At the beginning of the pandemic, the CDC advised that children and adolescents were considered the lowest-risk group with regards to medical concerns and complications from Covid-19. As the pandemic rages on, we are seeing a rise in pediatric Covid-19 cases and hospitalizations and we are witnessing a global syndemic of mental health issues in young people.
I have written about the pandemic’s profound mental health impact on young people in the past but a new study from the University of Calgary, showing that depression and anxiety symptoms have doubled in children and adolescents globally when compared to pre-pandemic times is more than cause to raise the alarm again. This study is further evidence that many different demographics will suffer from Covid-19 related post-traumatic stress disorder (CV-PTSD).
The University of Calgary study is a meta-analysis, which pools together data from 29 separate studies from around the world, including 80,879 youth globally. The meta-analysis includes 16 studies from East Asia, four from Europe, six from North America, two from Central and South America, and one from the Middle East. Prior to the pandemic, rates of clinically significant generalized anxiety and depressive symptoms in large youth cohorts were approximately 11.6% and 12.9%. The meta-analysis found that the pooled estimates of clinically elevated child and adolescent depression and anxiety were 25.2% and 20.5%, respectively, suggesting that both had likely doubled.
The most alarming finding was that mental health difficulties were more prevalent as the pandemic persisted. Indicating that as the pandemic continues, mental health issues are worsening and compounding among young people. A potential delay of 2-4 years is often observed between the traumatic event and the development of a mental health disorder, meaning that while we may be seeing some of the initial effects of the pandemic, we will continue to see more over the next 2-4 years.
Dr. Sheri Madigan, PhD, co-author of the paper and UCalgary clinical psychologist believes that the unpredictability of the pandemic is contributing to this increase. “We’re continuing to see compounding effects of the pandemic,” she says. “It’s disjointing for kids because they can’t predict what their environment is going to look like, and we know when their world lacks predictability and controllability, their mental health suffers.”
The researchers also found that females and older youth were both at greater risk for both depression and anxiety difficulties. For many children and adolescents, life during the pandemic barely resembles a typical childhood. Critical developmental needs go unmet as children are isolated from friends, and miss out on typical school activities such as sporting teams and performing arts productions or milestones like prom and graduation. In particular, adolescent brains are wired for seeking out new social and romantic connections that allow them to achieve a sense of status and self worth, critical in managing symptoms of depression and anxiety. Family members cannot often fill the void left by decreased socialization with peers, leading to increasing rates of loneliness among youth.
Lead author of the study and clinical psychologist, Dr. Nicole Racine, PhD, believes that this could be a contributing factor to these dramatically rising rates of depression and anxiety. “Once you enter adolescence you begin differentiating from your family members and your peers can actually become your most important source of social support,” says Racine. “That support has been greatly reduced, and in some cases absent altogether, during the pandemic.”
Research shows that routines support healthy social-emotional development in early childhood, however, with the constant reopening and closing of schools, daycares, and after-school activities, this can be difficult to maintain. A structured and predictable home environment can also help children develop their self-regulation skills to identify and manage their feelings and not become overwhelmed. But with the financial impact of the pandemic and the increased psychological stress placed on parents and caregivers juggling work and childcare, it may be also not always be possible to provide such an environment. But rebuilding and maintaining routines with children around sleeping, eating, and taking care of their bodies will be critical in their recovery.
But the burden cannot be solely on parents and caregivers. As this issue continues to escalate, we need to be implementing a recovery plan now. Children’s hospitals in Canada are reporting a 100% increase in mental-health-related admissions and McMaster Children’s Hospital specifically has reported a 200% increase in pediatric suicide attempts. As a result, Canada’s children’s hospitals and advocacy organizations have united to create a #codePINK campaign. The term “Code Pink” is used to declare a pediatric emergency, and the campaign is calling on the federal and provincial/territorial governments to act immediately to address this emergency. We need a similar call to action both in the US and globally, a rapid expansion and increase in access to mental health services. Youth have some of the highest unmet needs in mental health care. The development of specialized services such as youth mental health hubs will go a long way in addressing that disparity.
Finally, the impact on youth mental health is yet another reason to ensure our schools and daycares are implementing vaccination, masking, physical distancing, testing and tracing policies, and using ventilation and wastewater surveillance to reopen safely. Only then can children begin to reclaim the experiences required for healthy social and emotional development.