ADOLESCENT MENTAL HEALTH DURING COVID-19 1
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,
2. University of Victoria, A192 Cornett Building, 3800 Finnerty Road, Victoria, BC,
Corresponding Author Contact Details:
Stephanie Craig, Department of Psychology, York University, 4700 Keele St, Toronto, Ontario,
Canada, M3J 1P3. E: firstname.lastname@example.org
Funding: This project was supported in part by a Canadian Institutes of Health Research
fellowship awarded to Dr. Stephanie Craig.
ADOLESCENT MENTAL HEALTH DURING COVID-19 2
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
ADOLESCENT MENTAL HEALTH DURING COVID-19 3
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
ADOLESCENT MENTAL HEALTH DURING COVID-19 4
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
ADOLESCENT MENTAL HEALTH DURING COVID-19 5
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.
ADOLESCENT MENTAL HEALTH DURING COVID-19 6
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
ADOLESCENT MENTAL HEALTH DURING COVID-19 7
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.
ADOLESCENT MENTAL HEALTH DURING COVID-19 8
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%).
ADOLESCENT MENTAL HEALTH DURING COVID-19 9
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 <
ADOLESCENT MENTAL HEALTH DURING COVID-19 10
.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)
ADOLESCENT MENTAL HEALTH DURING COVID-19 11
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
ADOLESCENT MENTAL HEALTH DURING COVID-19 12
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.
ADOLESCENT MENTAL HEALTH DURING COVID-19 13
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
ADOLESCENT MENTAL HEALTH DURING COVID-19 14
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.
ADOLESCENT MENTAL HEALTH DURING COVID-19 15
Demographics of the present sample (N = 809)
Trans/ Nonbinary individuals
Asian (East and Southeast)
Foster/ Group/ Other
School attendance in spring
Mixed (online and in person)
ADOLESCENT MENTAL HEALTH DURING COVID-19 16
Rates of psychopathology across genders
(n = 809)
(n = 313)
(n = 455)
(n = 41)
F (2, 806) = 3.17
F (2, 806) = 6.72***
F (2, 806) = 13.78***
F (2, 806) = 21.41***
F (2, 806) = 38.95***
F (2, 806) = 17.53***
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
ADOLESCENT MENTAL HEALTH DURING COVID-19 17
Rates of substance use across whole sample
More than 1x a
Drug use (n = 685)
ADOLESCENT MENTAL HEALTH DURING COVID-19 18
Rates of violence in the home compared across genders.
(n = 716)
(n = 275)
(n = 405)
(n = 37)
From parent to teen
1.12 (.29) a
1.10 (.17) a
F (2, 713) = .26
1.64 (.64) a
1.80 (.61) a
F (2, 714) = 9.14***
From teen to parent
F (2, 710) = 1.79
1.40 (.41)a, b
F (2, 710) = 3.75*
F (2, 692) = 3.60*
F (2, 692) = 13.86***
Note. Means with different superscripts differ at p < .05 level by Tukey HSD with Bonferroni
correction; *** p < .001
ADOLESCENT MENTAL HEALTH DURING COVID-19 19
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
ADOLESCENT MENTAL HEALTH DURING COVID-19 20
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