Screen Time for Children Rose During COVID-19 Pandemic, Remained High After Restrictions Lifted

Authors: Monique Hedderson, Assiamira Ferrara, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health supported this research.

What were the study results?

Total screen time among children ages 4 to 12 increased during the early stages of the COVID-19 pandemic as lockdowns and school closures were widespread. Screen time remained higher in the later pandemic, even after several restrictions had been lifted. The study found that children used screens an average of 1.75 hours/day more during the early pandemic (December 2020 – April 2021) compared to before the pandemic (July 2019 – March 2020). During the later pandemic (May 2021 – August 2021), screen time remained on average 1.11 hours/day higher than the pre-pandemic average. Both recreational and educational screen time increased during the COVID-19 pandemic.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

The study shows that increases in screen time among children persisted more than one year into the pandemic, after many COVID restrictions had been lifted. These findings can help inform clinical guidelines that could aid parents and their children in re-establishing healthy media use habits. Pediatricians can help parents reset family media use priorities and limits that may have changed during the early stages of the COVID-19 pandemic using tools like the American Academy of Pediatrics Family Media Plan.

Why was this study needed?

Excessive screen time among children may be associated with obesity-promoting health behaviors and adverse mental health. The COVID-19 pandemic initially led to widespread school closures, shelter-in-place laws, closures of recreational facilities and cancellation of youth sports, increases in number of parents working from home, and social distancing recommendations, all of which may have impacted screen time among children. Prior studies have reported screen time levels during the pandemic but were unable to document changes in screen time because most lacked pre-pandemic assessments. This study is among a handful of ECHO studies to include pre-pandemic assessments of screen use in order to document changes during the pandemic.

Who was involved?

The study included 228 parent-child pairs from three ECHO cohorts across the United States (Colorado, California, and South Dakota). Parents reported their children’s screen time. The geographically, racially, and ethnically diverse participants ranged in age from 4 to 12 at the start of the study.

What happened during the study?

ECHO researchers surveyed parents about their children’s media use before, during the early, and later periods of the pandemic. The study assessed total, educational (not including remote school), and recreational screen time and examined trends in screen use before and at two points during the pandemic.

What happens next?

Additional studies are needed to determine whether the increases in screen time among children during the pandemic impacted longer term obesity and mental health outcomes in children. Future studies can also clarify whether specific types of screen time adversely impacted children’s health during the pandemic.

Where can I learn more?

Access the full journal article, titled “Trends in screen time use among children during the COVID pandemic, July 2019 through August 2021” in JAMA Network Open.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published February 15, 2023

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Screen Time for Children Rose During COVID-19 Pandemic, Remained High After Restrictions Lifted

Mothers Who Experience More Life Changes Due to the COVID-19 Pandemic Reported More Symptoms of Traumatic Stress

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Mothers Who Experience More Life Changes Due to the COVID-19 Pandemic Reported More Symptoms of Traumatic Stress

Authors: Tracy Bastain, Amy Margolis, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health supported this research.

What were the study results?

The study identified two groups of mothers based on their pandemic experiences. One of these groups experienced more changes to their daily life routines, more isolation from friends and family, and more changes to their health behaviors, when compared to the other group who experienced fewer pandemic-related changes in their lives.

Mothers who reported more life changes also reported more symptoms of traumatic stress due to the pandemic. The mothers who fell into the group that experienced more changes and reported more symptoms of traumatic stress tended to be women with higher incomes and higher education. Sixty-six percent of the women in the high change group were white. The women in the high change group were more likely to report financial concerns as a cause of stress. They were also more likely to report that the pandemic affected their healthcare.

In contrast, the group that reported fewer changes tended to have lower education and lower income. The women in this group were primarily Black and Native American. Hispanic women were split evenly between the two groups.

Both groups reported similar rates of COVID-19 infection in the household and similar work changes.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

Impact

As compared to fathers, during the COVID-19 pandemic more mothers have been affected by job and income losses, taken on more childcare burdens related to remote schooling, and have made major adjustments to their daily routines. This study found that mothers who had the most changes to their work, health, and social support systems also reported the highest amounts of traumatic stress due to the pandemic. These findings suggest that the association between sociodemographic, stressful life events, and mental health should be considered in future studies examining the long-term outcomes of the COVID-19 pandemic.

Why was this study needed?

The goal of this study was to better understand the mental health impacts of the COVID-19 pandemic on mothers in the United States and Puerto Rico.

Who was involved?

This study included 11,473 mothers from 62 ECHO cohorts across the U.S. and Puerto Rico.

What happened during the study?

ECHO researchers investigated the potential impacts of the COVID-19 pandemic on maternal mental health, from April 2020 through August 2021. The researchers looked for patterns of pandemic-related changes in maternal health and health behaviors, healthcare visits, work and finances, and coping strategies. They then used these data to group the mothers by those who had more or fewer pandemic-related changes to examine whether these groups reported higher or lower symptoms of traumatic stress related to the pandemic.

What happens next?

Future studies could examine how changes over the course of the pandemic affect mothers’ stress and well-being.

Where can I learn more?

Access the full journal article, titled “COVID-19 Pandemic Experiences and Symptoms of Pandemic-Associated Traumatic Stress Among Mothers in the US,” in JAMA Network Open.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published December 16, 2022

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Mothers Who Experience More Life Changes Due to the COVID-19 Pandemic Reported More Symptoms of Traumatic Stress

During the COVID-19 Pandemic, Children’s Sleep Schedules Changed, But Their Time Asleep Stayed the Same

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During the COVID-19 Pandemic, Children's Sleep Schedules Changed, But Their Time Asleep Stayed the Same

Authors: Maristella Lucchini, et al.

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health.

What were the study results?

During the COVID-19 pandemic, children in the United States went to bed later, woke up later, and took longer to fall asleep, but their overall time spent asleep did not change. Interviews with caregivers revealed that they prioritized routines to maintain their children’s amount of sleep but were more flexible about bedtime. Across all time periods studied, children from racial and ethnic minority communities went to bed later, slept less, and napped more often.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This is one of the first studies investigating changes in childhood sleep habits in the United States during the COVID-19 pandemic using data collected before and during the pandemic. The researchers found significant changes in children’s sleep habits, as well as differences in children’s sleep behaviors between racial/ethnic groups. These results highlight potential areas for future research and support the need to examine and address root causes of racial/ethnic sleep disparities in childhood.

Why was this study needed?

Sleep health during childhood is important for overall health and brain development. Poor sleep can increase a child’s risk for chronic illnesses, behavioral problems, and poor memory. Factors that affect sleep health may have been significantly impacted by the COVID-19 pandemic due to lockdowns and curfews, increased stress, and changes in social support. Many studies have shown that, due to systemic and structural inequities, the pandemic has affected the health behaviors of children differently based on their socioeconomic status, race, and ethnicity. These differences may worsen existing gaps in children’s health.

Several studies have reported on how the pandemic has affected childhood sleep habits, but few of these studies involved children in the United States. Most previous studies have relied on self-reported or time-limited data and have focused primarily on early stages of the pandemic. The goal of this study was to investigate changes in nighttime sleep habits and frequency of daytime naps during the COVID-19 pandemic.

Who was involved?

This study included 528 children aged 4 to 12 from 14 ECHO cohorts across the United States. The caregivers of 38 participants provided additional information about how they thought their children’s sleep habits may have been affected by the COVID-19 pandemic.

What happened during the study?

The researchers compared data from before the pandemic with data collected at two different time periods during the pandemic. They used this data to examine the length of time it took children to fall asleep, time spent asleep at night during the week and on weekends, and the frequency of later bedtimes and daytime naps. They also collected sociodemographic information (child sex, age, race and ethnicity, maternal education) from self-reports and medical records.

What happens next?

ECHO researchers are currently analyzing and publishing results on changes in diet, physical activity, and screen time during the COVID-19 pandemic from the same cohort of children.

Where can I learn more?

Access the full journal article, titled “Impact of the COVID-19 pandemic on children’s sleep habits: an ECHO study,” in Pediatric Research.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published October 4, 2022

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During the COVID-19 Pandemic, Children's Sleep Schedules Changed, But Their Time Asleep Stayed the Same

During the COVID-19 Pandemic, Children’s Screen Time Increased

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During the COVID-19 Pandemic, Children's Screen Time Increased

Authors: Traci Bekelman, et al.

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health.

What were the study results?

The study found that overall children’s screen time increased significantly during the pandemic with Hispanic children and non-Hispanic Black children having the most noticeable increase in screen time. The study didn’t find any significant increase in the amounts of sugary drinks and unhealthy snack foods children consumed during the pandemic, but it did find a more noticeable increase among Hispanic children and older children. The amount of time children spent asleep increased but only among children whose sleep time was below the recommended range before the pandemic.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This study shows how the disruptions caused by the COVID-19 pandemic affected children’s daily lives. The results of this study suggest that the pandemic may have worsened sociodemographic disparities for some child health behaviors, particularly in relation to the amount of time children spent looking at screens. This research suggests that families may need more support to re-establish healthy routines and reduce the negative effects of the pandemic on their children’s health behaviors.

Why was this study needed?

For many children, public health measures to mitigate the spread of the COVID-19 pandemic disrupted their daily routines, and prevented them from using community resources, such as parks and organized sports. During the first few months of the pandemic, there were changes in children’s health behaviors—such as diet, screen time, physical activity, and sleep habits. However, there are limited data on what happened to children’s health behaviors after the earliest, most restrictive lockdown period. This is an important topic because children’s health behaviors have been linked to their overall mental and physical health, academic achievement, and quality of life.

Who was involved?

The study included 347 children between the ages of 4 to 12 years and their caregivers recruited from ECHO cohorts in California, Colorado, North Dakota, and New Hampshire. Of those participants, 47% percent were female, and 62% were non-Hispanic White.

What happened during the study?

ECHO researchers collected data on children’s diet, physical activity, screen time, and sleep habits before and during the pandemic. The researchers also surveyed caregivers on how they thought their children’s health behaviors had changed during the pandemic. This study also explored how sociodemographic factors affected children’s health behaviors to identify children who are more likely to experience less recommended changes in behaviors.

What happens next?

This research may help us identify ways to support families with children in future public health emergencies. The ECHO Program is currently working to study changes in other related health behaviors. This includes changes in how well children follow national dietary guidelines, use of social media, and bedtimes/wake-up times.

Where can I learn more?

Access the full journal article, titled “Health Behavior Changes during the COVID-19 Pandemic: A Longitudinal Analysis among Children,” in the International Journal of Environmental Research and Public Health.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published August 19, 2022

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During the COVID-19 Pandemic, Children's Screen Time Increased

During the Pandemic, Children Whose Parents Had Flexible Work Schedules and More Financial Security Were More Likely to Have Less Screen Time and More Sleep

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During the Pandemic, Children Whose Parents Had Flexible Work Schedules and More Financial Security Were More Likely to Have Less Screen Time and More Sleep

Authors: Traci Bekelman, Katherine Sauder, et al.

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health.

What were the study results?

Children with parents who were able to change their work schedule to care for their children during the pandemic had less screen time and slept longer at night. Children with parents who were stressed about money and access to food and therefore unable to change their work schedule, drank more sugary drinks, were less active, and slept less at night. Similar to pre-pandemic study results, what children ate and their level of physical activity differed by their age and sex.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This study shows how children’s diet, physical activity, and sleep behaviors during the pandemic were linked to the work schedules and stress of their parents. Parents stressed about money may need help getting their kids to be more active, eat better, use technology less, and sleep more.

Why was this study needed?

The COVID-19 pandemic changed family habits and financial situations for many. ECHO researchers wanted to know how parents' coping strategies, stress, and financial situations affected their children’s health behaviors during the first seven months of the pandemic.

Who was involved?

This study included 3,315 children between 3 and 17 years from 50 ECHO cohorts across the United States. Information about the children’s sex, age, race, and ethnicity were reported by a parent or found in their medical records.

What happened during the study?

Parents answered questions about their child’s diet, physical activity, screen time, and sleep during the first seven months of the COVID-19 pandemic. The parents also described how they were personally coping with the pandemic and what they were most stressed about.

What happens next?

ECHO researchers will continue to look at how financial stress and parents’ work schedules affect children’s health behaviors. This will help guide future strategies to encourage healthy behaviors among children even during stressful times like a pandemic.

Where can I learn more?

Access the full journal article, titled “Sociodemographic Variation in Children's Health Behaviors During the COVID-19 Pandemic,” in Childhood Obesity.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published July 19, 2022

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During the Pandemic, Children Whose Parents Had Flexible Work Schedules and More Financial Security Were More Likely to Have Less Screen Time and More Sleep

Families Who Had More COVID-19 Pandemic-Related Hardships Had More Stress, Lower Child Life Satisfaction

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Families Who Had More COVID-19 Pandemic-Related Hardships Had More Stress, Lower Child Life Satisfaction

Author(s): Courtney K. Blackwell, et al.

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health, with co-funding from the Office of Behavioral and Social Sciences Research (OBSSR).

Footnote: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

What were the study results?

Families with more COVID-19 pandemic-related hardships had higher levels of caregiver and child stress and lower child life satisfaction. Children who had higher levels of social connection and family engagement had better life satisfaction. For younger children, family engagement also decreased the negative effect of stress on life satisfaction. For adolescents, having anxiety and/or depression was a risk factor associated with lower life satisfaction during the pandemic.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This study demonstrated the different ways caregivers, children, and adolescents have coped with stress and adapted to the COVID-19 pandemic. The results of this study highlight the importance of family engagement and peer social connection in promoting children’s well-being during adverse events. This study also showed that stress and well-being are not direct opposites, suggesting the need for interventions that can both decrease children’s stress and improve their well-being.

Why was this study needed?

Families have faced many challenges during the COVID-19 pandemic, but we don’t yet know much about how these challenges have impacted children’s mental health. While negative mental health outcomes are important to research, it is just as important to understand what helps children maintain positive mental health during hard times. This study investigated how the impact of COVID-19 pandemic-related family hardships have affected child and adolescent well-being and identified factors that can improve and protect their well-being during difficult times.

Who was involved?

This study surveyed 977 caregivers of children ages 2 to 12 from 11 ECHO cohorts and 669 adolescents ages 11-17 and their caregivers from five ECHO cohorts. These participants came from 30 U.S. states.

What happened during the study?

The researchers collected survey data from May 2020 to May 2021. These surveys asked each participant about their family’s COVID-19 pandemic experience. The researchers combined data from the different cohorts to look at how pandemic-related sources of stress (also called “hardships”) were related to caregiver and child stress, and how stress, social connection, family engagement, and pre-existing mental health conditions related to children’s life satisfaction.

What happens next?

The next steps for this research include looking at which specific COVID-19 family hardships have the most impact on caregiver and child stress and well-being so that we can design more specific interventions.

Where can I learn more?

Access the full journal article, titled “Youth well-being during the COVID-19 pandemic” in Pediatrics.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published: March 18, 2022

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Families Who Had More COVID-19 Pandemic-Related Hardships Had More Stress, Lower Child Life Satisfaction

ECHO Study Links Fast Growth During First Five Years of Life With Younger Onset of Puberty in Children

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ECHO Study Links Fast Growth During First Five Years of Life With Younger Onset of Puberty in Children

Author: Izzuddin M. Aris, et al.

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) program, the Office of the Director, and the National Institutes of Health.

What were the study results?

In male children, gaining weight or growing faster than their peers in the first five years of life was associated with entering puberty at a younger age. The researchers found similar results in female children, but only among those with faster weight gains during early childhood (two to five years of age). Female children with faster weight gains during infancy (six months to two years of age) and early childhood started their periods earlier and had more advanced pubic hair development.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This study has a direct clinical impact. As pediatricians regularly measure weight and height during routine visits and use growth curves to identify abnormal growth predictions, they could closely monitor children who have faster weight and height gains in the first five years of life for earlier onset of puberty. These study results may also inform future studies that aim to develop and/or test interventions to potentially help prevent earlier onset of puberty, such as good nutrition, environmental exposures, physical activity, and other behaviors related to growth during the first five years of life.

Why was this study needed?

Puberty is a key stage during child development. Previous research indicates that children in the United States are entering puberty at younger ages. These children may be in danger of developing certain diseases, such as type 2 diabetes, later in life. A better understanding of how early life factors affect puberty development is important for combating earlier puberty onset.

Who was involved?

This study included almost 7,500 children from 36 birth cohorts. All participating cohorts had documented at least one measure of weight and height in the first five years of the child’s life and at least one measure of puberty development.

What happened during the study?

The researchers used participants’ weight and height data to look at the following signs of puberty: age when the child experienced the most growth due to puberty; age of their first period (in female children only); puberty development score; and pubic hair development. The team then examined how gains in weight, height, and body mass index at different stages between birth and age 5 were related to puberty development, controlling for maternal and child characteristics.

What happens next?

The team planned follow-up studies that will aim to identify the mechanisms behind these initial observations. They also aim to identify the role of puberty in explaining the relationship between early life factors and longer-term chronic diseases, such as type 2 diabetes.

Where can I learn more?

Access the full journal article, titled “Analysis of early life growth and age at pubertal onset in US children” in JAMA Network Open.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published February 4, 2022

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ECHO Study Links Fast Growth During First Five Years of Life With Younger Onset of Puberty in Children

ECHO Study Suggests Negative Associations Between Chronic Conditions and Positive Health May Be Primarily Attributed to a Co-Occurrence of Depression

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ECHO Study Suggests Negative Associations Between Chronic Conditions and Positive Health May Be Primarily Attributed to a Co-Occurrence of Depression

Author(s): Julia Schuchard, Courtney K. Blackwell, Jody M. Ganiban, Angelo P. Giardino, Monica McGrath, Phillip Sherlock, Dana M. Dabelea, Sean C. L. Deoni, Catherine Karr, Cindy T. McEvoy, Barron Patterson, Sara Santarossa, Sheela Sathyanarayana, Irene Tung, Christopher B. Forrest

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) program, the Office of the Director, and the National Institutes of Health.

What were the study results?

Of the 16 mental and physical health conditions included in this study, only depression showed a meaningful association with lower life satisfaction among children aged 8 to 17. Ninety-five percent of children with depression also had another chronic condition.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

The study results suggest that negative associations between chronic conditions and positive health may be primarily attributed to a co-occurrence of depression. The symptoms of physical and developmental health conditions may last for years, or even a lifetime. However, interventions like regular screening for depression, particularly among children with other health conditions, could help minimize the effects these conditions have on life satisfaction.

Why was this study needed?

Although medical science has primarily focused on the negative outcomes of chronic conditions, looking at the effect of these conditions on positive health is equally important to help children thrive. Pediatric positive health refers to children's assessments of their well-being. Understanding the relationship between different types of chronic conditions and positive health outcomes may help clinicians promote children’s well-being and adaptability to health challenges.

The ECHO Program provides opportunities to study positive health—one of its five outcome areas—in large, diverse samples of children.

Who was involved?

Participants in this study included 1,764 children aged 8 to 17 in 13 cohorts across the United States. Of these children, 45% were teenagers, 50% were girls, 8% were Latinx, and 23% were Black. Also, 54% of participating children had a chronic physical or mental health condition.

What happened during the study?

Children completed questionnaires about their own physical, mental, and social health and life satisfaction. Parents reported on their children’s chronic health conditions, including a variety of physical, developmental, and mental health conditions.

What happens next?

More research is needed to understand the potential impact of mental health interventions, such as increasing the availability of mental health assessments for children and adolescents.

Where can I learn more?

Access the full journal article, titled “Influences of chronic physical and mental health conditions on child and adolescent positive health,” in Academic Pediatrics.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published: February 1, 2022

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ECHO Study Suggests Negative Associations Between Chronic Conditions and Positive Health May Be Primarily Attributed to a Co-Occurrence of Depression

ECHO Researchers Develop Shorter Survey for Measuring Sources of Stress in Adults

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ECHO Researchers Develop Shorter Survey for Measuring Sources of Stress in Adults

Author(s): Phillip Sherlock, Madeleine U. Shalowitz, Carolyn Berry, David Cella, Courtney K. Blackwell, Whitney Cowell, Karen M. Reyes Rodriguez, Rosalind J. Wright

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) program, the Office of the Director, and the National Institutes of Health.

What were the study results?

The researchers were able to reduce the 80-question CRISYS-R to just 24 essential questions, resulting in a short form CRISYS questionnaire (CRISYS-SF). The CRISYS-SF covers the same 11 areas of stress that are addressed in the CRISYS-R. Participants received very similar scores from both the CRISYS-R and CRISYS-SF.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

In large-scale studies, lengthy questionnaires can contribute to lower response rates, leading to incomplete or low-quality data. The CRISYS-SF offers doctors and researchers a way to screen for participant stress, identifying the sources of that stress, and determining the most effective interventions.

Why was this study needed?

Stress can have a significant impact on the psychological, social, and physical health of individuals. But the questionnaires that are often used to understand stress exposure can be long and burdensome. The goal of this research was to create a shorter version of the Crisis in Family Systems-Revised (CRISYS-R) that still covers all relevant areas of stress.

Who was involved?

The study included 884 pregnant women from the PRogramming of Intergenerational Stress Mechanisms (PRISM) study, which recruited pregnant women from prenatal clinics in New York City and Boston beginning in 2011. One-third of these women were born outside of the U.S., and 20% spoke Spanish as a primary language. Around 20% of participating women had less than a high school education, and 60% reported having financial trouble.

What happened during the study?

Participants completed the CRISYS-R questionnaire through an in-person or phone interview in their preferred language. The researchers used statistical methods and expert feedback to identify which questions on the CRISYS-R provided the most insight into the participant’s level of stress exposure.

What happens next?

Researchers can use the CRISYS-SF to investigate relationships between stressful life events and specific health outcomes.

Where can I learn more?

Access the full journal article, titled “A short form of the Crisis in Family Systems (CRISYS) in a racially diverse sample of pregnant women,” published in Current Psychology.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published 01 October 2021

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ECHO Researchers Develop Shorter Survey for Measuring Sources of Stress in Adults

ECHO Study Unifies Two Popular Surveys for Screening Adult Depression

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ECHO Study Unifies Two Popular Surveys for Screening Adult Depression

Authors: Courtney K. Blackwell, Xiaodan Tang, Amy J. Elliott, Tracy Thomes, Hannah Louwagie, Richard Gershon, Benjamin D. Schalet, David Cella

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health, with co-funding from the Office of Behavioral and Social Sciences Research (OBSSR).

What were the study results?

The EPDS and PROMIS-D both ask about increased sadness and decreased interest in daily activities. While the EPDS has additional content related to anxiety and suicidal ideation, the results of the two surveys were strongly linked. The researchers were able convert scores from the EPDS to PROMIS-D scores. The scoring conversion worked for different ages, ethnicities, races, and study sites.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

Adults are encouraged to get regular depression screenings. The EPDS survey is often used to detect depression in women during and after pregnancy. Doctors who want to continue long-term screening for women after pregnancy may want to convert EPDS scores into more general PROMIS-D scores for consistent tracking. Within ECHO, depression research spanning more than one cohort may need to convert between the EPDS and PROMIS-D surveys to combine data from multiple sites.

Why was this study needed?

Depression affects more than 17 million adults in the U.S. each year, and women are at higher risk for depression, particularly during and after pregnancy. Regular screening of adults for symptoms of depression is important for early intervention. Different surveys are used to track depression symptoms in adults, including ones specific to women during and after pregnancy. However, researchers need a uniform set of survey measures to track depression over a long time and to conduct nationwide research on depression. This study tried to unify two popular depression surveys: the Edinburgh Postnatal Depression Scale (EPDS), which is used during and after pregnancy; and the Patient-Reported Outcomes Measurement Information System Depression (PROMIS-D), which is used at any time in adulthood.

Who was involved?

Around 1,200 mothers from two study sites in the Northern Plains of the United States completed the EPDS and PROMIS-D surveys. Most of the participants were around 35 years old and white, but this sample also included American Indian/Alaska Natives. About half of the participants had a 4-year college degree or higher.

What happened during the study?

The participants filled out the EPDS and PROMIS-D. Researchers collected data and demographics using an online survey.

What happens next?

The survey conversion table made through this study may be useful for doctors and researchers interested in tracking depression symptoms over time. New studies may seek to confirm the link between EPDS and PROMIS-D using bigger, more diverse groups. Studies may also look at linking other depression surveys with the PROMIS-D for easier, more unified tracking of depression.

Where can I learn more?

The conversion table is available at prosettastone.org.

Access the journal abstract, titled, “Developing a common metric for depression across adulthood: Linking PROMIS Depression with the Edinburgh Postnatal Depression Scale,” in Psychological Assessment.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published: May 31, 2021

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ECHO Study Unifies Two Popular Surveys for Screening Adult Depression