Anxiety increased among children and adolescents during pandemic-related school closures in Europe: a systematic review and meta-analysis

Table 2 Summary of findings

Outcome	Number of studies	Standardised mean difference, 95% CI	Odds Ratio, 95% CI	Summary of findings	Certainty of evidence (GRADE)
General anxiety symptoms	12 studies [20,21,22,23, 36, 45, 46, 49, 51,52,53, 55]	Low risk of bias studies:0.34, 0.17 to 0.51 All studies: 0.14, -0.02 to 0.31		Low risk of bias studies predicted an increase in general anxiety symptoms in the total population, female and male children and adolescents with a dose response-relationship.	⊕ ⊝ ⊝ ⊝ Very low ^a,b,c
Clinically relevant anxiety rates	4 studies [44, 45, 48, 56]		Low risk of bias: 1.08, 0.98 to 1.19 All studies: 0.99, 0.85 to 1.15	Low risk of bias studies predicted no increase in clinically relevant anxiety rates in the total population and male children and adolescents; however, with partly moderate confidence intervals.	⊕ ⊝ ⊝ ⊝ Very low ^a,b,c

^aDowngraded -1 for risk of bias due to some concerns about bias as 66% of the included studies were assessed with serious or critical risk of bias
^bDowngraded -1 for inconsistency due to a significant chi² test and a substantial high I² test (> 50%), further analysis via subgroup analysis, sensitivity analysis and meta-regression analysis were conducted
^cDowngraded -1 for indirectness due to moderate confidence intervals and overlap of the line of no effect of the 95% CI in total effect estimate, although a broad sample size

ISSN: 1753-2000