Alice Schluger, Ph.D.
Certified Wellness Practitioner, Wellness for Dancers
As our masks are being lifted, the exposure of our vulnerabilities as individuals, within communities, and globally is becoming more visible. The current perspective is beginning to highlight the numerous psychological ramifications of the prolonged COVID-19 pandemic. There appears to be a looming mental health crisis among youth with potential long-standing repercussions. Dealing with the traumatic events and life adjustments that have occurred in the wake of the pandemic has been a tremendous challenge for adults, but consider the weight of the additional burden on children and adolescents. Let’s explore what we have uncovered so far.
Mental Health Effects on Children and Adolescents
Studies have revealed significant negative effects of the pandemic on the mental health and wellbeing of children and adolescents (Schwartz & Costello, 2021). Even before the COVID-19 outbreak, mental health problems in young people were evident. Approximately one in five children, ages 3-17 had a diagnosable mental or emotional disorder. Therefore, it was expected that the pandemic would create further psychological distress in this age group. This prediction was borne out by a notable increase in young people seeking emergency mental health care in the past few years (Cloutier & Marshaal, 2020).
The anxiety and isolation during the pandemic was compounded by the physical closing of schools and the abrupt transition to remote learning (Liu et al., 2020). The loss of a concrete network of teachers and classmates caused many young people to feel disconnected, lonely, and hopeless. Interviews conducted with several teens at The Washington Post elicited a recurring statement in various communications: “I feel so alone.” These expressions continue to underscore feelings of helplessness and alienation among adolescents during these uncertain times in the “post-pandemic” era.
Vulnerable populations, such as disadvantaged youth and those with special needs or pre-existing behavioral issues have been the most severely affected by these considerable changes (Fegert et al., 2020). The negative impact on LGBTQ youth’s overall health and wellbeing is of particular concern (Ormiston & Williams, 2022). Children are also highly susceptible because of their limited understanding of the pandemic, along with the lack of coping skills. A closer look at some of the pressing concerns facing children and adolescents today is warranted for the development and provision of appropriate support.
Substance Abuse Issues
Risk factors for adolescent substance use, such as social isolation, stress and boredom have been heightened by the pandemic (Sarvey & Welsh, 2021). Additionally, anger, rage, and frustration may also exacerbate risk. It’s not surprising that such factors have taken a huge toll on the lives of young people. According to a 2020 CDC report, drug use is also associated with mental health and suicide risk, along with sexual risk behaviors, and violence. Research has shown a rise in alcohol and cannabis use in adolescents related to the constraints of social distancing and extreme stressors (Dumas et al., 2020).
A large Canadian study indicated that the initial COVID-19 outbreak temporarily reduced the frequency of alcohol consumption and binge drinking among youth (Gohan et al., 2022). As the pandemic went on, however, the frequency increased to a level comparable to pre-pandemic rates of drinking. The authors suggest that this trend may continue, and become the accepted norm for drinking behavior in adolescents and teens.
A greater reliance on virtual connections with friends has encouraged substance use as a way to maintain popularity and peer approval. Solitary substance use, which has been linked to depression, anxiety and unhealthy coping mechanisms in adolescents, may also be becoming more problematic (Dumas et al., 2020). Recognition of substance abuse may now also be more difficult, as alterations in mood, motivation, or attention spans may be warning signs of substance use, but it may be more difficult for parents to assess these behavioral changes in the context of the pandemic upheaval.
Disordered Eating Attitudes and Behaviors
Individuals with eating disorders have been at elevated risk for worsening symptoms during the pandemic. The increase in both newly-diagnosed and previously diagnosed adolescents with eating disorders seeking help has been has been evident (Schwartz & Costello, 2021). One reason might be fears connected with food insecurity, which could encourage binge eating, fasting, and compensatory disordered eating behaviors (Cooper et al., 2020). Both inpatient and outpatient cases increased following the onset of the COVID-19 pandemic, particularly within the first year. This leveled off somewhat in the second year but still remained above pre-pandemic baselines (Hartman-Munick et al., 2022).
Adolescents with eating disorders frequently have co-existing mental health conditions or behavioral problems. The sudden life changes brought about by the pandemic were tied to feelings of confusion, uncertainty, and loss of control. With the constant influx of social media messages about weight and food, in addition to “digitally enhanced” photo images, more restrictive eating patterns and body image concerns are likely to manifest. The lack of social support, coupled with disruptions in daily eating routines, may also contribute to disordered eating attitudes and behaviors in this population (Schwartz & Costello, 2021).
Depression and Suicide Risk
Depression, suicidal thoughts and actions and other self-harming behaviors are more prevalent in adolescents under crisis situations (Sarvey & Welsh, 2021). Youth suicide rates have been increasing, and this is now the second leading cause of death in adolescents (Goldstein et al., 2022). The overwhelming stressors related to the pandemic have not been experienced before, so successful coping mechanisms are not readily identifiable. Lockdown, quarantine, and social distancing mandates severely hampered vital interpersonal connections. Since peer relationships are extremely important for socialization during adolescence, this may have intensified feelings of loneliness and despair (Alvis et al., 2020).
Psychological problems, including irritability, anxiety and excessive clinginess were observed in children in quarantine (Imran et al., 2020). Children have been struggling with adaptations to unfamiliar circumstances, and an accompanying degree of social and emotional stress. Adjustments to remote learning created learning difficulties for many children, as did the transition back to in-person schooling. In many cases, academic progress has been hampered by virtual learning, due to lack of access to technology and/or technological challenges for both students and teachers. For high school and college students, significant academic pressures were further exacerbated by constant disruptions in their educational environment.
Directions for the Future
As we gradually emerge from the pandemic and re-enter our “new normal” lives, how should we be responding to this impact on the mental health of children and adolescents? The younger generation has been confronted with an unprecedented trauma that will require multidimensional solutions and strategies. From an educational standpoint, schools must provide a safe, supportive space for students returning to brick-and-mortar learning.
In addition to reaching out and asking about students’ wellbeing, comprehensive mental health and behavioral resources must be made available. Mental health prevention and education programs for students, parents and the community are also necessary to increase attention and awareness about these issues. This constitutes an area of intervention for health psychologists to contribute their expertise in the planning and implementation of effective programs.
For families, ongoing parental support and reassurance is critical under these circumstances to validate teens’ feelings and ease anxiety as much as possible. Active listening is imperative for keeping the lines of communication open and encouraging children to confide their concerns in adults. Children and adolescents also need to know that asking for help is nothing to be ashamed of, and that qualified professionals are there for guidance and assistance.
There is still a great deal we need to learn about the mental health consequences of the pandemic. Promoting resilience in youth is illuminated by the stark contrast between the power of connectedness and the destructiveness of isolation. Continued research is essential for the development of appropriate psychological interventions and to inform health policy decision-making. It may also be advantageous to implement more robust screening tools that do not create further stigmatization about these sensitive issues.
The pandemic may be “over” in some respects, but the aftershocks will remain with us for some time. Health psychologists must be adequately prepared to address ongoing mental health challenges in the future, and protect our youth from engaging in harmful behaviors. The shift towards telehealth and remote counseling is still relatively new, so we must continue to examine the effectiveness of these technological approaches with children, adolescents, and teens. As the demand for these services increases, accessibility to quality mental health resources is essential, particularly for underserved and marginalized populations. Overall, we must remain vigilant and committed to our youth as we tackle these pandemic-era challenges.
Alvis, L., Douglas, R., Shook, N., & Oosterhoff, B. (2020). Associations between adolescents’ prosocial experiences and mental health during the COVID-19 pandemic. PsyArXiv Preprints. https://doi.org/10.31234/osf.io/2s73n
Center for Diseases Control and Prevention. (2020). Youth risk behavior survey: Data summary & trends report. Retrieved from: https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBSDataSummaryTrendsReport2019-508.pdf
Cloutier, R. L., & Marshaal, R. (2020). A dangerous pandemic pair: Covid-19 and adolescent mental health emergencies. American Journal of Emergency Medicine, 46, 776-777. https://doi: 10.1016/j.ajem.2020.09.008
Cooper, M., Reilly, E. E., Siegel, J. A., Coniglio, K., Sadeh-Sharvit, Pisetsjky, E. M., & Anderson, L. M. (2020). Eating disorders during the COVID-19 pandemic and quarantine: An overview of risks and recommendations for treatment and early intervention. Journal of Treatment & Prevention, 30(1), 54-76. https://doi.org/10.1080/10640266.2020.1790271
Dumas, T. M., Ellis, W., & Litt, D. M. (2020). What does adolescent substance use look like during the COVID-19 pandemic? Examining changes in frequency, social contexts, and pandemic-related predictors. Journal of Adolescent Health, 67(3), 354-361. https://doi.org/10.1016/j.jadohealth.2020.06.018
Fegert, J. M., Vitello, B., Plener, P. L., & Clemens, V. (2020). Challenges and burden of the coronavirus 2019 (COVID-19) pandemic for child and adolescent mental health: A narrative review to highlight clinical and research needs in the acute phase and the long return to normality. Child Adolescent Psychiatry & Mental Health, 14(20), 1-11. https://doi.org/10.1186/s13034-020-00329-3
Gohari, M. R., Varatharajan, T., MacKillop, J., & Leatherdale, S. T. (2022). Examining the impact of the COVID-19 pandemic on youth alcohol consumption: Longitudinal changes from pre-to-intra-pandemic drinking in the COMPASS study. Journal of Adolescent Health, 71(6), 665-672. https://doi.org/10.1016/j.jadohealth.2022.07.007
Goldstein, E. V., Prater, L. C., & Wickenzer, T. M. (2022). Preventing adolescent and young adult suicide: Do states with greater mental health treatment capacity have lower suicide rates? Journal of Adolescent Health, 70(1), 83-90. https://doi.org/10.1016/j.jadohealth.2021.06.020
Hartman-Munick, S. M., Lin, J., Millre, C. E., Braverman, P. K., Brigham, K. S., Fisher, M. M., Golden, N. H., Jary, J. M., Lemly, D. C., Matthews, A., Ornstein, R. M., Roche, A., Rome, E. S., Rosen, E. L., Sharma, Y., Shook, J., Taylor, J. L., Thew, M., Vo, M., & Richmond, T. K. (2022). Association of the COVID-19 pandemic with adolescent and young adult eating disorder care volume. JAMA Pediatrics, 176(12), 1225-1232. doi:10.1001/jamapediatrics.2022.4346
Imran, N., Aamer, I., Sharif, M. I., Bodia, Z. H., & Neveed, S. (2020). Psychological burden of quarantine in children and adolescents: A rapid systemic review and proposed solutions. Pakistan Journal of Medical Sciences, 36(5), 110-6. https://doi: 10.12669/pjms.36.5.3088
Liu, C. H., Pinder-Amaker, S., Hahm, H., & Chen, J. A. (2020). Priorities for addressing the impact of the COVID-19 pandemic on college student mental health. Journal of American College Health, 70(5), 1356-1358. https://doi.org/10.1080/07448481.2020.1803882
McCarthy, E. (2021, February 11). The loneliness of an interrupted adolescence. The Washington Post. https://www.washingtonpost.com/lifestyle/style/teenagers-covid-pandemic-mental-health/2021/02/10/3389983a-39d6-11eb-9276-ae0ca72729be_story.html
Ormiston, C., & Williams, F. (2022). LGBTQ youth mental health during COVID-19: Unmet needs in public health and policy. The Lancet, 399(10324), 501-503. https://doi.org/10.1016/S0140-6736(21)02872-5
Sarvey, D., & Welsh, J. W. (2021). Adolescent substance use: Challenges and opportunities related to COVID-19. Journal of Substance Abuse Treatment, 122, 108212. https://doi.org/10.1016/j.jsat.2020.108212
Schwartz, M. D., & Costello, K. L. (2021). Eating disorder in teens during the COVID-19 pandemic. Journal of Adolescent Health, 68(5), 1022. https://doi.org/10.1016/j.jadohealth.2021.02.014