Study: Abuse, violence, other events linked to poor mental health in teens during COVID pandemic
As new recommendations encourage providers to screen teens for anxiety, a survey published Thursday found a majority of high school students reported a potentially traumatic event during the COVID-19 pandemic that may have contributed to poor mental health and suicidal behaviors.
Researchers from the Centers for Disease Control and Prevention found nearly 3 out of 4 students reported at least one adverse childhood experience (ACE), like emotional abuse or food insecurity, between January and June 2021, according to the study published in the agency's Morbidity and Mortality Weekly Report.
Students who reported these experiences were also twice as likely to report they had poor mental health and up to six times more likely to report suicidal behaviors, like considering suicide, making a suicide plan, or attempting suicide in the past year compared to students who didn't report recent ACEs.
"What we're finding is actually consistent with what we see elsewhere in the literature, that all forms of abuse as well as many ACEs are associated with poor outcomes," said lead author Dr. Kayla Anderson, an epidemiologist at the CDC's division of violence prevention. "Emotional abuse may play a relatively larger role in adolescents mental health."
Nearly 4,400 nationwide students were asked about physical or emotional abuse, parental job loss, or food insecurity during the pandemic, or sexual violence, physical teen dating violence or electronic bullying in the past 12 months. Emotional abuse had the strongest link to poor mental health and suicidal behavior.
The survey comes days after the U.S. Preventive Services Task Force recommended Tuesday that providers screen all children and teenagers between 8 and 18 years old for anxiety, which Anderson said can be one of the many mental health outcomes from adverse childhood experiences.
"We're seeing a lot of young people when they're returning back to school having issues with social anxiety," said Dr. Anisha Abraham, acting chief of adolescent and young adult medicine at Children's National Hospital. "It's so important to identify these issues before it get worse so they can get support."
Although mental health outcomes may have worsened throughout the pandemic, health experts say these issues have been increasing since before COVID-19.
A recent article published in JAMA Pediatrics found anxiety and depression among children ages 3 to 17 has increased between 2016 and 2020, according to an analysis from the National Survey of Children's Health.
Before the pandemic, anxiety increased 27% from 2016 to 2019. By 2020, 5.6 million, or more than 9% of kids, had been diagnosed with anxiety problems.
"We have seen a lot of more stress and anxiety related to social media, comparing themselves and others," said Dr. Jennifer Katzenstein, director of psychology, neuropsychology and social work, and co-director of the Center for Behavioral Health at Johns Hopkins All Children's Hospital.
Despite these increases, use of mental health care among children and adolescents did not increase over the five-year period. In 2020, only 80% of kids who needed counseling or mental health services actually received care in the past year, which is a slight decrease from the 82% who got care in 2016.
Poor mental health can impede a child or teen's ability to focus in school and have normal friendships, Abraham said, and it's important to identify an issue and intervene early before it affects their adulthood.
"Over time, it could put them at risk for other chronic health conditions like using substances," she said.
Experts urged parents to monitor their children and contact a healthcare provider if they suspect their child's mental health may be at risk. According to the Centers for Disease Control and Prevention, there are multiple forms of anxiety that can manifest in different ways:
- Separation anxiety: Being very afraid when away from parents
- Phobias: Having extreme fear about a specific thing or situation, such as dogs, insects, or going to the doctor
- Social anxiety: Being very afraid of school and other places where there are people
- General anxiety: Being very worried about the future and about bad things happening
- Panic disorder: Having repeated episodes of sudden, unexpected, and intense fear that come with symptoms like heart pounding, trouble breathing, or feeling dizzy, shaky, or sweaty
The CDC says behaviors seen in children with depression may include:
- Feeling sad, hopeless, or irritable a lot of the time
- Not wanting to do or enjoy doing fun things
- Showing changes in eating, sleep, and energy patterns
- Having a hard time paying attention
- Feeling worthless, useless, or guilty
- Showing self-injury and self-destructive behavior
While screening for anxiety and depression may help providers intervene early, Anderson argued another important strategy is strengthening social services to support families and prevent adverse childhood experiences from happening in the first place.
"We know that we can prevent ACEs from happening, and that would go potentially a long way to improving youth mental health," she said.
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