Michiel A. J. Luijten

Objective. The COVID-19 pandemic was a major global stressor for children and adolescents, raising concerns about longer-term consequences for mental health and wellbeing. Many studies reported increased mental health problems during and shortly after the pandemic, but less is known about longer-term post-pandemic patterns across domains and informants.Method. We used repeated cross-sectional data from Dutch children and adolescents aged 8-18 years in the Netherlands Twin Register (NTR, N = 39,178, 50% girls) and a representative general-population sample (N = 2,782, 48% girls). Parent- and child-reported mental health problems and wellbeing were assessed using pre-pandemic, pandemic, and post-pandemic data through 2025. Post-pandemic patterns were examined by comparing 2024/2025 outcomes with 2023 and pre-pandemic levels using pre-registered multilevel models.Results. Parent-reported internalizing and externalizing problems in 2024/2025 did not differ from 2023 levels (B = -0.03 to 0.03), but remained higher than pre-pandemic levels (B = 0.28 to 0.31). Child-reported depressive symptoms were lower in 2025 than in 2023 (B =-2.31), anxiety did not differ (B =-0.75), and anger was higher (B =1.13). Compared with pre-pandemic levels, child-reported depression, anxiety, and anger were all higher in 2025 (p <.001). Wellbeing patterns were mixed across informants and samples (B =-1.05 to 0.10).Conclusions. Up to 2025, youth mental health and wellbeing did not show a general return to pre-pandemic levels. Patterns differed across domains and informants, highlighting the importance of continued multi-informant monitoring.

Sickle cell disease has a profound impact on the physical, mental and social health of affected children. Currently, there is considerable variability among the available patient reported outcomes measures (PROMs) used in children with sickle cell disease, and no consensus has yet been achieved. We aim to assess the psychometric properties of the generic pediatric and proxy Patient-Reported Outcomes Measurement Information System (PROMIS®) measures in children with sickle cell disease living in the Netherlands. Dutch children with sickle cell disease aged 5–17 years old and their caregivers were eligible. The following self-report and proxy-report PROMIS® item banks were evaluated: Anger, Anxiety, Depressive Symptoms, Fatigue, Mobility, Pain Interference, Peer Relationships, Cognitive Functioning, and Global Health. We assessed unidimensionality through confirmatory factory analysis, convergent validity with subscales from the Pediatric Quality of Life Inventory, discriminant validity, reliability, and inter-rater reliability. The study enrolled 102 patients and 102 caregivers, of which 71 were dyads. All item banks displayed sufficient unidimensionality and convergent validity. Discriminant validity was hypothesized and found for “Global Health,” “Mobility” ( d > 0.3), “Fatigue,” and “Pain Interference” ( d > 0.3), although some comparisons were non-significant. Reliability was acceptable ( a > 0.80, SEM < 0.44) for all PROMIS® measures. Inter-rater reliability was moderately-strong for all item bankss (ICC 0.60–0.78) except for “Peer Relationships” (ICC = 0.47, r = 0.31) and “Global Health” (ICC = 0.26, r = 0.16), which scored lower on correlation. Conclusion : PROMIS® measures displayed sufficient psychometric properties for use in pediatric sickle cell disease care and research. Proxy-reports seem viable as alternative to self-report forms of PROMIS®. What is Known: • Sickle cell disease has a profound impact on the physical, mental and social health of affected children and identifying early signs of decline is crucial to intervene before complications arise. • No consensus has yet been achieved among the available patient reported outcomes measures (PROMs) used in children with sickle cell disease living in Europe. What is New: • This study provides evidence that PROMIS® measures displayed sufficient psychometric properties for use in European pediatric sickle cell disease care and research. • Proxy-reports seem viable as alternative to self-report forms of PROMIS®

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.

BACKGROUND Patient-reported outcome measures (PROMs) and shared decision-making (SDM) are increasingly valued in Pediatric physiotherapy (PPT). Online PROM portals can facilitate PROM use and SDM, but require adaptation for its use in PPT. OBJECTIVE This study aimed to adapt the online KLIK PROM portal for primary PPT, identify preferences for data visualization, and explore integration of SDM. METHODS A co-design approach was used. Two co-creation sessions including adolescents, parents, patient representatives, PPTs, and researchers were organized and results were discussed in an analyze-session with the research team. Subsequently, a demo version of the adapted KLIK portal was tested for usability in twelve individual think aloud sessions with parents, adolescents, and PPTs. After discussing results in a second analyze-session, the final version of the KLIK PROM portal was developed. Thematic content analysis was applied to all qualitative data. RESULTS Key adaptations included automatically selecting predefined PROM sets based on the patient registration form depending on complaints and age, and the possibility to schedule a series of PROMs linked to evaluation moments. Literal responses on items without color coding were preferred by patients and parents, while PPTs favored line graphs with heatmaps indicating concerning scores. Both patients and PPTs emphasized the importance of discussing results in person using child-friendly visualizations. Aggregated data were valued for supporting reflective practice. SDM was integrated into the portal through information pages, subtle nudges to encourage PPTs and patients to engage in SDM, and by motivating patients to complete PROMs by personalizing the portal. CONCLUSIONS The adapted KLIK portal is ready for pilot implementation in primary PPT. Updates should be applied based on user feedback from ongoing evaluations. While PROM use can facilitate SDM, impact on SDM depends on effective patient-clinician dialogue and should be further investigated.