Youth mental health outcomes varied during pandemic, study finds

The COVID-19 pandemic caused many disruptions in the daily lives of children and families around the world, which has been associated with various mental health challenges among youth. However, a new study from the Environmental influences on Child Health Outcomes (ECHO) Program at the National Institutes of Health presents a more nuanced picture, suggesting that mental health improved for certain groups of children and adolescents.

Research led by Courtney K. Blackwell, Ph.D. and Kaja LeWinn, ScD, found that the pandemic had minimal impact on child mental health. The impact included minor decreases in externalizing problems, anxiety, and depression. However, average outcomes might not capture the full picture.

This work is published in JAMA Network Open.

"Our research shows that the pandemic's impact on children varied depending on their individual characteristics, and average changes in the youth population do not fully capture these differences," said first author Dr. Blackwell of Northwestern University's Feinberg School of Medicine.

The study found that children who had clinically significant mental health problems before the pandemic experienced notable improvements in their mental health, especially for ADHD symptoms and externalizing problems such as aggression and rule-breaking. Other factors such as income, race, age, and gender had small influences on changes in youth mental health, with some groups experiencing declines and others experiencing increases in symptoms. For instance, this study found that:

• Black children showed small decreases in internal distress and symptoms of depression and ADHD compared to white children.

• Children from lower-income families (below 130% of the Federal Poverty Level) showed declines in depression and ADHD symptoms whereas children from higher income families (350% of the federal poverty line and above) showed small increases in internalizing symptoms.

• Girls showed a slight increase in externalizing behaviors, such as acting out, compared to boys.

• Children older than 12 years old showed an increase in internal feelings of distress and symptoms of depression compared to younger children, whose internalizing symptoms did not change.

"Perhaps most surprisingly, some children that we would have expected to fare worse during the pandemic, like those with more significant behavior problems before the pandemic, improved. It may be that, for these children, a break from school-related stressors and demands benefited their mental health," said study senior author Dr. LeWinn of the University of California San Francisco.

What happened during the study

Most existing research has focused on the first year of the pandemic and either included children from outside the U.S. or primarily focused on teenagers. This ECHO study included 1,229 youth ages 6 to 17 years from nine ECHO Cohort study sites in the U.S. Youth were socioeconomically diverse: 51.7% identified as white, 31.6% as Black, 12.0% as multiracial, and 3.3% as another race; 9.6% identified as Hispanic; and 18.7% came from households at or below 130% of the federal poverty level.

Researchers examined changes in mental health scores on the Child Behavior Checklist, a parent-reported measure of youth behavior and mental health. They compared scores from before the pandemic (Jan. 1, 2015 to March 12, 2020) to scores during the pandemic (March 13, 2020 to Aug. 31, 2022). They also looked at how these changes varied based on different sociodemographic factors and pre-existing mental health problems.

"By identifying which individual characteristics were associated with improvements and which were associated with declines in mental health, we can better target interventions to those most at risk while also identifying potential resiliency factors that can help protect youth mental health even during times of great social and economic crisis," said Dr. Blackwell.

Future studies can investigate the impact of school closures on mental health, particularly for marginalized or vulnerable youth, said Dr. LeWinn.

"Importantly, any mental health improvements we observed in this study are greatly overshadowed by the significant and negative impacts of the pandemic on educational outcomes. However, our work suggests that by using long-term data that includes pandemic-related school disruptions, we can gain unique insights into how schools impact children's mental health," said Dr. LeWinn.