Damian Sendler: The coronavirus disease 2019 pandemic is causing significant anxiety and depression in children and adolescents, according to research. There is a possibility that adolescents, particularly females, are at greater risk. It is possible that these issues are exacerbated by factors such as social isolation and a lack of exercise. Somatic symptoms, depression, and anxiety may be more common in children who are concerned about coronavirus disease 2019. Children may be more vulnerable to abuse if their parents are under stress or have mental health issues. Depression and anxiety should be routinely screened for by medical and behavioral health professionals. Mental health services need to be more widely available.
Damian Jacob Sendler: This year’s coronavirus disease (COVID-19) has wreaked havoc on the lives of children and adolescents around the globe. As of January 16, 2021, there have been 23,440,774 cases of COVID-19 in the United States and more than 390,938 total US deaths as a result of this virus. 2 Families have been affected greatly by the pandemic-related school and business closures and community lockdowns. Children were forced to attend online schools as a result of the first global lockdowns, which began on January 23rd, 20203, in China.3 Many school districts in the United States began moving to online school in March 2020, coinciding with the closure of local campuses. 4 With each new outbreak of COVID-19, the United States has responded by imposing and then removing restrictions at the local and state level across the country. This is an ever-changing situation, with new pressures appearing on a regular basis.
Dr. Sendler: In addition to the pandemic-related changes mentioned, concurrent sociopolitical stressors are likely to affect the mental health of children and adolescents at this time. COVID-19 has been referred to as the “Wuhan virus” or the “Chinese virus” by some American politicians, which has led to reports of a racism pandemic against Asian Americans in the US. 5 Chinese American parents and children ages 10 to 18 who were surveyed reported being targeted by or witnessing COVID-19 racial discrimination in the early stages of this research. 6
The death of George Floyd at the hands of the police on May 25 sparked additional racial-based stressors in the United States.
7 Many children were exposed to instances of violence and/or racism as a result of media coverage and a video depicting his death. Outrage over police violence led to months of protests and demonstrations, peaking in June 2020, which focused the country on the issue of racial justice. 8 COVID-19 pandemic stressors and these sociopolitical events in the United States are difficult to separate.
COVID-19 has been linked to increased levels of depression and anxiety in children and adolescents, as well as post-traumatic symptoms, in the earliest reviews of original research into the drug’s impact on mental health.
10 In November 2020, Fong and Iarocci11 published a review of previous pandemic research and new COVID-19 findings and concluded that social isolation and quarantining during a pandemic results in significant anxiety, post-traumatic stress disorder (PTSD), and fears in children and adolescents. Reduce barriers to mental health services for children and their families, according to the authors.
Parents and children have both noted a decline in mental health among children during the pandemic. 14% of parents with at least one child under the age of 18 reported that their child’s behavioral health had deteriorated after March, with little difference across racial, ethnic, socioeconomic, and educational groups. This was found in a US study of 1000 parents. 23 Parents’ and children’s mental health problems have reportedly gotten worse for these families as their children have gotten younger, their child care has dried up, and there has been an increase in food insecurity. About a month after the pandemic began, Canadian researchers gathered data from clinical and community samples of young people aged 14 to 28. When compared to preandemic functioning, the community sample showed the most significant decline in mental health. Some of these college students returned to their parents’ homes after the outbreak of the pandemic, which may have contributed to their decreased substance use.
Suicide-related behaviors have been compared over time using large health-related datasets. From March to July of 2020, Hill and colleagues17 compared the percentage of adolescents seen reporting recent suicidal ideation and recent attempts in a large US city hospital emergency department (ED) with the same months in 2019. Compared to 2019, they found higher rates of suicidal thoughts in March and July 2020, and higher rates of recent suicide attempts in February through April and July 2020. This suggests that events in 2020 are to blame for these increases. The rates of completed suicides among youth under the age of 20 in Japan, in contrast, were compared using public data from March through May of 2019 and the same months in 2020. 18 Suicide among Japanese teenagers increased from March to May of each year, but the numbers did not worsen in 2020. Due to COVID-19 restrictions, researchers hypothesized that the youth staying at home with family may have been a protective factor.
Often, children and adolescents who are experiencing a mental health crisis are referred to hospital emergency departments. For the months of January through October of 2019 and 2020, Leeb and colleagues20 analyzed emergency department visit rates for children under the age of 18 using data from the Centers for Disease Control and Prevention, which reported general mental health-related visits in 47 US states. After March 2020, sharp increases were found in the percentage of mental health-related visits per 100,000 emergency department visits. These increases continued through October. In addition, the proportion of visits related to mental health increased significantly from the end of March to the end of October compared to the same months in 2019. Mental health-related visits for children aged 5 to 11 increased by 24% between 2019 and 2020, while visits for adolescents aged 12 to 17 years increased by 31% from 783 to 972 visits per 100,000 visits (from 3098 per 100,000 emergency department visits to 4051 per 100,000). Pandemic-related stressors may be to blame for these increases in children and adolescents’ anxiety levels. As a possible explanation for this increase, the authors suggested that the public’s difficulty in accessing community mental health services may be a factor.
Damian Sendler
During the COVID-19 pandemic, children between the ages of 7 and 13 have been reported to exhibit higher rates of anxiety and depression than normal.
Studies on children during this time period have found rates of significant depressive symptoms ranging from 2.2% to 11.78%.
From 1.8 percent 26 to 18.92 percent 12 to 23.87 percent.
3.16 percent of the population is said to suffer from post-traumatic stress disorder (PTSD).
An increase in inattention and a need for reassurance have been noted as the most problematic behaviors, as have difficulties in school, misbehavior, anxiety, social isolation, and depression.
The pandemic has led to a wide range of behavioral issues in adolescents, including depression, anxiety, misbehavior, social isolation, (inadequate) attention, and impulsivity, according to parents.
Significant anxiety symptoms were reported by as many as 10.4% of participants and as few as 29.27 percent of participants, according to research.
Significant depressive symptoms are more common in female adolescents than in males, with rates ranging from 17.3% to 22.28 percent.
Damian Jacob Markiewicz Sendler: In comparison to younger children, several studies have found that high school seniors have the highest levels of depression, anxiety, and stress. 24 The postpandemic months (March to October, 2020) saw a rise in the number of mental health-related emergency department visits among adolescents ages 12 to 17, with females accounting for the majority of these visits. 20 39.9 percent of a community sample of mostly college-aged youth reported symptoms of an internalizing disorder (eg, depression or anxiety) and 16.9 percent reported symptoms of an externalizing disorder (eg, aggression, oppositionality). 16 Researchers who looked at college-aged students found that 34.85% of them reported having somatic symptoms, especially when stressed about the necessities of daily life.
Damian Jacob Sendler
A lack of social interaction and loneliness has been linked to an increased risk of depression and possibly anxiety in children, according to research. 28 Social isolation has been linked to depression and anxiety in the COVID-19 studies cited here, including children who were unhappy with their home quarantine,24 those whose parents had to leave work,25 and those who were left alone on weekdays. 12 Social isolation can have a particularly negative impact on the mental health of young people who identify as members of a sexual minority. Research by Fish and colleagues29 with lesbian, gay, bisexual and transgender (LGBTQ) youth identified the difficulties of being homebound with unsupportive families, as well as the loss of in-person socialization for LGBTQ youth. For LGBTQ youth, maintaining social support and mental health via electronic connections is critical, according to researchers.
The COVID-19 pandemic has necessitated the use of mobile phones and the Internet. In the early weeks of the pandemic, some parents claimed to have had success soothing their children with media entertainment, but a large study of children and teenagers found that smartphone and Internet addiction (defined as excessive use) was associated with increased depression.
During the pandemic, children who engaged in regular physical activity showed less hyperactive–inattentive behavior and exhibited more prosocial behaviors.
22 Conversely, a lack of exercise during COVID-19 has been linked to higher levels of depression and anxiety, and researchers suggest that physical activity may serve as a protective factor. 12 Sedentary behavior has been shown to have significant negative effects on children’s mental health, according to Mittal and colleagues30, who point out that children’s play is essential for them to reach developmental milestones. Alternatives such as zoom and community and academic partnerships were emphasized as important means of ensuring that children remain physically active.
A correlation between COVID-19 risk perception and child and adolescent mental health was found. Living in an area with high COVID-19 concentrations has been shown to have detrimental effects on health (ie, City of Wuhan compared with other areas in China). Children who lived close to Wuhan had higher depression levels3, more problems with their peers, and more behavioral issues in general. 31 Primary school students were found to have increased somatic symptoms and anxiety when they experienced higher concerns about threats to their health and well-being, which is in line with this finding. 21 Children with more severe sleep problems had more COVID-positive family members or neighbors, according to a study by Yeasmin and colleagues25. There was a significant association between the number of COVID-19 cases in a family’s geographic area and adolescent internalizing problems, according to Fitzpatrick and coworkers14. Community restrictions that were more lenient were linked to more internalizing and externalizing problems in children and adolescents, suggesting that children felt safer and had better mental health outcomes when community restrictions were in place.
Damien Sendler: Exposure to COVID-related information may have an effect on mental health, according to some evidence. Grade school students who spent more time reading COVID-19 media reports had higher levels of anxiety and PTSD symptoms, according to a large study conducted 1 month after quarantine. PTSD symptoms were found to be the only ones associated with how much attention such reports received in the same research study. 26 A different study, on the other hand, found that children whose parents did not talk to them about COVID-19 had higher levels of depression, anxiety, and stress. 24 There was less depression and anxiety in the teens in the large study who had more knowledge about COVID-19, were optimistic about it, and were taking additional safety precautions.
The well-being of a child and a parent are inextricably linked. Studying parent well-being during the COVID-19 pandemic found that hardships like decreased work, incomes, and increased caregiving burden were directly linked to the well-being of parents. 15 More than two-thirds of the parents surveyed in a study in the United States reported that their mental health had deteriorated as a result of the pandemic. 23 As a result, domestic violence and child abuse are more likely to occur as a result of these stressful situations. 32 For children aged 4 to 10, studies conducted by COVID-19 found that parental depression, job loss, and previous maltreatment predicted higher rates of maltreatment. 33 A study that looked at the parenting of a broader range of children (18 years old) found that parents were less likely to abuse their children when they received more support and felt in control. 34 It’s no coincidence that families are spending more time together due to COVID-19 restrictions and the pandemic’s effects on parental mental health, according to Rodriguez and colleagues. 35 In order to help and educate families and communities in order to safeguard children, the authors advocate a proactive approach rather than a reactive one.
Anxiety and depression have been found to be increased in children and adolescents who have been exposed to the COVID-19 pandemic compared to pre-pandemic levels. Teenagers, particularly females and seniors in high school, may be the most affected, according to the research. These mental health issues are linked to social isolation and sedentary behavior, according to research. Somatic symptoms, depression, and anxiety may be more common in children who are afraid of the COVID-19. Anxiety and post-traumatic stress disorder (PTSD) symptoms may increase if children are exposed to too much information about COVID without parental guidance.
Many parents, especially single parents and parents of young children, are experiencing significant economic and personal stress, as well as an increase in mental health symptoms. Some children may be more vulnerable to child maltreatment as a result of pandemic-related stressors and situations, as is evident from the effects on their parents’ mental health.
It will be critical to make mental health services more readily available to children and their families. Mental health care should be integrated into medical settings in order to provide comprehensive and front-line care. As the situation evolves, it will be necessary to conduct research into the long-term effects of COVID-19, as well as studies into the most effective methods of prevention and treatment.