Comparative study of children’s mental health outcomes in Tyrol, Austria, and South Tyrol, Italy, during the COVID-19 pandemic

Tables 1 and 2 show the sociodemographic factors of the two surveys. For the TCCS study, random selection was not aimed at; thus, it is impossible to confirm that the sample comparisons are representative of the population being studied. The COP‑S 2021 data can be regarded as representative of the age and gender of the young South Tyrolean population, as well as for migration background and single parenthood of South Tyrolean families.

In both surveys, mothers responded to the survey questions in approximately 90% of parents. The proportion of girls in North Tyrol was higher (51.2%) vs. South Tyrol (41.4%) in the TCCS. Proportion of girls in COP‑S 2021 was 49.8%. In the TCCS, the proportion of 7–10 year-old children from North Tyrol was higher (75.2%) compared to South Tyrol (64%). The percentage of 7–10 year-old children in COP‑S 2021 was 60.1%. In the TCCS, the proportion of children living in a city was about the same between North Tyrol and South Tyrol (19.7% vs. 19.1%). For COP‑S 2021 this proportion was 26.4%.

The prevalence of COVID-19 was higher in the South Tyrolean subgroup of the TCCS (47.7%) than in North Tyrol (30.2%). The prevalence of COVID-19 in COP‑S 2021 was 28.9%. In TCCS, only 0.3% reported a COVID-19 death in the family in Tyrol, while the percentage was higher for TCCS respondents from South Tyrol (8.1%). The percentage reported from COP‑S 2021 was 13.5%. In TCCS, 5.5% of children from North Tyrol received psychological treatment, compared to 1.8% from South Tyrol. In COP‑S 2021, the proportion of children receiving psychological treatment was 3%.

Tables 3 (TCCS) and 4 (COP-S) present parent-reported psychosomatic complaints and symptoms of anxiety. The results were comparable, with no significant differences between the children from North Tyrol and South Tyrol in the TCCS. Most frequent symptoms were stubborn, sullen, or irritable (North Tyrol 47.6% vs. South Tyrol 42.9%; p-value 0.609); trouble sleeping (30.8% vs. 23.2%, p-value 0.150); nervous, highly strung, or tense (29.4% vs. 29.5%; p-value 0.934).

The results for self-reported psychosomatic complaints are presented in Tables 5 (TCCS) and 6 (COP-S). In the TCCS, similar rates of psychosomatic complaints could be found between children in North Tyrol and in South Tyrol. Most frequent symptoms were sleeping problems (57.4% North Tyrol vs. 65% South Tyrol), anger fits (59.4% vs. 47.5%), and not being able to have good or happy feelings (28.7% vs. 37.5%).

In COP‑S 2021 (Table 6), children reported irritability/bad temper (58.2%), difficulties getting sleep (40.6%), and nervousness (39.9%) as the most frequent symptoms.

Age- and sex-specific psychosomatic complaints in the COP‑S 2021 survey are shown for the age groups 7–10 years and 11–13 years in Fig. 1. Significant differences between boys and girls were found in parents’ reports of children aged 7–10 years (p = 0.005), with girls feeling more frequently nervous (40.6%) than boys (37.3%; and for 11–13-year-olds [p < 0.014]) and with girls having more frequent stomachaches (28.5% vs. boys 22.2%). Significant differences between boys and girls could also be found in self-reports (11–13 years). Girls reported more frequent symptoms for stomachache (38.1% vs. boys 21.6%; [p < 0.001]), feeling low (girls 37.4% vs. boys 28.8%; [p = 0.008]), irritability, bad temper (girls 62.1% vs. boys 54.3%; [p = 0.023]), feeling nervous (girls 45% vs. boys 34.7%; [p = 0.002]), and feeling dizzy (girls 18% vs. boys 12%; [p = 0.015]). Significant differences in boys’ parents’ reports between age groups were found, with 11–13 year-old boys having more frequent headaches (27.7% vs. 7–10 year-old boys, 20%; p < 0.001), backache (12.7% vs. 4.6%; p < 0.001), and dizziness (6.5% vs. 3.3%; p = 0.018). Significant differences regarding boys between parents and children’s answers were found for backache, with boys reporting more frequent backache (22.5% vs. 12.7%; p < 0.001) and sleeping difficulties (40.2% vs. 38.8%). Parents reported more frequent irritability/bad temper (60.4% vs. 54.3%; p < 0.001). Significant differences between parent reports and girls’ self-reports were shown for headaches (girls 34.8% vs. parents 27.6%; p = 0.001), stomachache (38.1% vs. 28.5%; p < 0.001), backache (21.9% vs. 13.8%; p < 0.001), feeling nervous (45% vs. 37.8%), sleeping difficulties (40.9% vs. 34.4%), and dizziness (18% vs. 9.6%). Parents reported more frequent irritability/bad temper (68%) than girls (62.1%; p < 0.001).

Table 7 presents the mean values (M) and standard deviations (SD) of child-reported threats, exposure, trauma, and anxiety in the TCCS, comparing North Tyrol and South Tyrol. No significant differences were observed in any of the scales. In North Tyrol and South Tyrol, 28.6% and 24.1% of the children met the criterion for clinically significant internalizing problems, respectively. However, when examining social problems, children from North Tyrol exhibited significantly higher social problems than children from South Tyrol. Apart from this finding, no other significant differences in problem behavior or emotional problems were observed between the children in the two regions (Table 8).

The results of the qualitative analysis (Table 9) showed that the identified themes were consistent with the original PTG dimensions described by Tedeschi and Calhoun [19]. Only the dimension “spiritual and existential change” could not be identified as a separate growth and depreciation dimension. The following themes were extracted: “family strength, spirituality” (characterized by a growing together of the family), “values and virtues” (basic human values such as benevolence came to the fore), “new competences and experiences” (changes in the children’s development and experience), and “importance of intra- and extra-familial relationships” (qualitative as well as quantitative aspects of relationships were of great meaning). Parallel to the themes with the PTG dimensions, themes consistent with posttraumatic depreciation (PTD) were found, namely “weakening of the own person,” “little appreciation of life,” “few new opportunities,” and “weakened relationships with others.” “Weakening of the own person” was mentioned only by North Tyroleans, all other topics were mentioned by both groups; however, the number of statements varied between the two groups. It is clear that the most significant event during the corona crisis was the lockdown with accompanying quarantine in March 2020, as even in June and July 2021, parents related to this point in time.

Parents were asked where they had wished to receive support during the last months using five categories: 51.5% selected “dealing with school problems of my child,” 44.5% “dealing with the feelings of my child,” 30.5% “dealing with my child’s behavior,” 18% “returning to normality after the lockdown for my child,” and 14.7% “dealing with relations within our family.”

Furthermore, it was possible to add answers in an open field, i.e., the parents could fill out other support they would have wished for which was not already stated as a category in the questionnaire. The most frequently mentioned problem was the combination of homeschooling and smart work. Parents proposed opening schools even during the lockdown. In addition, many parents mentioned the need for more personal contact between teachers and parents during home schooling, as well as more support regarding peer problems between children. Moreover, reduced social contacts and, consequently, an extended use of digital media was perceived as a big problem: parents proposed to return to normality as soon as possible and to get support on how to teach meaningful use of digital media to their children. Finally, access to physiotherapy and psychotherapies was reduced during the pandemic, and families often had to deal with problems alone. Parents proposed extending public resources.

The TCCS study in South Tyrol had a slightly lower proportion of girls compared to North Tyrol, and also a lower percentage of 7–10-year-old children than North Tyrol. These differences may be attributed to recruitment methods. South Tyrol experienced higher COVID-19 death rates than North Tyrol [30, 31], and fewer South Tyrolean children received psychological treatment than North Tyrolean children. Differences in available mental health programs may contribute to this variation [32‐34].

Both regions (North Tyrol and South Tyrol) reported similar rates of psychosomatic complaints. In the COPSY-Germany study [3], psychosomatic complaints increased during the pandemic in children and adolescents aged 11–17 years. The comparative study showed comparable rates of headaches, stomachaches, feeling low, and feeling dizzy in the TCCS between North and South Tyrol. Significant sex and age group differences were found in parent-reported psychosomatic complaints in the COP‑S 2021. Approximately 30% of children experienced at least one psychosomatic symptom, with prevalence rates varying based on methodological differences and other factors. According to a meta-analysis [35], prepandemic prevalence rates ranged from 5 to 83%, with a pooled prevalence of 31.0%.

Regarding children’s perceived threat, exposure, trauma, behavior, and emotional problems, no significant differences were found between North Tyrol and South Tyrol in the TCCS, except for higher social problems reported by children from North Tyrol, possibly due to stricter quarantine measures. There were no significant differences in PTG and PTD themes between the two regions, except for “weakening of the own person” found only in North Tyroleans. While no comparative survey results between the TCCS and COP‑S 2021 can be presented, qualitative analysis of responses from the COP‑S 2021 study highlighted common challenges faced by parents, including dealing with school problems, handling their child’s feelings and behavior, remote schooling challenges, reduced social contacts, increased digital media use, and limited access to therapies.

The KAT-III and SCARED are used to assess anxiety in children. The TCCS found no significant differences in trauma between North Tyrolean (21.8%) and South Tyrolean children (25%). Traumatic events may cause short-term distress, but in complex family situations, symptoms can persist and lead to psychiatric disorders [36]. All symptoms, including psychosomatic complaints and anxiety, should be considered as warning signs in children and adolescents to prevent serious psychopathology beyond the pandemic.

Based on the findings of these two surveys in the same population, future proposals include the need for ongoing monitoring of children’s psychological health during crises like the COVID-19 pandemic, using regular surveys for valuable data, and targeted interventions. Addressing psychosomatic symptoms is crucial, as they can provide valuable indications of potential mental health problems, reflecting underlying emotional or psychological distress. Comprehensive support mechanisms should be implemented in healthcare and school systems [13]. Specialized trauma experts may promote children’s PTG [14] and deliver mental health care in nontraditional settings, such as schools and primary care, which may be especially effective [37, 38]. Collaborative research between neighboring regions can offer insights into the factors influencing children’s mental health and inform evidence-based policies and interventions. The impact of differences in the education and healthcare systems on psychological complaints warrants further exploration.

Comparative studies on children’s psychosocial wellbeing in the neighboring North Tyrol and South Tyrol regions offer valuable insights, but there are limitations to consider. Both studies relied on self-reported data from parents and children and were potentially affected by bias. Conducted at a specific point in time, they provide a snapshot of children’s wellbeing, and longitudinal studies can enhance understanding over time. Focusing on a specific geographical area, they may not fully represent the diverse experiences of larger populations. Confounding factors such as socioeconomic status have not been extensively explored. Despite these limitations, these studies have provided valuable information on children’s psychological health during the COVID-19 pandemic.