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Rates of Adolescent Mental Health Problems, Substance Use, and Violence in the Home during COVID-19: Does Gender Matter?


Abstract and Figures

Objective: There has been concern regarding the mental health impact of coronavirus disease 2019 (COVID-19), and subsequent public health interventions due to isolation, anxiety around the pandemic, and increased conflict in the home. The purpose of this study was to explore current rates of mental health problems, COVID-19 related stress, substance use, and violence at home among adolescents with comparisons across genders. Method: Participants (N = 809) from Canada were recruited via social media to complete an online survey. Participants (Mage = 15.67, SD = 1.37) identified as female (56.2%), male (38.7%), or trans/non-binary individuals (TNBI; 5.1%). Results: A large portion of adolescents met clinical cut-off for depression (51.2%), anxiety (40%) and Post-Traumatic Stress Disorder (45%). High rates of ADHD, ODD, and social phobia symptoms (ranging from 9%-20%) were also reported. Adolescents were mainly concerned with the health of family members and vulnerable populations, as well as the increased family stress at home during COVID-19. Rates of substance use were higher than expected with over 50% of youth engaging in some form of substance use, and almost 20% engaging in regular substance use. Rates of experiencing and perpetrating psychological violence at home were higher than physical violence and were close to rates in high-risk populations. TNBI and females reported higher rates of mental health problems, and violence at home compared to males. Conclusions: Increased rates of mental health problems, substance use, and violence in the home necessitate targeted supports that encourage positive coping amidst the additional stresses of COVID-19.
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Rates of Adolescent Mental Health Problems, Substance Use, and Violence in the Home during
COVID-19: Does Gender Matter?
Stephanie G. Craig PhD1*, Megan E. Ames PhD2, Bianca C. Bondi MA1,
& Debra J. Pepler PhD1
1. York University, 5021 Dahdaleh Building, 4700 Keele St, Toronto, Ontario, Canada,
M3J 1P3
2. University of Victoria, A192 Cornett Building, 3800 Finnerty Road, Victoria, BC,
Canada V8P5C2
Corresponding Author Contact Details:
Stephanie Craig, Department of Psychology, York University, 4700 Keele St, Toronto, Ontario,
Canada, M3J 1P3. E:
Funding: This project was supported in part by a Canadian Institutes of Health Research
fellowship awarded to Dr. Stephanie Craig.
Objective: There has been concern regarding the mental health impact of coronavirus disease
2019 (COVID-19), and subsequent public health interventions due to isolation, anxiety around
the pandemic, and increased conflict in the home. The purpose of this study was to explore
current rates of mental health problems, COVID-19 related stress, substance use, and violence at
home among adolescents with comparisons across genders. Method: Participants (N = 809) from
Canada were recruited via social media to complete an online survey. Participants (Mage = 15.67,
SD = 1.37) identified as female (56.2%), male (38.7%), or trans/non-binary individuals (TNBI;
5.1%). Results: A large portion of adolescents met clinical cut-off for depression (51.2%),
anxiety (40%) and Post-Traumatic Stress Disorder (45%). High rates of ADHD, ODD, and social
phobia symptoms (ranging from 9%-20%) were also reported. Adolescents were mainly
concerned with the health of family members and vulnerable populations, as well as the
increased family stress at home during COVID-19. Rates of substance use were higher than
expected with over 50% of youth engaging in some form of substance use, and almost 20%
engaging in regular substance use. Rates of experiencing and perpetrating psychological violence
at home were higher than physical violence and were close to rates in high-risk populations.
TNBI and females reported higher rates of mental health problems, and violence at home
compared to males. Conclusions: Increased rates of mental health problems, substance use, and
violence in the home necessitate targeted supports that encourage positive coping amidst the
additional stresses of COVID-19.
Keywords: Adolescents, COVID-19, mental health, maltreatment, substance use
The emergence of coronavirus disease 2019 (COVID-19), and subsequent public health
interventions, such as social distancing and quarantine, has had significant impact on the daily
lives of adolescents. There is increasing concern regarding the mental health impact of these
public health measures due to isolation, anxiety around the pandemic, and increased conflict in
the home(1). Research on previous pandemics has revealed increased risk for depression, post-
traumatic stress disorder (PTSD), substance use disorder, and other mental health concerns(2, 3).
In previous pandemics, those in quarantine have been found to have four times the risk of mental
health difficulties relative to those not quarantined(4). There have been multiple calls for rapid
research on the rate of mental health and substance use problems in adolescents due to school
and social service closures during the COVID-19 pandemic(1, 2); however, there is a scarcity of
research on this concern. Compounding the risk for mental health, there is additional concern
regarding the potential for increased violence within the home(5, 6); however, little to no
research has examined this topic for adolescents during COVID-19. Thus, the purpose of the
current study was to examine the rates of mental health problems, COVID-19 related stress,
substance use, and violence in the home for adolescents in a Canadian national sample.
There has been an global rapid response in research on mental health during the COVID-
19 pandemic. The first research to emerge was from China. Researchers found adolescents (ages
7-18) in the areas with the highest rate of COVID-19 cases and subsequent public health
measures to have higher rates of anxiety and depressive symptoms(7). Specifically, the authors
found that 22% of their sample was above the clinical cut-off for depression. Another study in
China found 31.8% of young adults (ages 18-30) met the clinical cut-off for Post-Traumatic
Stress Disorder(PTSD; 8). Increased rates of mental health problems in adolescents were also
reported by parents in Italy and Spain(9). In a Canadian study conducted in April 2020 found
that in a community sample of young adults ages 18-28, 13% met criteria for depression and
10% for anxiety(10). The extent to which stress is related specifically to COVID-19 is less clear.
Some studies have found young adults to be more concerned with family members becoming ill
than their own health(10). Other studies have found parents to report that their children were
afraid of COVID-19(9). There are numerous concerns around the current research on adolescent
mental health during the time of COVID-19, including few studies of adolescents under the age
of 18(10), an overrepresentation of female respondents(>80%; 9, 11), and a narrow focus on
depression and anxiety as outcomes. To our knowledge, no study has reported on the rates of
other mental health difficulties in adolescence during COVID-19, such as Conduct Disorder
(CD), Oppositional Defiant Disorder (ODD), or Attention-Deficit/Hyperactivity Disorder
(ADHD). The present study was designed to address the paucity of research on stress related to
COVID-19 in addition to understanding the rates of broad mental health problems.
There is growing evidence that adolescents’ substance use is also a concern during this
pandemic. Dumas, Ellis (12) compared adolescents’ (ages 14-18) retrospective reports of
substance use prior to the pandemic to current rates of substance use. Authors found that the
number of adolescents using substances decreased during the pandemic; however, for those
using substances, the frequency of alcohol and cannabis use increased(12). In a community
sample aged 18-28(10), the authors also found decreases in substance use compared to
retrospective reports of pre-pandemic use. In this sample, 3% of the sample scored above the
clinical cut-off for substance use disorder. However, both studies were collected at the beginning
of the quarantine, and little is known about substance use after months of sheltering in place.
Finally, there is increasing concern regarding the risk of increased violence in the home.
Stress related to COVID-19, such as financial uncertainty, limited social support, and anxiety
around the pandemic may put additional pressure on parents, increasing tensions in the home(5).
Several authors noted the increased risk of domestic violence with stay-at-home orders and
school closures(5, 13) and experiences of physical, psychological, and witnessing interpersonal
violence(IPV) can put children at risk for future mental health problems(e.g., 14, 15, 16). It is,
therefore, critical to assess current rates of violence in the home to inform practice and policies
to mitigate future risk. To our knowledge, no study has focused on the rates of violence in the
home for adolescents during COVID-19.
Prior to the pandemic, gender differences in rates of mental health, substance use, and
violence in the home have been consistently reported(16, 17), however, there is a scarcity of
research on the gender differences during COVID-19. A study of youth and young adults ages
14-35 in China indicated that PTSD symptoms were higher in males than females(18). Females
have been found to have higher rates of depression, loneliness, and COVID-19 stress use
compared to males(11). Dumas et al. (2020) found a decrease in the number of girls using
substances, but not boys. There has been substantially less research on trans or non-binary
individuals (TNBI), however, one study found that number of lesbian, gay, bisexual, transgender,
and queer adolescents requesting support from an online chat support group doubled since the
beginning of the pandemic(19). No study has examined COVID-19 related stress and violence in
the home across self-identified genders.
Despite a rapid increase in research on the effects of the COVID-19 pandemic on
adolescent mental health and functioning, there remain significant gaps in the literature. The
purpose of this study was to fill these gaps by exploring current rates of mental health problems,
COVID-19 stress, substance use, and violence at home among adolescents. We also focused on
differences in rates across self-identified genders.
Participants (N = 809) were adolescents ages 12-18 (M = 15.67, SD = 1.37) who lived in
Canada. Participants were distributed across all provinces and territories, with the exception of
Nunavut, as follows: Ontario (33.9%), British Columbia (14.5%), Alberta (19.8%), the prairies
(Manitoba and Saskatchewan; 11.1%.), Quebec (8.1%), the maritime provinces (Nova Scotia,
New Brunswick, Newfoundland and Labrador, and Prince Edward Island; 12.1%), and the
territories (Yukon and Northwest Territories; 0.5%).
Adolescents were recruited through online advertisements on social media platforms
(e.g., Facebook, Twitter, Instagram) from June 17 to July 31, 2020. Informed consent was
obtained by youth. To ensure competency, youth were required to answer two questions
pertaining to the risks and benefits and two questions regarding the purpose of the outlined study.
A total of 168
adolescents were unable to answer at least one of the questions correctly and
were excluded from the study. All participants who completed the survey were entered into a
draw for a $250 electronic gift certificate to an online store. The study protocol was approved by
the all authors Institutional Research Boards.
Demographics were assessed through youth self-report including gender, ethnicity, age,
family composition, and provincial location.
Not included in the 809 participants
Ontario Child Health Study Scales (OCHS(20)) is a 52-item self-report measure of
emotional and behavioral problems in the past four months. The current study examined the CD,
ODD, ADHD, Depression, Anxiety, Separation Anxiety, and Social Phobia scales. Items were
measured on a three-point Likert scale from 0 (never or not true) to 2 (often or very true). T-
scores were calculated based on previously established norms(20). A T-score above 70 indicates
a score that is two standard deviations above the population mean, and thus of clinical concern.
Each scaled score was also converted to a binary measure at the threshold closest to the
prevalence of the corresponding disorder(21). These threshold scores were determined in the
weighted general population sample of the 2014 OCHS youth and applied to all respondents(22).
Internal consistency for all scales was good (α = .68-.88).
Children’s Revised Impact of Event Scale (CRIES-13(23)) is a self-report measure used
to screen youth at risk for PTSD. Youth were asked about how frequently statements were true in
the past seven days on a four-point Likert scale from 0 (None) to 5 (A lot). The total scale ranged
from 0-65 and consisted of three subscales: intrusion, avoidance, and arousal. A clinical cut-off
score of 30 determines whether a adolescent is high-risk for PTSD(23). Internal reliability in
current sample was excellent (α = .91).
COVID-19 stress scale(24) is a measure based on Statistics Canada’s scale for assessing
COVID-19’s impact on mental health. Participants were asked how concerned they were about
the impact of COVID-19 regarding health-related (e.g., ‘my own health’, ‘the country’s
population health’) and other COVID-19 stressors (e.g., ‘family stress from confinement”).
These concerns were rated on a four-point Likert scale from 1 (Not at all) to 4 (Extremely). Items
were examined individually.
Drug History Questionnaire (DHQ; 25) is a 14-item self-report measure of substance use.
Youth reported whether they had ever used each drug, and how often they used in the past 90
days, on a 7-point Likert scale ranging from None to More than 1x a day. Items were combined
into categories: None, Less than once a month to once a month, and More than once a week.
Conflicts Tactics Scale (CTS; (26)) is a measure that assesses violence within
relationships. We utilized a modified version of the CTS(15) that measures adolescents’
experiences of psychological and physical violence in their relationships with their parents (e.g.,
“Done to you by your parent” and “Done by you to your parent”) or between their parents
(“From one parent to another”) in the past four months. Psychological and physical violence
each comprised of seven items rated on a 4-point Likert scale from 1 (Never) to 4 (Always). The
mean score for each subscale was used in the analysis. The scales showed good reliability (α =
Data were analyzed in SPSS 26.0(27) and calculated based on the number of adolescents
who completed that section of the survey. Missing data were calculated at the item level using a
person-centered mean when less than 80% of the scale was missing. We examined gender
differences using ANOVA with Tukey post-hoc tests for continuous measures. Due to the
number of comparisons and the large sample size, alpha was set to .01 for t-tests, and Bonferroni
corrections were conducted for all post-hoc analyses.
Demographics are shown in Table 1. Youths identified as female (56.2%), male (38.7%),
or TNBI (5.1%).
What are the rates of mental health problems?
Mental health rates were examined using T-scores and clinical cut-offs (Table 2). In the
present sample, a high proportion of adolescents exceeded the clinical cut-off for depression
(51.9%) and anxiety (39.2%). Almost half of the adolescents (45.7%) reported PTSD symptoms
above the clinical cut-off. One in five adolescents reported ODD (19.3%) and ADHD (20.3%)
problems above the clinical cut-off. The rates of separation anxiety (6.4%) and social phobia
(8.9%) were not as elevated.
T-scores were compared across genders: there was a significant gender difference for
ODD, ADHD, depression, and anxiety, separation anxiety, and social phobia. There was no
significant gender difference for CD. TNBI endorsed significantly more symptoms than males
and females for ADHD, depression, anxiety, social phobia and PTSD. Females endorsed
significantly higher levels of depression, anxiety, social phobia, and PTSD, than males. Both
female and TNBI endorsed significantly more symptoms of ODD and separation anxiety than
What is the rate of COVID-19 related stress?
The most common COVID-19 related health concerns identified by the adolescents were
for the health of vulnerable people (M = 3.14, SD = .89) and members of their household (M =
2.77, SD = .99; Figure 1). Adolescent were also concerned about overloading the healthcare
system (M = 2.68, SD = .96), the world’s population health (M = 2.52, SD = .95), and Canada’s
population health (M = 2.46, SD = .91). Adolescents were significantly less concerned with their
own health (M = 2.06, SD = .91) compared to vulnerable people’s health, t(786) = -28.05, p <
.001, members of their household, t(787) = -19.62, p < .001, Canada’s population health, t (787)
= -10.90, p < .001, and the world’s population health, t(787) = -11.60, p < .001.
In terms of COVID-19 related stress, youth were concerned about civil disorder (M =
2.40, SD = .99), maintaining social ties (M = 2.42, SD = .97), the ability of people to cooperate
and support one another during the crisis (M = 2.49, SD = .93), family stress and confinement (M
= 2.64, SD = 1.05), and, to a lesser extent, family violence at home (M =1.38, SD = .79).
Rates of COVID-19 related stress across genders are reported in Figure 1. There were
gender differences for vulnerable people’s health (F(2, 784) = 6.93, p < .001) and conflict at
home (F(2, 785) = 10.76, p < .001) with females and TNBI reporting more concerns than males.
Females also scored higher than males on the ability to cooperate and support one another (F(2,
784) = 6.70, p < .001). Finally, TNBI were more concerned with their household’s health
compared to males (F(2, 784) = 4.22, p < .05).
What are the rates of drug and alcohol use?
Rates of substance use are presented in Table 3. Alcohol (42.3%), nicotine (16.5%), and
cannabis (20.7%) were the most commonly used substances. Of concern, 1 in 5 adolescents
(19.7%) reported engaging in regular (i.e., once a week or more) use of at least one substance.
Rates of substance use did not differ across genders (all p > .05).
What is the rate of violence in the home?
Means of violence at home for male, female, and TBNI adolescents are shown in Table 4.
The means for all the scales were above 1, indicating that on average youth reported some form
of violence in the home. Youth reported higher rates of psychological than physical violence
from their parents (t(715) = -25.28, p < .001), towards their parents (t(712) = -24.33, p < .001)
and between their parents (t(694) = -19.92, p < .001). TNBI reported higher rates of experiencing
psychological violence by parents than males but were not different than females. TNBI also
reported higher rates of physical and psychological violence between their parents compared to
males and females.
The current study examined the prevalence of and gender differences in adolescents’
mental health, COVID-19 related stress, substance use, and violence in the home in a Canadian
national sample. Over half of the adolescents met clinical cut-off for depression and 40% met
clinical cut-off for anxiety. Although these cut-off points are not diagnostic, they indicate that a
high proportion of adolescents are at high risk of being diagnosed with a disorder(21). These
rates are consistent with other research conducted during the pandemic which showed high rates
of depression and anxiety among adolescents in China(28); however, they are higher than rates
reported in the early months of the pandemic in North American samples(10, 11). We also found
high rates of ADHD and ODD symptoms (19%-20%), demonstrating the wide range of mental
health problems that adolescents are experiencing during the pandemic. Almost one in two
adolescent indicated PTSD symptoms in the clinical range. Minimal research has examined
PTSD specifically in adolescents; however, research on young adults during COVID-19 has
found 31.8% meet the clinical cut-off for PTSD(8). PTSD symptoms can have a negative effect
on the immune system through inflammatory responses(29), which can last up to six months
following a traumatic event(30). The adolescents’ reports of high levels of PTSD symptoms are
therefore concerning given the potential long-term nature of the current pandemic.
Notably, the current study took place approximately three to four months following the
implementation of quarantine and social distancing, whereas previous studies were conducted at
the beginning of the quarantine(11). There is a concern that self-isolation may increase the risk
of mental health problems(31). As youth continue to be isolated from their peers and support
systems(11) and families continue to face cumulative stress, the rates of adolescent depression
and anxiety may continue to increase(2). Ongoing research on adolescent mental health, as well
as increased mental health services for adolescents, may be critical in managing a potential
mental health crisis following COVID-19.
For COVID-19 related stress, youth were less anxious about their own health compared
to the health of others. Youth who live with or have contact with family members who have
compromised health may experience increased increased stress regarding COVID-19. This stress
may also contribute youths’ adherence to public health measures such as physical distancing and
mask wearing. However, previous research found time spent watching or reading news related to
COVID-19 and social media use, to be associated with COVID-19 stress(11). At this point, there
is a paucity of research on risk factors for, and consequences of COVID-19 related stress.
Almost half of adolescents reported drinking alcohol since the lockdown began in March,
while just under a quarter reported using cannabis. Concerningly, almost 20% of adolescents
reported using substances regularly (i.e., once a week or more). These rates are higher than
national averages for alcohol and cannabis(PHAC, 32) and higher than previous research on
substance use among adolescents in Canada during the COVID-19 pandemic(12). With the high
rate of mental health problems, adolescents may be engaging in substance use to help regulate
feelings of depression, anxiety, or frustration with the stresses of the ongoing pandemic(33). The
rate of use is particularly troubling as adolescents have been found to use substances with their
friends during the pandemic(12), with whom they may not be socially distancing.
Youth reported experiencing and perpetrating rates of psychological violence within the
home similar to rates reported by high-risk samples(15). There is a significant concern regarding
the risk of increasing violence in the home for children and adolescents(5, 13). This worry is
compounded by months-long school closures at the time of the survey, as schools often serve as
the largest source of reports to protective services(34). Our results support the calls for
physicians to screen for potential violence and maltreatment and to provide support and services
for families in need to mitigate the increased risk to youth(34).
In terms of gender differences, compared to males, females had higher levels of
depression, anxieties, PTSD, which is consistent with the general literature(17, 35). Although
females had higher rates of depression, the average T-score for males was higher than expected
for a normative sample, indicating a high rate of depressive symptoms across genders. TNBI
reported the highest rate of all mental health problems with the exception of CD symptoms.
These results are consistent with above average rates for TNBI found in studies prior to the
pandemic(36, 37). Females and TNBI were more likely to be concerned with COVID-19
impacting vulnerable people’s health compared to males. Previous research has shown COVID-
19 stress is related to depression and anxiety(11), which is consistent with the present study’s
finding that females and TNBI have more concerns than males in this domain given their
heightened rates of mental health problems. Finally, TNBI reported experiencing higher rates of
violence in the home compared to males. Previous research has shown adolescent TNBI
experience high rates of psychological violence from their parents(36); thus, our results highlight
these ongoing issues within the COVID-19 context. Although our results are broadly consistent
with past literature on gender differences, they also indicate that TNBI may be at an increased
risk for negative mental health consequences during the pandemic. These youth will need
targeted supports to cope with the additional stress of COVID-19, violence at home, and the
potential for social isolation(2).
There are a number of limitations to note. First, our study relied on self-report. Multiple
respondents (e.g., parent, teacher) are required to obtain a fuller picture of youths functioning.
Second, the clinical cut-offs used here are not diagnostic and only indicate a youth is at high risk
of meeting criteria for the disorder(21). Third, we recruited through social media, which made
targeting adolescents from minority ethnicities, and low income and/or remote families without
internet or data difficult to recruit. Thus, our results may not be generalizable to these
populations and caution should be taken in interpreting our results. Finally, it is possible that
adolescents who were struggling with mental health problems were more likely to complete the
survey compared to youth who were not. Replication studies are needed.
Adolescents are experiencing a wide range of mental health concerns during the
pandemic, with female and TNBI at heightened risk. This study demonstrates the need to create
and promote services that are accessible and support the mental health of adolescents. High rates
of mental health problems, substance use, and violence in the home necessitate targeted supports
that encourage positive coping amidst the additional stresses of COVID-19. Given the potentially
long-term nature of the COVID-19 pandemic, and the likelihood of subsequent mental health
ramifications, further longitudinal investigations are warranted.
Table 1.
Demographics of the present sample (N = 809)
%/M (SD)
15.67 (1.37)
Trans/ Nonbinary individuals
Asian (East and Southeast)
Indigenous/Metis/First Nations
Lives with
Foster/ Group/ Other
Family composition
Two caregivers
One caregiver
School attendance in spring
Mixed (online and in person)
In person
Table 2.
Rates of psychopathology across genders
% cut-off
M (SD)
M (SD)
M (SD)
(n = 809)
(n = 313)
(n = 455)
(n = 41)
F (2, 806) = 3.17
(10.96 b
F (2, 806) = 6.72***
F (2, 806) = 13.78***
F (2, 806) = 21.41***
F (2, 806) = 38.95***
Separation Anxiety
F (2, 806) = 17.53***
Social Phobia
F (2, 806) = 21.69***
(n = 703)
F (2, 699) = 16.29***
Note. CD = Conduct Disorder, ODD = Oppositional Defiant Disorder, ADHD = Attention
Deficit Hyperactivity Disorder, CRIES = Children’s revised impact of event scale, PTSD = Post
Traumatic Stress Disorder; Means with different superscripts differ at p < .05 level by Tukey
HSD with Bonferroni correction; *** p < .001
Table 3.
Rates of substance use across whole sample
None (%)
Less than
1x/month- 1/
month (%)
More than 1x a
week (%)
Drug use (n = 685)
Ecstasy/ MDMA
Prescription (not
Table 4.
Rates of violence in the home compared across genders.
M (SD)
M (SD)
M (SD)
(n = 716)
(n = 275)
(n = 405)
(n = 37)
From parent to teen
1.12 (.29)
1.13 (.29)a
1.12 (.29) a
1.10 (.17) a
F (2, 713) = .26
1.59 (.62)
1.49 (.56)b
1.64 (.64) a
1.80 (.61) a
F (2, 714) = 9.14***
From teen to parent
1.04 (.13)
1.05 (.14)a
1.03 (.12)a
1.06 (.19)a
F (2, 710) = 1.79
1.37 (.40)
1.32 (.38)c
1.40 (.41)a, b
1.45 (.48)a
F (2, 710) = 3.75*
Between parents
1.07 (.22)
1.07 (.23)a
1.06 (.19)b
1.16 (.35)b
F (2, 692) = 3.60*
1.43 (.58)
1.31 (.49)c
1.48 (.59)b
1.75 (.77)a
F (2, 692) = 13.86***
Note. Means with different superscripts differ at p < .05 level by Tukey HSD with Bonferroni
correction; *** p < .001
Figure 1.
Rates of COVID-19 related stress by gender.
Note. Pop = population, * p < .05, ** p < .01, *** p < .001, all differences are compared to
COVID-19 related stressors
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... Given the devastating consequences associated with mental health illnesses among adolescents, a meta-analysis study conducted by Benton et al. (2021) reported that there is a crucial need for action toward addressing the increasing mental health illnesses among adolescents globally. Effective actions in addressing mental health illnesses among adolescents should include coordinated mental health care services and the availability of infrastructure (Craig et al., 2020). Effective mental health services could facilitate early detection of risks, foster diagnosis of conditions, and enable mental health care capable of mitigating relapse and other associated consequences (Von Der Embse et al., 2018). ...
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Introduction: The healthcare system over the years has witnessed evolvement and transformation in the care pattern, including in the mental healthcare system. This has seen a considerable and commendable improvement in patient care. This article aims to demonstrate the need for "presence practice" and practical implications thereof, in the care of adolescents with mental health illnesses and to further demonstrate the need for connecting and attuning mental health care for good care and positive nurse and patient outcomes. The developmental stage of adolescents is characterized by various psychosocial changes. At the same time, the emergence of numerous mental health conditions is prevalent at the adolescent stage, contributing to the disease burden among this age group. Understandably, the prevalence of mental health illnesses in adolescents could be associated with their vulnerability and the result of the interaction of numerous biopsychosocial factors in the lives of the individuals, asserting influences on their development and mental health such as family challenges, the stress associated with schooling, relationship issues, and abuse. Method: This article follows a quality improvement method where the author took time to nonsystematically explain existing literature on presence practice and its practical implication and further practically demonstrated the need for and how to facilitate connecting and attuning mental health care for good care and positive nurse and patient outcomes. Result: Presence practice should be adopted by mental health nurses to foster the establishment of relational care with mental health care users, such as adolescents with mental illness, and to help mitigate relapse. Being open-minded and preparing their minds to be receptive and present during care should be part of nurses effective presence practice. Conclusion: The article concludes that mental health nurses, as frontline caregivers, should always endeavor to connect and attune care to the needs of the adolescents receiving mental health care to foster positive outcomes.
... These sex differences in trajectories of internalizing problems during our five week study likely reflect pre-existing sex differences in internalizing symptoms that are amplified during adolescence (Lewinsohn et al., 1998;Martel, 2013;Salk et al., 2017) and periods of high stress. In line with these findings, many studies during COVID-19 report evidence of this sex disparity (Barendse et al., 2021;Craig et al., 2020;Halldorsdottir et al., 2021;Qi et al., 2020). This increased vulnerability to internalizing problems could be due in part to sex differences in the cognitive or affective experience of coping with stressors. ...
The COVID-19 pandemic has touched the lives of adolescents around the world. This short-term longitudinal, observational study followed 1,334 adolescents (11–17 yo) to investigate whether social-ecological resilience relates to intra- and inter-personal resources and/or the caregiver relationship relates to changes in internalizing symptoms during five stressful weeks of COVID-19 lockdown in Perú. In this work, we contextualize social-ecological resilience in relation to culturally-relevant personal and caregiver resources that youth can use to adapt to stressful situations. We found that adolescents who reported higher levels of personal, caregiver, and overall resilience had lower levels of anxiety and depressive symptoms at week six. We also find that personal, caregiver, and overall resilience moderated the change in anxiety symptoms from week 6 to week 11 of lockdown in 2020. Our findings underscore the importance of social-ecological resilience related to both intra/interpersonal resources and the caregiver relationship for minimizing the harmful impacts of COVID-19 on adolescent internalizing symptoms.
... Of note, those respondents who reported symptoms more commonly associated with a common cold also reported higher mental health symptoms (e.g., behavioral and attention concerns, anxiety and depression symptoms, substance use). Craig et al. (2020) also explored current rates of mental health problems and COVID-19 related stress in Canadian youth; they found that females endorsed significantly higher levels of depression, anxiety, social phobia, and PTSD than males. As the data were collected during the early stages of quarantine and school closures (June 2020), the findings may represent the initial effects of social isolation and family confinement on adolescent mental health, as much as concerns over the health effects of COVID-19 itself. ...
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Students have been multiply impacted by the COVID-19 pandemic: threats to their own and their family’s health, the closure of schools, and pivoting to online learning in March 2020, a long summer of physical distancing, and then the challenge of returning to school in fall 2020. As damaging as the physical health effects of a global pandemic are, much has been speculated about the “second wave” of mental health crises, particularly for school-aged children and adolescents. Yet, few studies have asked students about their experiences during the pandemic. The present study engaged with over two thousand ( N = 2,310; 1,288 female; M age = 14.5) 12- to 18-year-old Alberta students during their first few weeks of return-to-school in fall 2020. Students completed an online survey that asked about their perceptions of COVID-19, their fall return-to-school experiences (84.9% returned in-person), their self-reported pandemic-related stress, and their behavior, affect, and cognitive functioning in the first few weeks of September. The majority of students (84.9%) returned to school in person. Students reported moderate and equal concern for their health, family confinement, and maintaining social contact. Student stress levels were also above critical thresholds for 25% of the sample, and females and older adolescents (age 15–18 years) generally reported higher stress indicators as compared to males and younger (age 12–14 years) adolescents. Multivariate analysis showed that stress indicators were positively and significantly correlated with self-reported behavioral concerns (i.e., conduct problems, negative affect, and cognitive/inattention), and that stress arousal (e.g., sleep problems, hypervigilance) accounted for significant variance in behavioral concerns. Results are discussed in the context of how schools can provide both universal responses to students during COVID-19 knowing that most students are coping well, while some may require more targeted strategies to address stress arousal and heightened negative affect.
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Στο άρθρο παρουσιάζεται μια πολυεπίπεδη παρέμβαση για την εκτίμηση αναγκών και τη στήριξη των σχολικών κοινοτήτων στο πλαίσιο της πανδημίας COVID-19 με έμφαση στη σύνδεση θεωρίας, εκπαίδευσης, έρευνας και πράξης. Το άρθρο περιλαμβάνει δύο αλληλένδετες ενότητες, στις οποίες περιγράφονται ο σχεδιασμός και ενδεικτικά ευρήματα ερευνητικού προγράμματος για την αξιολόγηση των αντιλήψεων των μελών της σχολικής κοινότητας σε σχέση με ψυχολογικές και εκπαιδευτικές διαστάσεις της πανδημίας, καθώς και εκπαιδευτικές δράσεις και παρεμβάσεις για τη στήριξη των σχολικών/εκπαιδευτικών κοινοτήτων. Τα ευρήματα αφορούν στα δεδομένα από τη χορήγηση -ανάλογα με την ομάδα συμμετεχόντων- της Κλίμακας Γενικευμένου Άγχους (GAD-7), της Σύντομης Κλίμακας Ψυχολογικής Ανθεκτικότητας (BRS), ερωτηματολογίου για την εξ αποστάσεως εκπαίδευση, καθώς και ειδικά διαμορφωμένων ανοικτών και κλειστών ερωτήσεων σε εκπαιδευτικούς (n = 414), γονείς (n = 499) και εφήβους (n = 256). Τα ευρήματα ανέδειξαν, μεταξύ άλλων, υψηλά επίπεδα άγχους και μέτρια προς χαμηλά επίπεδα ανθεκτικότητας σε εκπαιδευτικούς και γονείς και αισθήματα ανησυχίας σε εφήβους. Οι ενήλικες συμμετέχοντες αναφέρθηκαν στην ανάγκη κατάλληλης προετοιμασίας των σχολικών μονάδων για τη διαχείριση της παρούσας κρίσης. Τα ευρήματα σε συνδυασμό με τη διεθνή βιβλιογραφία έθεσαν τη βάση για την ανάπτυξη ποικίλων δράσεων στο πλαίσιο της κοινωνικής δικαιοσύνης σε κάθε φάση της πανδημίας, όπως ανάπτυξη/διάχυση ενημερωτικού υλικού, επιμόρφωση εκπαιδευτικών/γονέων, εκπαίδευση προπτυχιακών/μεταπτυχιακών φοιτητών/τριών, στήριξη σχολείων και διεθνείς συνεργασίες. Στο άρθρο γίνεται αναφορά στο ρόλο των πανεπιστημίων στην παροχή σχολικών ψυχολογικών υπηρεσιών και στην αναγκαιότητα ανάπτυξης ολοκληρωμένων σχεδίων δράσης σε επίπεδο πρόληψης για τη διαχείριση κρίσεων στη σχολική κοινότητα σε εθνικό επίπεδο.
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Background Youth mental health appears to have been negatively impacted by the COVID-19 pandemic. The impact on substance use is less clear, as is the impact on subgroups of youth, including those with pre-existing mental health or substance use challenges. Objective This hypothesis-generating study examines the longitudinal evolution of youth mental health and substance use from before the COVID-19 pandemic to over one year into the pandemic among youth with pre-existing mental health or substance use challenges. Method A total of 168 youth aged 14–24 participated. Participants provided sociodemographic data, as well as internalizing disorder, externalizing disorder, and substance use data prior to the pandemic’s onset, then every two months between April 2020–2021. Linear mixed models and Generalized Estimating Equations were used to analyze the effect of time on mental health and substance use. Exploratory analyses were conducted to examine interactions with sociodemographic and clinical characteristics. Results There was no change in internalizing or externalizing disorder scores from prior to the pandemic to any point throughout the first year of the pandemic. Substance use scores during the pandemic declined compared to pre-pandemic scores. Exploratory analyses suggest that students appear to have experienced more mental health repercussions than non-students; other sociodemographic and clinical characteristics did not appear to be associated with mental health or substance use trajectories. Conclusions While mental health remained stable and substance use declined from before the COVID-19 pandemic to during the pandemic among youth with pre-existing mental health challenges, some youth experienced greater challenges than others. Longitudinal monitoring among various population subgroups is crucial to identifying higher risk populations. This information is needed to provide empirical evidence to inform future research directions.
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Background Despite the well-known adverse health conditions and negative economic outcomes associated with mental health problems, accessing treatment is difficult due to reasons such as availability and cost. As a solution, digital mental health services have flooded the industry, and new studies are quickly emerging that support their potential as an accessible and cost-effective way to improve mental health outcomes. However, many mental health platforms typically use clinical tools such as the Patient Health Questionnaire-9 (PHQ-9) or General Anxiety Disorder-7 (GAD-7). Yet, many individuals that seek out care do not have clinical symptomatology and thus, traditional clinical measures may not adequately capture symptom improvement in general well-being. As an alternative, this study used the health-related quality of life (HRQoL) tool from the Centers for Disease Control and Prevention “Healthy Days” measure. This subjective measure of well-being is an effective way to capture HRQoL and might be better suited as an outcome measure for treatments that include both clinical and subclinical individuals. Objective The purpose of this study was to describe changes in HRQoL in clinical and subclinical members assessing virtual care and to examine the association between text-based behavioral coaching and virtual clinical sessions with changes in HRQoL. MethodsA total of 288 members completed the 4-item HRQoL measure at baseline and at 1 month following use of the Ginger on demand behavioral health platform. Baseline anxiety and depression levels were collected using the GAD-7 and PHQ-9, respectively. ResultsMembers completed on average 1.92 (SD 2.16) coaching sessions and 0.91 (SD 1.37) clinical sessions during the assessment month. Paired samples t tests revealed significant reductions in the average number of unhealthy mental health days between baseline (mean 16, SD 8.77 days) and follow-up (mean 13.2, SD 9.02 days; t287=5.73; P
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Background: During the Coronavirus Disease 2019 (COVID-19) pandemic, patient portals and their message platforms allowed remote access to healthcare. Utilization patterns in patient messaging during the COVID-19 crisis have not been studied thoroughly. In this work, we propose to characterize patients and their use of asynchronous virtual care for COVID-19 via a retrospective analysis of patient portal messages. Objective: To perform a retrospective analysis of portal messages to probe patient asynchronous response to the COVID-19 crisis. Methods: We collected over 2 million patient-generated messages (PGMs) at Mayo Clinic during February 1 - August 31, 2020. We performed descriptive statistics on PGMs related to COVID-19 and incorporated patients' sociodemographic factors into the analysis. We analyzed the PGMs on COVID-19 in terms of COVID-19 related care (e.g., COVID-19 symptom self-assessment and COVID-19 tests and results) and other health issues (e.g., appointment cancellation, anxiety, and depression). Results: The majority of PGMs on COVID-19 pertained to COVID-19 symptom self-assessment (42.50%) and COVID-19 tests and results (30.84%). The PGMs related to COVID-19 symptom self-assessment and COVID-19 test results had dynamic patterns and peaks similar to the newly confirmed cases in the US and Minnesota. The trend of PGMs related COVID-19 care plans paralleled trends in newly hospitalized cases and deaths. After an initial peak in March, the PGMs on issues such as appointment cancellations and anxiety regarding COVID-19 had a declining trend. The majority of message senders were 30-64 years old, married, female, white, or urban residents. This majority was an even higher proportion among patients who sent portal messages on COVID-19. Conclusions: During the COVID-19 pandemic, patients increased portal messaging utilization to address healthcare issues about COVID-19 (particularly, symptom self-assessment and tests and results). Trends in message utilization closely followed national trends in new cases and hospitalizations. There is a wide disparity for minority and rural populations in utilization of PGMs for addressing the COVID-19 crisis. Clinicaltrial:
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Background: Existing mental health apps are largely not aimed at generally healthy young people who may be experimenting with addictive substances and mind-altering experiences. Objective: The aim of this study is to examine the interest and expectations of young people regarding a proposed smartphone app designed to help protect and promote mental health and resilience in the face of risks associated with substance use. Methods: The study was based on agile system development and had 3 empirical substudies. Our feasibility study (study 1) included an anonymous questionnaire that examined the potential interest of young people in this type of app. It was answered by 339 Israelis aged 18-30 years. The second part of the feasibility study was a pilot study with 1.2% (4/339) of the people who answered the questionnaire and expressed interest in participating in a focus group. They tested and refined the elements planned for the focus groups. Study 2 was a participatory design study involving 7 focus groups of 5 to 7 participants each (young people aged 18-35 years, n=38). Persona development, open discussion, and a Technology Acceptance Model questionnaire were used to elicit user expectations and requirements for the app and to understand the perceived usefulness and usability of the proposed features. Study 3 comprised in-depth interviews with experts in the field of youth mental health and drug use to enlist their professional opinion regarding the value of such an app and recommendations about the features it should include. Results: The mock-up for the proposed app had five key features: personalized assessment of risk for a drug-associated mental crisis, support for self-monitoring, useful information (eg, warning signs and first-aid guidelines), resilience-building exercises, and a support center. Participants rated highly the usefulness of all 5 main features and 96% (24/25) of the specific features we proposed within those main categories. The participants also suggested additional features as well as a new user persona we had not considered: the parents or family members of the young person. The focus groups rated highly the perceived usability of the app. Most of the experts saw value in all the main features and suggested specific knowledge sources for the app's content. Finally, participants of both the feasibility study and the participatory design study expressed moderate to high interest in using the app for self-help and high interest in using the app to help friends. Conclusions: The findings provide preliminary encouraging support for the 5 main features suggested by the research team and reinforce recommendations for mobile health apps found in the literature. The findings emphasize the insight that this kind of app should be designed primarily for use by individuals seeking to help others.
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The COVID-19 quarantine has affected more than 860 million children and adolescents worldwide, but to date, no study has been developed within Western countries to examine the psychological impact on their lives. The present study aims to examine for the first time the emotional impact of the quarantine on children and adolescents from Italy and Spain, two of the countries most affected by COVID-19. Participants were 1,143 parents of Italian and Spanish children aged 3 to 18 years who completed a survey providing information about how the quarantine affects their children and themselves, compared to before the home confinement. Results show that 85.7% of the parents perceived changes in their children's emotional state and behaviors during the quarantine. The most frequent symptoms were difficulty concentrating (76.6%), boredom (52%), irritability (39%), restlessness (38.8%), nervousness (38%), feelings of loneliness (31.3%), uneasiness (30.4%), and worries (30.1%). Spanish parents reported more symptoms than Italians. As expected, children of both countries used monitors more frequently, spent less time doing physical activity, and slept more hours during the quarantine. Furthermore, when family coexistence during quarantine became more difficult, the situation was more serious, and the level of stress was higher, parents tended to report more emotional problems in their children. The quarantine impacts considerably on Italian and Spanish youth, reinforcing the need to detect children with problems as early as possible to improve their psychological well-being.
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Purpose The overarching goal of this study was to provide key information on how adolescents' substance use has changed since the corona virus disease (COVID)-19 pandemic, in addition to key contexts and correlates of substance use during social distancing. Methods Canadian adolescents (n = 1,054, Mage = 16.68, standard deviation = .78) completed an online survey, in which they reported on their frequency of alcohol use, binge drinking, cannabis use, and vaping in the 3 weeks before and directly after social distancing practices had taken effect. Results For most substances, the percentage of users decreased; however, the frequency of both alcohol and cannabis use increased. Although the greatest percentage of adolescents was engaging in solitary substance use (49.3%), many were still using substances with peers via technology (31.6%) and, shockingly, even face to face (23.6%). Concerns for how social distancing would affect peer reputation was a significant predictor of face-to-face substance use with friends among adolescents with low self-reported popularity, and a significant predictor of solitary substance use among average and high popularity teens. Finally, adjustment predictors, including depression and fear of the infectivity of COVID-19, predicted using solitary substance use during the pandemic. Conclusions Our results provide preliminary evidence that adolescent substance use, including that which occurs face to face with peers, thereby putting adolescents at risk for contracting COVID-19, may be of particular concern during the pandemic. Further, solitary adolescent substance use during the pandemic, which is associated with poorer mental health and coping, may also be a notable concern worthy of further investigation.
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We are facing an unprecedented time during the COVID-19 pandemic. Measures have been taken to reduce the spread of the virus, including school closures and widespread lockdowns. Physical isolation combined with economic instability, fear of infection, and uncertainty for the future has had a profound impact on global mental health. For adolescents, the effects of this stress may be heightened due to important developmental characteristics. Canadian adolescents (n = 1,054; Mage = 16.68, SD = 0.78) completed online surveys and responded to questions on stress surrounding the COVID-19 crisis, feelings of loneliness and depression, as well as time spent with family, virtually with friends, doing schoolwork, using social media, and engaging in physical activity. Results showed that adolescents are very concerned about the COVID-19 crisis and are particularly worried about schooling and peer relationships. COVID-19 stress was related to more loneliness and more depression, especially for adolescents who spend more time on social media. Beyond COVID-19 stress, more time connecting to friends virtually during the pandemic was related to greater depression, but family time and schoolwork was related to less depression. For adolescents with depressive symptoms, it may be important to monitor the supportiveness of online relationships. Results show promising avenues to stave off loneliness, as time with family, time connecting to friends, as well as physical activity were related to lower loneliness, beyond COVID-19 stress. These results shed light on the implications of the COVID-19 pandemic for adolescents and document possible pathways to ameliorate negative effects.
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Objectives The current novel coronavirus disease of 2019 (COVID-19) pandemic presents a time-sensitive opportunity to rapidly enhance our knowledge about the impacts of public health crises on youth mental health, substance use, and well-being. This study examines youth mental health and substance use during the pandemic period. Methods A cross-sectional survey was conducted with 622 youth participants across existing clinical and community cohorts. Using the National Institute of Mental Health-developed CRISIS tool and other measures, participants reported on the impacts of COVID-19 on their mental health, substance use, and other constructs. Results Reports of prepandemic mental health compared to intrapandemic mental health show a statistically significant deterioration of mental health across clinical and community samples ( P < 0.001), with greater deterioration in the community sample. A total of 68.4% of youth in the clinical sample and 39.9% in the community sample met screening criteria for an internalizing disorder. Substance use declined in both clinical and community samples ( P < 0.001), although 23.2% of youth in the clinical sample and 3.0% in the community sample met screening criteria for a substance use disorder. Participants across samples report substantial mental health service disruptions (48.7% and 10.8%) and unmet support needs (44.1% and 16.2%). Participants report some positive impacts, are using a variety of coping strategies to manage their wellness, and shared a variety of ideas of strategies to support youth during the pandemic. Conclusions Among youth with histories of mental health concerns, the pandemic context poses a significant risk for exacerbation of need. In addition, youth may experience the onset of new difficulties. We call on service planners to attend to youth mental health during COVID-19 by bolstering the accessibility of services. Moreover, there is an urgent need to engage young people as coresearchers to understand and address the impacts of the pandemic and the short, medium, and long terms.
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Objective : The sudden outbreak of Coronavirus Disease 2019 (COVID-19) has had a dramatic effect on the mental health of the public. In the present study, we demonstrated the psychological effects on children and adolescents associated with the epidemic . Methods : By using convenience sampling method, questionnaires, such as Spence Child Anxiety Scale, Child Depression Inventory and Coping style Scale, were distributed to participating 359 children and 3254 adolescents online. Results : The anxiety levels of children and adolescents were (23.87±15.79) and (29.27±19.79), respectively. 22.28% respondents were suffering from depressive symptoms. Seven significant factors associated with increased levels of anxiety, including female, resident in urban regions, emotion-focused coping style. Nine factors associated with increased levels of depression, such as smartphone addiction (OR 1.411, 95% CI 1.099–1.180), Internet addiction (OR 1.844, 95% CI 1.209–2.811), and resident in Hubei province (OR 3.107, 95% CI 1.252–7.708). Two additional factors associated with decreased levels of depressive symptoms: hours spend on Internet per day before the epidemic (OR 0.652, 95% CI 0.609–0.697) and tendency to apply problem-focused coping style (OR 0.937, 95% CI 0.923–0.951). Conclusion : Our findings indicate that the COVID-19 outbreak has had a significant psychosocial impact on children and adolescents. Findings of current levels of anxiety and depression not only highlight the need to address emotional distress for children and adolescents during the epidemic but also provide researchers with scientific fundamentals to formulate targeted interventions based on the significant influencing factors.
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Background: The coronavirus disease 2019 (COVID-19) is profoundly affecting life around the globe. Isolation, contact restrictions and economic shutdown impose a complete change to the psychosocial environment in affected countries. These measures have the potential to threaten the mental health of children and adolescents significantly. Even though the current crisis can bring with it opportunities for personal growth and family cohesion, disadvantages may outweigh these benefits. Anxiety, lack of peer contact and reduced opportunities for stress regulation are main concerns. Another main threat is an increased risk for parental mental illness, domestic violence and child maltreatment. Especially for children and adolescents with special needs or disadvantages, such as disabilities, trauma experiences, already existing mental health problems, migrant background and low socioeconomic status, this may be a particularly challenging time. To maintain regular and emergency child and adolescent psychiatric treatment during the pandemic is a major challenge but is necessary for limiting long-term consequences for the mental health of children and adolescents. Urgent research questions comprise understanding the mental health effects of social distancing and economic pressure, identifying risk and resilience factors, and preventing long-term consequences, including-but not restricted to-child maltreatment. The efficacy of telepsychiatry is another highly relevant issue is to evaluate the efficacy of telehealth and perfect its applications to child and adolescent psychiatry. Conclusion: There are numerous mental health threats associated with the current pandemic and subsequent restrictions. Child and adolescent psychiatrists must ensure continuity of care during all phases of the pandemic. COVID-19-associated mental health risks will disproportionately hit children and adolescents who are already disadvantaged and marginalized. Research is needed to assess the implications of policies enacted to contain the pandemic on mental health of children and adolescents, and to estimate the risk/benefit ratio of measures such as home schooling, in order to be better prepared for future developments.
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Psychological health problems, especially emotional disorders, are common among adolescents. The epidemiology of emotional disorders is greatly influenced by stressful events. This study sought to assess the prevalence rate and socio-demographic correlates of depressive and anxiety symptoms among Chinese adolescents affected by the outbreak of COVID-19. We conducted a cross-sectional study among Chinese students aged 12–18 years during the COVID-19 epidemic period. An online survey was used to conduct rapid assessment. A total of 8079 participants were involved in the study. An online survey was used to collect demographic data, assess students’ awareness of COVID-19, and assess depressive and anxiety symptoms with the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder (GAD-7) questionnaire, respectively. The prevalence of depressive symptoms, anxiety symptoms, and a combination of depressive and anxiety symptoms was 43.7%, 37.4%, and 31.3%, respectively, among Chinese high school students during the COVID-19 outbreak. Multivariable logistic regression analysis revealed that female gender was the higher risk factor for depressive and anxiety symptoms. In terms of grades, senior high school was a risk factor for depressive and anxiety symptoms; the higher the grade, the greater the prevalence of depressive and anxiety symptoms. Our findings show there is a high prevalence of psychological health problems among adolescents, which are negatively associated with the level of awareness of COVID-19. These findings suggest that the government needs to pay more attention to psychological health among adolescents while combating COVID-19.
Purpose LGBTQ youth are a population who experience unique stressors. This study investigated their experiences with the COVID-19 pandemic via Q Chat Space—a national online chat-based support program. Methods Transcript data from 31 synchronous, text-based chats collected during the onset of state-based “social distancing” ordinances in Spring 2020 were analyzed. Results While encountering COVID-19–related stressors likely to be experienced by youth generally, participants' experiences were concomitantly imbued with LGBTQ-specific intrapersonal, interpersonal, and structural challenges. Difficulties included maintaining mental health, being isolated with unsupportive families, and loss of in-person identity-based socialization and support. Conclusions Findings highlight the importance of synchronous, text-based online platforms to enable LGBTQ youth to feel safe to seek support while at home. Given the potential for long-term physical distancing, concerted efforts are required to provide necessary resources and support for LGBTQ youth during the COVID-19 pandemic.
Objective Disease containment of COVID-19 has necessitated widespread social isolation. We aimed to establish what is known about how loneliness and disease containment measures impact on the mental health in children and adolescents. Method For this rapid review, we searched MEDLINE, PSYCHINFO, and Web of Science for articles published between 01/01/1946 and 03/29/2020. 20% of articles were double screened using pre-defined criteria and 20% of data was double extracted for quality assurance. Results 83 articles (80 studies) met inclusion criteria. Of these, 63 studies reported on the impact of social isolation and loneliness on the mental health of previously healthy children and adolescents (n=51,576; mean age 15.3) 61 studies were observational; 18 were longitudinal and 43 cross sectional studies assessing self-reported loneliness in healthy children and adolescents. One of these studies was a retrospective investigation after a pandemic. Two studies evaluated interventions. Studies had a high risk of bias although longitudinal studies were of better methodological quality. Social isolation and loneliness increased the risk of depression, and possibly anxiety at the time loneliness was measured and between 0.25 to 9 years later. Duration of loneliness was more strongly correlated with mental health symptoms than intensity of loneliness. Conclusion Children and adolescents are probably more likely to experience high rates of depression and probably anxiety during and after enforced isolation ends. This may increase as enforced isolation continues. Clinical services should offer preventative support and early intervention where possible and be prepared for an increase in mental health problems.
This study sought to identify factors associated with depression, anxiety, and PTSD symptomatology in U.S. young adults (18-30 years) during the COVID-19 pandemic. This cross-sectional online study assessed 898 participants from April 13, 2020 to May 19, 2020, approximately one month after the U.S. declared a state of emergency due to COVID-19 and prior to the initial lifting of restrictions across 50 U.S. states. Respondents reported high levels of depression (43.3%, PHQ-8 scores ≥ 10), high anxiety scores (45.4%, GAD-7 scores ≥ 10), and high levels of PTSD symptoms (31.8%, PCL-C scores ≥ 45). High levels of loneliness, high levels of COVID-19-specific worries, and low distress tolerance were significantly associated with clinical levels of depression, anxiety, and PTSD symptoms. Resilience was associated with low levels of depression and anxiety symptoms but not PTSD. Most respondents had high levels of social support; social support from family, but not from partner or peers, was associated with low levels of depression and PTSD. Compared to Whites, Asian Americans were less likely to report high levels across mental health symptoms, and Hispanic/Latinos were less likely to report high levels of anxiety. These factors provide initial guidance regarding clinical management for COVID-19-related mental health problems.