Generation COVID-19: We cannot ignore our young people’s mental health during the pandemic
Little attention has been placed on the deleterious effects of the COVID-19 pandemic on adolescents’ mental health. This group, un-affectionately coined as Generation COVID-19, is especially at risk, influenced in large part by the consequences of social isolation.
What is it?
Mental health symptoms, although not identifiably mental health disorders, have been on the rise during the pandemic across all age groups. Particularly vulnerable are those with pre-existing mental health diagnoses and young adults. Among children, early studies from China during quarantine suggest that up to 1 in 5 children experienced either depression or anxiety symptoms.
Such studies have suggested an uptick in mental health symptoms, often measured by self-report scales such as the Patient Health Questionnaire (PHQ)-9; however scales offer self-report of symptoms at a designated time point. They likely don’t give an indication of overall presentation or diagnosis.
It may be useful therefore to frame these symptoms as the result of chronic, elevated stress, which can cause many downstream consequences. Chronic stress, such as that induced by the uncertainty and social consequences of the pandemic, can increase the levels of stress hormones (adrenaline and cortisol) in the body, and push one into a fight or flight response mode. This can impact less essential functions such as digestion, sleep, immune function, and even memory. In young people, this often manifests as physical complaints, sleeplessness, irritability and withdrawal. This type of ongoing fight or flight response can cause a figurative narrowing of vision and perspective, ultimately even leading to hopelessness, a key predictor in suicidality. Over time, this can impact function across multiple spheres of life, particularly social life. And when additional threats are perceived (such as rising COVID-19 cases), the innate response of an individual exposed to chronic stress is to withdraw. This type of withdrawal can lead one to socially isolate, which can be particularly harmful to young people.
And social isolation?
Social isolation is likely have longer acting impacts for young people; it is much more than simply limiting contact with others for a short period of time. Indeed, learning how to navigate social relationships and transition to learned adult roles through observation, experience, emotional management, and practicing in social settings are key to adolescent development. And for most young people, this happens outside of the home. Yet, this step has been stunted for many as we have moved past initial isolation to a longer period of staying home/out of school combined with the unpredictable future. Research analyzing the likelihood of developing future mental health concerns after disaster or pandemic events from 1946-2000 suggests that social isolation and loneliness may increase the risk of depression up to 10 years after the pandemic. It is also anticipated for those young people entering the workforce, many will face long term unemployment and missed educational opportunities. Thus, just as these young people are transitioning to adulthood, mental health symptoms can peak, at a time when there may also be difficulty in entering the job market.
So what can we do?
There are several actions that families and those invested in policy may take to better support adolescent mental health:
1. Mental health interventions a. Increase access to consultation to primary care providers and available referrals to behavioral health services for screening and early intervention (virtual or in person). b. Create effective and feasible adolescent friendly electronic interventions. A 2018 review found little evidence in this area, but there is room for increased research/development into studies to test/trial new interventions. c. Increase telehealth services available to children and adolescents through collaboration with insurers to ensure reimbursement, particularly across state lines. d. Gather more data on prevalence, incidence, and effective interventions once rolled out.
2. Educational interventions a. Engage learners in social and emotional development as a priority over other content and collaborate with educators to integrate content across the curriculum. b. Foster community based mentorship programs (such as through libraries and community centers) to provide adult learning opportunities and safe spaces outside of the home (even if virtual). c. Target interventions to decrease the stress response rather than focusing on psychiatric disorders alone. Mindfulness based interventions (MBIs) especially hold promise for reducing stress symptoms and may have a lower barrier to uptake as there may be more stigma around traditional mental health treatment.
3. Support for families a. Encourage parents and families to seek help for themselves as needed to model appropriate stress response. b. Promote messages to families to encourage safe behaviors for teens but to prioritize socialization. c. Create guidelines for structure in the home, particularly around food, sleep, activity, and school/work. Creating certainty in the home environment can foster control and decrease stress response related to uncertainty in the external environment.
4. Encourage organizations to put out teen friendly content and engage! a. Teens are able to digest a great deal of information. Engage them to understand the information on COVID-19 and let them be a part of it. Who knows, tik-tok or some other type of challenge may be just the thing to build community!
Few would argue that the COVID-19 pandemic has not changed daily life for young people. As academic years pass, social and holiday events are missed, and young people continue to be isolated from their social networks, there are significant risks to the mental health and well-being of adolescents. We can combat this challenge by shifting focus to screen and support adolescents for mental health symptoms, increase promotion of socialization (in a safe way), support practices that lower the stress response, and to engage young people in the process of information and dissemination!