, Facebook Messenger, text message, chat) Listening to music on your device Taking photos Watching TV or movies or videos (e.g. Netflix, Lightbox, TVNew Zealand On Demand, YouTube and music videos) Playing games - on your own on your device Playing games – with your family/bubble members/friends on a device Searching the internet (e.g. Google) Creating digital art (art using a computer) Making or editing a film or video Making new music, songs or sound recordings Writing a story or poem Coding/ programming Trading or buying stuff on your device (not as part of a game) Other activity using a screen-based device (Type here)

PART ONE: HEALTH AND WELLBEING

Q28 Have you had any contact (face-to-face, telephone or online) with your friends outside your family during lockdown?

Q32 If yes - how have you been in contact with family not living with you? (You can select as many as you need)

Yes

Telephone

Texting, chatting

Q29 If yes - how have you been in contact with friends? (You can select as many as you need)

Facetime/Zoom other videoconferencing, Online platforms such as Google Classrooms/ Seesaw

Telephone

Apps such as WhatsApp/HouseParty

Texting, chatting

Online Games

Facetime/Zoom other videoconferencing,

In person (even if with physical distancing)

Online platforms such as Google Classrooms/ Seesaw Apps such as WhatsApp/HouseParty

Letters Other (type here)

Online Games In person (even if with physical distancing) Letters Other (type here)

Q33 How often have you connected with your family not living with you during lockdown? (Answer for each of the platforms identified above) Everyday

Q30 How often have you connected with your friends during lockdown? (Answer for each of platforms identified above) Everyday A few times a week Weekly Fortnightly, Less than fortnightly Only once or twice Q31 Earlier we asked you about contact with friends. Now we would like to know about contact with extended family not living with you. Have you had any contact (face-to-face, telephone or online) with extended family members / whānau not living with you (e.g. grandparents, aunts, uncles, cousins etc) during lockdown?

A few times a week Weekly Fortnightly Less than fortnightly Only once or twice Q34 During lock down, on a school day (Monday Friday), about how many hours a day are you spending on screens (including schoolwork)? 0 hours Up to 1 hour Between 1 and 2 hours Between 2 and 3 hours Between 3 and 4 hours Between 4 and 5 hours

Yes

Between 5 and 6 hours

Between 6 and 7 hours Between 7 and 8 hours Between 8 and 9 hours More than 10 hours (if so how many to the nearest hour?)

Growing Up in New Zealand COVID-19 Wellbeing Survey

Q35 During lock down, on a weekend day (SaturdaySunday), about how many hours a day are you spending on screens (including schoolwork)? 0 hours Up to 1 hour Between 1 and 2 hours Between 2 and 3 hours Between 3 and 4 hours Between 4 and 5 hours Between 5 and 6 hours Between 6 and 7 hours Between 7 and 8 hours Between 8 and 9 hours More than 10 hours (if so how many to the nearest hour?)

Not At All

A Little

Some

A Lot

I was bothered by things that usually don’t bother me I felt like I couldn’t pay attention to what I was doing I felt down and unhappy I felt like I was too tired to do things I felt like something good was going to happen I felt scared. I didn’t sleep as well as I usually sleep I was happy I felt lonely, like I didn’t have any friends It was hard to get started doing things

PART ONE: HEALTH AND WELLBEING

Anxiety (heading not included in digital survey) Q37 This set of questions also asks you how you have been thinking, feeling, or acting. For each item, please select the answer that seems most true for you during the past week. Remember there are no right or wrong answers, just answer how you have been feeling recently. (Choose one for each line) I felt scared I worried about what could happen to me I felt worried I felt like something awful might happen I worried when I went to bed at night I feel nervous I worried when I was at home I got scared really easily I was afraid that I would make mistakes I thought about scary things

Growing Up in New Zealand COVID-19 Wellbeing Survey

Never

Almost Never

Sometimes

Often

Almost always

Activities Q38 How often do you do the following activities with the people in your bubble during the lockdown? (Choose one for each line)

Never/ almost never

Once a week

I do NOT agree

Agree a little bit

Several times a week

Once a day

Several times a day

I don’t know

Agree Agree a lot somewhat

Totally agree

I don’t know

Reading books together in my bubble Watching TV/movies together in my bubble Talking about feelings, or issues in my bubble Singing a song, playing music, or doing some other musical activity in my bubble Drawing a picture or doing another art/ craft activity in my bubble Homework and/ or school work or talking about homework or school work in my bubble Outdoor sporty activities together (e.g. passing a ball, going for a walk, bike-riding, scootering) in my bubble Baking or cooking together in my bubble Doing chores or housework together in my bubble Eating a meal together in my bubble Q39 How true are the following statements about the food and drinks you have been having during the lockdown. If you think you eat the same as before select I do NOT agree (Choose one for each line) I eat more food than before I eat more often during the day than before (more meals and snacks) I eat more fruit than before I eat more vegetables than before I eat more potato chips, chocolate, biscuits, cake or lollies I drink more fizzy drink than before I drink more water than before I eat a greater variety (different types) of food than before

PART ONE: HEALTH AND WELLBEING

Q40 What did you like most about the food in your bubble?

Q44 What has worried you most about being in lockdown?

Type your answer below

Q41 What foods did you miss most in your bubble?

Q45 What are you most excited for/ about when lockdown is over?

Type your answer below

Tell us more about how you have felt in the last few weeks Q42 What have been the best things for you about being in lockdown? Type your answer below

Q43 What have been the hardest things for you about being in lockdown? Type your answer below

Growing Up in New Zealand COVID-19 Wellbeing Survey

Q46 Is there anything else you want other people to know about what it’s like to be in lockdown for you? Type your answer below

APPENDIX C: Survey response rate Eligible cohort

Participated in survey

Response rate

5756

2421

42.1

Boy

2964

1200

40.5

Ref

Girl

2784

1220

43.8

1.15

0.024

<10

European

2599

1339

51.5

Ref

Māori

1390

498

35.8

0.76

<0.001

Pacific

738

213

28.9

0.70

0.002

Asian

867

315

36.3

0.69

<0.001

Other

131

42.0

0.98

0.917

Missing

<10

Low (1-3)

1800

919

51.1

Ref

Medium (4-7)

1899

890

46.9

1.01

0.939

High (8-10)

1345

517

38.4

1.01

0.950

Missing

712

13.3

Urban

4445

2058

46.3

Ref

Rural

599

268

44.7

0.828

0.047

Missing

712

13.3

≤ 30 years

159

21.4

Ref

31 - 35 years

700

188

26.9

1.34

0.226

36 - 40 years

1298

459

35.4

1.56

0.061

41 - 45 years

1873

891

47.6

1.94

0.005

46 - 50 years

1381

685

49.6

2.12

0.002

>50 years

343

163

47.5

1.94

0.01

Missing

<10

No secondary school qualification

319

29.8

Ref

Secondary school/NCEA 1–4

1277

423

33.1

1.03

0.85

Diploma/Trade Cert/NCEA 5–6

1762

632

35.9

1.11

0.518

Bachelor’s degree

1419

717

50.5

1.69

0.002

Higher degree

961

547

56.9

1.99

<0.001

Missing

<10

Total

Logistic model Odds Ratio

P-value -

SEX

Missing ETHNICITY (prioritised)

SOCIOECONOMIC DEPRIVATION

RURALITY

MOTHER AGE

MOTHER EDUCATION

PART ONE: HEALTH AND WELLBEING

APPENDIX D: Demographic variables Participated in the survey (N=2421) N

Boy

1200

50%

Girl

1220

50%

Missing

<10

European

1339

55%

Māori

498

21%

Pacific

213

Asian

315

13%

Other

Missing

<10

European

2017

83%

Māori

498

21%

Pacific

317

13%

Asian

343

14%

Other

Missing

<10

Low (1-3)

919

38%

Medium (4-7)

890

37%

High (8-10)

517

21%

Missing

Urban

2058

85%

Rural

268

11%

Missing

≤ 30 years

31 - 35 years

188

36 - 40 years

459

19%

41 - 45 years

891

37%

46 - 50 years

685

28%

>50 years

163

Missing

<10

No secondary school qualification

Secondary school/NCEA 1–4

423

17%

Diploma/Trade Cert/NCEA 5–6

632

26%

Bachelor’s degree

717

30%

Higher degree

547

23%

Missing

<10

SEX

ETHNICITY (prioritised)

ETHNICITY (total response)

SOCIOECONOMIC DEPRIVATION

RURALITY

MOTHER AGE

MOTHER EDUCATION

Growing Up in New Zealand COVID-19 Wellbeing Survey

APPENDIX E: Potential predictors of depression and anxiety Participated in the survey (N=2421) N

Normal

1609

67%

Overweight

427

18%

Obese

226

Missing

137

≤ 8 hours

199

9 hours

417

17%

10 hours

1117

46%

≥ 11 hours

424

18%

Don’t know

Missing

174

None

1642

68%

Once

433

18%

≥ 2 times

Don’t know

Missing

174

No events

371

15%

One event

798

29%

Two events

574

24%

Three events

315

13%

≥ Four events

215

Don’t know

<1%

Missing

228

No events

2047

One event

259

11%

Two events

Missing

BODY SIZE Underweight

MEAN HOURS OF SLEEP

FREQUENCY OF NIGHT WAKING

FREQUENCY OF EARLY ADVERSE CHILD EXPERIENCES

FREQUENCY OF MATERNAL DEPRESSION

PART ONE: HEALTH AND WELLBEING

APPENDIX F: Other variables of interest to health and mental wellbeing Participated in the survey (N=2421) N CONNECTEDNESS Not connected 113 A little connected 186 Moderately connected 970 More connected 944 Missing 208 WORRIED ABOUT HOW MUCH MONEY THE FAMILY HAS Always 86 Often 144 Sometimes 630 I don’t think about it 1170 I don’t know 238 Missing 153 SCHOOL ATTENDANCE Doing schoolwork at home 2183 Returned to school 76 Missing 162 MOTHERS CONCERNS REGARDING CHILD HEALTH Vision 219 Hearing/Speech 176 Behavioural/Autistic Spectrum 182 Learning 163 Movement/Mobility/Physical 57 Other 80 No concerns 1546 NUMBER OF CONCERNS REGARDING CHILD HEALTH None 1546 One 478 Two or more 181 Did not respond 44 Missing 172 NUMBER OF PEOPLE IN THE CHILD’S BUBBLE AT LOCKDOWN 2 or 3 164 4 or 5 1476 6 or more 643 Missing 138 NUMBER OF ESSENTIAL WORKERS IN THE CHILD’S BUBBLE DURING LOCKDOWN None 1352 One 668 Two or more 263 Missing 138 NUMBER OF REGULAR POSITIVE CHILDHOOD EXPERIENCES DURING LOCKDOWN 0-2 276 3–4 1026 5-6 920 Missing 199

n 5% 8% 40% 39% 9% 4% 6% 26% 48% 10% 6% 90% 3% 7% 9% 7% 8% 7% 2% 3% 64% 64% 20% 8% 2% 7% 7% 61% 27% 6% 56% 28% 11% 6% 11% 42% 38% 8%

www.growingup.co.nz www.auckland.ac.nz www.uniservices.co.nz www.msd.govt.nz

Growing Up in New Zealand is a University of Auckland study, managed by UniServices and funded by the New Zealand government.

Life during Lockdown

Findings from the Growing Up in New Zealand COVID-19 Wellbeing Survey PART 2: EDUCATION

Growing Up in New Zealand:

Life during Lockdown: Findings from the GUiNZ COVID-19 Wellbeing Survey Part 2: Education Authors Kane Meissel

Sarah Gerritsen

Molly Bergquist

Stephane Janicot

Jonathan Kumarich

Fiona Langridge

Carin Napier

Sarah-Jane Paine

Elizabeth Peterson

Avinesh Pillai

Ashley Smith

Boyd Swinburn

Natalie Walker

Seini Taufa

Pat Bullen

Clare Wall

Nandini Dubey

Susan Morton

John Fenaughty September 2021 Suggested Citation: Meissel K, Bergquist M, Kumarich J, et al. The Growing Up in New Zealand COVID-19 Wellbeing Survey: Part 2: Education. Auckland: Growing Up in New Zealand, 2021. ISSN: 2253-251X (online) © Growing Up in New Zealand 2021 Contact details: Professor Boyd Swinburn, Acting Research Director, Growing Up in New Zealand, PO Box 18288, Auckland 1743, Phone +64 9 373 7599 Further information on Growing Up in New Zealand is available at www.growingup.co.nz This report has been produced by the University of Auckland for the Ministry of Education, with Crown funding managed by the Ministry of Social Development. Disclaimer: This work is licensed under the Creative Commons Attribution 3.0 New Zealand licence. In essence, you are free to copy, distribute and adapt the work, as long as you attribute the work to the authors and abide by the other licence terms. To view a copy of this licence, visit http://creativecommons. org/licenses/by/3.0/nz/. Please note that no departmental or governmental emblem, logo or Coat of Arms may be used in any way which infringes any provision of the Flags, Emblems, and Names Protection Act 1981. Attribution to the Crown should be in written form and not by reproduction of any such emblem, logo or Coat of Arms. The cover image and the image on pg 2 were taken by photographer Shona Dey. They are part of her Lockdown Bubble series which documented families in their neighbourhood during the 2020 Level-4 Lockdown.

Table of Contents Executive Summary..........................................................2

3.7 Household Dynamics......................................... 22

Context ..............................................................................2

3.8 Positive Experiences.......................................... 24

Findings............................................................................. 3

List of Figures ...................................................................6

3.8.1 Community involvement and school satisfaction.............................................. 24

List of Tables..................................................................... 7

3.9 Activities............................................................. 26

Glossary............................................................................8

3.9.1 Participation in activities......................... 26

3.9.2 Activity participation and school satisfaction.............................................. 27

Introduction...............................................................9 1.1 COVID-19 in Aotearoa New Zealand.....................9

3.10 Device Use.......................................................... 28

1.2 Children’s Experiences of COVID-19.....................9 1.3 Overview of Growing Up in New Zealand........... 10

3.10.1 Apps used in lockdown............................ 28

1.4 Aims of the COVID-19 Wellbeing Survey............. 10

3.10.2 Frequency of screen-based activities..... 28

2. Methods..................................................................... 11

4. Longitudinal Findings..............................................30

2.1 Study Design....................................................... 11

4.1 Comparisons of Activity Participation...............30

2.2 Data Collection.................................................... 11

4.2 Screen Time.........................................................31

2.3 Survey Questions................................................. 11

4.3 Comparisons of School Satisfaction.................. 32

2.4 Data Analyses...................................................... 11 3. Cross-sectional Findings..........................................12

4.3.1 Comparisons of schooling across sociodemographic characteristics.......... 33

3.1 Survey Respondents............................................12

5. Discussion................................................................38

3.2 Participant Characteristics.................................13

6. Strengths and Limitations...................................... 41

3.3 Māori Participant Response Rates......................16

3.4 Household Bubbles.............................................17

Acknowledgements........................................................43

3.4.1 Bubble information...................................17

References..................................................................... 44

3.4.2 Essential workers.....................................18

APPENDICES....................................................................47

3.5 School During Lockdown.....................................18 3.5.1 School attendance....................................18 3.5.2 School satisfaction...................................18 3.6 Connections........................................................19

Future Directions.....................................................42

APPENDIX A: Additional Detail Related to Study Methods................................................................. 47 APPENDIX B: COVID-19 Wellbeing Survey Questionnaire................................................................... 52

3.6.1 Connection with friends and family.........19

APPENDIX C: Survey Response Rate................................ 63

3.6.2 Type of contact.........................................21

APPENDIX D: Demographic Variables..............................64

Growing Up in New Zealand COVID-19 Wellbeing Survey

Executive Summary This report details findings from the online COVID-19 Wellbeing Survey delivered in May 2020, at which time, Aotearoa New Zealand was experiencing strict COVID-19 pandemic restrictions. This survey was completed by 2,421 children aged 10–11 years who are a part of the Growing Up in New Zealand longitudinal study. The survey provided the opportunity to: 1) understand the children’s experiences during lockdown, both positive and negative, by hearing directly from the children themselves and 2) ascertain the likely level of engagement by the cohort in an online digital data collection process. This report focuses on findings related to COVID-19 ‘bubbles’, lockdown activities, family life, school satisfaction, device use and screen time, and connectedness. Findings are compared with responses from when the children were approximately eight years of age where possible.

Context Concerns have been raised about the potential effects of the restrictions and social distancing measures implemented as part of the Aotearoa New Zealand COVID-19 pandemic response in early-2020, particularly in relation to children and young people. These restrictions limited children’s access to school, friends

Growing Up in New Zealand COVID-19 Wellbeing Survey

and family, and extra-curricular activities—all of which may have impacted on children’s wellbeing. Children have been identified as a group especially vulnerable to the psychosocial impacts of the COVID-19 pandemic as they often lack properly developed coping strategies and emotional reactions which may result in them experiencing greater stress and trauma than adults. Furthermore, these effects are likely to have been unevenly experienced, with children disproportionately affected depending on their sociodemographic characteristics. To determine the effects of COVID-19 lockdown restrictions for Aotearoa New Zealand children, longitudinal information from before the pandemic needs to be compared to during and after the pandemic. The Growing Up in New Zealand data used in this report provides such information through comparisons of data collected during COVID-19 restrictions and from before the pandemic, drawing on both crosssectional and longitudinal analyses of these data. Further important insights will be enabled by future data collection waves—most crucially by determining whether impacts on aspects of the cohort’s wellbeing were contextual and temporary, or more long-lasting and potentially in need of specific policy attention.

Findings Overall, 42% (n=2421) of the 5,756 eligible children from the Growing Up in New Zealand study completed the COVID-19 Wellbeing Survey. Key findings are reported below.

uncertainty of the pandemic, families and whānau continued to connect with each other in meaningful ways and participate in a variety of activities together. Furthermore:

Children were adaptable to new ways of life

• Four in five children (79%) agreed they had a good time with their family in lockdown.

Through the disruption of the COVID-19 pandemic, Aotearoa New Zealand children demonstrated an impressive ability to adjust to new circumstances. For example: • Despite the abrupt change to school modality, many children (64%) still reported feeling connected to their school or kura often or always. • One in four children (24%) reported an increase in school satisfaction between age eight and lockdown. • Eleven percent of children had more than one household bubble in lockdown, with 48% of these children able to move between their bubbles at least every week. • Responses to open-ended questions indicated some children enjoyed the flexibility to the distance learning routine, having increased independence, more free-time, and increased self-regulation in their learning during lockdown. • Most children stayed in frequent (virtual) contact with others, with 86% categorised as ‘moderately’ or ‘more’ connected to friends and family outside of their household bubbles. • However, differences in connection to those outside of bubbles differed by demographic characteristics. For example, children living in higher deprivation areas were less likely to have frequent connection, perhaps due to digital access inequities.

• Eighty-eight percent of children felt supported by their family during the pandemic restrictions. • Almost all children (96%) regularly shared a meal with their family. • A large proportion of children (84%) had people in their bubble involved in their school work several times a week or more. • There was a 21% increase in children doing outdoor activities with their family at least once a day during lockdown compared with age eight. • Compared to when they were eight-years-old, children reported a 23% increase in baking or cooking with someone in their family several times a week in lockdown.

Device use and screen time was frequent Device use in lockdown increased markedly since age eight, with the average time spent in front of screens being 4.8 hours during the weekdays and 4.0 hours on the weekend days (compared with 2.2 hours on the weekdays and 1.5 on the weekend days at age eight). Additionally: • YouTube was the most popular app used by children in lockdown, with 76% of children using this app. • Devices were used every day for school/homework by 67% of the children. • There was high use of apps with restrictions of 13+ years of age.

Children enjoyed their household bubbles and regularly participated in activities with others

• Children living in areas with the least socioeconomic deprivation reported the highest screen time during the weekdays (five hours per day).

Many families and whānau were able to foster experiences that saw the majority of children in this study reporting lockdown as a largely positive time. Despite the

• Weekend screen use saw children from higher deprivation areas reporting the highest average of 4.5 hours per day. PART TWO: EDUCATION

Key factors were identified for successful schooling

Experiences of school differed across demographic groupings

Engagement with activities, both school-related and non-academic, were key to boosting children’s enjoyment in schooling during the lockdown restrictions. This suggests that supporting families to connect with each other as they did during lockdown is promising for enhancing learning moving forward. Specifically, facilitating family participation in community activities, and arts and cultural events may boost successful schooling experiences. For example:

Overall, the mean school satisfaction score was 9.4, reflecting scores in the mid-point between “sometimes” and “often” satisfied. This was a marked drop from school satisfaction at age eight (mean=11.7, corresponding with “often” satisfied). While it was to be expected that the circumstances and change to schooling modality would present challenges, some children reported more challenging schooling experiences than others. Furthermore:

• Engaging in activities at least once a day corresponded with higher school satisfaction scores. This observation was evident across a wide range of activities including household chores, sports, and baking or cooking.

• 76% of children experienced a decrease in school satisfaction relative to reported satisfaction at age eight.

• High involvement in reading and cooking/baking with people inside their bubble corresponded with the highest levels of school satisfaction. • Children that never/almost never engaged in homework or housework with others in their bubble generally saw the lowest levels of school satisfaction. • Children who reported very high engagement in community activities (online or in their bubble) during lockdown had the highest school satisfaction scores compared to others. • High device use during the weekends in lockdown was associated with lower school satisfaction. • School satisfaction did not differ by frequency of concern about family money situation.

• Children in larger bubbles of seven or more people generally saw higher levels of school satisfaction. Inversely, children in bubble sizes of two (including the cohort child) tended to have the lowest scores. • Tamariki Māori experienced the largest decline in mean score of school satisfaction between age eight and lockdown. • Children of Asian and Pacific ethnic groups saw the smallest relative decreases in school satisfaction, with drops in mean school satisfaction scores of 1.7 and 1.6 respectively (compared with 2.3 for the cohort overall) between age eight and lockdown. • There were no significant differences in school satisfaction scores between children identified with a disability and those not. • Between age eight and lockdown, school satisfaction declined similar amounts for children who reported being bullied at age eight and those who did not. • However, when examining differences in school satisfaction at lockdown only, those who indicated they were never/hardly ever bullied had significantly higher school satisfaction at lockdown than those who were bullied.

Growing Up in New Zealand COVID-19 Wellbeing Survey

Lockdown was socially and emotionally challenging for some children Many children had concerning social and emotional reports during lockdown and may not have been receiving the support they required. The reduced social contact during lockdown restrictions may have had negative repercussions, with possible implications for mental and emotional wellbeing needing to be explored further. Given learnings from studies conducted about the consequences of traumatic events for children (e.g., from the Canterbury earthquakes) the social and emotional challenges children faced during lockdown is of concern. The fact that many children felt they were rarely listened to, may not have had enough opportunities to share their feelings and issues with others, and some had increased anxiety over money, are all factors that need ongoing monitoring. Specifically, this report found: • When asked about having someone to talk to about their feelings, a large proportion (45%) did not feel they had someone they could share with very often. • Thirteen percent of children indicated they rarely felt listened to by the people who looked after them in their bubble(s). • Two in three children (66%) did not talk about their feelings or issues frequently with those in their bubble. This corresponded with a 26% decrease in frequency of talking about feelings and issues several times a week compared with age eight, and a 34% increase of children stating that they never or almost never talked about their feelings. • Many children (38%) worried sometimes, often, or always about how much money their family had during lockdown.

Next steps and policy implications Understandably, children have not been immune to the psychosocial effects of COVID-19. The positive and negative experiences of the children in this study provide policy stakeholders with information to guide strategies and supports for families and whānau. Moving forward, policy makers may wish to think about how these findings can be taken to: • Support families to continue to connect with each other in the ways they did during lockdown, • Provide children with more flexibility, independence, and free-time in their learning where they require it, • Identify the additional resources and ongoing support children may need, given many faced emotional and social challenges during lockdown restrictions, • Investigate the specific systemic factors responsible for differing schooling experiences during lockdown and ensure COVID-19 does not deepen inequities, • Ensure equitable access to devices in future online and distance learning, • Tailor post-pandemic approaches given children had very different lockdown experiences. Ongoing monitoring of children is essential to understand the true impact of the lockdown restrictions for children and their families and whānau. Continuing to hear directly from children should be prioritised as pandemic responses are designed and implemented by government and agencies. Additionally, the upcoming Growing Up in New Zealand 12-year DCW will be important for providing the opportunity to assess longer-term impacts of the pandemic.

PART TWO: EDUCATION

List of Figures Figure 1:

Recruitment summary....................................12

Figure 17: Bubble activities during lockdown................ 26

Figure 2: Sociodemographic characteristics of participants and non-participants in the COVID-19 Wellbeing Survey............................14

Figure 18: Mean school satisfaction with participation in various activities during lockdown............ 27

Figure 3: Difference in sociodemographic characteristics of participants and non‑participants in the COVID-19 Wellbeing Survey...........................................15 Figure 4: Difference in sociodemographic characteristics of Māori participants and non‑participants in the COVID-19 Wellbeing Survey............................................16 Figure 5:

Bubble size......................................................17

Figure 6: Number of children with essential workers in bubble.........................................................18 Figure 7:

Connectedness by ethnicity..........................20

Figure 8:

Connectedness by deprivation index............20

Figure 9:

Connectedness by bubble size......................20

Figure 10: Connectedness by disability..........................21 Figure 11: Children’s reports of household dynamics during lockdown............................................ 22 Figure 12: How often children worried about money during lockdown............................................ 23 Figure 13: Box plot of children’s school satisfaction by level of worry about money...................... 23 Figure 14: Positive experiences in lockdown................. 24 Figure 15: Community involvement during lockdown.... 25 Figure 16: Box and whisker plot of school satisfaction scores by children’s level of community involvement during lockdown....................... 25

Growing Up in New Zealand COVID-19 Wellbeing Survey

Figure 19: Apps used by children in lockdown............... 28 Figure 20: Frequency of screen-based activities........... 29 Figure 21: Difference in activity participation between eight-year and lockdown................30 Figure 22: Time spent on screens during weekdays and weekends in lockdown...................................31 Figure 23: Histogram of school satisfaction at eight‑year and lockdown............................... 32 Figure 24: Change in school satisfaction between eight‑year and lockdown by socioeconomic position............................ 33 Figure 25: Change in school satisfaction between the eight-year and lockdown by ethnicity........... 34 Figure 26: Change in school satisfaction between eight‑year and lockdown by bubble size....... 35 Figure 27: Change in school satisfaction between eight‑year and lockdown by disability........... 35 Figure 28: Change in school satisfaction between eight‑year and lockdown by bullying............. 36 Figure 29: Change in school satisfaction between eight-year and lockdown with weekday device usage.................................................. 36 Figure 30: Change in school satisfaction between eight‑year and lockdown with weekend screen usage.................................................. 37

List of Tables Table 1:

School attendance during lockdown..............19

Table 2: Method of contact with friends and extended family..............................................21 Table 3: Average hours of screen time at eight-year and lockdown by area-level socioeconomic deprivation quintile (NZDep2013).................. 32 Table 4: Survey response rate..................................... 63 Table 5:

Demographic variables..................................64

PART TWO: EDUCATION

Glossary

Term

Definition or translation

COVID-19

Coronavirus disease (2019)

DCW

Data Collection Wave

GUiNZ

Growing Up in New Zealand

MSLSS

Multidimensional Students Life Satisfaction Scale

NZDep2013

New Zealand Area Level Socio-economic Deprivation 2013 Score

OECD

Organization for Economic Cooperation and Development

WHO

World Health Organization

Growing Up in New Zealand COVID-19 Wellbeing Survey

1. Introduction This report outlines the experiences of children in Aotearoa New Zealand, recruited from among the Growing Up in New Zealand (GUiNZ) longitudinal cohort study, during the lockdown restrictions implemented in response to the COVID-19 pandemic from March 2020. COVID-19 is the disease caused by the coronavirus SARS-CoV2, first identified in Wuhan, China in December 2019. With humans having no pre-existing immunity to this novel virus but proving susceptible to infection, the rapidly transmitting COVID-19 virus spread throughout the world in early-2020. On the 11th of March 2020, the World Health Organization (WHO) declared a worldwide state of emergency (1). Since it has been identified, COVID-19 has been ranked in the top five causes of death globally (2). Internationally, control measures were implemented in attempts to contain the virus and control transmission. These measures varied markedly between nations (3).

1.1 COVID-19 in Aotearoa New Zealand The first case of COVID-19 in Aotearoa New Zealand was detected on the 28th of February 2020 (4). The Aotearoa New Zealand Government initially took a containment approach (“flatten the curve”) to control transmission of the COVID-19 virus, before pivoting to an ‘elimination’ approach (5). This approach aimed to manage the existing COVID-19 cases, minimise the spread of infection, quickly stamp out the virus, and prevent onward transmission, including from cases that returned from overseas, until an effective treatment or vaccine could be found. A four-level alert system was introduced in March 2020 to manage this approach (6). Restrictions placed on the population increase throughout the levels. At 11:59pm on the 25th of March 2020, Aotearoa New Zealand moved into Level 4 (Lockdown) which restricts all non-essential movement and advised people to stay at home in their immediate household ‘bubble’ (7). Essential movement was permitted, such as grocery shopping and recreational activity in the local area with physical distancing. All educational facilities, public venues, and businesses closed, except essential services. This lockdown continued until the 27th of April after which the country was moved into Alert Level 3 (Restrict). This alert level requires people to remain at home but saw the

opening of some businesses provided they had no physical interaction with customers. Educational facilities opened with limited capacity for children of essential workers. On the 13th May 2020, Aotearoa New Zealand dropped back to Alert Level 2 (Reduce) which allowed educational facilities, businesses, and public venues to re-open with physical distancing. There have been fewer than 3000 confirmed or probable cases of COVID-19 in Aotearoa New Zealand and 26 COVID-19-related deaths (as of May 2021 (4)). However, the majority of these cases contracted the virus overseas or during their return journey to Aotearoa New Zealand, rather than through community transmission. The fast scientific-based response from the Aotearoa New Zealand Government, the interventions administered (e.g., border control measures), and the high public compliance to the COVID-19 control measures, saw the lowest COVID-19related deaths among the 37 Organization for Economic Cooperation and Development (OECD) countries (8). Although children and young people in Aotearoa New Zealand have been comparatively unaffected by COVID-19 virus transmission and are not at significant risk of infection, the lockdown restrictions are likely to have affected other aspects of their wellbeing.

1.2 Children’s Experiences of COVID-19 Capturing the experiences of children during COVID-19 is essential for understanding the implications, both positive and negative, of the pandemic. International research has documented concern about the immediate and ongoing effects of COVID-19 for children given the pandemic and associated measures have limited access to friends, family, schools, and other social interaction and participation (9,10,11,12). For example, a longitudinal study of German children and young people between the ages of 7–17 found many reported feeling highly burdened by the COVID-19 pandemic—more than half found home-schooling and learning to be more difficult than before the pandemic and two in five reported their relationships with their friends had been impaired (12). However, international literature about the implications of COVID-19 for children and young people may have limited applicability to Aotearoa New Zealand due to PART TWO: EDUCATION

the differing control measures and comparatively low prevalence of the disease. To date, few studies in Aotearoa New Zealand have been published where children and young people were asked about their experiences of COVID-19 and associated restrictions. In a notable report, the Office of the Children’s Commissioner surveyed 1,402 children and young people in May 2020, finding very diverse experiences of lockdown (13). Some children (29%) indicated that life was better or much better during lockdown whereas others reported life to be worse or much worse than their life prior to lockdown (23%). With respect to education, learning remotely was reported as a positive experience for some students. However, a separate study conducted by the Educational Review Office (ERO) revealed many students in Aotearoa New Zealand struggled with learning at home during lockdown (14). Cross-sectional studies, such as the reports detailed above, provide a useful snapshot of the experiences of children and young people during the COVID-19 pandemic. However, the design of cross-sectional studies means they are unable to establish any causal relationship between COVID-19 alert levels and health and wellbeing in the children. Such relationships are more readily answered using a longitudinal cohort study design such as the GUiNZ longitudinal cohort study, where data from before COVID-19 are able to be compared to data during the COVID-19 pandemic. The GUiNZ study also has comprehensive demographic information about the cohort, allowing for findings to be stratified by participant characteristics so experiences specific to sub-groups can be reported. This report aims to address the knowledge gap by detailing children’s experiences during COVID-19 Alert Levels 3 (Restrict) and 4 (Lockdown), as well as making comparisons with earlier time points where possible to provide patterns of experiences over time for children involved in the GUiNZ longitudinal cohort study.

1.3 Overview of Growing Up in New Zealand The GUiNZ longitudinal cohort study recruited 6822 pregnant women living within the Auckland, Counties Manukau, or Waikato District Health Board regions who were due to have their babies between 25th April 2009 and 25th March 2010. The subsequent child cohort consisted of 6,853 children, whose birth parameters closely aligned to all Aotearoa New Zealand births in 2007–2010 (15). Since its inception, five major data collection waves (DCW) have been completed face-toface in homes with the GUiNZ cohort (antenatal, and when the children were approximately 9 months, 24 months, 54 months, and eight years of age). Between the main faceto-face DCWs, age specific data have been collected using online electronic questionnaires and telephone interviews. 10

Growing Up in New Zealand COVID-19 Wellbeing Survey

A sixth in-home DCW was planned for 2020, when the children were approximately 11 years of age, but data collection was delayed to June 2021, when the children were approximately 12 years of age. A brief online survey, the COVID-19 Wellbeing Survey, was designed to hear directly from the children in the GUiNZ cohort about their experiences of COVID-19 lockdown and to understand how aspects of their wellbeing may have changed since the last DCW which ended in early-2019. Additionally, this survey tested the application of a digital questionnaire between routine face-to-face DCWs to provide valuable information about the utility and acceptability of this digital mode of engagement with an existing cohort, particularly given the uncertainty associated with the feasibility of face-to-face data collection during the ongoing COVID-19 pandemic.

1.4 Aims of the COVID-19 Wellbeing Survey The overarching aims of the COVID-19 Wellbeing Survey were to understand these children’s experiences of lockdown and, at the same time, explore the ability to connect electronically with the GUiNZ cohort. The specific aims of the questionnaire related to understanding the experiences of COVID-19 restrictions included: 1. Understand the attitude and feelings of children about schoolwork during lockdown, and their thoughts about returning to school. 2. Understand whether children had access to, and use of, electronic devices during lockdown, and the amount of time they spent on these devices. 3. Determine how engaged children were with activities involving family and friends during lockdown. 4. Determine whether children had any changes in eating behaviours and attitudes toward food during lockdown. 5. Understand what the children liked, or did not like, about lockdown. 6. Understand what the children worried about and were most excited about during lockdown. 7. Understand how lockdown impacted children’s general health, and mental and physical wellbeing, particularly: - Whether this impact differed according to key socio-demographic variables. - Whether their mental and physical wellbeing had changed from when they were eight years of age. The objectives of this report are to present the findings from the COVID-19 Wellbeing Survey relevant to household bubbles, school, family, connectedness, activities and experiences, and media and screen time (Aims 1-3). Separate publications focus on health, and mental and physical wellbeing (Aim 7), eating behaviours and attitudes toward food (Aim 4), as well as qualitative analysis of free text fields (Aims 5 and 6).

2.1 Study Design A cross-sectional survey design was utilised. Children were eligible if: the person who had completed the “Mother Questionnaire” at the most recent data collection wave (DCW) the child had taken part in had not withdrawn from the GUiNZ study prior to May 2020; this person had a contact email address; and the child was living in Aotearoa New Zealand at the time of survey distribution. Children whose caregivers had requested that all communications be in Te Reo Māori were ineligible for the survey (n=11), as translation of the survey was unfortunately not possible given time constraints.

2.2 Data Collection Email invitations to participate in the survey were generated from the Qualtrics® digital platform and sent to the person who had completed the “Mother Questionnaire” at the most recent DCW the child had taken part in (and had not withdrawn prior to May 2020 and had a contact email address). The invitation included an individualised link to the survey, which directed them to a web-based online survey accessible on all devices (computer, tablet, phone). The front page of the survey described the purpose of the questionnaire and gave children the opportunity to accept or decline to participate. Children could complete the survey independently or receive help from a family member if required. To increase compliance with survey completion a media release was issued, as well as a more targeted campaign promoting the survey to GUiNZ participants via Facebook, Instagram and Twitter, the Growing Up website and participant e-newsletter. While koha are typically offered to participants as part of main data collection waves, this was not possible for the COVID-19 Wellbeing Survey.

2.3 Survey Questions The COVID-19 Wellbeing Survey consisted of 46 questions in total (see Appendix B). Questions were not compulsory, and children could progress to the next section of the questionnaire if they wished to skip any section. The questionnaire asked children about their household ‘bubbles’, feelings, experiences, activities, home and family life, school, current health, media and screen time, connectedness, depressive and anxiety symptoms, and food and drink. This report focuses on data related to questions about: COVID-19 “bubbles”, experiences, activities, family life, school, media use and screen time, and connectedness.

2.4 Data Analyses Analyses were undertaken using R (version 4.0.5), RStudio, and RMarkdown. All statistical analyses and resulting code for this report have been peer reviewed by an independent member of the GUiNZ Biostatistics team (not involved in the study). Standard summary statistics are used to report survey responses across questions pertaining to COVID-19 ‘bubbles’, experiences and activities, family life, school satisfaction, current health, media use and screen time, and connectedness. Many of the summary statistics are also stratified by ethnic and sociodemographic subgroups. A strength of having a longitudinal dataset is the ability to undertake analyses that consider the contribution of early-life experiences for life during COVID-19. Where possible we have approached the longitudinal analyses with the aim of comparing similar measures across time and identifying earlier experiences that are predictive of wellbeing during COVID-19.

PART TWO: EDUCATION

3. Cross-sectional Findings This section explores the findings from the crosssectional analysis of the COVID-19 Wellbeing Survey. Findings related to questions about household bubbles, school, connectedness, household dynamics, experiences, activities, and media and screen use are explored according to various demographic and other variables of interest. Analyses in this section describe the lived experiences of Aotearoa New Zealand children during the COVID-19 lockdown restrictions. Longitudinal analyses linking the findings from this section to past GUiNZ DCWs are presented in the following section, section four.

3.1 Survey Respondents In total, 5,756 GUiNZ children in the main cohort were eligible to participate in the COVID-19 Wellbeing Survey (as per the eligibility criteria in section 2.1). The survey went live on the 8th of May 2020. At that time Aotearoa New Zealand was in Alert Level 3 (Restrict), 12 days after stepping down from Alert Level 4 (Lockdown). The live link was originally open for seven days. A small number

of children declined to participate when they had not meant to do so. Their parents contacted the study team and asked for the children to be re-issued a survey link, which extended the period of data collection. The survey was closed on the 24th of May 2020, by which time the country had moved to Alert Level 2 where people could go back to work and school with physical distancing. Overall, 2,421 children completed the COVID-19 Wellbeing Survey. This response rate applies to the 5,756 children who were able to engage in the survey because their parent had provided consent, they had a current contact email, and the children had access to a device with internet connection. This survey was the first time an online DCW had been utilised with the GUiNZ children themselves and had a response rate of 42%, which is considered high for a digital survey of this nature (16). Figure 1 indicates that 70% of the children completed the survey during Alert Level 3 (Restrict) and 30% during Alert Level 2 (Reduce). Furthermore, the majority of children (69%, n=1669) who participated completed all questions in the survey.

100%

Cumulative percentage

98% 75%

70%

50%

27%

23%

25%

Alert Level 3

Alert Level 2

May 08

May 09

May 10

May 11

May 12

Figure 1: Recruitment summary 12

Growing Up in New Zealand COVID-19 Wellbeing Survey

May 13 Date

May 14

May 15

May 16

May 17

May 18

3.2 Participant Characteristics Demographic characteristics of the COVID-19 Wellbeing Survey population are shown in Figures 2, 3, and Appendix C. Almost all participating children (99%) were aged 10-11 years, with a similar proportion of boys and girls. A high proportion of children were from low deprivation areas (38%, n=919, NZDep2013 group 1–3) and medium deprivation areas (37%, n=890, NZDep2013 scores 4–7), compared to 21% (n=517) from high deprivation areas (NZDep2013 groups 8–10). Ethnicity data in Appendix C are presented using both prioritised ethnicity and total response ethnicity. Of the Pacific group (total response), the following nationalities were represented: • Samoan: 53% (n=169) • Tongan: 26% (n=83) • Cook Island Māori: 22% (n=71) • Niuean: 12% (n=38) • Fijian: 6% (n=18) • Other: <1% (n=<10) Of the Asian group (total response), the following nationalities were represented: • Chinese: 30% (n=102) • Indian: 29% (n=99) • Filipino: 10% (n=33) • Other: 34% (n=116) The ‘Other’ category represents nationalities with less than 10% of the cohort children (e.g., Sri Lankan, Korean, Japanese, Cambodian, Vietnamese, etc).

A NOTE ON ETHNICITY: Throughout this report child ethnicity is predominantly externally prioritised based on Stats NZ Level 1 ethnicity groupings in the following order of priority: Māori, Pacific, Asia, Middle Eastern/ Latin American/African, Other, or European if used as an independent variable (17). The strengths of this method include prioritisation of the Māori ethnic group, befitting for targeted resourcing and policy development included in Te Tiriti o Waitangi responsibilities (18). Additionally, ethnic groupings are mutually exclusive which is a requirement for many statistical tests. For analyses conducted on separate ethnic groups, ethnicity is coded across multiple variables (using total response coding) based on Stats NZ Level 1 ethnicity groupings (dummy variables indicating if the participant belongs to a specific ethnicity or not). In other words, multi-ethnic participants were included in each relevant ethnic group. The strength of this method is the inclusion of all ethnic groups with which each individual identifies. Figures 2 and 3 compare the characteristics of children and families in the GUiNZ study who participated with those who did not participate. A lower response rate to the survey was observed for boys, Māori, Pacific, and Asian children, and children who had mothers with fewer educational qualifications (i.e., no secondary school qualification, secondary school/NCEA 1–4, and diploma/ trade certificate/NCEA 5–6), though in some cases these differences were modest (e.g., by gender). Response rates did not differ significantly between children living in rural and urban areas. See Appendix D for further technical detail regarding response bias.

PART TWO: EDUCATION

Percentage

60%

Child gender

40% 20% 0%

Percentage

60%

Boy

Girl

Child ethnicity

40% 20% 0%

European

Māori

Pacific

Asian

Other

Mother age (years) Percentage

60% 40% 20% 0%

<30

30-35

35-40

40-45

45-50

50+

Deprivation index (NZDEP2013 decile) Percentage

60% 40% 20% 0%

Percentage

60%

Mother education

40% 20% 0%

No secondary school qualification

Scondary school / NCEA 1-4

Diploma/Trade cert/ NCEA 5-6

Population growth

Eligible

Bachelor’s degree

Higher degree

Responded

Note: Child ethnicity reported as externally prioritised according to Stats NZ Level 1 ethnicity groupings.

Figure 2: Sociodemographic characteristics of participants and non-participants in the COVID-19 Wellbeing Survey 14

Growing Up in New Zealand COVID-19 Wellbeing Survey

Percentage

10%

Child gender

5% 0% -5% -10%

Percentage

10%

Boy

Child ethnicity

5% 0% -5% -10%

Percentage

10%

European

Pacific

Asian

Other

5% 0% -5%

10%

Percentage

Māori

Mother age (years)

-10%

<30

30-35

35-40

40-45

45-50

50+

Deprivation index (NZDEP2013 decile)

5% 0% -5% -10%

10%

Percentage

Girl

Mother education

5% 0% -5% -10%

No secondary school qualification

Scondary school / NCEA 1-4

Diploma/Trade cert/ NCEA 5-6

Under representation

Bachelor’s degree

Higher degree

Over Representation

Note: Child ethnicity reported as externally prioritised according to Stats NZ Level 1 ethnicity groupings.

Figure 3: Difference in sociodemographic characteristics of participants and non‑participants in the COVID-19 Wellbeing Survey PART TWO: EDUCATION

3.3 Māori Participant Response Rates Response bias based on sociodemographic characteristics was also explored for all participants who identified as Māori from the main cohort (n=1390). In total 498 tamariki Māori responded to the COVID-19 Wellbeing Survey—a response rate of 36% (compared with 42% overall). Compared with Figure 3, the response bias pattern for tamariki Māori is similar to the pattern for the full cohort.

by sociodemographic groupings in the COVID-19 Wellbeing Survey. There was small to moderate over-representation of girls, tamariki Māori living in lower deprivation areas, those with older mothers, and those whose mothers have a higher educational qualification. There was a correspondingly small to moderate underrepresentation of boys, those with younger mothers, those living in the most deprived areas, and tamariki Māori whose mothers have lower educational qualifications.

Figure 4 provides a closer examination of the over- and under-representation for tamariki Māori

Percentage

10%

Child gender

5% 0% -5% -10%

Percentage

10%

Boy

Mother age (years)

5% 0% -5% -10%

Percentage

10%

<30

30-35

35-40

40-45

50+

Deprivation index (NZDEP2013 decile)

0% -5%

10%

Mother education

5% 0% -5% -10%

No secondary school qualification

Scondary school / NCEA 1-4

Diploma/Trade cert/ NCEA 5-6

Under representation

Figure 4: Difference in sociodemographic characteristics of Māori participants and non‑participants in the COVID-19 Wellbeing Survey

45-50

-10%

Percentage

Girl

Growing Up in New Zealand COVID-19 Wellbeing Survey

Bachelor’s degree

Over Representation

Higher degree

3.4 Household Bubbles Under Alert Level 4 (Lockdown) and Alert Level 3 (Restrict), members of the public not working for essential services are legally required to stay home in their ‘bubble’ unless following guidelines about permitted activities (e.g., grocery shopping, exercise, etc (19)). The term ‘bubble’ has been used to describe a household unit (or units for blended families and those sharing custody of children). Describing the characteristics of these bubbles is of interest given the novelty of the ‘bubble’ concept, and to understand the social environments the children in this study were exposed to during lockdown in 2020.

Eleven percent (n=249) of children reported having more than one bubble at the beginning of Alert Level 4 (Lockdown). The majority of these participants had two bubbles (60%, n=148). Movement between bubbles was frequent with 15% (n=38) of children reporting daily movement, 33% (n=81) moving every week, and 52% (n=129) moving less often. Participants were asked about the people who they shared their bubble(s) with. Most of the GUiNZ children lived with their mother (97%, n=2215), father (87%, n=1997), and sibling/s (89%, n=2034) during COVID-19 restrictions. Fifteen percent (n=373) of children had at least one new person join their bubble who did not live with them before Alert Level 4 (Lockdown). Of these children, 32% (n=120) had a close family member (such as a sibling) join, 34% (n=127) had a grandparent join, and 34% (n=130) had another family member or friend join their bubble.

KEY FINDINGS: • Eleven percent of children had more than one household bubble in lockdown. Movement between these bubbles was frequent with 48% of children moving at least every week. • Two in five children (41%) had one or more essential workers in their bubble(s). A higher proportion of Pacific children reported having at least one essential worker in their household bubbles.

Despite the novelty of the ‘bubble’ concept and the associated restrictions involved in keeping to one’s bubble, many children were positive about spending time with those in their bubble, as indicated in the quote below.

3.4.1 Bubble information Children participating in the COVID-19 Wellbeing Survey were asked to provide information about their bubbles during COVID-19 restrictions. The vast majority of children (90%, n=2065) reported having between three and six people in their bubble, including themselves (Figure 5). Pacific and Māori children, on average, were more likely to have a higher number of people in their bubble (ethnicity reported as total response).

“Being with my whānau. I love my bubble!”

29.5%

40%

European 13.9%

30%

20% 5.8% 35.2%

10%

3.6%

1.2%

2.1%

Ethnicity - Total response

Percentageof total response

WHAT ARE THE BEST THINGS ABOUT LOCKDOWN?

Māori

4.6 (1.3)

5.1 (1.9)

Pacific Asian Other

5.7 (2.1)

4.6 (1.2)

4.3 (1.1)

0% 2

4 5 6 7 8+ 0 2 4 6 8 Number of people in bubble Average number of people in bubble (incl SD) Note: Child ethnicity reported as externally prioritised according to Stats NZ Level 1 ethnicity groupings.

Figure 5: Bubble size PART TWO: EDUCATION

3.4.2 Essential workers During Alert Level 4 (Lockdown) and Alert Level 3 (Restrict), members of the public were required to work from home. Only workers of essential services were able to leave their household bubbles to attend work as long as they complied with necessary health and safety protocols (19). Essential workers included those who were medical professionals, residential facility staff, border security, some education staff, building and construction workers, and those working in primary industries. Two in five children (41%, n=934) had an essential worker 59.2%

European

Ethnicity - Total response

Percentageof total response

60%

as part of their household bubble(s). However, Pacific children had the highest proportion (47%, n=148) of essential workers (Figure 6). Despite the increased risk for Pacific communities during the pandemic, due to higher numbers involved in essential work, Pacific providers and communities were able to mitigate this risk by mobilising and providing mass accessible COVID-19 testing, as well as responding to other needs in a holistic way, for example providing food and social care for the elderly (4). Pacific peoples make up 8.1% of the Aotearoa New Zealand population, but make up 12% of those who have been tested for COVID-19, highlighting the proactive response by our Pacific communities (20).

40% 29.3%

20% 9.3% 2.3%

Māori Pacific Asian Other

43.1%

37%

47.4%

40.6%

46.2%

0% 0

1 2 3+ 0 20% 50% 75% 100% Number of essential workers Percentage of bubbles with essential workers Note: Child ethnicity reported as externally prioritised according to Stats NZ Level 1 ethnicity groupings.

Figure 6: Number of children with essential workers in bubble

3.5 School During Lockdown Lockdown saw the closure of in-person educational facilities, where face-to-face learning abruptly ceased. With very little time to prepare for new ways of learning, students and teachers were required to adapt quickly to distance and online instruction. Efforts were taken by schools, teachers, students, government, and families and whānau to continue instruction and learning where possible (21). However, the major shift in schooling modality understandably provided some new challenges for learning. 3.5.1 School attendance Children responded to a question about whether they had returned to school. Three percent (n=76) of children had returned to school at the time the COVID-19 Wellbeing Survey was undertaken (Table 1). It is likely these children had parents who were considered essential workers, and thus the children could attend school but with restricted movement and mixing. 3.5.2 School satisfaction Students’ feelings about school and schoolwork are inextricably linked to their engagement and attention 18

Growing Up in New Zealand COVID-19 Wellbeing Survey

on learning tasks (22). Positive feelings towards school are key for promoting academic success and buffering against disengagement from learning (23). The Multidimensional Student Life Satisfaction Scale (MSLSS) enabled children to report on different aspects of engaging with school in lockdown (24). Items were adapted to reflect the lockdown “bubble” environment. Children were able to respond on a five-point scale: “Never”, “Sometimes”, “Often”, “Almost Always”, and “I don’t know”. Scores across six items were summed, with a minimum possible score of zero and a maximum score of 18. The six statements that students responded to were: 1. I look forward to doing school work in my bubble 2. I like school work in my bubble 3. School work in my bubble is interesting 4. I wish I didn’t have to do school work while in my bubble 5. There are many things about school in my bubble that I like 6. I enjoy the school activities I do in my bubble

Table 1: School attendance during lockdown Children n

2183

90%

Returned to school

Missing

162

Doing schoolwork at home

The mean school satisfaction score across all children was 9.4, reflecting scores in the mid-point between sometimes and often satisfied. The upcoming sections in this report will explore how school satisfaction scores differed by experiences during lockdown and demographic characteristics.

KEY FINDINGS:

With the change to schooling modality, it was expected children and their families would have some struggles with schooling as they juggled new ways of working, learning, and doing home-life. Indeed, many of the children in this study indicated their lack of enjoyment in school through the open-ended response questions. An example response is provided below.

• Children living in higher deprivation areas were less likely to have frequent connection with family and friends outside of their household bubble (Figure 8).

WHAT’S IT LIKE BEING IN LOCKDOWN?

“I didn’t enjoy it because we were separated from people. School was very hard and mum and dad were always worried about it.” 3.6 Connections Social connections are an essential aspect of child and youth wellbeing (25). Concern has been raised as to the impact of COVID-19 social restrictions for children given most were isolated from friends and family (26). Although shared experiences of the pandemic may have brought some households together, there was also the potential for COVID-19 restrictions to make it more difficult for children to find meaningful and supportive connection. Limited social contact has potential to reduce perceived closeness and belonging and increase loneliness and feelings of isolation (27). One of the key aims of the COVID-19 Wellbeing Survey was to understand both the actions taken by children to connect with others and the levels of felt connection during Alert Levels 3 (Restrict) and 4 (Lockdown) restrictions.

• Eighty-six percent of children were categorised as ‘moderately connected’ or ‘more connected’ to friends and family outside of their household bubbles.

• The most popular methods for connecting with friends and family included video calling, telephone, texting/chatting, and platforms such as Google Classrooms/Seesaw. 3.6.1 Connection with friends and family Ninety-eight percent (n=2193) of children reported connecting with their friends and family outside of their bubble at some point during COVID-19 restrictions (e.g., via social media platforms, telephone, and texting). Based on the frequency of this contact, children were categorised into four groups: more connected, moderately connected, a little connected, and not/ almost not connected. Eighty-six percent (n=1914) of children were categorised as ‘moderately connected’ or ‘more connected’. However, 5% (n=113) of children were relatively unconnected with friends and family. Differences in connection were evident across sociodemographic groups. Boys had less frequent connection than girls, with 16% (n=168) of boys categorised into the ‘a little connected’ or ‘not/ almost not connected’ groups, compared with 11% (n=131) of girls. One in five Asian (n=52), and Pacific (n=33) children were categorised into the ‘a little connected’ or ‘not/almost not connected’ groups (Figure 7), while this was one in seven for Māori (n=66) and one in ten for European children (n=146).

PART TWO: EDUCATION

Ethnicity

European Māori Pacific Asian 0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Proportion of responses More connected Moderately connected A little connected Not or almost not connected Note: Child ethnicity reported as externally prioritised according to Stats NZ Level 1 ethnicity groupings.

Figure 7: Connectedness by ethnicity

Children living in higher deprivation areas (NZDep2013 deciles 9–10) were less likely to have frequent connection with family and friends outside of their household bubble (Figure 8). Given much of this connection was facilitated online, this may reflect lower access to technology in these areas.

Deprivation index (Quintile)

5 4 3 2 1 0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Proportion of responses More connected

Moderately connected

A little connected

Not or almost not connected

Figure 8: Connectedness by deprivation index

Children with larger household bubbles had less frequent connection (see Figure 9), potentially a reflection of the larger network already available within the bubble.

8+ 7

Bubble size

6 5 4 3 2 0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Proportion of responses More connected

Moderately connected

Figure 9: Connectedness by bubble size 20

Growing Up in New Zealand COVID-19 Wellbeing Survey

A little connected

Not or almost not connected

100%

Connectedness tended to be lower among children whose parents had reported concerns about their child’s behaviour (Figure 10). In contrast, those with vision concerns reported somewhat higher levels of connectedness than other groups, including those for whom no concerns had been raised.

socially separated from their family and peers, as indicated by the quote below. WHAT’S THE HARDEST THINGS ABOUT LOCKDOWN?

“Not being able to see my friend, not being able to go to school, not being able to touch anything.”

Overall, while many of the children in this study were well connected to people outside of their household bubble, some children still had difficulties with being

Disability

No concerns have been raised Vision concerns

Learning disabilities Hearing/speech concerns Behaviour concerns 0%

10%

20%

30%

40%

50%

60%

70%

80%

100%

90%

Proportion of responses More connected

Moderately connected

A little connected

Not or almost not connected

Figure 10: Connectedness by disability

3.6.2 Type of contact Children were asked how they kept in contact with their friends and extended family who were not part of their household bubble(s) during COVID-19 restrictions. A variety of methods were used to keep in touch with those outside their bubble (see Table 2). The most popular methods for

connecting with friends were video calling (e.g., Facetime/ Zoom/Other videoconferencing), telephone, and other online platforms such as Google Classrooms/Seesaw. In contrast, for connecting with family, texting/chatting and video calling were the most common methods.

Table 2: Method of contact with friends and extended family Friends

Family

Telephone

695

35%

1283

64%

Texting, chatting

1133

57%

871

43%

Facetime/Zoom/Other videoconferencing

1656

83%

1523

76%

Platforms such as Google Classrooms/Seesaw

1013

51%

Apps such as WhatsApp/House Party

415

21%

402

20%

Online Games

954

48%

245

12%

In person (even if with physical distancing)

523

26%

639

32%

Letters

178

158

Other

217

11%

PART TWO: EDUCATION

3.7 Household Dynamics COVID-19 lockdown typically saw families spending more time together as people were restricted to their household bubbles, bar essential movements (28). This change to daily lives and routines, required families to negotiate new ways of home-life, work, and school within their households. The blurring of lines between these domains likely had different effects across families. KEY FINDINGS: • Seventy-nine percent of children agreed they had a good time with their family in lockdown.

Generally, children reported positive experiences of family life within their bubbles (Figure 11), with 79% (n=1776) agreeing a lot/totally agreeing they had a good time with their family. When asked about their home life, the majority of children (77%, n=1783) agreed a lot/ totally agreed that they had enough places to play or have a good time in their household. The quote below reflects these experiences.

WHAT ARE THE BEST THINGS ABOUT LOCKDOWN?

“Being able to spend more time with my family and I am able to talk to my friends a lot. We are happy with each other.”

• However, 13% of children rarely felt listened to by the people who looked after them in their bubble(s). • Many children (38%) worried sometimes, often, or always that their family did not have enough money in lockdown. • School satisfaction scores did not differ by frequency of concern about family money situation.

Questionnaire item

How much do you agree with the following? We have a good time together as a family

98%

In my bubble there are enough places to play or to have a good time

98%

I feel safe when I am out and about in the area I live in

96%

My parents (or the people who look after me) listen to me

94%

100

50 Response

0 Percentage

I do not agree I don’t know

Agree a little bit Agree somewhat

100

Agree a lot Totally agree

Note: Percentages represent the proportion of children who reported categories on either side of the centre line.

Figure 11: Children’s reports of household dynamics during lockdown Some children reported more challenging experiences during lockdown. Twelve percent (n=278) of children did not agree they felt safe when they were out and about in their neighbourhood very much of the time. Reasons for these experiences may be related to fear around COVID-19 as many children, when answering the open-ended response questions, mentioned their worries about COVID-19 in the community. An example of one of these quotes is opposite. 22

Growing Up in New Zealand COVID-19 Wellbeing Survey

WHAT HAS WORRIED YOU MOST IN LOCKDOWN?

“That when my family members are out shopping, they could just come back with the virus.”

Thirteen percent (n=298) of children indicated rarely feeling listened to by the people who looked after them in their bubble (as indicated by the ‘I don’t know’, ‘I do not agree’, and ‘agree a little bit’ categories). Early adolescence is a time of significant cognitive development alongside increases in autonomy, which, in some cultures, can also see an increase in family conflict (29). It may be children were not feeling listened to as they were experiencing the heightened family conflict that can arise during developmental stage. However, this interpretation requires further examination.

over half of children did not worry about money at all (52%, n=1170), many worried sometimes, often, or always (38%, n=860; Figure 12). School satisfaction scores were examined by children’s level of worry about money to understand if financial concerns were affecting children’s perceptions of their schooling during lockdown. Figure 13 shows very similar median school satisfaction scores across the children who had different levels of worry. There were no significant differences in mean scores of reported school satisfaction in lockdown by level of concern about family money situation.

Children were asked how often they worried about how much money their family had during lockdown. While

How often do you worry about how much money your family has?

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Percentage of responses Worry frequency

I don’t know

I don’t think about it at all

Sometimes

Often

Always

Figure 12: How often children worried about money during lockdown How much do you agree with the following?

Frequency of worrying about money

I don’t know

8.9

I don’t think about it at all

9.5

Sometimes

9.5

Often

9.4

Always

9.1

10 School satisfaction score

Figure 13: Box plot of children’s school satisfaction by level of worry about money

PART TWO: EDUCATION

3.8 Positive Experiences

(25%, n=569) reported feeling connected to their school or kura only some of the time. When asked about having someone to talk to about their feelings, a large proportion (45%, n=1021) did not feel they had someone they could share with very frequently. Given many children expressed concern about the stress their family was under during the lockdown restrictions (see section 3.7), it may be that these children viewed sharing their emotions as a further burden and did not want to add to family stress. However, an alternative and potentially more likely explanation, is that given the pre-adolescent age of the children who took part in the study, peers and others outside of the immediate family context are likely becoming more essential for emotional support than in earlier-childhood (29). With reduced contact, many children may not have been receiving the social support they required, as exemplified in the quote below.

Positive childhood experiences have been demonstrated to provide protective effects during times of heightened risk (30). As the COVID-19 pandemic and associated restrictive measures posed a threat to child wellbeing, children were asked about seven different resilience factors—family support, community participation, school connection, contact with friends, feelings of safety, family cohesion, and having someone to share their feelings with. KEY FINDINGS: • Eighty-eight percent of children felt supported by their family. • However, many children (45%) did not feel they had someone they could talk with about their feelings very frequently.

WHAT’S IT LIKE BEING IN LOCKDOWN?

• Children who were always involved in community activities had higher school satisfaction.

“I think for me it was hard because one of my friends was kinda some[one] I could pour my emotions out but I don’t have her number…”

Figure 14 details children’s reports of how often they had positive experiences during lockdown. Eighty-eight percent (n=1981) of children felt supported by their family during the pandemic restrictions. Some children

Questionnaire item

How often during lockdown have you: Feel safe and protected in your home

95%

Felt your family supported you in this time

88%

Felt able to keep in touch with friends

13%

64%

Felt connected to school/kura

11%

64%

Felt able to talk to someone about your feelings

19%

55%

Participated in community activities within your bubble

25%

44%

100

50 Response

Never I don’t know

0 Percentage Almost never Sometimes

100

Often Always

Note: Percentages represent the proportion of children who reported categories above/below the centre group. The percentage of the centre group (i.e., those reporting “sometimes”) reflects the proportion not reported in the graph.

Figure 14: Positive experiences in lockdown

Growing Up in New Zealand COVID-19 Wellbeing Survey

3.8.1 Community involvement and school satisfaction Others connected online with church or mosque activities.

COVID-19 control measures heavily restricted involvement in community. However, many people found creative avenues to connect with their neighbourhoods and existing communities in novel ways. Tens of thousands of New Zealanders participated in a nationwide teddy bear hunt where stuffed toys were placed in windows across the country for children to spot from a distance as they explored their local neighbourhoods (31).

As shown in Figure 15, the level of engagement with community activities (either online or in their bubble) varied considerably. About one in five children reported never or almost never engaging in community activities, while almost half (44%) reported often or always doing so.

How often during lockdown have you participated in communities within your bubble? (e.g. teddy bear hunt, Easter egg hunt, online church/mosque etc activities, online arts or cultural events e.g. ballet, theatre, waiata)

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Percentage of responses Involvement frequency

Always

Often

Sometimes

Almost never

Never

I don’t know

Figure 15: Community involvement during lockdown

Given previous research demonstrates the importance of such engagement for other areas of life such as schooling (32), reports of community participation were compared to school satisfaction scores. As seen in Figure 16, school satisfaction scores differed across levels of community involvement during lockdown. Children who indicated

always being involved in community activities during lockdown had significantly higher school satisfaction scores compared to all other groups (as indicated by Welch’s t-test). Frequent participation in community activities was associated with an increased enjoyment and liking of school during COVID-19 restrictions.

How much do you agree with the following?

Frequency of community involvement

Always

10.6

Often

9.6

Sometimes

9.1

Almost never

8.6

Never

I don’t know

8.9 5

10 School satisfaction score

Figure 16: Box and whisker plot of school satisfaction scores by children’s level of community involvement during lockdown

PART TWO: EDUCATION

3.9 Activities

3.9.1 Participation in activities

Activity engagement is a key asset for child and youth wellbeing, helping to shape identity, form relationships, and develop essential life skills (33). During COVID-19 restrictions, many children had the chance to spend more time doing various activities together with other members of their household bubbles.

The COVID-19 Wellbeing Survey asked children about the types of leisure activities they did with others in their household bubbles (Figure 17). Eightyfour percent (n=1856) had others in their bubble involved in their school work several times a week or more. Many children expressed their enjoyment of having more time to do activities with those in their bubble, as indicated in the quote below.

KEY FINDINGS: • A large proportion of children (84%) had people in their bubble involved in their school work several times a week or more.

WHAT ARE THE BEST THINGS ABOUT LOCKDOWN?

“…going out for walks everyday with my mum, baking more with my family, and doing activities too.”

• Ninety-six percent of children regularly shared a meal with their bubble. • Increases in participation across all reported activities related to an increase in school satisfaction, with the exception of watching TV/movies.

Questionnaire item

How often do you do the following activities with the people in your bubble during the lockdown? Eating a meal together

96%

Doing or talking about home/schoolwork

16%

84%

Outdoor sporty activities together

21%

79%

Watching TV/movies together

24%

76%

Doing chores or housework together Singing a song, playing music, or some sort of other musical activity Drawing a picture or doing another craft/activity

31%

69%

45%

55%

45%

55%

Reading a book together

54%

46%

Baking or cooking together

55%

45%

Talked about feelings, or issues

66%

34%

100

50 Response

0 Percentage

Never/almost never I don’t know

Once a week Several times a week

100

Once a day Several times a day

Note: Percentages represent the proportion of children who reported categories on each side of the centre line.

Figure 17: Bubble activities during lockdown community involvement during lockdown Ninety-six percent (n=2120) of children indicated they shared a meal together with their bubble frequently during lockdown. Shared meal times have been found to create greater opportunities for sharing during childhood and adolescence (34). However, 66% (n=1449) of children in this study did not talk about their feelings or issues frequently with those in their bubble despite the vast 26

Growing Up in New Zealand COVID-19 Wellbeing Survey

majority sharing a meal often. It may be that children were turning to others outside their bubble for emotional disclosure. Alternatively, lockdown restrictions may have had negative repercussions for children, in which case strategies for supporting children’s self-disclosure may be needed in future crises given this can promote mental and emotional wellbeing.

3.9.2 Activity participation and school satisfaction Activities during lockdown were also compared to school satisfaction scores. Figure 18 shows how the frequency of various activities a young person participated in during lockdown related to overall school satisfaction: • Increased participation levels across all activities related to an increase in school satisfaction, with the exception of watching TV/movies together in which there was no relationship. • High involvement in reading, and cooking/baking with people inside their bubble (multiple times per day) corresponded with the highest levels of school satisfaction (mean scores=10.5 and 10.6, respectively).

Watching TV/movies together

There is a clear relationship between frequency of activity participation with others and school satisfaction, with engaging in these activities once a day or more positively contributing to school satisfaction. These findings give insight into factors that supported enjoyment of school during lockdown and align with previous research suggesting that both family involvement and activity participation is associated with positive child and youth development and enhanced wellbeing (33,35).

8.7

9.2

9.4

9.6

10.1

8.9

9.1

9.4

9.6

9.7

Reading a book together

8.6

9.1

9.7

9.4

10.5

Outdoor sporty activities together

8.3

9.4

9.1

9.6

9.4

Eating a meal together

9.2

8.5

8.8

8.9

9.6

Drawing a picture or doing another craft/activity

8.3

9.2

9.5

9.6

10.1

Doing or talking about home/schoolwork

7.9

8.1

9.1

9.4

9.8

9.1

9.5

9.3

9.8

8.5

9.2

9.4

9.5

10.6

Never/almost never

Once a week

Talked about feelings, or issues Singing a song, playing music, or some sort of other musical activity

Questionnaire item

• Children who never/almost never engaged in homework or housework with others in their bubble generally saw the lowest levels of school satisfaction (mean scores=7.9 and 8.0, respectively).

Doing chores or housework together Baking or cooking together

Once a day Several times a week Response Note: School satisfaction scores range from 0 – 18.

Several times a day

Figure 18: Mean school satisfaction with participation in various activities during lockdown

PART TWO: EDUCATION

3.10 Device Use

3.10.1 Apps used in lockdown

Internationally, device-based activities increased substantially during COVID-19 restrictions as other extracurricular and recreational activities were suspended (36, 37). This section explores the apps and screen-based activities Aotearoa New Zealand children used during lockdown.

Children were asked about the apps they used in lockdown (Figure 19). The most commonly used apps were YouTube (76%, n=1675), Google Hangouts (38%, n=842), TikTok (33%, n=718), and Facebook Messenger (23%, n=515). As the children in the GUiNZ cohort advance into the adolescent years, an upswing in social media use is expected. Many children were using TiKTok and many other apps that are not permitted until they are 13+ years of age, emphasising the need for increased cyber-safety knowledge for children and young people—particularly if COVID-19 and the associated lockdowns have accelerated the uptake of social media among children approaching adolescence.

KEY FINDINGS: • YouTube was the most popular app used by children in lockdown (76% of children used this app). • Sixty-seven percent of children used devices every day for school/homework. YouTube

1675 (76%)

Hangouts

842 (38%)

TikTok

718 (33%)

Messenger

515 (23%)

Application

278 (13%)

SnapChat

245 (11%)

Instagram

195 (9%)

Houseparty

171 (8%)

None

109 (5%)

Facebook

71 (3%)

Twitter

22 (1%)

500

1000 Number of Children

1500

2000

Figure 19: Apps used by children in lockdown 3.10.2 Frequency of screen-based activities Children used devices for a wide range of screen-based activities during lockdown (Figure 20). • Sixty-seven percent (n=1500) and 60% (n=1348) of children used devices every day for school/homework and watching TV/videos respectively. • Most children (85%, n=1896) played video games at least once a week. Video gaming was a source of social connection too, with 73% (n=1619) reporting playing video games with others at least one a week or more. • Devices were seldom used for trading or buying stuff, making music, or programming.

Growing Up in New Zealand COVID-19 Wellbeing Survey

Almost all children (95%, n=2144) were using devices for school/homework at least once a week. However, a small percent of children (5%, n=163) rarely used devices for school/homework during the lockdown period. These children may have had alternative ways of doing schoolwork that did not involve devices, but considering most schooling shifted to an online delivery mode, a more likely explanation is that both uptake and access to schoolwork varied for some children in Aotearoa New Zealand. Further investigation into whether there were systemic barriers preventing effective engagement with online schooling is warranted to identify gaps in schooling throughout the pandemic, and to ensure equitable access to schooling in the future.

During lockdown, how often have you been doing the following things using a screen-based device? 4%

95%

Watching TV/videos

95%

Internet surfing

89%

Phone/video calls

86%

Playing videogames

85%

Playing videogames with others

73%

Listening to music

69%

Emails

68%

Taking photos

61%

Instant messaging

16%

55%

Writing a story/poem

21%

52%

Using social media

24%

40%

Other

31%

39%

Making digital art

45%

33%

Making or editing film or video

45%

29%

Programming

54%

19%

Making music

55%

14%

Trading or buying stuff

66%

Device activity

School/homework

100

50 Response

Hardly ever/never I don’t know

0 Percentage About once a month About once a week

100

Several times a week Every day

Note: Percentages represent the proportion of children who reported categories on either side of the centre line.

Figure 20: Frequency of screen-based activities

PART TWO: EDUCATION

4. Longitudinal Findings KEY FINDINGS:

The previous sections have reported the experiences of children in Aotearoa New Zealand during COVID-19 lockdown restrictions. Collated information about this cohort from earlier data collection waves provides an opportunity to make comparisons between time points. Findings related to questions from the COVID-19 Wellbeing Survey about activities, screen time, and school are compared to the same questions asked at the eight-year DCW to determine change over time. Findings are related to various demographic characteristics to explore the nuances of this change. The upcoming GUiNZ 12-year DCW will also be important for enabling these findings to be further explored to understand the longer term impact of COVID-19.

• Between eight-year and lockdown, there was a 21% increase children doing outdoor sporting activities with their family once a day. • Children reported a 23% increase baking or cooking with someone in their family several times a week in lockdown. • There was a 34% increase of children stating that they never or almost never talked about their feelings. Figure 21 shows the increase and decrease between frequency of activity participation. There was a 21% increase in children doing outdoor sporting activity with their family once a day since eight years of age. With children’s regular sporting activities (e.g., organised sport through schools and clubs) being postponed and many family members working from home, the lockdown restrictions likely allowed for more time for shared outdoor activities to be done at home or in local parks (e.g., backdoor cricket).

4.1 Comparisons of Activity Participation At both the eight-year DCW and lockdown, activities (e.g., reading, outdoor sporting activity, and chores) that the children participated in with their family were reported. Analyses were undertaken to explore the change in activity participation across the DCWs.

34%

-26%

-9

-8

Singing a song, playing music, or some other musical activity

-10%

-8%

Reading a book together

14%

-6%

-9%

-6%

Outdoor sporty activities together

-2%

-25%

-8%

21%

15%

Drawing a picture or doing another art/craft activity

-17%

15%

10%

Doing or talking about home/schoolwork

-6%

-16%

-8%

26%

Doing chores or housework together

-7%

-20%

-4%

17%

15%

Baking or cooking together

-18%

-12%

23%

Never/almost never

Once a week

Several times a week Response

Once a day

Several times a day

Questionnaire item

Talked about feelings, or issues

Figure 21: Difference in activity participation between eight-year and lockdown 30

Growing Up in New Zealand COVID-19 Wellbeing Survey

There was a 26% decrease in frequency of talking about feelings and issues several times a week, and a 34% increase of children stating that they never or almost never talked about their feelings. As suggested in section 3.8 (Positive Experiences), it is likely this is, at least in part, related to the pre-adolescent developmental stage where peer relationships are becoming increasingly important in terms of self-disclosure, emotional support, and openness, sometimes more so than family relationships (29). The frequency of talking about feelings and issues between eight-year and lockdown was also examined across demographic groupings. There was no significant difference by gender, socioeconomic position, or bubble size. In terms of ethnicity, Asian children reported a greater decline between age eight and lockdown than other ethnic groups. These findings warrant further investigation to establish why this decline was particularly greater for these children (e.g., they may have had others outside their household bubble they were sharing with instead). Comparisons between activity participation during the lockdown and eight-year DCWs need to be interpreted with caution. While they may be attributed to the unique circumstances of COVID-19 restrictions, differences may also be due to the older age of the cohort at the lockdown survey, different perceptions of involvement (i.e., motherreport versus child-report), or the wider range of people in the bubble. Indeed, the higher frequency of engagement in chores may well be due to children perceiving their own contribution as much higher than their mothers’ perception. Nevertheless, the much higher frequency reported by children in terms of not talking about their feelings is notable and potentially concerning.

4.2 Screen Time Three in ten (n=661) children reported less than three hours of screen time per weekday during the lockdown,

with around one in five (n=452) children reporting six or more hours of screen time per week day. Figure 22 shows a histogram of weekday screen time and weekend screen time, with the overlap represented by the darker blue colour. On average, children spent more time on their devices during weekdays compared to weekends; likely a function of high levels of device use for schoolwork on weekdays. The exception was for children living in high deprivation areas who reported almost no difference in screen use between weekdays and weekend days. Screen time during lockdown was compared to mothers’ reports of their children’s screen time at eight-yearsold. On average, children at age eight spent 2.2 hours in front of screens during the weekdays and 1.5 hours on the weekend days. This screen time increased during lockdown with children reporting an average of 4.8 hours of screen time per day during the weekdays and an average of 4.0 hours for the weekend days. Much of this increase may be attributed to most schoolwork moving to online delivery during lockdown. Additionally, increased screen time hours are consistent with figures observed in Australian children of a similar age, so may be typical of screen use at this life stage (36). At age eight there was a statistically significant difference in screen time according to socioeconomic position (Table 3), with children from the highest neighbourhood deprivation grouping (Quintile 5) reporting a higher average screen time of 2.6 hours per weekday and two hours per weekend day, relative to those in other deprivation groups. In contrast with age eight, during lockdown, children living in areas with the least socioeconomic deprivation (Quintile 1) reported the highest screen time during the weekdays, with an average of five hours a day. Weekend screen use patterns during lockdown were more aligned with age eight, with children from higher deprivation areas (Quintile 5) reporting the highest average of 4.5 hours on the weekend days.

20%

Responses

15%

10%

0 hours

<1 hour

1-2 hours 2-3 hours 3-4 hours 4-5 hours 5-6 hours 6-7 hours 7-8 hours 8-9 hours 10+ hours

Daily hours Type

Weekday

Weekend

Figure 22: Time spent on screens during weekdays and weekends in lockdown PART TWO: EDUCATION

Table 3: Average hours of screen time at eight-year and lockdown by area-level socioeconomic deprivation quintile (NZDep2013). Eight-year Weekday

Weekend

Weekday

Weekend

NZDEP Quintile 1 (lowest deprivation)

2.1

1.4

5.0

3.9

NZDEP Quintile 2

2.0

1.5

4.7

3.8

NZDEP Quintile 3

2.2

1.5

4.7

4.0

NZDEP Quintile 4

2.4

1.7

4.6

4.1

NZDEP Quintile 5 (highest deprivation)

2.6

2.0

4.6

4.5

The finding that weekday device use increased much less for children living in areas in the highest deprivation quintile (2 hours compared with 2.5-3 hours for the lowest 3 quintiles) may reflect different approaches to teaching and learning in lockdown by different schools— those in higher deprivation areas may have been more likely to opt for more hard copy learning options in response to publicised issues around lack of device access for some children (38). However, children were not explicitly asked about the reasons for time spent in front of screens, so caution is needed when interpreting these conclusions.

4.3 Comparisons of School Satisfaction Collated information about this cohort from the eightyear DCW provides an opportunity to make comparisons between school satisfaction scores during lockdown restrictions. As described in previous sections, children were asked about their school satisfaction at age eight and again during the COVID-19 Wellbeing Survey. KEY FINDINGS:

Response Frequency

• School satisfaction was lower during lockdown compared with at age eight for just over threequarters of the cohort.

• Tamariki Māori experienced the largest decline in average school satisfaction, while children of Asian and Pacific ethnic groups reported the smallest declines. • School satisfaction scores tended to be higher for children in larger bubbles, and declines tended to be smaller. • Device usage (especially weekend use) was associated ith lower school satisfaction at both age eight and during lockdown. Considerable declines between these two time points are evident. Differences in scores for the COVID-19 Wellbeing sample at eight-year and lockdown DCWs are presented in more detail in Figure 23, where the overlap is represented by the darker brown colour. This histogram shows the decrease in school satisfaction during lockdown across the full cohort of children who responded to the COVID-19 Wellbeing Survey (note: the participants shown are matched; 87% (n=2099) of those who took part in the survey about lockdown had responded to the school satisfaction scores at age eight). Overall school satisfaction scores dropped markedly between the eight-year DCW (mean=11.7) and the COVID-19 Wellbeing Survey (mean=9.4).

300

200

100

School satisfaction Group

Lockdown

Figure 23: Histogram of school satisfaction at eight-year and lockdown 32

Lockdown

Growing Up in New Zealand COVID-19 Wellbeing Survey

8 year

Of the children who had school satisfaction scores at both timepoints, 76% (n=1604) experienced a decrease in satisfaction since age eight. Given the considerable change to schooling modality, it is understandable that school satisfaction declined for the majority of children. Adapting to online and distance learning appears to have been challenging for many children. However, it is noteworthy that many children continued to report high satisfaction and one in four children (n=495) reported an increase in school satisfaction between age eight and lockdown. Responses to the open-ended questions indicate that some children enjoyed the flexibility of the distance learning routine, having increased independence, and more free-time during lockdown, as exemplified in the quotes below. Interestingly, there were no differences in the likelihood of increased or decreased school satisfaction by demographic groupings (socioeconomic position, gender, ethnicity, or bubble size). WHAT ARE THE BEST THINGS ABOUT LOCKDOWN?

“I get to wake up later because I don’t have to leave early for school.”

4.3.1 Comparisons of schooling across sociodemographic characteristics School satisfaction scores were analysed across different sociodemographic groupings at age eight and lockdown. Changes between these time points were also assessed. Gender For both the eight-year and lockdown DCWs boys generally had lower school satisfaction than girls. The difference in school satisfaction between boys (-2.4) and girls (-2.2) remained fairly similar between the two DCWs, indicating that the decline in school satisfaction was similar for both genders. Socioeconomic position The spread of school satisfaction scores were broadly similar across Aotearoa New Zealand deprivation quintiles, with the exception of Quintile 4 (NZDep2013 groups 7–8) which had a significantly larger decline in mean satisfaction than all other quintiles (-2.8; see Figure 24).

“Distance learning. Organising myself to change from a normal school routine to being independent at home using devices to do daily school work.” “Having time to yourself and getting school work done in my own time.”

Lockdown

8 Year

9.8

12.1

Difference -2.2

NZDEP index quintile

Quintile 5

-2.8

Quintile 4 9.1

11.9 -2.1

Quintile 3 9.4 Quintile 2

11.5

9.4

-2.3

11.7

-2.2

Quintile 1 9.3 8

11.6 10

11 School satisfaction

Figure 24: Change in school satisfaction between eight-year and lockdown by socioeconomic position PART TWO: EDUCATION

Ethnicity

respectively—a significantly smaller decline compared to Māori, European, and children of other ethnicities.

Figure 25 displays the mean scores for each ethnic group at both timepoints and shows the difference between these school satisfaction scores. At age eight, school satisfaction was broadly similar across ethnic groups. There were marked declines reported for each ethnic group during lockdown but the degree of decline differed between groups. Tamariki Māori experienced the largest decline in mean score, with a decrease of 2.6 points. Children in the European and Other ethnic categories also saw a substantial decline in mean score, with decreases of 2.5 and 2.4 respectively. Children of Asian and Pacific ethnic groups saw the smallest relative decreases, with drops in mean school satisfaction scores of 1.7 and 1.6

For Pacific children, higher levels of school satisfaction in lockdown may relate to the larger network available within the bubble for many children. Pacific children, on average, reported larger bubble size (see section 3.4) and this face-to-face social interaction may have acted as a protective factor against lower school satisfaction. Indeed, previous research finds social connectedness to be key factor in school satisfaction—one that fosters more enjoyment in children’s learning (39). Further investigation of schooling experiences across ethnic groups is warranted to more extensively understand the reasons for ethnic differences in school satisfaction, particularly given the sample bias (see Appendix D).

Lockdown

8 Year

9.3

11.6

Difference -2.4

European

-2.6

Ethnicity

Māori 9

11.6 -1.6

Pacific 10.3 Asian

11.9

10.2

-1.7

11.9

-2.5

Other 9 8

11.5 10

11 School satisfaction

Figure 25: Change in school satisfaction between the eight-year and lockdown by ethnicity

Growing Up in New Zealand COVID-19 Wellbeing Survey

Bubble size In terms of bubble size, school satisfaction scores tended to be higher for children in larger bubbles (see Figure 26), and declines tended to be smaller across the two timepoints. These children may have benefited from the greater face-to-face socialisation that came with having larger bubbles and positioned them to take greater

enjoyment from distance learning. For those in a bubble size of two, school satisfaction declined markedly, and significantly more than those in larger bubbles, especially compared with bubbles of 7 – 8+ people. Children in bubbles of sizes 3 – 6 people generally had similar school satisfactions to both each other and the overall mean.

Lockdown

8 Year

11.8

Difference -1.8

-1.5

Bubble size (including child)

7 9.8

11.3 -2.5

6 9.4

12 -2.4

5 9.3

11.7 -2.3

4 9.4

11.6 -2

3 9.5

11.5

-3.2

2 8.6

11.8

11 School satisfaction

Figure 26: Change in school satisfaction between eight-year and lockdown by bubble size Disability Children generally saw similar declines in school satisfactions between time points regardless of the type and whether they had a disability or not (Figure 27). Additionally, there was no significant difference across group means (as indicated by the ANOVA test statistic).

Lockdown

8 Year

9.5

11.7

Disability type

Difference -2.2

Vision concerns No concerns have been raised

-2.2 9.5

Learning disabilities

11.8 -1.8

8.8

10.6

Hearing/ speech concerns

9.2

Behaviour concerns

-2.3

11.5

-2.8 8.1 8

10.9 9

11 School satisfaction

Figure 27: Change in school satisfaction between eight-year and lockdown by disability

PART TWO: EDUCATION

Bullying at age eight At age eight, children were asked how frequently they were bullied by other students at school. These reports were compared to school satisfaction scores at lockdown to understand if this bullying was having lasting effects on schooling over time. Figure 28 shows school satisfaction declined a similar amount for each group, with no differences relative to the level of bullying

Bullying frequency

Never/ hardly ever

at age eight. However, when examining differences in school satisfaction at lockdown only, those who indicated they were never/hardly ever bullied maintained significantly higher school satisfaction than those who were. It is likely that experiences of bullying at age eight had persistent effects into lockdown.

Lockdown

8 Year

9.5

11.8

Difference -2.3

1 or 2 times a year

-2.5 9.1

11.5

1 or 2 times a month

-1.8 9.7

1 or 2 times a week

11.6

9.1

Almost every day

-2.3

11.4

-2 8.7 8

10.8 9

11 School satisfaction

Figure 28: Change in school satisfaction between eight-year and lockdown by bullying frequency at age eight Screen time School satisfaction and screen time were examined longitudinally at age eight and lockdown. Children were grouped into categories depending on their reported screen time at both time points. These groups were examined in regard to school satisfaction scores over time. For weekday screen use, analyses revealed the decline in school satisfaction scores was slightly

larger for those reporting <2 hours of daily weekday use, compared to those in other usage groups. However, generally the decline over time was similar across groups (Figure 29). There were no significant differences in mean score at lockdown, and a weak negative relationship between school satisfaction and screen time at age eight.

Lockdown

8 Year

9.1

11.2

Difference -2.1

>10 hours

-2.2

Hours of daily weekday device use

7-8 hours 8.7

10.9 -2.2

6-7 hours 9.2

11.4 -2.5

5-6 hours 9.4

11.9 -2.2

4-5 hours 9.5

11.7 -2.1

3-4 hours 9.7

11.8

9.6

11.7

-2.1

2-3 hours

-3

1-2 hours 9

12 -2.7

<1 hour 9.4

12.1

-3.1

0 hours 8.2 8

11.4 9

11 School satisfaction

Figure 29: Change in school satisfaction between eight-year and lockdown with weekday device usage 36

Growing Up in New Zealand COVID-19 Wellbeing Survey

As indicated in Figure 30, a decline in school satisfaction was evident as weekend screen time increased at both the eight-year DCW and lockdown DCW. No significant differences in the amount of decline in school satisfaction between the two time points were observed across different weekend screen usage groups.

Lockdown

8 Year

9.1

10.9

Difference -1.8

>10 hours

-2.6

Hours of daily weekend device use

7-8 hours 8.3

10.9 -3

6-7 hours 8.9

11.9 -2.5

5-6 hours 9.2

11.6 -2.7

4-5 hours 9.1

11.8 -2.1

3-4 hours 9.4

11.6 -2.2

2-3 hours 9.6

11.8 -2.1

1-2 hours 9.7

11.8 -2.1

<1 hour 9.9

-2.6

0 hours 9.7 8

12.2 10

11 School satisfaction

Figure 30: Change in school satisfaction between eight-year and lockdown with weekend screen usage This section has provided a detailed account of the demographic differences in the school satisfaction scores compared with school data collected at age eight. Overall, there were marked declines in school satisfaction. However, when asked about what they were most excited for when lockdown was over, many children expressed their excitement for returning to school, as indicated opposite.

WHAT ARE YOU MOST EXCITED FOR WHEN LOCKDOWN IS OVER?

“Getting back to school and playing on playground and seeing other kids.”

PART TWO: EDUCATION

5. Discussion The COVID-19 Wellbeing Survey was designed to hear directly from children in Aotearoa New Zealand about their life during lockdown. The findings provide a snapshot of the experiences of the 2,421 children who participated in the survey during some of the strictest COVID-19 restrictions. Insights into their COVID-19 ‘bubbles’, activities, home life, school, media and screen use, and connectedness are provided. The data from the survey were also linked to data collected in previous GUiNZ DCWs to contextualise these experiences. The findings from the COVID-19 Wellbeing Survey add to the current understanding of the impact of COVID-19 lockdowns on children in Aotearoa New Zealand. The results align with other Aotearoa New Zealand studies (13, 14, 40), and confirm some of the positive aspects of lockdown such as increased family time, and more self-regulated and autonomous learning. Negative experiences of lockdown such as decline in schooling also resonate with other findings (41, 42). Importantly, the COVID-19 Wellbeing Survey was able to provide a comparison with the same children at age eight, which is valuable in itself, but alongside other data can deepen our understanding of the current short-term effects and provide insight into possible longer-term issues. In line with a study conducted with parents of Māori and Pacific students (43), one of the key issues brought to light in this report is the exacerbation of existing social and educational disparities. Yet, both studies found larger household ‘bubbles’ to be a protective factor for students’ learning—an insight for policy in terms of a supportive schooling experience for students who are often underserved in Aotearoa New Zealand. The finding of children reporting more outdoor activities with their families during lockdown suggests positive daily routines of physical activity were being implemented during lockdown restrictions. However, this finding also raises concerns about these routines being lost when normal patterns of life are resumed. Similarly, simple moments of quality family interaction, such as baking together, may also be lost in the return to pre-lockdown daily routines. Differently, when examined with school satisfaction, these findings hint 38

Growing Up in New Zealand COVID-19 Wellbeing Survey

at the links between family and home activities and school engagement that are worth considering. The digital divide is another area of concern that has consistently been raised in other Aotearoa New Zealand studies (14). These findings provide a tangible finding that could readily be addressed. Largely, the results in this report suggest that, despite these strict lockdown restrictions, families were able to create positive environments and experiences for children. For example: • Eighty-eight percent of children felt supported by their family during the pandemic restrictions. • Almost all children (96%) regularly shared a meal with their family. • A large proportion of children (84%) had people in their bubble involved in their school work several times a week or more. • Since age eight, there was a 21% increase in children doing outdoor activities with their family once a day. • Engaging in activities at least once a day corresponded with higher school satisfaction scores. This observation was evident across a wide range of activities including household chores, sports, and baking or cooking. Children displayed an impressive ability to adapt to the dramatic changes to everyday life and work with the challenges of distance-learning and being socially distanced from friends and family. For instance: • Despite the abrupt change to school modality, many children (64%) still reported feeling connected to their school or kura often or always. • Responses to open-ended questions indicated some children enjoyed the flexibility to the distance learning routine, having increased independence, and more free-time during lockdown. • Most children stayed in frequent (virtual) contact with others, with 86% categorised as ‘moderately’ or ‘more’ connected to friends and family outside of their household bubbles.

However, for many children lockdown created significant challenges and deepened existing inequities. For example: • Tamariki Māori experienced the largest decline in mean score of school satisfaction between age eight and lockdown. • Those who indicated they were bullied at age eight had significantly lower school satisfaction scores than those who were never/hardly ever bullied. • A large proportion (45%) did not feel they had someone they could share their feelings with very often. • Since age eight there was a 26% decrease in frequency of talking about feelings and issues several times a week, and a 34% increase of children stating that they never or almost never talked about their feelings. As the COVID-19 pandemic continues, the ongoing monitoring of children is essential for understanding the impacts of the pandemic and implement strategies to reduce harmful effects. Additionally, understanding the positive implications of the pandemic and associated restrictions can reveal important learnings to taken forward into post-pandemic ways of life. Hearing from children themselves, and their diverse experiences, is key for the designing of strategies and supports to be implemented by government and agencies.

Implications Although the results may not be generalisable to the experiences of all children in Aotearoa New Zealand, the findings from this report provide much needed information to guide further development of appropriate response strategies to support children, families and whānau throughout and after the pandemic. Moving forward, policy makers may wish to think about how these findings can be taken to: Support families to continue to connect with each other Children and their families and whānau demonstrated tenacity in the face of adversity. In contrast with initial concerns, many were able to create home environments and experiences that saw the majority of children in this study reporting lockdown as a largely positive time. These experiences and the connection between families and whānau had positive implications for satisfaction with schooling during lockdown, particularly for those in larger household bubbles. Supporting families to continue to connect with each other in the ways they did during lockdown is a promising avenue for enhancing learning. In particular, facilitating family participation in community activities, and arts and cultural events may boost successful schooling experiences.

Tailor post-pandemic strategies to children with differing experiences This report has highlighted the very different experiences of lockdown for children in Aotearoa New Zealand. Differences across sociodemographic characteristics were evident, for example, across school satisfaction scores, device use, and connectedness with friends and family outside of household bubbles. Postpandemic strategies targeted towards children should be tailored and appropriately reflective of the vast range of experiences during the pandemic. Identify additional emotional and social supports Many children reported social and emotional experiences that are concerning and indicate they may not have been receiving the support they required during lockdown. Given learnings about the long-term consequences of traumatic events on children’s lived for example, from the Canterbury earthquakes, the social and emotional challenges children faced during lockdown is of concern. The fact that many children felt they were rarely listened to, may not have had enough opportunities to share their feelings and issues with others, and some had increased anxiety over money, are all factors that need ongoing monitoring. Existing programmes that were in in place in Canterbury post-earthquakes, such as Mana Ake, provide a good model for school-based social and emotional support for children and their families and whānau. Other trauma-informed schooling, artsbased or social and emotional approaches could be integrated into school programmes to provide support and continue to foster resilience to future crisis events. Implications for schooling This shift to online- and distance-based learning happened swiftly and on an untested scale, requiring rapid trial and error accompanied by uncertainty from many teachers, schools, and children. As the New Zealand Government and schools reflect on this process and strategise for the future, the findings from this report may add some valuable suggestions. Results point to these children having very different experiences of schooling in lockdown. For example, children in larger bubbles generally saw higher levels of school satisfaction whereas children in bubble sizes of two (including the cohort child) tended to have the lowest scores. Out of all ethnic groups, tamariki Māori experienced the largest decline in

PART TWO: EDUCATION

mean score of school satisfaction between age eight and lockdown, and also had the lowest average satisfaction. Investigation of the specific systemic factors responsible for these differing schooling experiences during lockdown is needed to ensure COVID-19 does not further exacerbate existing inequities. Experiences of bullying at age eight was found to have a lasting effect on school satisfaction during lockdown, with those who indicated they were never/hardly ever bullied at eight-years-old having significantly higher school satisfaction scores than those who were bullied. Whether this bullying has persisted since the children were eight years old and throughout lockdown, or if earlier experiences of bullying are having lasting effects, is unclear. Either way, bullying prevention and response strategies need to be examined and children who experience bullying require targeted support. It should be noted that increased screen time and device use by children was observed. This potentially increased the pervasive nature of cyberbullying where in-person forms of bullying were not occurring (44). Further research is needed to understand bullying during lockdown and the effects of bullying generally in more detail. Meaningful interventions need to be enacted to mitigate these effects of bullying on learning and other aspects of child wellbeing.

Growing Up in New Zealand COVID-19 Wellbeing Survey

Results from this study point to device use increasing substantially since age eight. Given the lockdown restrictions, age of the children, and learning shifting predominantly online, this increase in screen time was not unexpected. However, results in this report suggest that device access may have been more limited for children from lower socioeconomic areas. Strategies to ensure equitable access to devices and online schooling options are needed. Finally, many children reported high feelings of connectedness to school despite distance learning. Additionally, several children responded to the open-ended questions with comments about the enjoyment and freedom flexible learning gave them. Given these positive results, schools and children should be commended for their efforts to adjust to a highly challenging set of circumstances. These findings also suggest providing new ways to give children more flexibility, independence, and free time, and autonomy to self-regulate their learning where they require and request it may be of value.

6. Strengths and Limitations A strength of the GUiNZ longitudinal cohort study is having the ability to compare data from before COVID-19, to the data collected during the pandemic to understand the experiences of COVID-19 in light of earlier context. Comprehensive data were available for many variables of interest from previous DCWs, meaning recall bias was minimised. The ability to calibrate the COVID-19 findings to baseline data from previous DCWs is unique to the GUiNZ study within the Aotearoa New Zealand context. Other Aotearoa New Zealand research on the experiences and wellbeing of children at the time of the pandemic has been cross-sectional in design and unable to compare to baseline reports from before the COVID-19 lockdown. However, some of the observed changes are likely to be confounded with the cohort’s increasing age and not solely attributable to factors relating to the pandemic. Thus, the long-term impact of COVID-19 on the GUiNZ children and their families/whānau will be able to be more fully understood in future DCWs. However, almost two thirds of the cohort did not participate in the survey. As an opportunistic survey, it was not expected that all children in the GUiNZ cohort would be reached, so it was anticipated that the sample may not be representative of the full cohort and Aotearoa New Zealand children in general. In particular, response bias was evident across sociodemographic groupings meaning specific findings related to subgroups may not be representative. This survey was also the first attempt at an online DCW with the children in the GUiNZ cohort. The response rate of 42% is considered high for a digital survey (16), and provides preliminary evidence as to the potential for successful utilisation of digital technology in future DCWs. However, there was differential engagement with the online survey by demographic characteristics including ethnicity and deprivation levels. Considering this information along with some non-response likely due to digital inequity, there is need to further explore connectivity and barriers to digital engagement as the study engages more directly with the cohort of ‘digital natives’.

The data collection processes utilised for the eightyear DCW and the COVID-19 Wellbeing Survey were also different, with face-to-face interviews used for the eight-year DCW, compared to a remote, self-completed online survey for the COVID Wellbeing Survey. This difference in data collection methods may have impacted on the ability of the data to be compared across DCWs. Additionally, some of the data on the same measures compared over time were phrased slightly differently and/or informed by different participants (i.e., mother reported at eight-year and child reported at lockdown). How these different questions were interpreted over time and by the different informants may have varied. Therefore, these findings should be interpreted with some caution. The data are self-reported and therefore subject to some degree of bias. For example, more objective measures of activity involvement, screen and media use, and household dynamics may not align with the self-reported measures and some questions may be impacted by social desirability bias. However, as this survey sought to understand the experiences of children during the COVID-19 lockdown, the best way to collect this data was from the children themselves. Consequently, self-report measures were deemed the most appropriate tool for this study. Finally, the instrument used to measure school satisfaction has not been validated in children aged 10-11 years within an Aotearoa New Zealand sample. Preliminary testing of the instrument in analyses for this report suggested the scale has good reliability (as indicated by a high Cronbach alpha value of 0.9). However, further invariance testing and validation of the tool is needed to ensure the validity of the results in this report.

PART TWO: EDUCATION

7. Future Directions This survey was administered opportunistically during the time of an unexpected global pandemic and a strict national lockdown period in Aotearoa New Zealand. The advantage of the survey was that it utilised an existing cohort of children with well-characterised demographic, home-life, school, and wellbeing information. The intent of the survey was to capture a snapshot of life during this high stress time, through the eyes of the children themselves. Future DCWs will be important to assess the on-going and long-term impact of the COVID-19 pandemic and associated lockdowns for children and their families. In particular, the upcoming 12-year DCW will collect data from the GUiNZ cohort in 2021/22. The longitudinal analyses in this report are focused on comparing responses to the COVID-19 Wellbeing Survey with the eight-year data. The eight-year DCW was the most recent DCW to the COVID-19 lockdown and therefore, provided the most proximal data for comparison. Future work could explore the longitudinal analyses in this report in more detail, using data from earlier GUiNZ DCWs.

Growing Up in New Zealand COVID-19 Wellbeing Survey

Acknowledgements We are incredibly grateful to the children and families who are a part of the Growing Up in New Zealand (GUiNZ) study. The significant contribution you make to the study and your continuous commitment to generously share your time and information is hugely valuable. Thank you for your trust and we recognise our responsibility to protect the information shared with us. The authors and contributors of this report are members of both the GUiNZ team and Ministry of Education. From the Ministry of Education: Analyst, Jonathan Kumarich. From GUiNZ: the Foundation Director (Professor Susan Morton), Professor Boyd Swinburn (Research Director), Named Investigators (Dr Kane Meissel, Associate Professor Elizabeth Peterson, Dr Pat Bullen, Dr John Fenaughty, Professor Clare Wall), Pacific Theme Lead (Seini Taufa), Māori Theme Leads (Dr Sarah-Jane Paine and Professor Te Kani Kingi), Associate Professor Natalie Walker, Senior Research Fellows (Dr Sarah Gerritsen, Dr Carin Napier), Research Fellow (Dr Fiona Langridge), Research Assistants (Molly Bergquist, Ashley Smith), Biostatisticians (Avinesh Pillai, Stephane Janicot), and Nandini Dubey (Medical Student). The authors also acknowledge that the content of this report is informed by experts in the specific research domains and themes for GUiNZ, and feedback from the Ministry of Social Development and Ministry of Education. Further information regarding the expert advisory team and study design is available on our website: www.growingup.co.nz This report would not be possible without the efforts of all those involved in the wider GUiNZ team to get the survey out into field. We acknowledge specifically Professor Susan Morton (Foundation Director), Annette Gohns (General Manager), Rina Prasad (Lead Data Manager), Carin Napier (Research Manager), Amelia Willems (Research Delivery Manager), Cherie Lovell (Interview Manager), Ash Smith (Research Assistant), Saraid Black and Kirsty Jones (Communications Managers). We also acknowledge Professor Carol Mutch who provided useful feedback on a draft of the report. We are grateful to Davanti Consulting who developed the online survey, enabling this questionnaire to be sent to the children.

We thank the key funders of GUiNZ, who contribute to the study’s sustainability and help to ensure that the information from the families contributes evidence to inform the policy environment in Aotearoa New Zealand. We thank the initial funders of GUiNZ, in particular the Ministry of Social Development, supported by the Health Research Council of New Zealand and the University of Auckland. Many government agencies contribute to the ongoing sustainability and utility of GUiNZ. We thank the Ministry of Social Development for management of the Crown funding of GUiNZ and acknowledge further funding and support received from the Ministries of Health and Education, as well as Te Puni Kōkiri, the Ministries of Justice and Business, Innovation and Employment, the Ministry for Pacific Peoples, the Ministry for Women, the Departments of Corrections and Labour, the New Zealand Police, Sport New Zealand, and the Office of the Health and Disability Commissioner. We also acknowledge the support of the Office of the Children’s Commissioner, Housing New Zealand, the Office of Ethnic Communities, Statistics New Zealand, and the Treasury. GUiNZ acknowledges the ongoing support and advice provided by the University of Auckland and Auckland UniServices Limited, as well as the advisory and governance groups of the study including all Named Investigators, the Steering Group, Policy Forum, our Expert Scientific Advisory Group, our Kaitiaki Group, our Pasifika Advisory Group, and our Data Access Committee. Further information about the GUiNZ, governance and design of this longitudinal study is available on our website: www.growingup.co.nz

PART TWO: EDUCATION

References 1. World Health Organization. Coronavirus disease 2019 (COVID-19) Situation Report—51. World Health Organization: 2020. Available from: https:// www.who.int/emergencies/diseases/novelcoronavirus-2019/situation-reports 2. Troeger C. Just how do deaths due to COVID-19 stack up? Washington, United States of America: 2021. Available from: https://www. thinkglobalhealth.org/article/just-how-do-deathsdue-covid-19-stack 3. Zhang Y, Zhang H, Ma X, Di Q. Mental health problems during the COVID-19 pandemics and the mitigation effects of exercise: a longitudinal study of college students in China. International Journal of Environmental Research and Public Health. 2020;17(10):3722. 4. Ministry of Health. COVID-19: Case demographics. Ministry of Health, Wellington: 2021. Available from: https://www.health.govt.nz/our-work/ diseases-and-conditions/covid-19- novelcoronavirus/covid-19-data-and-statistics/covid-19case-demographics 5. Ministry of Health. COVID-19: Elimination strategy for Aotearoa New Zealand. Ministry of Health, Wellington: 2021. Available from: https://www. health.govt.nz/our- work/diseases-and-conditions/ covid-19-novel-coronavirus/covid-19-responseplanning/covid-19-elimination-strategy-aotearoanew-zealand 6. Ministry of Health. COVID-19: Current Cases. Ministry of Health, Wellington: 2021. Available from: https://www.health.govt.nz/our-work/ diseases-and-conditions/covid-19- novelcoronavirus/covid-19-data-and-statistics/covid-19current-cases 7. New Zealand Government. History of the COVID-19 Alert System. New Zealand Government, Wellington: 2021. Available from: https://covid19. govt.nz/alert-levels-and-updates/history-of-thecovid-19-alert-system/ 44

Growing Up in New Zealand COVID-19 Wellbeing Survey

8. Baker MG, Wilson N, Anglemyer A. Successful elimination of Covid-19 transmission in New Zealand. New England Journal of Medicine. 2020;383(8):e56. 9. Fore HH. A wake-up call: COVID-19 and its impact on children’s health and wellbeing. Lancet Global Health. 2020;1(20):19–20. 10. Liu JJ, Bao Y, Huang X, Shi J, Lu L. Mental health considerations for children quarantined because of COVID-19. Lancet Child & Adolescent Health. 2020;4(5):347– 11. Saurabh K, Ranjan S. Compliance and psychological impact of quarantine in children and adolescents due to COVID-19 pandemic. The Indian Journal of Paediatrics. 2020;87:532-6. 12. Ravens-Sieberer U, Kaman A, Erhart M, Devine J, Schlack R, Otto C. Impact of the COVID-19 pandemic on quality of life and mental health in children and adolescents in Germany. European Child & Adolescent Psychiatry. 2021:1-1. 13. Office of the Children’s Commissioner. Life in Lockdown: Children and young people’s views on the nationwide COVID-19 level 3 and 4 lockdown between March and May 2020; 2020. Office of the Children’s Commissioner, Wellington. Available from: https://www.occ.org.nz/publications/ reports/life-in-lockdown/ 14. Educational Review Office. COVID-19: Learning in Lockdown; 2020. Educational Review Office, Auckland. Available from: https://ero.govt.nz/ourresearch/covid-19- learning-in-lockdown 15. Morton SM, Ramke J, Kinloch J, Grant CC, Carr PA, Leeson H, Lee AC, Robinson E. Growing Up in New Zealand cohort alignment with all New Zealand births. Australian and New Zealand Journal of Public Health. 2015;39(1):82-7. 16. Blumenberg C, Barros AJ. Response rate differences between web and alternative data collection methods for public health research: a systematic review of the literature. International Journal of Public Health. 2018;63(6):765-73.

17. Stats NZ. Ethnicity standard classification: Findings from public consultation November 2019. Stats NZ, Wellington: 2020. Available from www.stats.govt. nz.

28. Jenkins M, Hoek J, Jenkin G, Gendall P, Stanley J, Beaglehole B, Bell C, Rapsey C, Every-Palmer S. Silver linings of the COVID-19 lockdown in New Zealand. PloS one. 2021;16(4).

18. Callister P, Didham R, Potter D, Blakely T. Measuring ethnicity in New Zealand: developing tools for health outcomes analysis. Ethnicity and Health. 2007;12(4):299-320.

29. Brown B B, Larson J. Peer Relationships in Adolescence. Handbook of Adolescent Psychology. 2009;2(3):74–103.

19. New Zealand Government. Alert Levels and Updates. New Zealand Government, Wellington: 2021 Available from: https://covid19.govt.nz/alertlevels-and-updates 20. Ratuva S, Crichton-Hill Y, Ross T, Basu A, Vakaoti P, Martin-Neuninger R. Integrated Social Protection and COVID-19: Rethinking Pacific Community Responses in Aotearoa. Journal of the Royal Society of New Zealand. 2021;51(1):37–54. 21. New Zealand Government. Covid19: Government moving quickly to roll out learning from home. New Zealand Government, Wellington: 2021. Available from: https://www.beehive.govt.nz/release/ covid19-government-moving-quickly-roll-outlearning-home 22. Hirvonen R, Putwain D W, Maatta S, Ahonen T, Kiuru N. The Role of Academic Buoyancy and Emotions in Students’ Learning-Related Expectations and Behaviours in Primary School. British Journal of Educational Psychology. 2020; 90(4):948-63. 23. Reschly A, Huebner E S, Appleton J J, Antaramian, S. Engagement as Flourishing: The Contribution of Positive Emotions and Coping to Adolescents’ Engagement at School and with Learning. Psychology in the Schools. 2008;45(5),419–431. 24. Rowe EW, Kim S, Baker JA, Kamphaus RW, Horne AM. Student personal perception of classroom climate: Exploratory and confirmatory factor analyses. Educational and Psychological Measurement. 2010;70(5):858-79. 25. Department of the Prime Minister and Cabinet. Child Wellbeing Strategy; 2019. Department of the Prime Minister and Cabinet, Wellington: 2019. Available from: https://childyouthwellbeing.govt. nz/sites/default/files/2019-08/summary- childyouth-wellbeing-2019.pdf 26. Magson NR, Freeman JY, Rapee RM, Richardson CE, Oar EL, Fardouly J. Risk and protective factors for prospective changes in adolescent mental health during the COVID-19 pandemic. Journal of Youth and Adolescence. 2021;50(1):44-57. 27. Ryan R M, Deci E L. Self-Determination Theory and the Facilitation of Intrinsic Motivation, Social Development, and Well-Being. American Psychologist. 2000:55(1):68–78.

30. Liebenberg L, Ungar M, Vijver FV. Validation of the child and youth resilience measure-28 (CYRM-28) among Canadian youth. Research on social work practice. 2012;22(2):219-26. 31. The Guardian. ‘Bear hunt’ helps banish coronavirus boredom for New Zealand children. 2020. Available from: https://www.theguardian.com/world/2020/ mar/31/bear-hunt-helps-banish-coronavirusboredom-for-new-zealand-children 32. Lerner RM, Lerner JV, Almerigi JB, Theokas C, Phelps E, Gestsdottir S, Naudeau S, Jelicic H, Alberts A, Ma L, Smith LM. Positive youth development, participation in community youth development programs, and community contributions of fifth-grade adolescents: Findings from the first wave of the 4-H study of positive youth development. The Journal of Early Adolescence. 2005 Feb;25(1):17-71. 33. Wang MT, Degol J. Staying engaged: Knowledge and research needs in student engagement. Child Development Perspectives. 2014;8(3):137-43. 34. Fulkerson JA, Story M, Neumark-Sztainer D, Rydell S. Family meals: perceptions of benefits and challenges among parents of 8-to 10-yearold children. Journal of the American Dietetic Association. 2008;108(4):706-9. 35. Furrer C, Skinner E. Sense of Relatedness as a Factor in Children’s Academic Engagement and Performance. Journal of Educational Psychology. 2003;95(1):148–162. 36. Oberle E, Ji XR, Guhn M, Schonert-Reichl KA, Gadermann AM. Benefits of extracurricular participation in early adolescence: Associations with peer belonging and mental health. Journal of Youth and Adolescence. 2019; 48(11):2255-70. 37. Schmidt SC, Anedda B, Burchartz A, Eichsteller A, Kolb S, Nigg C, Niessner C, Oriwol D, Worth A, Woll A. Physical activity and screen time of children and adolescents before and during the COVID-19 lockdown in Germany: a natural experiment. Scientific Reports. 2020;10(1):1-2. 38. Radio New Zealand. COVID-19: Ministry of Education reveals support plans for distance learning. Radio New Zealand: Auckland: 2020. Available from: https://www.rnz.co.nz/news/ national/413763/covid-19-ministry-of-educationreveals-support-plans-for-distance-learning PART TWO: EDUCATION

39. Fredricks J A, Blumenfeld P C, Paris A H. School Engagement: Potential of the Concept, State of the Evidence. Review of Educational Research. 2004;74(1):59–109.

43. Riwai-Couch M, Bull A, Ellis B, Hall K, Nicholls J, Taleni T, Watkinson R. School-led learning at home: Voices of parents of Māori and Pasifika students. Auckland: Evaluation Associates Ltd; 2020.

40. Moore W, Andersen I. Insights from learners in lockdown. Auckland: Evaluation Associates Ltd; 2020. Available from https://www.evaluate.co.nz/ learnersinlockdownreport

44. Armitage R. Bullying during COVID-19: the impact on child and adolescent health. British Journal of General Practice. 2021;71(704):122.

41. Hood N. Learning from lockdown: What the experience of teachers, students and parents can tell us about what happened and where to next for New Zealand school system. Auckland: The Education Hub; 2020. Available from https:// theeducationhub.org.nz/learning-from-lockdowntrying-to-understand-the-variations-in-studentengagement/ 42. Hood, N. Learning from lockdown: Trying to understand variations in student engagement. Auckland: The Education Hub; 2020. Available at https://theeducationhub.org.nz/learning-fromlockdown-trying-to-understand-the-variations-instudent-engagement/

Growing Up in New Zealand COVID-19 Wellbeing Survey

45. Salmond CE, Crampton P. Development of New Zealand’s deprivation index (NZDep) and its uptake as a national policy tool. Canadian Journal of Public Health/Revue Canadienne de sante’e publique. 2012:7-11.

APPENDICES APPENDIX A: Additional detail related to the study methods.

This appendix describes the study design, data collection process, and survey questions in more detail than in the main body of the report.

Study Design An electronic survey (the COVID-19 Wellbeing Survey) was designed and distributed to all eligible children in the GUiNZ cohort via an emailed link to their parent’s email address (the parent was identified as the person who had completed the “Mother questionnaire” at the most recent DCW the child had taken part in). Children were deemed eligible if their parent had not withdrawn from the GUiNZ study prior to May 2020, the primary caregiver had a contact email address, and the cohort child was living in Aotearoa New Zealand at the time of survey distribution. Children who solely communicated in Te Reo Māori (n=13) were ineligible for the survey, as translation of the questionnaire was unfortunately not possible given time constraints associated with the need to distribute the survey during the lockdown period. Additional data have been sourced from previous GUiNZ DCWs to contribute additional demographic variables and variables that enable longitudinal analyses.

Ethics Approval Ethical approval for the survey was obtained from the Northern B Health and Disability Ethics Committee on the 29th of April 2020 (NTY/08/06/055 AM15).

Data Collection The survey was designed in-house by members of the GUiNZ research team, and the ‘Our Voices’ research team (the ‘Our Voices’ project is funded by a Ministry of Business, Innovation and Employment grant). The Qualtrics® digital platform was used, as it met the security and storage requirements of the University of

Auckland. Davanti Consulting Limited were engaged to assist with getting the survey prepared in the platform, and to develop an engaging interface for the children completing the survey. GUiNZ had an existing relationship with Davanti via the ‘Our Voices’ research project. The data collection process was undertaken in collaboration with the GUiNZ research team. On the 8th of May 2020, when Aotearoa New Zealand was in Alert Level 3 (Restrict), the COVID-19 Wellbeing Survey was sent to all eligible GUiNZ participants via an invitation email to each child’s primary caregiver. The invitation included an individualised link to the survey, which directed them to a web-based online survey accessible on all devices (computer, tablet, phone). The survey remained live until 24 May 2020. This survey was also sent to the GUiNZ pilot group, ‘Leading Light: Rōpū Pīata’, who normally experience the data collection measures before the GUiNZ cohort and provide feedback to guide data collection strategies. However, in this instance, given the time pressure to get the survey into field during the lockdown period, the Leading Light group were engaged at the same time as the main cohort, with a focus on trialling the electronic connections and digital responses from this group. Responses from the Leading Light group have been excluded from the final dataset for analyses given significant differences in key demographic variables from the main cohort (e.g., being 6-15 months older) and challenges in comparing consistent outcomes for this group over time. The front page of the survey described the purpose of the questionnaire and gave children the opportunity to accept or decline to participate. Children could complete the survey independently or receive help from a family member if required. To increase compliance with survey completion, a general media campaign promoting the survey to GUiNZ participants was run whilst the survey was live. While koha are typically offered to participants PART TWO: EDUCATION

as part of main data collection waves, this was not possible for the COVID-19 Wellbeing Survey.

Variables The following sections described the measures used for analyses in this report, including how each variable has been derived and used. Linked socio-demographic measures from previous GUiNZ DCWs Sociodemographic and ethnicity measures were linked from previous GUiNZ DCWs, specifically: • Sex. Based on data collected at 6-weeks, participants were grouped into boy or girl, as assigned at birth. • Age. Calculated using the child’s date of birth (as recorded at 6-week) and the date each young person participated in the COVID-19 Wellbeing Survey, as per the date stamp within the online survey. • Socio-economic position. Based on NZDep2013 from data collected in the eight-year DCW. NZDep2013 uses 2013 Aotearoa New Zealand census data to derive an indicator of socioeconomic hardship based on selected dimensions of neighbourhood deprivation (45). Deprivation scores are categorised into 10 deciles, with decile 1 representing the 10% of neighbourhoods that are the least deprived, and 10 the most deprived. Quintiles are used in bivariate and multivariate analyses to increase cell counts. • Maternal education. Determined using the mother’s report of their highest education level at the Antenatal DCW. Five levels of education are used: No secondary school qualification; Secondary school/ NCEA 1–4; Diploma/Trade Cert/NCEA 5–6; Bachelor’s degree; Higher degree. • Maternal age. Calculated using the mother’s date of birth as reported at the Antenatal DCW, and the date each child participated in the COVID Wellbeing Survey as per the date stamp within the online survey. Maternal age is grouped into six categories: ≤30 years; 31-35 years; 36-40 years; 41-45 years; 46-50 years; >50 years. • Child’s ethnicity. As reported by the mother at the 54-month DCW, with one or more ethnicities permitted. Ethnicity was externally prioritized based on Stats NZ Level 1 ethnicity groupings in the following order of priority: Māori, Pacific, Asia, Middle Eastern/ Latin American/African, Other or European if used as an independent variable (17). For analyses conducted on separate ethnic groups, ethnicity was coded across multiple variables (using total response coding) based on Stats NZ Level 1 ethnicity groupings (dummy variables indicating if the participant belongs to a specific ethnicity or not). In other words, multi-ethnic 48

Growing Up in New Zealand COVID-19 Wellbeing Survey

participants were included in each relevant ethnic group. Missing values of ethnicity at the 54-month DCW were replaced with the child’s ethnicity reported by the mother at the 9-month DCW. • Disability. Schooling experiences in COVID-19 restrictions may differ for children who have been identified with a disability. For this reason, school outcomes were investigated according to disability. At the 8Y DCW mothers were asked if they had areas of concern about their child’s wellbeing and development, for example, in relation to vision, hearing, speech, growth/development, and behaviour. Based on these data, concerns have been grouped for analyses into: Hearing and/or Speech concern; Vision concerns; Learning difficulties; Behavioural concerns; and No concerns. Other concerns (e.g., concerns about growth/development) indicated by mothers at the eight-year DCW were not used due to small cell sizes.

Measures of COVID-19 experiences The following measures from the COVID-19 Wellbeing Survey are used for analyses in this report: • Bubbles. The term ‘bubble’ is used to describe a household unit which is self-isolating. During Covid-19 Alert Levels 3 and 4 people in Aotearoa New Zealand are instructed to stay at home only with those in their bubble and restrict contact with other bubbles. The COVID-19 Wellbeing Survey asked children to report how many people were living in the household at the time of the survey; how many bubbles the child was in at the beginning of lockdown and, if more than one, how often they moved between bubbles (Every day; Every week; Less often); and their relationship to others in their bubble(s). • Connectedness. Children were asked to report how often during lockdown they connected with family and friends outside of their household bubbles using a six- point scale (Everyday; A few times a week; Weekly; Fortnightly; Less than fortnightly; Only once or twice). A ‘connectedness’ variable was derived and categorised as below: - Not/Almost Not Connected: Responded that they connected with both friends and family fortnightly or less. - A Little Connected: Responded that they connected with either friends or family once per fortnight or more. - Moderately connected: Responded that they connected with either friends or family a few times a week or more. - More Connected: Responded that they connected with both friends and family a few times a week or more each.

• Positive childhood experiences. Children were asked how often during lockdown they had: Felt able to talk to someone about their feelings; Felt their family supported them in this time; Participated in community activities within their bubble; Felt connected to school/kura; Felt able to keep in touch with friends; Felt safe and protected in their home; and, Felt worried about how people in their home were getting on. Each statement had six options for answering (Never; Almost never; Sometimes; Often; Always; I don’t know). These seven questions were adapted from (but are not identical to) the Positive Childhood Experiences Scale which was adapted from four subscales included in the validated “Child and Youth Resilience Measure–28” (30). • Activities. Children were also asked about the activities they did during lockdown with others in their bubble(s). These activities included: book reading; watching TV/movies; talking about their feelings or issues; singing, playing music or other musical activity; outdoor sports activities; baking or cooking; chores; drawing or other art/crafts; and eating meals. Children indicated how often they did each of these activities on a five-point scale from Never/almost never to Several times a day. Participants were asked the same questions at the eight-year DCW and have been linked for analyses in this report. • Screen-based activities. Children were asked about their screen-based activities during lockdown (e.g., schoolwork, social media, sending/receiving emails). Participants were also asked to indicate the amount of time during lockdown that they spent doing each activity using a five-point scale ranging from Every day to Hardly ever/never. These same measures were used in the eight-year DCW and have been linked for analyses in this report.

• Screen time. Children were asked to indicate the hours they spent on screen during an average school day during lockdown (Monday–Friday). Time spent on screens during a weekend day (Saturday–Sunday) was also recorded. This was compared with mother’s reports of their child/ren’s time spent on devices at age eight. • School satisfaction. Six items from the Multidimensional Students Life Satisfaction Scale (MSLSS) were used to assess school satisfaction during lockdown; these items had the highest factor loadings in the original 8-item MSLSS, as identified by Rowe and colleagues (24). These questions were adapted to be relevant to lockdown (e.g., I look forward to doing schoolwork in my bubble). When the COVID-19 Wellbeing Survey was sent to participants, most children were still doing their schooling remotely from home however, some had recently returned to school. For children attending school in person, the six questions asked participants to respond in relation to their schooling when they were at home (e.g., I enjoyed the school activities I did in my bubble). Each statement had five answer options (0 = Never; 1 = Sometimes; 2= Often; 3 = Almost Always; I don’t know). Scores across the six items were summed (after reverse coding the negatively worded item). Sum scores ranged from 0–18, with higher number reflecting higher levels of school satisfaction. People who answered “I don’t know” were assigned a ‘missing data’ status for the statement. The same six items were asked during the eight-year DCW (though without the reference to “bubbles”) and responses from those who participated in the COVID-19 Wellbeing Survey have been linked for analyses.

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APPENDIX B: Survey questionnaire Child Questionnaire Growing Up in New Zealand University of Auckland Email: contact@growingup.co.New Zealand www.growingup.co.New Zealand NOTE: The question numbers below are as they appear in the online survey but are not visible to the children.

Introduction Welcome to this Growing Up in New Zealand special survey to find out more about your experience of the Covid-19 “lockdown”.

Q1 Are you happy to take part in this special Growing Up in New Zealand survey? You can say yes or no. Select the option below. Yes

No → Go to END OF QUESTIONS and to the Closing statement Q2

What is your full name?

When is your birthday?

(Day) (Month) Q4

How old are you today in years?

Q5 How many people are living in the house you are in right now? Number of children – including you (aged less than 18) Number of adults (18 or over)

Total

Q6 At the beginning of lockdown (in level 4) did you have more than one bubble? Yes No

Growing Up in New Zealand COVID-19 Wellbeing Survey

Q7 If yes, At the beginning of lockdown (in level 4), how many bubbles did you have?

Q10 Who they are to you? (e.g. mum, dad, aunty, brother etc.)

Q11 How old are they? – if you know (if you are not sure you can guess)

Q12 Tick the box if they lived with you before the level 4 lockdown?

Q13 Did they have to leave the house to go to work somewhere else during level 4 lockdown? (You can choose more than one. It is okay if you don’t select one)

Q14 Who has looked after you in lockdown? (You can choose more than one. It is okay if you don’t select anyone)

My family and local neighbourhood Q15 How often during lockdown have you: (Choose the best one for each line)

Never

Almost never

Sometimes

Often

Always

I Don’t know

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I do NOT agree

Agree a little bit

Agree Agree a lot somewhat

Totally agree

I don’t know

Sometimes

Almost always

I don’t know

Q18 Tell us if you have gone back to school already or are still at home in your bubble? 18.1 I am still doing school work at home in my bubble 18.2 I have gone back to school Q19 If 18.1, How often are the following statements true? (Choose one for each line) I look forward to doing school work in my bubble I like school work in my bubble School work in my bubble is interesting I wish I didn’t have to do school work while in my bubble There are many things about school in my bubble that I like I enjoy the school activities I do in my bubble I am looking forward to going back to how school was before we had lockdown I am worried about missing out on my usual school work while we are in lockdown

Growing Up in New Zealand COVID-19 Wellbeing Survey

Never

Often

Q20 If 18.2, when you were doing school in your bubble, how often were the following statements true? (Choose one for each line)

Never

Sometimes

Often

Almost always

I don’t know

Media use Q22 Do you have internet at home? (Tick one only) Yes No (go to next section) I don’t know Q23 Do you have a device that you can use during lockdown?

Q25 Do any of your devices have a camera? (pull through answers from previous questions) Child will select from the list pulled through from previous question and tick if the device has a camera Q26 Do you belong or use any sites listed below? (Select as many as you use) None

Yes

Facebook

Messenger

Houseparty Reddit Tik Tok Instagram Snapchat Twitter WhatsApp YouTube Hangouts Something else? List them here:

A virtual reality headset Something else (list here): I don’t know PART TWO: EDUCATION

Q21 How would you say your health is right now? (Choose one only)

Q27 During lockdown, how often have you been doing the following things using a screen-based device? (Choose the best one for each line)

Every day

Growing Up in New Zealand COVID-19 Wellbeing Survey

Excellent

Several times a week

Very good

About once a week

Good

Fair

Poor

About once a month

Hardly ever / never

I don’t know

Q28 Have you had any contact (face-to-face, telephone or online) with your friends outside your family during lockdown?

Q32 If yes - how have you been in contact with family not living with you? (You can select as many as you need)

Yes

Telephone

Texting, chatting

Q29 If yes - how have you been in contact with friends? (You can select as many as you need)

Facetime/Zoom other videoconferencing, Online platforms such as Google Classrooms/ Seesaw

Telephone

Apps such as WhatsApp/HouseParty

Texting, chatting

Online Games

Facetime/Zoom other videoconferencing,

In person (even if with physical distancing)

Online platforms such as Google Classrooms/ Seesaw Apps such as WhatsApp/HouseParty

Letters Other (type here)

Online Games In person (even if with physical distancing) Letters Other (type here)

Q33 How often have you connected with your family not living with you during lockdown? (Answer for each of the platforms identified above) Everyday

Yes

Between 5 and 6 hours

Between 6 and 7 hours Between 7 and 8 hours Between 8 and 9 hours More than 10 hours (if so how many to the nearest hour?)

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Depression (heading not included in digital survey) Q36 Below is a list of the ways you might feel or behave. Please pick how much you have felt or acted this way during the past week. (Choose one for each line) I was bothered by things that usually don’t bother me I felt like I couldn’t pay attention to what I was doing I felt down and unhappy I felt like I was too tired to do things I felt like something good was going to happen I felt scared. I didn’t sleep as well as I usually sleep I was happy I felt lonely, like I didn’t have any friends It was hard to get started doing things

Growing Up in New Zealand COVID-19 Wellbeing Survey

Not At All

A Little

Some

A Lot

Never

Almost Never

Sometimes

Often

Almost always

I felt scared I worried about what could happen to me I felt worried I felt like something awful might happen I worried when I went to bed at night I feel nervous I worried when I was at home I got scared really easily I was afraid that I would make mistakes I thought about scary things

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Activities Q38 How often do you do the following activities with the people in your bubble during the lockdown? (Choose one for each line)

Never/ almost never

Once a week

I do NOT agree

Agree a little bit

Several times a week

Once a day

Several times a day

I don’t know

Agree Agree a lot somewhat

Totally agree

I don’t know

Growing Up in New Zealand COVID-19 Wellbeing Survey

Q40 What did you like most about the food in your bubble?

Q44 What has worried you most about being in lockdown?

Type your answer below

Q41 What foods did you miss most in your bubble?

Q45 What are you most excited for/ about when lockdown is over?

Type your answer below

Tell us more about how you have felt in the last few weeks Q42 What have been the best things for you about being in lockdown?

Q46 Is there anything else you want other people to know about what it’s like to be in lockdown for you? Type your answer below

Type your answer below

Q43 What have been the hardest things for you about being in lockdown? Type your answer below

PART TWO: EDUCATION

APPENDIX C: Survey response rate Eligible cohort

Participated in survey

Response rate

5756

2421

42.1

Boy

2964

1200

40.5

Ref

Girl

2784

1220

43.8

1.15

0.024

<10

European

2599

1339

51.5

Ref

Māori

1390

498

35.8

0.76

<0.001

Pacific

738

213

28.9

0.70

0.002

Asian

867

315

36.3

0.69

<0.001

Other

131

42.0

0.98

0.917

Missing

<10

Low (1-3)

1800

919

51.1

Ref

Medium (4-7)

1899

890

46.9

1.01

0.939

High (8-10)

1345

517

38.4

1.01

0.950

Missing

712

13.3

Urban

4445

2058

46.3

Ref

Rural

599

268

44.7

0.828

0.047

Missing

712

13.3

≤ 30 years

159

21.4

Ref

31 - 35 years

700

188

26.9

1.34

0.226

36 - 40 years

1298

459

35.4

1.56

0.061

41 - 45 years

1873

891

47.6

1.94

0.005

46 - 50 years

1381

685

49.6

2.12

0.002

>50 years

343

163

47.5

1.94

0.01

Missing

<10

No secondary school qualification

319

29.8

Ref

Secondary school/NCEA 1–4

1277

423

33.1

1.03

0.85

Diploma/Trade Cert/NCEA 5–6

1762

632

35.9

1.11

0.518

Bachelor’s degree

1419

717

50.5

1.69

0.002

Higher degree

961

547

56.9

1.99

<0.001

Missing

<10

Total

Logistic model Odds Ratio

P-value -

SEX

Missing ETHNICITY (prioritised)

SOCIOECONOMIC DEPRIVATION

RURALITY

MOTHER AGE

MOTHER EDUCATION

Growing Up in New Zealand COVID-19 Wellbeing Survey

APPENDIX D: Demographic variables Participated in the survey (N=2421) N

Boy

1200

50%

Girl

1220

50%

Missing

<10

European

1339

55%

Māori

498

21%

Pacific

213

Asian

315

13%

Other

Missing

<10

European

2017

83%

Māori

498

21%

Pacific

317

13%

Asian

343

14%

Other

Missing

<10

Low (1-3)

919

38%

Medium (4-7)

890

37%

High (8-10)

517

21%

Missing

Urban

2058

85%

Rural

268

11%

Missing

≤ 30 years

31 - 35 years

188

36 - 40 years

459

19%

41 - 45 years

891

37%

46 - 50 years

685

28%

>50 years

163

Missing

<10

No secondary school qualification

Secondary school/NCEA 1–4

423

17%

Diploma/Trade Cert/NCEA 5–6

632

26%

Bachelor’s degree

717

30%

Higher degree

547

23%

Missing

<10

SEX

ETHNICITY (prioritised)

ETHNICITY (total response)

SOCIOECONOMIC DEPRIVATION

RURALITY

MOTHER AGE

MOTHER EDUCATION

PART TWO: EDUCATION

www.growingup.co.nz www.auckland.ac.nz www.uniservices.co.nz www.msd.govt.nz

Growing Up in New Zealand is a University of Auckland study, managed by UniServices and funded by the New Zealand government.