The pandemic generation: Investigating the long‐term impact of a large‐scale stressor on the anxiety of children

Abstract Background As a large‐scale global stressor, the COVID‐19 pandemic has a substantial impact on the mental health of children and adolescents. In this longitudinal study we investigate long‐term trajectories of anxiety of children during and after the pandemic (April 2020–April 2023), and identify associated risk factors. Methods A total of 514 children from a representative sample of the Dutch general population completed the Patient Reported Outcomes Measurement Information System Anxiety computerized adaptive test at least four of seven bi‐annual assessments (from April 2020 to April 2023). Longitudinal k‐means clustering analyses were conducted to identify distinct anxiety trajectories. The optimal solution was selected based on the Calinski‐Harabasz criterion and interpretability. We assigned participants to their best fitting cluster and compared sociodemographic characteristics between the clusters using T ‐tests and chi‐square tests to identify risk factors. Results We identified five distinct longitudinal trajectories of anxiety; stable high ( n = 71, 13.8%), stable medium ( n = 109, 21.2%), stable low ( n = 147, 28.6%), recovering ( n = 100, 19.5%) and delayed increase trajectories ( n = 87, 16.9%). The recovering group showed a return to anxiety levels within normal limits over time, while the delayed increase group experienced increased anxiety symptoms after the pandemic. Loss of income from the parents was identified as an important risk factor of belonging to the stable high trajectory (OR range 4.1–8.2, p < 0.001). Conclusion Children followed distinct anxiety trajectories during and after the COVID‐19 pandemic, showing variability in their long‐term mental health responses. Five trajectories were identified, and parental loss of income emerged as a strong risk factor for less favorable trajectories. These findings show the importance of monitoring mental health over longer periods and especially children that experience additional adversity on top of global stressors might be at risk for lasting mental health problems.