COVID-19 and Adolescent Mental Health: Important Findings from a Systematic Review of Survey Studies
While lockdowns were necessary to prevent the spread of the COVID-19 virus and protect our most vulnerable citizens, their negative impact on mental health has become quite evident. This is especially true for youth and adolescents. A study conducted by The Hospital for Sick Children and published in European Child & Adolescent Psychiatry found that 70.2 percent of school-aged children (6 to 18) experienced deterioration in one of the following six mental health domains: depression, anxiety, attention span, hyperactivity, irritability, and obsessions/compulsions.
“We found that overall, children were faring mostly worse, and occasionally better, compared to their pre-pandemic selves,” noted principal investigator Dr. Daphne Korczak, a child and adolescent psychiatrist with SickKids. “We also found that the mental health impacts of the pandemic were greater for school-aged children during the first lockdown, underscoring the importance of in-class learning and extracurricular activities for children.”
A group of researchers at various institutions throughout the United States took things a step further by analyzing 35 survey studies from around the world involving more than 65,500 participants between the ages of 4 to 19 years old. The following is a breakdown of the findings of the systematic review, published in SAGE Open Medicine.
Studies Used in the Review
The researchers conducted an electronic search of several databases for studies that were published from December 2019 to December 2020. They found more than 1,400 potentially eligible titles but removed more than 1,360 irrelevant records. They settled on 35 English-language studies that met their inclusion criteria. Twenty-seven of those studies were surveys and the other eight involved interviews with children between the ages of 4 and 19. Studies were conducted across a diverse range of countries, including China, Canada, Italy, Turkey, Germany, and the US.
Anxiety and Depression on the Rise
In analyzing the studies, the researchers noticed anxiety and depression as the most prominent negative psychological reactions to lockdowns and the pandemic in general. Of the 65,508 participants, 28 percent cited an increase in anxiety, while 23 percent reported feelings of depression. The other eight reported psychological reactions to the pandemic were: loneliness (5 percent), stress (5 percent), fear (5 percent), anger (3 percent), fatigue (3 percent), confusion (3 percent), and worry (3 percent).
The idea that children are experiencing anxiety and depression at an increasing rate due in part to the pandemic is backed up by other studies and data. In an Ann & Robert H. Lurie Children’s Hospital of Chicago survey of 1,000 parents, 71 percent said the pandemic has negatively affected their child’s mental health. According to Centers for Disease Control and Prevention data, emergency department visits for mental health purposes increased by 24 percent for children aged 5–11 and 31 percent for children aged 12–17 in 2020 compared to 2019.
The Most Vulnerable Children
The researchers also found that some children were more at risk than others of experiencing negative psychological reactions to the pandemic. These include youth with developmental disorders and physical health concerns such as attention deficit hyperactivity disorder, obsessive-compulsive disorder, severe obesity, cystic fibrosis, and chronic lung disease. The studies involved in the review highlighted a critical need for more youth mental health services and resources to address the complex needs of these vulnerable groups.
Risk Factors
In addition to health issues, the researchers analyzed a variety of other risk factors that made youth more likely to experience a decline in mental health during the pandemic. The studies showed that the female gender and higher grade levels were primary risk factors for depression and anxiety. Those who prefer spending their leisure time outdoors or in social settings were also at a greater risk for depression and anxiety, as COVID-related lockdowns kept them from doing what they enjoy. Finally, high school students who used negative coping strategies, including substance use and behavioral avoidance, were more likely to show symptoms of stress, depression, and anxiety.
Possible Therapeutic Interventions
While the researchers were unable to uncover studies with proven methods on how to intervene and improve youth mental health as a result of the pandemic, they did find several recommendations based on risk factors, coping strategies, and psychological needs. The studies they analyzed suggested that implementing positive coping strategies can help improve mental health outcomes. These strategies include engaging in physical activities, limiting screen time, and spending time with friends and family.
The studies also highlighted the importance of addressing the pandemic and any negative mental health outcomes as a family. Often, changes in family members’ moods and increases in stress and anxiety can increase tension among family members.
Finally, the studies also pointed to a need for additional social support for youth, especially those with disabilities. Schools should work to create supportive environments, while governments must prioritize spending on youth mental health services and resources.
