While the COVID-19 pandemic has impacted the mental health of a wide range of individuals, its adverse effects have been particularly detrimental to adolescents. In this article, I discuss evidence that shows the effects of the pandemic on adolescent patients, potential reasons for this increased distress, and what types of coping mechanisms adolescents have used to counter these effects.
Increases in multiple measures of psychopathology
Multiple online surveys and other studies have documented the pandemic’s impact on younger individuals. In the United States, visits to emergency departments by pediatric patients increased in the months after the first lockdown period.1 Several studies found increased rates of anxiety and depression among adolescents during the COVID-19 pandemic.2,3 In an online survey of 359 children and 3,254 adolescents in China, 22% of respondents reported that they experienced depressive symptoms.3 In an online survey of 1,054 Canadian adolescents, 43% said they were “very concerned” about the pandemic.4 In an online survey of 7,353 adolescents in the United States, 37% reported suicidal ideation during the pandemic compared to 17% in 2017.5 A Chinese study found that smartphone and internet addiction was significantly associated with increased levels of depressive symptoms during the pandemic.3 In a survey in the Philippines, 16.3% of adolescents reported moderate-to-severe psychological impairment during the pandemic; the rates of COVID-19–related anxiety were higher among girls vs boys.6 Alcohol and cannabis use increased among Canadian adolescents during the pandemic, according to an online survey.7 Adolescents with anorexia nervosa reported a 70% increase in poor eating habits and more thoughts associated with eating disorders during the pandemic.8 A Danish study found that children and adolescents newly diagnosed with obsessive-compulsive disorder (OCD) or who had completed treatment exhibited worsening OCD, anxiety, and depressive symptoms during the pandemic.9 An online survey of 6,196 Chinese adolescents found that those with a higher number of pre-pandemic adverse childhood experiences, such as abuse and neglect, had elevated posttraumatic stress symptoms and anxiety during the onset of the pandemic.10
Underlying causes of pandemic-induced distress
Limited social connectedness during the pandemic is a major reason for distress among adolescents. A review of 80 studies found that social isolation and loneliness as a result of social distancing and quarantining were associated with an increased risk of depression, anxiety, suicidal ideation, and self-harm.11 Parents’ stress about the risks of COVID-19 was correlated with worsening mental health in their adolescent children.12 A Chinese study found that the amount of time students spent on smartphones and social media doubled during the pandemic.13 In an online survey of 7,890 Chinese adolescents, greater social media, internet, and smartphone use was associated with increased anxiety and depression.14 This may be in part the result of adolescents spending time reading COVID-related news.
Coping mechanisms to increase well-being
Researchers have identified several positive coping mechanisms adolescents employed during the pandemic. Although some data suggest that increased internet use raises the risk of COVID-related distress, for certain adolescents, using social media to stay connected with friends and relatives was a buffer for feelings of loneliness and might have increased mental well-being.15 Other common coping mechanisms include relying on faith, volunteering, and starting new hobbies.16 During the pandemic, there were higher rates of playing outside and increased physical activity, which correlated with positive mental health outcomes.16 An online survey of 1,040 adolescents found that those who looked to the future optimistically and confidently had a higher health-related quality of life.17
Continuing an emphasis on adolescent well-being
Although data are limited, adolescents can continue to use these coping mechanisms to maintain their well-being, even if COVID-related restrictions are lifted or reimplemented. During these difficult times, it is imperative for adolescents to get the mental health services they need, and for psychiatric clinicians to continue to find avenues to promote resilience and mental wellness among young patients.