COVID-19 Pandemic Associated With Worsening Mental Health Outcomes for Adolescents

The COVID-19 pandemic was associated with worse outcomes in mental health for adolescents, which emphasizes the need to evaluate risks and resilience at the individual and social levels, according to the results of a study published in JAMA Network Open.¹

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The authors of the study found that in order to promote mental health, policy interventions should focus on home connectedness, peer friendship, and school climate while avoiding full school closures.¹

According to the CDC, in 2021, approximately 37% of high school students reported that they experienced poorer mental health during the pandemic and 44% reported persistently feeling sad or hopelessness over the same time period.²

The study authors aimed to determine the outcomes of the COVID-19 pandemic on adolescents’ mental health and the association with individual, family, friends, and school characteristics. The study included follow-up data from the My Resilience in Adolescence cluster randomized clinical trial, collected across 2 United Kingdom cohorts. The data were from mainstream United Kingdom secondary schools that had a strategy and structure that included social-emotional learning, had an appointed head teacher, and were not rated “inadequate” in the last official inspection.¹

Cohort 1 included 12 schools with 864 students and cohort 2 included 72 schools with 6386 students. Cohort 1 completed assessments from September 2018 to January 2020, before COVID-19 was declared a pandemic. Cohort 2 completed assessments from September 2019 to June 2021, which included 3 national lockdowns during the pandemic.¹

Investigators measured for changes in students’ risk of depression via the Center for Epidemiological Studies-Depression scale, social, emotional, and behavioral differences via Strengths and Difficulties Questionnaire, and mental well-being via the Warwick-Edinburgh Mental Well-Being Scale.¹ Investigators included a total of 7250 individuals with a mean age of 13.7 years, 55.4% identified as female, and 73.1% identified as White. Approximately 89% of cohort 1 and 46.3% of cohort 2 provided data that were analyzed.¹

Investigators found that the mental health difficulties increased in both cohorts, but there was a greater increase among students during the pandemic, which included the risk of social, emotional, and behavioral difficulties, as well as depression and mental well-being.¹ However, the study authors reported that positive school climate, high home connectedness, and friends during lockdown were associated with a lower risk of these mental health issues; however, the investigators found that positive school climate and outcomes did weaken overtime.¹

Uncertainty around having friends during lockdown led to an increased risk of depression and social, emotional, and behavioral difficulties. Household assets, studying conditions, home conflict, and the time spent in school did not cause changes in mental health, according to the investigators.¹

A combination of poor school climate and high home connectedness was associated with the greatest reduction in risks of depression while the opposite was associated with the greatest increase in risk of depression.¹

The risk for greater mental health deterioration was associated with being a female and initial low risk for mental health difficulties, according to the study investigators.

Furthermore, partial school attendance during the lockdown was associated with better adjustment to the pandemic compared to no attendance when returning to school.¹

Reference

1. Montero-Marin J, Hinze V, Mansfield K, Slaghekke Y, et al. Young people's mental health changes, risk, and resilience during the COVID-19 pandemic. JAMA Netw Open. 2023;6(9):e2335016. doi:10.1001/jamanetworkopen.2023.35016
2. New CDC data illuminate youth mental health threats during the COVID-19 pandemic. News release. Centers for Disease Control and Prevention. March 31, 2022. Accessed September 22, 2023. https://www.cdc.gov/media/releases/2022/p0331-youth-mental-health-covid-19.html