For most children and adolescents, the past year has been a shadow of a typical childhood. Instead, there have been strict stay-at-home orders, repeated opening and closures of schools, social distancing from peers and other supports, limited or no access to sport and extracurricular activities, and many missed milestones such as graduation.
"During this time, the family unit has been in crisis as well, with financial instability as well as increased psychological stress for caregivers. Independently and collectively, these events can catalyse mental health difficulties in children and youth," write Brae Anne McArthur, Nicole Racine and Sheri Madigan from the University of Calgary in this piece.
At the beginning of the pandemic, children and adolescents were the lowest-risk group with regards to medical concerns and complications from covid-19. Now, over a year into the pandemic, they have emerged as the invisible casualties of this global crisis. "Many clinicians and child-health practitioners are calling attention to a youth mental health crisis. Recently, national children’s charity Children First Canada declared a #codePINK, a term commonly used in health-care settings to indicate a pediatric emergency," state the authors.
Many pediatric hospitals have reported a 100 per cent increase in admissions for mental health problems, upwards of a 200 per cent increase in admissions for substance use and suicide attempts, and report that 70 per cent of children and youth have indicated that the pandemic has affected their mental health.
"Our child psychology research team sought to better understand the current state of children’s mental health globally, one year into the pandemic. This research summary, published in JAMA Pediatrics, shows that globally, one in four young people is experiencing clinically elevated depressive symptoms, while one in five is experiencing clinically elevated anxiety symptoms," they say.
These rates are all the more alarming when compared to pre-pandemic estimates, which were closer to one in 10 youth having clinically elevated anxiety and depression. This indicates that youth mental health difficulties have likely doubled during covid-19.
Child and youth mental health distress may be sustained long term. "When we looked deeper into which youth were struggling the most globally, we found that — consistent with pre-pandemic data — females and older youth were at greater risk for both depression and anxiety difficulties," write the authors. They also found that mental health difficulties were more prevalent as the pandemic persisted. This suggests that as the length of the pandemic continued, along with public health safety measures such as school closures and social distancing, clinically significant anxiety and depression symptoms also increased.
This indicates that children and youth globally are struggling with mental health difficulties, and their symptoms are worsening as the pandemic continues. "As researchers and psychologists, we are left wondering whether mental health difficulties in youth will continue to persist for years to come. Will their mental health deterioration be one of the most profound impacts of the covid-19 pandemic? We think so," they say.
Children and adolescents who endured the various disruptions and emotional and physical consequences of the pandemic are the future of our society. To help foster their well-being and our prosperity as a society, now is the time to act to protect the next generation. The authors have identified three primary objectives for pandemic recovery efforts aimed at improving child and youth mental health.
Take action now: We can’t wait to make services available to children who are suffering emotionally. We must act now to address a near doubling in mental health difficulties for children and youth during the pandemic. There is a need for government to develop urgent and strategic plans to address the mental health of youth and ensure the provision of accessible and equitable resources to support this initiative.
Return to routine: Decades of research on child development has shown that children thrive in the context of clear and consistent routines and structure. Many of the strategies used to reduce the spread of covid-19 have forced children and adolescents to stay indoors, resulting in disrupted routines, increased sedentary time (for example, more screen time, less physical activity) and a reduction in structured activities such as sports, camps and extracurriculars.
Keeping schools open and maintaining family routines during the pandemic can protect children’s mental health. It will also be critical to support families by ensuring they have the material and psychological resources needed to help their children.
Mental health supports for children: To address this ongoing crisis, there is a need for equitable mental health services that are accessible to all children and youth. Investing in new models of care that can be adapted to increase scalability should be prioritised.
This includes group and individual telemental health services (mental health services delivered by phone, texting or videoconference) and brief intervention approaches. Emerging research awaiting peer review suggests that single-session interventions for adolescent depression during COVID-19 can effectively reduce feelings of depression and hopelessness among youth. Increased access to, and availability of, mental health resources are critical.
Children and youth represent our largest investment in the future. The mental health implications of covid-19 have been particularly dire. Although there have been some covid-19 recovery initiatives targeted at this group, we need clear and actionable items to move forward with a mental health recovery plan that will address the increased severity of mental illness in children and adolescents and the rising need for services.