Currently submitted to: JMIR Public Health and Surveillance
Date Submitted: Sep 17, 2026
Open Peer Review Period: Sep 17, 2026 - Sep 17, 2026
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Health burden heterogeneity among children and young people during the COVID-19 pandemic: findings from the CLoCk study (2020-2023)
ABSTRACT
Children and young people’s (CYPs) physical and mental health may cluster in heterogeneous ways, particularly during and after the COVID-19 pandemic. Using longitudinal data from 6,152 CYP in England, we applied a machine learning approach to characterise multidimensional health burden across four timepoints over 24-months (between 2020-2023), incorporating physical symptoms, fatigue, emotional/behavioural difficulties, wellbeing, quality of life, and healthcare use. After random-forest imputation and dimensionality reduction via a variational autoencoder, we used k-means to identify four clusters: (1) low burden (30.7%); (2) intermediate mental health burden (23.0%); (3) increasing physical and mental health burden (24.9%); and (4) persistent high burden (21.4%). The increasing and high burden clusters were older, predominantly female, and characterised by poorer pre-pandemic physical and mental health. Baseline SARS-CoV-2 status was only modestly associated with cluster membership. Findings demonstrate substantial heterogeneity in post-pandemic health trajectories and support targeted, person-centred prevention and service planning strategies.
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