Even before the COVID-19 pandemic began, adolescent mental health in the United States was a growing and far-reaching concern.
As the effects of the pandemic rapidly spread in early 2020, adolescents were impacted in many ways, from school closures and changes to extracurricular activities to increasing isolation and distance from friends.
“The pandemic has been a novel experience for all of us, but adolescents may have been impacted differently than other age groups,” explains Anne E. Bowen, former clinical research coordinator for Stacey Simon, PhD, an associate professor of pediatric pulmonary medicine in the University of Colorado School of Medicine.
In recently published research, Bowen and Simon found that of nearly 700 13- to 19-year-olds surveyed, almost half endorsed moderate to severe anxiety at two time points in the first year of the pandemic and nearly three quarters endorsed moderate to severe depression.
“During the pandemic, it really hit home to me when teenagers were not able to go to school, not able to socialize, that we were seeing an increased awareness of the hardships that they were experiencing,” Simon says. “While there are a lot of negative things to come out of the pandemic, one tiny silver lining is the awareness of adolescent mental health.”
Reporting anxiety and depression
The idea to study anxiety and depression among adolescents during the first year of the pandemic was drawn from a larger study initiated by Katherine Wesley, PhD, an assistant professor of pediatric pulmonary medicine in the CU School of Medicine and study co-author, to research adolescent sleep habits during the pandemic.
“We did an analysis of those data and began discussing how we could learn more about adolescent mental health during that time,” Simon says. “We didn’t really know what to expect, but we knew many adolescents were home and we hoped to capture a national representation of this population.”
Using the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Depression and Anxiety short forms to assess mood symptoms including depression and anxiety during the seven days preceding the survey, participants completed eight-item questionnaires in May 2020 and between November 2020 and January 2021. Wesley and Simon advertised the online self-report survey on Facebook.
Participants were asked their age, school grade, race, ethnicity, and gender identity, as well as their zip code to assess socioeconomic status. Participants also were asked whether they previously had received a diagnosis of anxiety or depression from a health care professional.
Hearing and understanding
Of the 694 adolescent participants who completed questionnaires at both time points, 40% reported a pre-pandemic diagnosis of depression and 49% reported a pre-pandemic diagnosis of anxiety. During the pandemic, nearly half endorsed moderate to severe anxiety at both timepoints and almost three-quarters endorsed moderate to severe depression.
Anxiety and depression were more frequently reported by respondents who identified as female or gender diverse. Notably, Bowen and Simon found that those living in areas of higher community distress also had higher levels of anxiety and depression.
“We know that economically vulnerable communities were, and continue to be, disproportionally affected by the pandemic. It’s important for clinicians and educators, as well as policy makers, to be aware of and take action to mitigate such disparities,” Bowen says.
Among the lessons can be gleaned from the research is the ongoing need for parents or caregivers, educators, and health care providers to be aware of mental health symptoms, and to work together to build early interventions that help children cultivate resilience.
“People who work with adolescents know that they are at particularly high risk for experiencing these mental health symptoms,” Bowen says. “I think at every level – from legislatures to school systems to communities to families – we need to continue focusing on how to help adolescents make a healthy transition into adulthood.”
Simon adds that while conversations about mental health may be difficult or scary for parents or caregivers to initiate, “you’re not going to cause any of these symptoms just by opening up the conversation. Parents can really help their kids feel like they’re being heard and understood by encouraging that communication and taking it seriously, and then seeking help if the adolescent needs it.”