Children may have been largely spared the worst physical effects of COVID-19, but it has still upended their lives, and created real concern for their mental health and well-being. The COVID-19 pandemic has raised huge concerns for the mental health of an entire generation of children. But the pandemic may represent only the tip of a mental health iceberg – an iceberg we have ignored for far too long, says the latest UNICEF report on ‘The State of the World’s Children’ which has focused on mental health this time.
Child and teen mental health in the lockdown
Bearing this in mind, what do studies say about the pandemic’s impact on children’s and adolescents’ mental health? UNICEF’s Office of Research – Innocenti carried out a rapid review of papers, which were focused mainly on adolescents. The report, Life in Lockdown: Child and adolescent mental health and well-being in the time of COVID-19, indicates that the pandemic did fuel some increases in depression, although in most studies these symptoms were only mild to moderate. There were increases, too, in irritation and anger among children as well as anxiety.
Not all children were affected equally. Children and adolescents who faced the greatest mental health risks came from disadvantaged families, had pre-existing mental health conditions or a history of adverse childhood experiences. There was a difference in response, too, between boys and girls; girls were at greater risk of depressive symptoms, anxiety and behaviour issues, and boys were at greater risk of substance abuse. Less noticed, but worth noting, is that the pandemic may have improved life satisfaction for some children and families by relieving them of school pressure or allowing them to spend more time together.
Some positive outcomes
A study in China, for example, indicated that about a fifth of students reported being more satisfied with life during the school closures. In Italy, about half of parents reported positive changes in their relationship with their children. Indeed, family – including positive parenting, and being able to talk to parents and other family members – was a key protective factor for many children, providing much-needed support and bolstering resilience. Other factors included physical activity, feeling connected to friends, maintaining daily routines, and – for some young people – civic engagement.
As well as the Life in Lockdown report, a number of other studies have surveyed research from around the world. One of the most widely reported is a meta-study in JAMA Pediatrics, released in August 2021, that pulled together results from 29 studies worldwide, covering around 80,000 children and adolescents under 18. According to the study, rates of clinically significant generalized depression and anxiety doubled over the course of the pandemic, with one in four youth experiencing depression and one in five anxiety. The meta-study notes higher rates of anxiety and depression among girls and young women and of depression (but not anxiety) among older children. Among other factors, this latter finding may reflect the impact of social isolation on an age group that relies heavily on socializing with peers.
Mental health concerns for children
Studies so far indicate that the main areas in which the pandemic has affected the mental health of children and adolescents are:
Stress and anxiety
Both have increased, reflecting fear of infection, uncertainty over lockdowns and school closures, and the challenge of adjusting to the new normal. There was no strong evidence of increases in post-traumatic stress disorders (PTSD).
Depression and suicidal behaviour
There were moderate increases in depressive symptoms and sadness, especially among
older adolescents. Evidence so far does not indicate a rise in suicide rates.
Lockdown fuelled an increase in anger, negativity, irritability and inattention, particularly among children with attention deficit/ hyperactivity disorder (ADHD) and autism. Parents also reported that younger children became clingy and adolescents experienced more conduct problems and disruptive behaviours.
Alcohol and substance use
Limited studies indicate that adolescents, especially boys and young men, drank more and abused other substances as a coping mechanism to deal with the pandemic and other mental health issues.
Lockdowns and school closures meant less exercise, more screen time and disrupted sleep – all of which are associated to some extent with lower quality of life and increased psychological distress.
Positive mental health
There is evidence that some children enjoyed improved life satisfaction during pandemic lockdowns because they were able to spend more quality time with family
members and enjoyed a break from school and exams.
Two counter measures
Strengthening Evidence Base on school-based intErventions for pRomoting adolescent health (SEHER) in Bihar, is an example of a whole-school, multicomponent mental health promotion programme that has operated on a large scale and has been tested. It features activities for all students while also offering individualized counselling for students in need. It operates in conjunction with a life-skills training programme integrated into classrooms. Evaluations showed that the programme succeeded by creating a positive school atmosphere that featured strong, nurturing relationships between teachers and students and fostered a sense of belonging among students. The result was lower rates of depression, bullying and violence. Interestingly, SEHER improved students’ attitudes towards gender equity, depression, bullying and violence when the intervention was delivered by a counsellor. In contrast, when the intervention was delivered by teachers, there was little effect.
Among the promising digital interventions in use is EMPOWER, a digital training platform led by Harvard’s Global Mental Health Lab. EMPOWER was piloted in India in conjunction with an established mental health-care organization, and in 2021, efforts were underway to launch the programme in the United States. EMPOWER is also developing content on parenting, a key approach to building the foundation of mental health in children and young people.
The goal of the programme is to build a global mental health workforce and bridge the divide between the need and the lack of high-quality, evidence-based services in many parts of the world. EMPOWER uses digital technology to train and provide real-time guidance for community health workers, including nurses, social workers and midwives. It also uses digital platforms to remotely track the effects of mental health-care interventions.