Ethnic and socioeconomic inequalities in the mental health of children and young people with pre-existing mental health and neurodevelopmental conditions during the COVID-19 pandemic: a systematic review of longitudinal studies

The COVID-19 pandemic may have amplified existing inequalities and disproportionately impacted the mental health of children and young people (CYP) with pre-existing mental health and neurodevelopmental conditions. Evidence suggests the mental health impact on this clinical group was heterogeneous, but the role of ethnicity and socioeconomic position on longitudinal mental health outcomes is unclear. This systematic review investigates the longitudinal association between ethnic and socioeconomic inequalities and the mental health outcomes of CYP with pre-existing conditions during the pandemic. OVID Medline, EMBASE, APA PsycInfo, and Global Health databases were searched between January 2020 and November 2025 (PROSPERO CRD42024611865). Eligible papers included longitudinal studies that assessed mental health outcomes at multiple timepoints before and/or during the pandemic in CYP with pre-existing conditions and examined the effect of ethnicity and socioeconomic position on outcomes. Included studies were narratively synthesised. Ten studies (N = 3,887) were included. We found evidence that CYP from lower income brackets and who experienced financial hardship reported greater levels of internalising, neurodevelopmental, post-traumatic stress, and obsessive-compulsive symptoms. Weak associations were found between ethnicity and internalising symptoms. However, the findings were inconsistent across mental health outcomes, timepoints, and ethnic and socioeconomic position groups. There is some evidence for the association between lower socioeconomic position and increased mental health outcomes in CYP with pre-existing conditions during the pandemic. Further robust longitudinal research is warranted to examine the long-term consequences of the pandemic to better understand how ethnic and socioeconomic inequalities contribute to mental health outcomes.