Mental Health of Children during COVID-19

 Child and Adolescent Mental Health During the Pandemic

    

    After almost 2 years of living in a pandemic state, many people can attest to not only the physical, but also the mental toll of COVID-19. A previous post on this blog highlighted results from a study that attributed increased risk of psychiatric illnesses to COVID-19 infection. However, it's clear that you don't just need to be infected with COVID-19 to experience the adverse psychological effects of the pandemic; for children and adolescents, just living with the pandemic and its disruptions have lead to soaring rates of depression, anxiety, and suicide. The psychiatric effects of the COVID-19 pandemic are just as critical as the physical effects of COVID-19 infection, especially for children and adolescents, who have experienced enormous disruptions this past year including lockdown, online schooling, and possibly familial instability. In fact, the mental effects of the pandemic have been so great that in October 2021, the American Academy of Pediatrics (AAP) declared a National Emergency in Child and Adolescent Mental Health. This article highlights data from the Centers for Disease Control and Prevention (CDC) and the Journal of the American Medical Association (JAMA) on mental health and suicide rates for children and adolescents during the pandemic.

Suicide Attempts

    The CDC used data from the National Syndromic Surveillance Program and examined trends in mental health-related emergency department (ED) visits among adolescents and young adults aged 12-25 years. Although ED visits for suspected suicide in those aged 12-25 years were fewer in April-March 2020 than April-March 2019, ED visits for suicide attempts began increasing in adolescents aged 12-17 years during May 2020. From February 21-March 20, 2021, ED visits for suspected suicide attempts were 50.6% higher among girls aged 12-17 years than during the same period in 2019. For boys aged 12-17 years, ED visits for suicide attempts increased 3.7% compared to the previous year. Among adolescents aged 12-17 years, the average weekly number of ED visits for suicide attempts were 22.3% higher in summer 2020 and 39.1% higher in winter 2021 than during the corresponding periods in 2019. The CDC also noted a more pronounced increase in ED visits for females than males. 

    Conversely, young adults aged 18-25 years experienced a 16.8% drop in the number of ED visits for attempted suicide during spring 2020 compared with spring 2019. However, the rates of ED visits for suspected suicide attempts throughout the pandemic increased compared to 2019.

Depression and Anxiety

    The data published in JAMA was a meta-analysis of 29 studies that included a total of 80,876 participants with a mean age of 13 years. Out of the 29 studies, 16 were from East Asia, 4 were from Europe, 6 were from North America, 2 were from Central and South America, 1 was from the Middle East, and 8 reported having a racial or ethnic minority participants.

    Across the 80,876 youth participants globally, the pooled prevalence of clinically elevated depression was 25.2% and the pooled prevalence of clinically elevated anxiety was 20.5%. In other words, 1 in 4 adolescents globally are experiencing depression symptoms and 1 in 5 adolescents globally are experiencing anxiety symptoms. Compared to a prevalence of 12.9% for depression and 11.6% for anxiety in prepandmic years, the meta-analysis of these studies suggest that mental health struggles for youth during the pandemic have doubled. It was also revealed that prevalence rates for depression and anxiety were higher later in the pandemic, as well as in older adolescents and in girls.

Causes

   Studies from across the globe have found that the pandemic has lead to an increased rate of mental health struggles in children and adolescents, especially among girls. Researchers from the JAMA study say that "loss of peer interactions, social isolation, and reduced contact with buffering supports may have precipitated these increases." Additionally, with the shutdown of schools, many youth were unable to access their school's mental health services, which 80% of children rely on for their mental health needs. Furthermore, familial difficulties were another contributing factor in the worsening crisis of adolescent mental health. According to the AAP, over 140,000 children in the United States lost a primary and/or secondary caregiver. Many families also suffered from financial difficulties in addition to having to deal with possible illness and death of loved ones.

Going Forward

  The worsening crisis of child and adolescent mental health during the pandemic is one that needs to be addressed. Besides researching the long term effects of the pandemic on mental health, the AAP has also listed ways the policymakers at all levels of government can help address the mental health crisis (See here). If you or a loved one is experiencing mental health struggles, make sure to reach out to mental health resources (see here) and/or talk to a trained mental health professional. Remember to not only look out for the physical health of yourself and others during the pandemic, but also mental health!

Sources

1. Yard, Ellen, et al. “Emergency Department Visits for Suspected Suicide Attempts among Persons Aged 12–25 Years before and during the COVID-19 Pandemic - United States, January 2019–May 2021.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 17 June 2021, https://www.cdc.gov/mmwr/volumes/70/wr/mm7024e1.htm#F2_down.

2. Racine, Nicole, et al. “Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents during COVID-19.” JAMA Pediatrics, vol. 175, no. 11, 9 Aug. 2021, p. 1142., https://doi.org/10.1001/jamapediatrics.2021.2482.

3. “Aap-AACAP-Cha Declaration of a National Emergency in Child and Adolescent Mental Health.” Mental Health, American Academy of Pediatrics, https://www.aap.org/en/advocacy/child-and-adolescent-healthy-mental-development/aap-aacap-cha-declaration-of-a-national-emergency-in-child-and-adolescent-mental-health/.

4. “People Seeking Help.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 20 July 2021, https://www.cdc.gov/mentalhealth/tools-resources/individuals/index.htm.