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This post contains sensitive information including discussion of suicide. If you are in need of help, there are an abundance of resources on the National Suicide Prevention Hotline website. They also have an anonymous chat function, or you can call 800-273-8255.
On October 19, 2021, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association issued a declaration that children’s mental health had become a “national emergency.” The U.S. Surgeon General followed on December 7 with his own 53-page advisory on the dire state of youth mental health. Mental health challenges are rising among kids, which seems to be due to a perfect storm of increasing mental health challenges before the pandemic and a highly disruptive pandemic.
Mental health challenges, as defined by the U.S. Surgeon General on page 6, are: “symptoms that cause serious difficulties with daily functioning and affect our relationships with others, as in the case of conditions such as anxiety disorders, major depressive disorder, schizophrenia, bipolar disorder, and eating disorders, among others.”
Before the pandemic
Mental health challenges among children and youth are not new. Before COVID-19, pediatric mental health disorders were high: up to 20% of children and youth experience a mental health disorder in any given year, and the percentage has been increasing in recent years. The rate of suicides among 10-24 year-olds steadily rose between 2010 and 2018, and suicide was the second leading cause of death for the 10-24 year old age group in 2018.
Immediately following stay-at-home orders
Then COVID-19 hit. In-person school was closed, and children lost out on school-related activities and milestones. The isolation of remaining at home, concerns about the future, and potential economic strains on families contributed to declines in mental health. It’s clear from multiple studies that the first month or two of the pandemic significantly impacted mental health of kids.
At the beginning of the pandemic (April 2020), the proportion of pediatric emergency department visits for all mental health-related reasons increased 24-31% (depending on age). Then it stayed high for the rest of the year.
Specifically, research found the number of youth going to the ED for suicidal thoughts and behaviors increased from the start of the pandemic and remained higher than 2019. Overall, risk of presenting with suicide-related concerns was 133.5% higher among youth aged 5 to 12 years and 69.4% higher among youth aged 13 to 17 years, compared to 2019. Rates increased throughout the year for girls, specifically.
Later in the pandemic
At the end of 2020, a national survey was conducted by the Jed Foundation to assess youth well-being during the pandemic. They found that 1 in 3 families reported their child’s emotional health was worse than before the onset of COVID-19. The most common challenges that children experienced were loneliness (23%) and anxiety (22%), followed by trouble concentrating (20%).
Then, in August 2021, JAMA pediatrics published an article that reviewed 29 studies with over 80,000 youth worldwide. They found that 25.2% of youth experienced depression, and 20.5% experienced anxiety during the pandemic worldwide, which is double that of pre-pandemic estimates (11.6% for depression pre-pandemic and 12.9% for anxiety pre-pandemic). Interestingly, the rates of depression and anxiety were higher later in the pandemic, particularly among older adolescents and girls. Also, interestingly, the rates of anxiety were highest among adolescents in Europe (34%) and North America (21%).
Most recently (August-September 2021), NPR, the Robert Wood Johnson Foundation, and Harvard polled parents to assess the impact of the Delta wave on children. They found that 36% of households with children struggled with stress, anxiety, depression, or sleeping difficulties. Additionally, over a third of families reported severe challenges in social support (like child care).
The interest in mental health has never been greater. According to Google’s Year in Search, “how to maintain mental health” was searched more globally in 2021 than ever before. The figure below shows the popularity of mental health Google searches over time. The Y-axis shows the relative popularity of that search. So, 100 reflects the peak of popularity in 2021. A 50, for example, shows that the search term was half as popular at that time.
What’s the country’s plan to address this?
The Department of Education unveiled new guidance for supporting child mental health needs. In August, the U.S. Department of Health and Human Services pledged $85 million in funding to expand mental health services for children and youth. The “national emergency” declaration and the Department of Education's new resource included many key calls to action:
Reduce stigma. A CBS poll from 2019 showed that nearly 90% of individuals think stigma is associated with mental illness. Children with mental health conditions who experience stigma are often marginalized and forced out of classrooms or groups, which can result in low self-esteem and secrecy. The barrier of stigma exists even if sufficient services are available for children and youth.
Address current funding gaps. The entire mental health field for children and youth has been historically underfunded. Funding is necessary to provide evidence-based mental health screening, diagnosis, and treatment to all children and youth and address the current bed and resource shortages. Funding is also needed to expand the children’s mental health workforce and improve the mental health knowledge of educators. School districts also need funding to collect and access data that can inform mental health-related decisions for communities.
Coordinate services. The current delivery systems for mental health care are fragmented, and many children and youth are not receiving comprehensive services. Many services are offered at separate facilities with different providers and different funding streams. Mental health care should be integrated into primary care pediatrics, and community-based systems should connect families with resources. Telemedicine services should also remain available even when hospitals and clinics reopen to the public.
Advance health equity. Many groups (including LGBTQ+, youth of color, and youth from low-income families) are disproportionately impacted by mental health. Organizations must prioritize equity when expanding and implementing services.
What can parents do?
Authors in the Journal of Pediatric Health Care offered recommendations for addressing youth mental health challenges. What can parents do?
Daily routine. Work to keep children’s routines as “normal” as possible and engage in practices that improve the overall health of children and youth. Eat healthy meals together as a family, help them have a consistent sleep schedule, and make sure they are regularly attending school whether in-person or remote.
Validate your kids’ experiences. Talk honestly with them, and let them know that their emotions are real and ok to feel. Let them know that you love them and that you will get through this difficult time together.
Seek help. Just as routine screenings occur for physical health, screenings should also be done for mental health. Talk with your pediatrician or family doctor if you have any concerns or need help finding a mental health professional. School counselors can also be a helpful resource.
Safety. Keep medications – especially ones that are dangerous in overdose – and firearms locked up so that there is no chance that your children or their friends could access them.
Bottom line: Children had (and continue to have) a rough time during this pandemic. There’s a lot we can do on a national level, but also on an individual level to prioritize the needs of kids during this tough time.
Love, YLE, Rebecca Molsberry, and Dr. Lisa Uebelacker
Ms. Molsberry is my rockstar PhD candidate with expertise in mental health epidemiology. Because she doesn’t have enough to do (!) she graciously offered to keep the YLE community updated on mental health research across the world – a topic the YLE community has voiced considerable interest in.
Dr. Lisa Uebelacker is a Professor in the Department of Psychiatry and Human Behavior at Brown University and Co-Director of Behavioral Medicine and Addictions Research at Butler Hospital in Providence Rhode Island.
Other recent scientific highlights in mental health:
Ongoing Disparities in Digital and In-Person Access to Child Psychiatric Services in the United States - J Am Acad Child Adolesc Psychiatry. This study estimated that 6,035,402 children in the U.S. (approximately 10%) have inadequate availability of child psychiatric services within their counties. This is espeically true among kids rural or low-income counties.
Mental health concerns during the COVID-19 pandemic as revealed by helpline calls - Nature. A study investigated 8 million helpline calls in 19 countries and found that call volumes peaked at 35% above pre-COVID-19 levels during the first wave of the COVID-19 crisis. Fears about the pandemic and loneliness drove the increases in calls rather than suicidal ideation, relationship issues, or economic concerns.
Trends in U.S. patients receiving care for eating disorders and other common behavioral health conditions before and during the COVID-19 pandemic - JAMA Network Open. Starting in June 2020, the rate of hospitalizations for eating disorders doubled and remained elevated throughout the remainder of 2020.
FCC approves text-to-988 access to suicide prevention lifeline- FCC. On November 18, 2021, the Federal Communications Commission (FCC) voted unanimously to expand access to the National Suicide Prevention Lifeline by allowing individuals to send text messages to reach the Lifeline directly.
As a K12 educator, it's been an absolute nightmare navigating this pandemic, even at an independent school that supposedly has the means and ability to choose to do everything right.
There's a false dichotomy being pushed by non-teachers everywhere - schools are either allowing students' mental health to decay by being remote, or "supporting mental health" by returning to in-person learning. The problem is that the latter doesn't take into effect the simple idea that being in person in the middle of the pandemic is, at best, marginally better for mental health - students (and teachers!) feel less safe, and learning is still impacted because they're in a situation of constant worry and stress from the pandemic. In lulls like now, between BA.1 and BA.2, when they can pretend there is no pandemic, they seem fine - unless, of course, they live in multi-generational households with elderly family members, or have immunocompromised relatives (or are immunocompromised themselves). In those cases (a significant portion of the student body), they're now left to suffer and worry alone, without the support of their community. We've let the privileged kids return to not having to care about others, though, so I guess we really have returned to normal.
I'm avoiding the fact that the physical/mental health of the adult faculty and staff, especially those at high risk or those with families with high risk, is completely ignored. I'm a K12 educator with a pregnant wife and a number of high risk factors myself, and yet it was "return to normal" in January at the peak of BA.1 - no remote learning was ever seriously considered because the messaging at the national level was some perversion of 2003's "Mission Accomplished" banner as the cases skyrocketed. It took a week of sick leave to even find a doctor willing to write a note for accommodations, and I was told explicitly by my school that my pregnant wife's health would never be a consideration for present or future accommodations during a surge.
From a wider lens, this push to return to in-person learning AT ALL COSTS has been so blatantly economically-driven and need-blind to legitimate concerns for student and teachers' physical and mental health. A nihilistic and fatalistic attitude among students and teachers has grown in every school I have teacher friends in. I'm leaving education at the end of this school year, along with 35% of my school's entire faculty, because it's been made clear by our school and our government that we are expected to choose between our financial health and our physical/mental health; I can put myself and my family on the front line for the sake of the economic engine, or you can find another job. Guess what most people are choosing?
As the kids say - thank you for coming to my TED Talk.
Excellent post but only one comment; blaming the Pandemic alone for the increase in Youth struggling with mental health is wrong. Extrapolate the weeks graphed in the mental health ED visits and there is a period roughly between June and Aug 2019 that demonstrates a significant shift in ED visits. This period is pre-Pandemic and perhaps linked to the sense of loss of safety and belongingness, observation of deep societal division contributing to a loss of innocence and, no doubt, contributing to feelings of a lack of control as related to 1) out of control weather effects in the summer of 2019, 2) extreme political unrest and division experienced throughout USA society between the Mueller Report and Trump impeachment, and cultural unrest after far too many shooting incidences, amplification of cultural division along political lines and dehumanisation of people along cultural and racial divides.
Perhaps we shouldn’t get distracted by the Pandemic frosting on the very troubled, divided and bitter layer cake that has been baked for American children to feast on; it isn’t normal, it isn’t right, it isn’t fair and it is far too easy to avoid individual responsibilities and blame « The Pandemic ».