Since the early days of the pandemic, there has been growing concern about the possible harms that the pandemic and related restrictions may have had on the mental health of youth. Some researchers theorized that the pandemic would cause anxiety and depression in youth, particularly in parts of the world where schools were closed for extended periods of time ^[1]. The pandemic may have also affected other mental health outcomes, such as the prevalence of eating disorders and suicide in youth. For this blog post, we will focus on anxiety and depression. The research is complicated, and it changes all the time, so we will do our best to summarize some of the key findings related to our question so far.

Estimates of Depression and Anxiety in Youth Have Doubled

Recent estimates state that worldwide, an average of 1 in 4 youth are experiencing depression, and 1 in 5 youth are experiencing anxiety–both doubled from pre-pandemic estimates ^[2]. Furthermore, it seems these estimates are increasing the longer the pandemic continues ^{[2, 3]}. Earlier studies suggested that on average, youth mental health may have improved during the first wave of COVID-19 cases (from spring to early summer 2020), despite school closures and lockdowns ^[4]. However, recent evidence contradicts that conclusion, showing that on average, youth mental health probably worsened during the first wave, but not as much as it may have during subsequent waves ^[3]. Notably, the first wave was the shortest and least deadly wave of COVID-19 for many countries, whereas the second and third waves beginning in November 2020 tended to be significantly worse ^[5].

There are a variety of reasons why, on average, the youth population is experiencing worsening mental health. For starters, school closures and lockdowns prevented youth from socializing with their peers and teachers, often for weeks or months at a time ^[3]. Schools are also the primary source of mental and/or physical health care for some youth, so school closures have made it difficult for many to get the care they require ^{[2, 6]}. Finally, school closures may have strained relationships between some youth and their parents, but this straining could be partially attributed to parental loss of income and food insecurity ^[6].

Some Youths Are at Higher Risk Than Others

Not all youths are at the same risk for worsening mental health outcomes during the pandemic; some groups are at higher risk than others. For example, older adolescents may be at a higher risk for anxiety and depression because they rely on their peers for social support more than children do ^{[7, 8]}. Girls are at a higher risk than boys, perhaps because they are more likely to have an innate predisposition to symptoms of anxiety and depression. Furthermore, youths with a history of a past traumatic event and/or psychiatric diagnosis are at a higher risk as well ^[4].

Early data suggested that youth who are racial and ethnic minorities reported better overall mental health than White youths, but they were more susceptible to pandemic-related stress ^[4]. As the pandemic continues, it appears that racial and ethnic minority youth are at a higher risk for worsening mental health than White youths, and this is at least partially attributable to racial discrimination. For example, false claims that Asians carry and/or are responsible for the coronavirus fueled anti-Asian racism in multiple countries. In the United States, the number of anti-Asian hate incident reports increased by 149% during the first year of the pandemic ^[9]. LGBTQ youth are also likely to be at higher risk for worsening mental health during the pandemic. The population of LGBTQ youth have been historically underrepresented in studies and more work needs to be done to understand the unique risks they face not only throughout the pandemic, but more generally as well ^[10].

The Role of Resilience

The information we have discussed above is worrying, but there is some good news. Even though more youth are experiencing anxiety and depression on average, there are some who have not experienced more anxiety and depression, and there are some who have had improvements in their mental health. Some youths have experienced improvements in their mental health, for example, because they learn more effectively in an online school environment than in person ^[11].

There are also a variety of resilience strategies that many youths are benefitting from. We have arranged a list of such strategies. Our list is not exhaustive, but we have included strategies that are well-supported by research:

• Maintain strong routines around eating, sleeping, and exercising: Parents who have focused on maintaining strong routines, especially for younger children, have reported fewer disruptions in their child’s mental health than other parents ^{[3, 6]}
• Eat healthy food: Many youths are eating less healthy foods now than they were prior to the pandemic. Healthy food helps to protect against the symptoms of sadness, fear, etc., that often accompany anxiety and depression ^[12]. It is not literally true that ‘you are what you eat, but it is a useful phrase to keep in mind.
• Exercise more: On average, the youth population is exercising less during the pandemic. However, some youths are exercising more now than they did prior to the pandemic, and they tend to report better mental health outcomes than youths that are exercising less ^[6].
• Socialize online (or in person, when it is safe to do so): Socializing is important for good mental health. Most probably prefer to socialize in person, but during school closures and/or outbreaks of COVID-19, it is not always safe to socialize in person, especially with people outside of your immediate family. Luckily, we live in a digital age where most people have access to some form of electronic communication. If you’re stuck at home and you have access to electronic communication, then you may benefit from some online socializing with friends ^[13].
• Limit screen time, especially before bed: Electronics can be a blessing and a curse. They can enhance our everyday life and mental well-being, but they can also impede it. It is important to take time away from screens, especially before bed because the light emitted from them can make it harder to get a good night’s rest.

Key Takeaways

On average, more youth are experiencing anxiety and depression now than they did prior to the pandemic. However, not all youth are experiencing the pandemic in the same way; some youths are at higher risk than others, and some are doing better than they did prior to the pandemic. Furthermore, there are a variety of resilience strategies that work quite well to combat anxiety and depression, some of which we have listed here. The numbers and statements listed in this post are averages, which are useful for understanding trends, but they do not (by definition) accurately reflect the experience of every member of the youth population.

It is important to realize that the research on this issue is very complex, and it changes all the time. Even while writing this blog post, new evidence came out and we had to edit the draft to account for it. While it is too early to draw firm conclusions on the mental health impacts of the COVID-19 pandemic in youth, we hope to have highlighted some of the key findings so far, and we plan to write more on this subject in the future.

For More Information on Youth Mental Health and Mental Health Services . . .

The IWK Health Centre and the Nova Scotia Health Authority have put together two websites full of further information about mental and physical health, health services, and more for children and youth. For access to that information, please check out the links below:

IWK Health Centre, Helpful Websites for Children and Youth

Nova Scotia Health Authority, mental health and addictions information and services

References

[1] Kluger, J. (2020, July 23). The Coronavirus Seems to Spare Most Kids From Illness, but Its Effect on Their Mental Health Is Deepening. Time. https://time.com/5870478/children-mental-health-coronavirus/

[2] Racine N, McArthur BA, Cooke JE, Eirich R, Zhu J, Madigan S. Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19: A Meta-analysis. JAMA Pediatrics, 175(11):1142–1150. https://doi:10.1001/jamapediatrics.2021.2482

[3] Viner, R., Russell, S., Saulle, R., Croker, H., Stansfield, C., Packer, J., Nicholls, D., Goddings, A. L., Bonell, C., Hudson, L., Hope, S., Ward, J., Schwalbe, N., Morgan, A., & Minozzi, S. (2022). School Closures During Social Lockdown and Mental Health, Health Behaviors, and Well-being Among Children and Adolescents During the First COVID-19 Wave: A Systematic Review. JAMA pediatrics, 10.1001/jamapediatrics.2021.5840. Advance online publication. https://doi.org/10.1001/jamapediatrics.2021.5840

[4] Stinson, E. A., Sullivan, R. M., Peteet, B. J., Tapert, S. F., Baker, F. C., Breslin, F. J., Dick, A. S., Gonzalez, M. R., Guillaume, M., Marshall, A. T., McCabe, C. J., Pelham, W. E., 3rd, Van Rinsveld, A., Sheth, C. S., Sowell, E. R., Wade, N. E., Wallace, A. L., & Lisdahl, K. M. (2021). Longitudinal Impact of Childhood Adversity on Early Adolescent Mental Health During the COVID-19 Pandemic in the ABCD Study Cohort: Does Race or Ethnicity Moderate Findings?. Biological psychiatry global open science, 1(4), 324–335. https://doi.org/10.1016/j.bpsgos.2021.08.007

[5] WHO Coronavirus (COVID-19) Dashboard. (2022, January 24). World Health Organization. https://covid19.who.int/

[6] Patrick, S. W., Henkhaus, L. E., Zickafoose, J. S., Lovell, K., Halvorson, A., Loch, S.,  Letterie, M., & Davis, M. M. (2020). Well-being of Parents and Children During the COVID-19 Pandemic: A National Survey. Pediatrics, 146(4), e2020016824. https://doi.org/10.1542/peds.2020-016824

[7] Jones, E., Mitra, A. K., & Bhuiyan, A. R. (2021). Impact of COVID-19 on Mental Health in Adolescents: A Systematic Review. International journal of environmental research and public health, 18(5), 2470. https://doi.org/10.3390/ijerph18052470

[8] Manchia, M., Gathier, A. W., Yapici-Eser, H., Schmidt, M. V., de Quervain, D., van Amelsvoort, T., Bisson, J. I., Cryan, J. F., Howes, O. D., Pinto, L., van der Wee, N. J., Domschke, K., Branchi, I., & Vinkers, C. H. (2021). The impact of the prolonged COVID-19 pandemic on stress resilience and mental health: A critical review across waves. European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology, 55, 22–83. Advance online publication. https://doi.org/10.1016/j.euroneuro.2021.10.864

[9] Adams, Z. (2021, July 1). The mental health impact of anti-Asian racism. American

Psychological Association. https://www.apa.org/monitor/2021/07/impact-anti-asian-racism

[10] Ormiston, C.K., & Faustine, W. (2021). LGBTQ youth mental health during COVID-19:

unmet needs in public health and policy. The Lancet. In press. https://doi.org/10.1016/S0140-6736(21)02872-5

[11] Fleming, N. (2020, April 24). Why Are Some Kids Thriving During Remote Learning?

Edutopia. https://www.edutopia.org/article/why-are-some-kids-thriving-during-remote-learning

[12] O'Neil, A., Quirk, S. E., Housden, S., Brennan, S. L., Williams, L. J., Pasco, J. A., Berk, M.,  & Jacka, F. N. (2014). Relationship between diet and mental health in children and adolescents: a systematic review. American journal of public health, 104(10), e31–e42. https://doi.org/10.2105/AJPH.2014.302110

[13] Shankleman, M., Hammond, L. & Jones, F.W. Adolescent Social Media Use and Well-Being: A Systematic Review and Thematic Meta-synthesis. Adolescent Res Rev 6, 471–492 (2021). https://doi.org/10.1007/s40894-021-00154-5