Child and Adolescent Mental Health: Implications of COVID-19

Short Communication

Children’s mental health during the pandemic was negatively affected by social distancing and stay-at-home orders, in large part due to loneliness and isolation – known risk factors for poor mental health outcomes. A country-wide survey found that 1 in 5 young people felt the pandemic had a significant negative impact on mental health, nearly half of people with pre-existing mental health concerns reported a significant negative impact and 1 in 10 people under the age of 18 experiences a mental health condition following a COVID-19 diagnosis [1].

The pandemic resulted in the stripping away of all the trappings and distractions of everyday life which resulted, in a void in the automatic routine of daily life for many adults, but especially among children and adolescents. While for some, this newfound break from the demands of normal routine resulted in opportunities to for personal growth and self-reflection, for others this shift resulted in existential crisis. Nearly a quarter of high school students reported feeling disconnected from their classmates during the pandemic. A recent systematic review of 63 studies found an association between loneliness and mental health problems in children and adolescents [2]. Additionally, the duration of a child’s experience of loneliness is linked to mental health problems later in life. Moreover, COVID-19 related emotional reactions such as fear of contracting the virus, worry, and stress further contributed to the increase in mental health problems in children and adolescents [3, 4]. To cope with everyday forms of stress, children and adolescents need a basic predictable environment to successfully adapt. However, in the context of pandemic, methods of adapting to or coping with immediate environmental demands may later compromise a child’s ability to form relationships with others or develop sufficient coping strategies to handle stressors in the future. Children who are chronically aroused by a stressful environment mobilize biological responses repeatedly, often to the point of overload [5]. Children may show signs of being hyperresponsive to stress, such as excessive threat vigilance, mistrust, poor social relationships, impaired self- regulation, and unhealthy lifestyle choices [5]. In contrast, some children may become hyporesponsive, which includes underreacting to signs of danger or threat-indicating that their stress system is overtaxed and may be shutting down [5]. Without the normal distractions of modern existence, and left with increased time for introspection, many children and adolescents were left to wonder what life is all about and struggled to find purpose and meaning during these uncertain and challenging times.

Despite numerous public service announcements proclaiming the benefits of staying at home (e.g., an opportunity to get to know each other better and reconnect, playing games), for many children and adolescents being quarantined resulted in feelings of being trapped in unhealthy relationships and toxic family dynamics which only served to magnify existing problems. While in-person schooling ordinarily provided needed emotional and mental support, structure, and safety, given stay-at-home and quarantine orders, these safe havens were no longer an option. Many parents experienced increased stress and poor mental health during the pandemic related to child care and financial instability. The manner in which children respond to various forms of stress is related to the degree of parental support and assistance they receive to help them cope and adapt [5]. Thus, the poor mental health of parents may adversely affect children’s mental health. Additionally, children in low-income households were at greater risk for mental health issues and are less likely to have access to needed mental health care, compared to children in high- income households.

Overall, the pandemic has exacted a tremendous societal toll, the full extent of which is not likely to be known for years. The removal of typical distractions and normal coping mechanisms exposed the frailty of the human condition, magnified developmental crises, and revealed the superficial nature of our existence, and forced many children and adolescents to question what life is all about and what our role is in it.

Most schools returned to in-person learning this past fall, which posed another challenge. As mentioned, much needed socialization was lost during the height of then pandemic. Youth continue to struggle with getting back to a sense of normalcy [6]. Families are finding it challenging to find supports for their children and if they do, there is often a waiting list. More than ever before, it is critical that high access touch points (e.g., schools, pediatric primary care offices) are equipped with skilled mental health providers trained specifically in working with children, adolescents, and families. The issues children and families face are diverse and many and will require integrated seasoned and skilled professionals to help them navigate emotional, familial, and academic struggles. Of particular concern is the rise of the multiple variants in the United States as they are more contagious than previous variants of COVID-19 [7]. The higher transmission rates could lead to surges of COVID-19 cases in pockets of the country with low vaccination rates [7]. Schools may wish to be proactive and prepare for a possible spike of COVID-19 by making sure they are equipped to offer support to both students and their families. School counsellors may wish to create a support group for families that are struggling to navigate this stressful time as well as teach families skills that they can implement at home to help manage distress youth may continue to face [8].

There continues to be many unknowns, but it has become apparent that for many, mental health declined during the pandemic. As a society, the pandemic exposed the lack of priority related to mental health treatment as well as limited resources and services available for children, adolescents, and families. As a society, the challenge for schools, primary care providers, and therapists is to ensure that these high access touch points have enough skilled providers trained to work with children, adolescents and their families to navigate the challenges (familial, social, academic, emotional) resulting from the pandemic.