The Impact of COVID on Child and Adolescent Mental Health

To commemorate Mental Health Awareness Month this May, the American Public Health Association and the Substance Abuse and Mental Health Services Administration (SAMHSA) co-sponsored a webinar on the impact of COVID-19 on child and adolescent mental health. Dr. Melissa Brymer, Director of the Terrorism and Disaster Program of the UCLA/Duke University National Center for Child Traumatic Stress and its National Child Traumatic Stress Network, presented on the impact of COVID-19 on the lives and mental health of families and discussed strategies to address these pressing issues.

The COVID-19 pandemic significantly impacted many major aspects of life for families. These stressful changes have had deleterious effects to individuals’ mental health, including children and adolescents. Major stressors during the pandemic include worrying about being ill, financial impacts, social isolation, work-related stress, food insecurity, school-related burdens, and missing routine activities that assist with resilience. SAMHSA’s National Child Traumatic Stress Network, consisting of 140 centers across the country, plays a key role in identifying traumatic stress for children and adolescents. Its recent work focuses on assessing the traumatic impact of COVID-19 for families.

Identifying Traumatic Stress

While stressors from the pandemic have had an impact on all families in some way, traumatic stress must be differentiated. Child traumatic stress occurs when “children who have been exposed to one or more traumas over the course of their lives and develop reactions that persist and affect their daily lives after the traumatic events have ended” (NCTSN, 2003). The NCTSN is interested in identifying the traumatic stress that has impacted families and finding ways to support them.

The United States recently surpassed one million deaths from COVID-19, a sobering reminder of the traumatic stress that many individuals, including children and adolescents, have faced during the pandemic. A recent estimate found that approximately 140,000 children have lost either a primary or secondary caregiver during the pandemic (Hillis et al., 2021). Additional losses children may have experienced include inadequate access to medical care or overdoses related to the opioid crisis. It is also important to note that many families have been disproportionately impacted by the pandemic, including Black, Hispanic or Latino, and American Indian and Alaskan Native families (CDC, 2020). Furthermore, COVID has added complications to the grieving process, including being unable to say goodbye in-person due to hospital visitation policies, sudden or unexpected death, feelings of guilt regarding spreading illness to a loved one, stigma around discussing why a loved one died, disruption of end-of-life rituals, and caregivers who would normally provide support being less available or present due to COVID-19.

Risk Factors for Suicide and Substance Use Have Increased During the Pandemic

The pandemic has led to an increase in risk factors for youth suicide and substance use due to increased social isolation, anxiety, trauma, grief and loss, financial issues, family discord, limited coping strategies, disruption in services, and racism and discrimination. During 2020 there was a 31 percent increase in mental health-related emergency room visits for adolescents compared to 2019 (Yard et al., 2021). Certain groups are at higher risk for suicide and substance use, including adolescent girls and LGBTQ+, Asian, Black, Native American, and transition age youth (Yard et al., 2021; Ramchand et al., 2021; Ivey-Stephenson et al., 2019). It is important to note the connection between substance use with youth with trauma, and NCTSN has an e-learning course available on this topic. The NCTSN has also created a fact sheet for peers to learn how to recognize the signs of suicide and how to talk to their peers about this topic.

Rates of Abuse Have Increased During the Pandemic

During the pandemic, youth have reported experiencing more abuse. Over half of youth reported experiencing emotional abuse from a parent or caregiver (CDC, 2022). Additionally, emergency room doctors have reported an increase in the severity of abuse cases (Schmidt & Nantanson, 2020). While there are a variety of risk factors for abuse, financial instability and significant disruptions to the child welfare and juvenile justice systems may have contributed to the rising rates of abuse. Furthermore, it is important to note that some COVID related protocols, such as wearing face coverings, may be a trauma reminder for youth who have experienced previous maltreatment or abuse. To address child maltreatment, the NCTSN has developed a toolkit for the child welfare system and a toolkit for the juvenile justice system to ensure that both systems are prepared beforehand and during any natural disasters or future pandemics. Since maltreatment often occurs with younger children, the NCTSN is also working to highlight issues related to early childhood attachment and mental health.

How to Promote Coping Strategies for Families

In light of the increased traumatic stress many children and adolescents are facing from COVID-19, it is important to consider how to support them in this process. Dr. Brymer recommended the following strategies for families to help children and adolescents cope with traumatic stress: (1) discuss adapting end of life rituals; (2) validate their feelings; (3) use children’s books to discuss topics, such as grief; (4) provide routine and structure; (5) identify additional supports that are needed; (6) provide extra time, love, attention, patience, and reassurance; and (7) get extra help when needed. The NCTSN suggests that in order to address grief, providers should be trained in grief and prolonged grief resources, caregivers should be given strategies for supporting bereaved children, and families should receive help coping with other collective traumas.

Schools Play a Key Role in Addressing Mental Health for Children and Adolescents

Schools play a vital role in delivering mental health services to youth. However, there have been a variety of major disruptions to schools throughout the pandemic: shifts in school schedules, general setbacks for students, and the disproportionate impacts for students with disabilities who have Individualized Education Programs.  Educators are reporting loss of milestones and social connections for students, so it is essential to think about how schools can create a sense of belonging. Schools’ capacity for providing mental health supports for youth can be enhanced by creating trauma informed schools, strengthening family-school partnerships, addressing racism and hate, and developing and strengthening school-based interventions. It is also important to address teachers who may be dealing with their own traumatic stress. Dr. Brymer suggested two free resources to support teachers who have been affected by traumatic stress, the STAT Program and Classroom WISE.

To Learn More

The full recording of this webinar is available on the APHA website. For further information on NCTSN resources, view this comprehensive list of COVID-19 mental health resources for children and families.

References

Centers for Disease Control. (2020). Introduction to COVID-19 Racial and Ethnic Health Disparities. https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/racial-ethnic-disparities/index.html

Centers for Disease Control. (2022). New CDC data illuminate youth mental health threats during the COVID-19 pandemic. https://www.cdc.gov/media/releases/2022/p0331-youth-mental-health-covid-19.html

Hillis, S. D., Blenkinsop, A., Villaveces, A., Annor, F. B., Liburd, L., Massetti, G. M., Demissie, Z., Mercy, J. A., Nelson, C. A., 3rd, Cluver, L., Flaxman, S., Sherr, L., Donnelly, C. A., Ratmann, O., & Unwin, H. (2021). COVID-19-Associated orphanhood and caregiver death in the United States. Pediatrics, e2021053760. Advance online publication. https://doi.org/10.1542/peds.2021-053760

Ivey-Stephenson, A. Z., Demissie, Z., Crosby, A. E., et al. (2019). Suicidal Ideation and Behaviors Among High School Students — Youth Risk Behavior Survey, United States, 2019. MMWR Suppl 2020, 69(Suppl-1):47–55. DOI: http://dx.doi.org/10.15585/mmwr.su6901a6external icon.

Ramchand, R., Gordon, J. A., & Pearson, J. L. (2021). Trends in Suicide Rates by Race and Ethnicity in the United States. JAMA network open, 4(5), e2111563. https://doi.org/10.1001/jamanetworkopen.2021.11563

Schmidt, S. and Natanson, H. (2020). With kids stuck at home, ER doctors see more severe cases of child abuse. The Washington Post. https://www.washingtonpost.com/education/2020/04/30/child-abuse-reports-coronavirus/

The National Child Traumatic Stress Network. (2003). What is child traumatic stress? https://www.samhsa.gov/sites/default/files/programs_campaigns/childrens_mental_health/what-is-child-traumatic-stress.pdf

Yard E, Radhakrishnan L, Ballesteros MF, et al. Emergency Department Visits for Suspected Suicide Attempts Among Persons Aged 12–25 Years Before and During the COVID-19 Pandemic — United States, January 2019–May 2021. MMWR Morb Mortal Wkly Rep 2021;70:888–894. DOI: http://dx.doi.org/10.15585/mmwr.mm7024e1external icon.