Mental health outcomes following COVID-19- associated caregiver loss in children and adolescents: a six-year evidence gap

By May 2022, an estimated 10.5 million children worldwide had lost a parent or caregiver to COVID-19. We found only two cohorts with quantitative mental-health data: one in Iran and the South African Orphanhood and Caregiver Loss Among Adolescents and Youth study. Both reported more psychiatric and psychosocial difficulties among bereaved children than controls. In Iran, internalizing symptoms, post-traumatic stress, and suicidal ideation increased during follow-up, and no participant received mental-health care. In South Africa, likely mental disorder declined in both groups but remained more common among bereaved participants; suicidal ideation or attempts rose slightly in the bereaved group while falling among controls. Social support, food insecurity, and domestic violence were associated with outcomes. These children were bereaved during school closures, social isolation, disrupted mourning, and financial strain, when usual sources of support were often reduced. Yet few were identified and followed over time. Research funding priorities and fragmented health, education, mortality, and child-protection systems may have contributed to this gap. Many children bereaved in the first pandemic waves are now adolescents or young adults, but their longer-term mental-health course remains largely unknown. They should be identified, followed, and offered support according to clinical and family need.