Elevated levels of depression, anxiety, and other mental health challenges in children during the COVID-19 pandemic have been reported ( Cao, 2022; Ludwig-Walz et al., 2022; Orgilés Amorós et al., 2021). And while schools have reopened in Perú and children have returned to their classrooms, mid- to longer-term mental health impacts of the pandemic, particularly associated with prolonged home isolation and the death of family members, have yet to be fully examined. Initial warning data are emerging. For example, in a group of 562 Perúvian school children, Fernandez-Canani, Burga-Cachay and Valladares-Garrido (2022) reported 48% had lost a family member to COVID-19, 60% had post-traumatic stress disorder (PTSD), 76% had mild to serious depression, and 62% had mild to serious anxiety. Not surprisingly, levels of depression, anxiety, and stress are higher in Latin American students who experienced the death of a close family member from COVID-19 ( Mejia et al., 2022).

Of equal concern for educators and health professionals is the knowledge that many mental health disorders emerge at an early age. Indeed, more than 38%, 17%, 51%, and 34% of people suffering, respectively, from general anxiety disorder, PTSD, social anxiety disorder, or any mental disorder at all (such as depression, attention deficit hyperactivity disorder [ADHD], and panic disorder) experienced symptoms by 14 years of age ( Solmi et al., 2022). Hence the need for early intervention. As Rider et al. (2021, p. 1) have concluded, “early recognition and treatment of the potential impacts of the COVID-19 pandemic will help protect children’s and adolescents’ current and future mental health, development, learning, and wellbeing”. One of the basic purposes of this study is to examine current mental health levels of upper primary school children in Perú to further this assessment of needs.

The Transcendental Meditation technique is one such early intervention for improving the mental and physical health of children. According to Nader (2020, p. xviii), the technique is “a universal technique, effective for people of every culture, age, background, and educational attainment”. Practiced twice each day by school children for about ten to 15 minutes, once before classes begin and once before going home at the end of the day, Transcendental Meditation is an easy-to-practice, natural mental technique which allows the conscious thinking mind to experience a silent, peaceful level of deep rest and heightened awareness—a state of restful alertness. As a result of this brief but meaningful experience each day, students report greater energy, clarity of mind, relaxation, self-confidence, and happiness within themselves.

Importantly for this study, evidence gathered by researchers at some of the world’s leading health institutions over the last 50 years suggests practice of Transcendental Meditation reduces the incidence of depression, anxiety, and other mental health disorders. For example, at the Brigham and Women’s Hospital in Boston, Massachusetts, Azizoddin et al. (2021) observed significant reductions in burnout ( p < .05, d = 0.43–0.45), depression, anxiety, stress, and sleep disturbance ( p < .001, d = 0.70–0.87) in physicians, nurses, and physician-assistants during the COVID-19 pandemic; and at the Unified Behavioral Health Center for Military Veterans and their Families in New York, using a randomised controlled design over a 12-week period of Transcendental Meditation practice, Bellehsen et al. (2021) found statistically significant reductions of depression ( F = 7.02, p = .03, d = –0.84), anxiety ( F = 13.47, p = .001, d = –1.16), and sleep difficulties ( F = 6.40, p = .01, d = –0.80) in U.S. military veterans. At post-test, 50% of veterans in the Transcendental Meditation group no longer met PTSD diagnostic criteria as compared to 10% in the control group ( p = .007).

Such a proposition has also been tested in children, with similar results. At the University of Michigan’s Department of Family Medicine, Rosaen and Benn (2006) found evidence of increased emotional intelligence (i.e., improved social-emotional capacities) in 12–14 year-old school children after one year of practicing Transcendental Meditation; and at the Center for Brain, Consciousness and Cognition in Iowa, Grosswald et al. (2008) similarly found evidence of curtailed anxiety and stress, leading to reduced symptoms of ADHD in 11–14 year-old school children. In a randomised trial at the Louis Bolk Institute in the Netherlands, Jong et al. (2019) found evidence that Transcendental Meditation reduced the number of headaches, and the symptoms of depression and anxiety after three and then again after nine months of practice in children and adolescents between the ages of nine and 18 years; and at the Center for Wellness and Achievement in Education in California, in a controlled experiment, Wendt et al. (2015) found evidence of increased wellbeing—measured by elevated happiness, resilience, and self-confidence—in 14 year-old school children.

The authors of this study have therefore embarked on a pre-, peri- and post-pandemic research program in Perú to investigate the potential of Transcendental Meditation to enhance the mental and physical health of school children, more than 53,000 of whom have learned the technique since the late 1990s. The program now consists of: a) pre-pandemic quantitative findings associated with the health of 91 students in Huay-Huay, a high-altitude, remote Andean school ( Fergusson, Ortiz Cabrejos, & Bonshek,, 2021b), a large-scale confirmatory study on the physical, cognitive and emotional health of 520 students in four diverse school settings ( Fergusson, Ortiz Cabrejos, & Bonshek, 2022a), and third-person perspectives of the mental and physical health of students by parents and teachers in Puno ( Fergusson, Ortiz Cabrejos, & Bonshek, 2021a); b) peri-pandemic findings associated with the health and school performance of 54 primary and secondary school students who practiced Transcendental Meditation in relation to a matched comparison group of 53 students during home isolation ( Fergusson, Ortiz Cabrejos, & Bonshek, 2022b) and a proto-theoretical model of stress and psychosocial measures of cognitive, affective, and conative outcomes in students during home isolation ( Fergusson, Ortiz Cabrejos, & Bonshek, 2023a); and c) post-pandemic findings on increased wellbeing in orphan girls through Transcendental Meditation ( Fergusson, Ortiz Cabrejos, Bonshek, & Datey, 2023b). That Transcendental Meditation has been so widely embraced by children, parents, teachers, school and care facility administrators, and the Ministerio de Educación in this predominantly Catholic country is important because clearly participants and the government see no conflict between the practice of meditation, which is described as a natural process requiring no change in belief or lifestyle, and the practice of their religion.

The present normative study considered findings from the aforementioned literature and sought evidence for the proposition that practice of Transcendental Meditation might improve the post-pandemic mental health of school children in Perú. To guide this purpose, we asked the following research questions: RQ.—what are the current levels of depression, anxiety, and stress in upper primary school children in Perú; RQ.—how do these compare to other children in Latin America and elsewhere; RQ.—are these levels different when measured for school, age, gender, or grade level; RQ.—are there any indications that depression, anxiety, or stress are lower when Perúvian upper primary school children practice Transcendental Meditation, especially when controlled for school, age, gender, or grade level; and RQ.—is there any evidence that depression, anxiety, and stress are related constructs when measured in upper primary school children?

For this cohort, Cronbach alphas indicate internal consistencies of Cα = .80 for depression, Cα = .77 for anxiety, and Cα = .76 for stress, thereby representing comparable scale reliability to the normative data reported by Lovibond and Lovibond (1995a, p. 27), and compare favourably to findings reported by Mellor et al. (2018, p. 141) for 448 Chilean adolescents, and by Oei (2013, p. 1025) for 2,630 adults in Asia.

These findings can be considered ‘reliable’ at Cα = .60–.79 and ‘very reliable’ at Cα ≥ .80. As shown in Table 2, the present data were normally distributed, with acceptable levels of total average skewness ( Skew[0.55]) and kurtosis ( Kurt[–0.41]) recorded across all three scales. No missing data were identified.

Table 2

Table 2 shows scores for the total cohort of students, with depression M _dep = 6.68, anxiety M _anx = 6.30, and stress M _str = 7.25 for a total DASS-21 score of M _tot = 20.23.

Using the normative .-score standards of Lovibond and Lovibond (1995a), Table 3 shows: on the depression scale, 41% of children were classified as normal, 13% of children suffered from mild depression, 21% suffered from moderate depression, 12% suffered from severe depression, and 13% suffered from extremely severe depression; on the anxiety scale, 35% of children were classified as normal, 15% of children suffered from mild anxiety, 14% suffered from moderate anxiety, 11% suffered from severe anxiety, and 25% suffered from extremely severe anxiety; and on the stress scale, 35% of children were classified as normal, 15% of children suffered from mild anxiety, 14% suffered from moderate anxiety, 11% suffered from severe anxiety, and 25% suffered from extremely severe anxiety.

Table 3

Tables 4, 5, and 6 provide data related to depression, anxiety, and stress by school, gender, and grade level. Note, because age is a continuous, not nominal, variable, grade level can be taken as a proxy for age in these descriptive Tables.

Table 4

Table 4 indicates that average scores for all scales by school were largely the same, although the San Carlos scores were almost two points higher than the César Vallejo total; SDs were similar in both schools, with data sets normally distributed.

Table 5

Table 5 indicates that average scores for all scales by gender were largely the same, although the girls’ total score was more than two points higher than the boys’ score; SDs were somewhat lower for boys, with both data sets normally distributed.

Table 6 indicates that average scores for all grade level scales were somewhat the same, although the depression score for 5 ^th grade primary was one point higher than the scores for 4 ^th grade and for 6 ^th grade, and anxiety scores for 5 ^th grade were also higher than 4 ^th grade and 6 ^th grade. No obvious difference was observed between grades for stress, and SDs were similar for all grade levels, with both data sets normally distributed.

Table 6

The data related to group differences can be seen in Tables 7, 8 and 9. Table 7 indicates that Group 2 depression, anxiety, and stress scores were lower than Group 1. Thus, the Group 2 DASS-21 total M _tot = 17.49 was also lower than the Group 1 total M _anx = 23.18. SDs were similar, with both data sets normally distributed.

Table 7

Table 8 shows the results of analysis of variance, indicating that difference between Groups for all three DASS-21 scales were significant to p < .001.

Table 8

Figure 9 presents the tests of difference between the Group 1 and Group 2 total DASS-21 scores when school, age, gender and grade level are computed as covariates. Differences between Groups can be observed for all four computations (when testing for difference and covarying for school, age, gender, and grade level), however, these differences were not subject to the influence of either school, age, gender, or grade level, although there was a statistically significant difference between the DASS-21 scores of girls and boys, as noted in Table 5.

Table 9

As shown in Table 10, these findings are reflected in the scale ratings for each Group when compared to normative z-score standards of Lovibond and Lovibond (1995a). For Group 2 depression, 57% of student were rated as normal compared to 34% in Group 1 (a 41% difference); for Group 2 anxiety, 49% of student were rated as normal compared to 21% in Group 1 (a 57% difference); and for Group 2 stress, 62% of student were rated as normal compared to 50% in Group 1 (20% difference).

The same trend can be observed for Group 2 moderate, severe, and extremely severe ratings of all scales compared to Group 1, with many of the higher rated students in Group 1 in the ‘normal’ category in Group 2.

Table 10

Consistent with previous research, irrespective of before or after instruction in Transcendental Meditation, significant correlations were observed between depression and anxiety r = .80, p < .001, depression and stress r = .72, p < .001, and anxiety and stress r = .70, p < .001.

Table 2 provides evidence to answer RQ1. Mellor et al. (2018) measured the pre-pandemic mental health of Australian ( N = 371; M _age = 14.5), Chilean ( N = 448; M _age = 15.8), Chinese ( N = 558; M _age = 15.9), and Malaysian ( N = 388; M _age = 14.9) adolescents. They found: M _dep = 5.48, M _anx = 4.51, and M _str = 5.92 for female adolescents, and M _dep = 3.98, M _anx = 3.55, and M _str = 3.71 for male adolescents in Australia; M _dep = 6.72, Manx = 5.50, and M _str = 7.55 for female adolescents, and M _dep = 4.79, M _anx = 4.05, and M _str = 5.93 for male adolescents in Chile; M _dep = 5.65, M _anx = 6.51, and M _str = 7.68 for female adolescents, and M _dep =5.28, M _anx = 6.08, and M _str =6.69 for male adolescents in China; and M _dep = 5.69, M _anx = 6.25, and M _str = 6.72 for female adolescents, and M _dep = 5.56, M _anx = 5.30, and M _str = 6.24 for male adolescents in Malaysia. Our findings are generally higher than Mellor et al.’s data ( M _tot = 20.20 versus M _tot = 13.50 for Australia, M _tot = 17.20 for Chile, M _tot = 18.80 for China, and M _tot = 17.80 for Malaysia).

Chen et al. (2022) also measured the pre-pandemic mental health of 575 Chinese children ( M _age = 10.80), reporting M _dep = 5.86, M _anx = 7.98, and M _str = 7.96; the total score for these data in China was M _tot = 21.80. Our findings were generally lower than Chen at al.’s data ( M _tot = 20.23 versus M _tot = 21.80). In Australia, Chile, China, and Malaysia, females had in each case higher levels of depression, anxiety, and stress than males, as was the case with these upper-primary school children in Perú.

Using the DASS-21, Hernández-Yépez et al. (2022) found evidence from 400 university students in peri-pandemic Perú that 19.2% suffered from depression, 23.2% from anxiety, and 17.2% from stress. Using a different instrument with 863 students in four schools in post-pandemic Perú, Fernandez-Canani et al. (2022) found 24% of children were classified as having minimal depression (we equate this rating to ‘normal’ on the DASS-21), 30% of children suffered from mild depression, 19% suffered from moderate depression, 14% suffered from moderate to serious depression, and 13% suffered from serious depression.

Fernandez-Canani et al. (2022) also found 37% of children were classified as having no anxiety, 28% suffered from mild anxiety, 20% suffered from moderate anxiety, and 15% suffered from severe anxiety. For children diagnosed with PTSD, these percentages were even higher. In our study, 35% of children were classified as normal, 15% of children suffered from mild anxiety, 14% suffered from moderate anxiety, 11% suffered from severe anxiety, and 25% suffered from extremely severe anxiety. Thus, while both Fernandez-Canani et al.’s groups indicated the same ‘normal’ level of anxiety, a higher proportion of students in our cohort were rated in the highest category of anxiety. These combined findings answer RQ ₂.

The findings related to RQ ₃ indicate there is no difference in depression, anxiety, and stress levels for school or grade level but that girls had higher levels than boys, a finding consistent with those of Mellor et al. (2018), who found female adolescent scores were higher than male adolescent scores in Chile.

The data needed to answer RQ ₄ indicate that Group 2 depression, anxiety, and stress scores were lower than Group 1. Thus, the Group 2 DASS-21 total M _tot = 17.49 was also statistically lower than the Group 1 total M _anx = 23.18 even when covaried for school, gender, age, or grade level. Similarly, the ratings values on all scales (except ‘mild’) and for the total DASS-21 measure, Group 2 scores after Transcendental Meditation practice were more ‘normal’ than Group 1.

The correlational findings in this study, which answer RQ ₅, are higher than those reported by the authors for the original DASS-42 when administered to college students, i.e., between depression and anxiety r = .54, p < .001, depression and stress r = .56, p < .001, and anxiety and stress r = .64, p < .001 (Lovibond & Lovibond, 1995b, p. 337) but roughly the same as those for 2,630 participants from Indonesia, Malaysia, Singapore, Sri Lanka, and Thailand for depression and anxiety r = .75, p < .01, depression and stress r = .75, p < .01, and anxiety and stress r = .69, p < .01 ( Oei, et al., 2013).

The findings of this study can therefore be summarised in the following way and shown in Figure 1. Data indicate that the average total DASS-21 score of Perúvian upper-primary students is M _tot = 20.21, a level marginally lower than same-age students in China, but above adolescents in Australia, Chile, China, and Malaysia.

Figure 1

Note. own authorship.

Raw data were generated by Dr Lee Fergusson. Derived data supporting the findings of this study are available from the corresponding author Dr Lee Fergusson on request.