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The Effect of the Transmission of Coronavirus Disease-2019 on the Mentality of Parents and Children After the First Wave of Infections

The purpose of this study is to evaluate the effect of the spread of a new type of coronavirus infection (COVID-19) on the mental state in school-age children and parents focusing on the aspects of sleep disorders and depression. A questionnaire survey was conducted for 123 parents and 108 school-age children who visited Department of Pediatric Dentistry, Kyung Hee University Dental Hospital at Gangdong from April 2, 2020 through April 25, 2020, via the direct writing method. Participants were assessed with Pittsburgh Sleep Quality Index, Generalized Anxiety Disorder (GAD)-7, Center for Epidemiology Scale for Depression. Logistic regressions were used with a level of significance of 5%. The prevalence of GAD, depression, and poor sleep in parents were 34.1%, 17.1% and 44.7%, respectively. The prevalence of GAD in children was 20.4%. Logistic regression showed that stress from Emergency Alert Messages about COVID-19 was associated with GAD and depression in parents. In children, the degree of emotional change after COVID-19 was associated with GAD. This study confirmed that there was a change in the psychological status of children and guardians due to the epidemic of coronavirus disease-2019, and it would be necessary to consider their psychological status during dental treatment.

Disaster and Safety Countermeasures Headquarters requested that citizens practice strong social distancing or refrain from going out altogether from March 22 to April 5, 2020. Citizens were also asked to postpone or cancel meetings, events, and travel within the time frame [4].
The spread of COVID-19 has changed people's daily lives. The outbreak of a new type of infectious disease causes emotional distress such as depression and anxiety [5]. In previous studies, the negative psychological experiences of the new epidemic were mainly examined from the perspective of fear or worry about the epidemic and emotional distress [5][6][7].
In February 2020, the number of new confirmed cases per month in Korea surged to 3,319 due to the mass infection centered on Daegu branch of the Shincheonji Church of Jesus, and the first wave of infections resulted in 6,636 confirmed cases in March 2020 [8]. In April 2020, when the survey was conducted, the spread eased to 979 cases [8], but strong social distancing and online schooling were implemented. In Seoul, there were 372 confirmed cases in March 2020, and 183 confirmed cases in April 2020 [8].
Against this background, this paper aims to study the effect of spread of COVID-19 on the mental state of school-age children and parents. Ultimately, the purpose of this study is to understand the potential emotional states within the coronavirus pandemic to determine needed considerations in the treatment and counseling process. learning, and the stress of contacting coronavirus related news were included. Self-examination scales for anxiety, depression and sleep disorders were included to measure the psychological state of the adults. The questionnaire for children consisted only of self-examination scale for anxiety, which can be answered relatively easily, to assess the psychological state of the children.

1) Generalized Anxiety Disorder-7 scale
The Generalized Anxiety Disorder-7 scale (GAD-7), one of the most widely used tools for anxiety self-examination, was developed in 2006 by Spitzer et al . [9]. It consists of a total of 7 questions, with each question answered on a scale of 0 -3 points depending on the frequency of symptoms during the past 2 weeks (Fig. 1). The total scores ranged from 0 -21, a score greater than 5 points indicates that anxiety is present [9].

2) Pittsburgh Sleep Quality Index
Sleep quality was assessed using the Pittsburgh Sleep Qual-ity Index (PSQI), a self-report scale. It was developed by Buysse et al . [10] and was measured using the PSQI-K, the Korean version of the PSQI, which Sohn et al . [11] confirmed to ensure reliability and validity.
It consists of a total of 19 questions across the following 7 component areas: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, sleep drug use, and daytime dysfunction (Fig. 2). Scores for each component were calculated according to the PSQI evaluation method. The higher was the total score, the lower was the quality of sleep. A score greater than 5 points indicates a poor sleeper, while a score below 5 indicates a good sleeper.

3) Center for Epidemiologic Studies for Depression Scale
The Center for Epidemiologic Studies Depression Scale (CES-D) was developed by Radloff [12] in 1977 as a major screening tool for depression.
It consists of 20 questions that ask about the symptoms of the past week, with each question answered on a scale of 0 -3 points (Fig. 3). A total score of 15 points or less is normal, 16 to 20 points corresponds to mild depression, 21 -24 points corresponds to serious depression, and a score of 25 points or more corresponds to severe depression in need of expert treatment [12].

Statistical analysis
Frequency analysis was performed to analyze the basic characteristics of the participants. The following variables were analyzed among parents: employment status (employed or unemployed), monthly household income (less than or greater than six million won), changes in childcare arrangements, and coronavirus-related information searching time (less than 30 minutes, 30 minutes to an hour, over an hour). The independent samples t-test was conducted to compare the GAD-7, CES-D, and PSQI scores. In addition, by performing logistic regression analysis, odds ratios (OR), significance levels, and 95% reliability were calculated to evaluate factors affecting sleep quality, general anxiety disorder, and depression. In school-age children, the independent samples t-test was conducted to compare the GAD-7 scores between sexes. In addition, factors affecting GAD of school-age children were evaluated through logistic regression analysis. An independent t-test was con-

Ⅲ. Results
A total of 132 parents and 113 students was surveyed. Of these, 9 parents and 5 students who gave insincere answers were excluded. Of the 123 parents who were included in the study, 63.4% (n = 78) experienced emotional changes after the occurrence of COVID-19, and 61.8% (n = 76) answered that they felt anxiety (Table 1). Of the parent respondents, 54.5% and 55% felt the stress due to postponement of their children' s school and online learning and the stress of receiving Emer-    gency Alert Messages about COVID-19, respectively (Table   1). In 108 school-age children, 19.5% experienced emotional changes, while 48.1% responded that they felt anxiety ( Table   1). The stress felt by the children due to receiving Emergency Alert Messages was lower than that of the parents ( Table 2, p = 0.000), and there was no significant difference between children and adults in GAD-7 score (Table 2).
Sleep disorders were experienced by 44.7% of the parents, 34.1% had an anxiety disorder and 17.1% had at least mild depression ( Table 1).
From logistic regression analysis, the factor related to GAD was emergency alert stress (

Ⅳ. Discussion
Previous research on new types of infectious diseases has focused on the fact that new types of infectious diseases induce severe, uncontrolled levels of distress that are more severe than stress in everyday life [13][14][15]. The outbreak of a new type of infectious disease causes emotional distress such as depression and anxiety [5]. In previous studies related to SARS and MERS, the negative psychological experiences of the new epidemic were mainly examined from the perspective of fear or worry about the epidemic and emotional distress [5][6][7]. This study investigated the emotional changes and stress of the participants due to COVID-19 and media usage time for collecting coronavirus-related information or news and compared them to identify differences between parents and children. The results of the study showed that 44.7% of the parents suffer from sleep disorders, 34.1% suffer from anxiety disorders, and 17.1% suffer from depression ( Table 1). Most of the guardians were female, and the difference in mental health by gender was not confirmed. Some studies found that women    Logistic regression analysis COVID-19 = A new coronavirus infection, GAD = Generalized Anxiety Disorder-7, Sig. = Significance probability, OR = Odds ratio, CI = Confidence interval feel more anxious than men [16,17]. Since the number of participants was not enough to identify the differences according to gender, so more studies will be needed in the future.
One side, anxiety disorders occurred in 20.4% of the 108 children (Table 1). Children had less time for searching coronavirus-related information or news and more sleep time than parents ( Alert Messages with information on safety rules and areas of confirmed cases occurrence are being sent to each person in the area [18]. The stress experienced when parents received Emergency Alert Messages was identified as a contributor to changes in mental status (Table 3). Whether the cause of the stress was simply fatigue due to frequent text reception or distrust of the government's ability to cope, further research seems to be necessary.
Household income had a significant impact on the quality of sleep. however, this study did not take into account the potential variables and effects associated with income levels such as changes due to coronavirus situation. further studies can evaluate the influence of these socioeconomic variables.
In this study, coronavirus-related news or information searching time had no effect on mental state, and it was similar to the results of previous research. The study on the distress experienced by the general public for MERS infection also showed that media use frequency collecting MERS-related information did not affect the emotional distress experience [6].
Looking at the analysis of changes in daily life caused by