The COVID generation: The effects of the pandemic on youth mental health
Children and adolescents tend to have more mild disease compared to adults if they catch the coronavirus that causes COVID-19, but they are still struggling to cope with the pandemic. Curfews, closures, and lockdowns are taking their toll on their emotional wellbeing.
Against a decade-long pattern of deteriorating mental health among European youths, experts warn the COVID-19 pandemic made everything worse. Numerous studies observed sharp increases in rates of depression, anxiety, loneliness, and suicide attempts.
"Before the pandemic we had about 10 to 20 percent of children suffering from mental illness problems, not all of whom progressed to an impairment," said Dr. Nina Heinrichs, professor at the Department of Psychology at the University of Bremen. "Now, from the last 2 years, it looks like it'll go up to 20 to 25 percent."
Nevertheless, mental illness is notoriously difficult to assess in young people. According to Prof. Heinrichs, who is on the executive board of the RISE research project, which focusses on the prevention of child mental health problems, it is the externalized behaviors—of an aggressive, oppositional type—that are easiest to observe and get the most attention. Yet most youngsters do not misbehave, and instead hide their feelings. Internalized feelings, such as those that worsened during the pandemic, can be difficult to observe and are easily overlooked.
This means the reported rates of mental health problems among European young people are probably an underestimate. This can cause problems down the line. Prof. Heinrichs explained that 'feeling blue' can sometimes develop into full-blown disorders.
A daily measure of adolescents' mood
Studying the development of prosocial behavior in adolescence since 2016, a group of researchers in the Netherlands could not ignore the impact of the pandemic. Under the PROSOCIAL project, they sent daily questionnaires to more than 600 adolescents in Rotterdam asking them about their mood and daily experiences. The results showed that as the pandemic wore on, rates of tension increased while vigor decreased. These trends did not ease even during respites from lockdowns and other restrictions, for example over summer.
"We see in periods of disaster that the socio-economic inequalities that already exist in society enlarge," said Eveline Crone, professor of Developmental Neuroscience in Society at Erasmus University Rotterdam. As the coordinator of PROSOCIAL, she explained why. "Children who are already advantaged in terms of being in good schools or having parental support, they don't suffer that much during homeschooling. Children who are dependent on the schools for their personal growth get hit the hardest."
The pattern is clear across Europe and beyond: families and communities that were already economically disadvantaged suffered the effects of COVID worse.
Growing up in lockdown
"COVID lockdowns have forced families to live together, often in small homes, for long periods," said Lucie Cluver, professor at Oxford University, UK, and coordinator of the HEY BABY project, which aims to assess resilience-promoting pathways for families. Prof. Cluver said this has created enormous stresses for families, 'on top of COVID's economic effects including reduced income and job losses."
HEY BABY also revealed a related global increase in family violence, including partner violence and violence towards children. All this compounds the child mental illness problems directly, and via increases in cyber-bullying.
Schools, apart from their educational benefits, provide students with a refuge from family dramas, routine, activities, and sense of community. The closure of schools disrupted or ended these supports for students and parents.
Instead, students faced homeschooling, and many families have struggled with that too. Homeschooling at a minimum requires a quiet room and computer access, resources that some households cannot easily provide, especially if they are crowded. Homeschooling is more effective when parents supervise and are available for questions, yet unfortunately this is not always possible.
A silver lining
Many might expect stressed, unsupported youths to express their frustrations destructively. "We definitely did observe that young people developed more negative feelings during the pandemic," said Prof. Crone. "But on the other hand, we observed a need to give support to friends. This increased as the pandemic went on. We refer to these as pro-social experiences, because they are social acts directed towards the benefit of others."
PROSOCIAL also examined how young people directed help towards friends and family. Youths aged 18–25 reported more prosocial experiences towards their families, while experiences towards friends peaked in the 15–17 age group. These findings were unrelated to socio-economic factors. PROSOCIAL researchers also observed that helping others was associated with an increase in vigor, showing that giving help is a basic need for adolescents.
"One of the biggest misunderstandings of adolescence is that it's only a time of trouble," continued Prof. Crone. "Of course, there are some tensions in every family … but the idea that all adolescents develop into inconsiderate risk-takers is a misunderstanding." Although most young people show a reward-sensitivity, only about 10 to 15 percent get into trouble with excessively risky behaviors. Troubled youngsters often get most of the attention, yet PROSOCIAL's results indicate that most adolescents develop into socially considerate and committed young people who feel an innate need to contribute.
The PROSOCIAL team discovered that the same region of the brain corresponding to personal rewards (the ventral striatum) is also activated by helping others. This led to a new understanding of the adolescent brain as being ripe for social learning opportunities, and that providing opportunities for youths to help others is vital for their development.
"Prosocial opportunities help adolescents to see the perspectives of others and give them good feelings as well," said Prof. Crone. "We all have a fundamental need to be part of the group and to matter to others around us, but this is particularly enlarged during adolescence. Helping others feels good."
Tips and songs for families
People need support to cope with stressful times. The right support for young people and their families can make a huge difference.
HEY BABY and RISE worked together, co-leading a COVID parenting emergency response in conjunction with Parenting for Lifelong Health, an initiative with the World Health Organization and UNICEF, and the European Commission.
Dr. Jamie Lachman, senior researcher and teaching fellow at Oxford University, co-led the collaboration with Prof. Cluver. "Funding from the European Research Council and other partners was essential in allowing us to rapidly respond to the situation, and build an interagency collaboration that endorsed and supported the dissemination of parenting resources on a global level," said Lachman. The results formed the basis of the tips for families. The tips have been delivered to 210 million people in 198 countries and territories worldwide and have been used by 33 national governments including many in Europe. The advice has even been adapted into a song by a team of Broadway composers and producers. The tips cover spending quality time with children, praising them for behaving well, parents saying what behavior they want, creating routines, sensitively handling misbehavior and supporting families experiencing illness and bereavement from COVID-19. The tips also help parents take care of themselves.
Prof. Cluver summarized one of the simplest and most useful parenting tactics. "When you want to scream or throw something, try to take a moment and count to 10, breathing in and out slowly. If you can get into a different room, great; if not, look away for a moment. Just give yourself a chance to calm down before you say or do anything. It can really help."
Young people need advice too. Esteban de Manuel Keenoy is Director of the Institute for Health Services Research in Spain, and coordinator of the UPRIGHT project. He spearheaded a collective team response to Horizon's questions. The group said that resilience can be taught, but also that it is vitally important youngsters are taught this before they encounter serious problems. This would allow children and adolescents to thrive better in most situations and to avoid the development of mental illness as a response to stressful events.
UPRIGHT examined the teaching of resilience, including the roles of families and schools. Not surprisingly, the study concluded that families or primary caregivers play the main role in emotional education. Families that provide a safe and nurturing environment are best for developing confidence, inner strength, and self-esteem. Yet schools play a vital role too, especially since the ages of schooling are the ideal developmental period to acquire such important life skills.
The UPRIGHT team designed an intervention program where the entire communities of 17 schools from five countries were trained in both personal and community resilience skills. Also, 22 school communities served as control to compare the effectiveness of the intervention. Together, these taught 18 mental-health skills across four broad categories (coping, efficacy, mindfulness, and social-emotional learning) as a subject separate from the normal school curriculum.
The group that participated in the program reversed the trend of deteriorating youth mental health observed during the pandemic, improving almost to pre-pandemic levels.
A downward trend in youth mental health is not hopeless. Although young people generally have little control over their situation, many have nevertheless stepped up to the challenge, coping with COVID themselves by helping others cope. This, combined with making resilience training a normal part of school life, and providing opportunities to contribute, can bring significant developmental changes that protect against mental illness. Supporting young people helps everyone.
