Impact of COVID-19 on Mental Health in Adolescents: Comparison
Please note this is a comparison between Version 1 by Elizabeth Jones and Version 2 by Jason Zhu.

Globally, adolescents of varying backgrounds experience higher rates of anxiety, depression, and stress due to the pandemic. Secondly, adolescents also have a higher frequency of using alcohol and cannabis during the COVID-19 pandemic. However, social support, positive coping skills, home quarantining, and parent–child discussions seem to positively impact adolescent mental health during this period of crisis. Whether in the United States or abroad, the COVID-19 pandemic has impacted adolescent mental health. Therefore, it is important to seek and to use all of the available resources and therapies to help adolescents mediate the adjustments caused by the pandemic.

  • mental health
  • mental illness
  • mental disorder
  • psychiatric illness

1. Introduction

The COVID-19 pandemic has created a havoc across the world, which has resulted in over 2 million deaths, globally and forced billions into isolation due to stay at home orders [1]. As a result of social isolation, and the constant concern of infectivity, mental health consequences that are associated with the COVID-19 crisis are monumental [2][3][2,3]. However, researchers are focusing more on the mental health impact of this rapidly evolving global crisis in the elderly population [4]. There has been very little attention to the psychological toll of COVID-19 on adolescent mental health [5].
The psychological toll of COVID-19 among adolescents should be a focal point in COVID-19 research due to the severe and enduring impact of mental health, which leads to poor mental health outcomes and to poor physical health outcomes, such as the development of cardiovascular diseases [6][7][6,7]. The mental toll of this impact serves as a greater challenge for adolescents because this age range (characterized as young people between the ages of 13–17) lack the psychological capabilities of resilience and coping and the physiological development of adults [6][8][6,8]. The mental health challenges of adolescents are even greater among adolescents with pre-existing mental health conditions during periods of crisis, which may be a result of isolation, feelings of uncertainty, lack of daily routines, lack of access to health services provided through schools, and lack of advanced emotional development [9][10][9,10].
Globally, 10–20% of adolescents suffer from mental health conditions [11]. This statistic is likely to be affected by the vulnerability of adolescents during the COVID-19 pandemic [12]. Due to the negative outcomes associated with poor mental health statuses among adolescents, such as suicide, behavior problems, and emotional distress and the need for quality research to build resilience and to reduce anxiety among adolescents, it is imperative to review the impact of COVID-19 on adolescent health in the United States and abroad in order to understand the global state of adolescent mental health and to provide strategies that prevent poor mental health outcomes, such as anxiety and depression, presently and in the future [13].

2. Anxiety

Of the studies that addressed the impact of COVID-19 related anxiety for non-special populations, several studies established an association between the COVID-19 pandemic and rates of anxiety among adolescents [14][15][16][17][18][19][16,17,18,24,28,30]. One study in China [18][28] identified that low support (Odds Ratio [OR] = 3.18, 95% Confidence Intervals [CI]: 2.54 to 3.98) and medium support (OR = 2.19, 95% CI: 1.94 to 2.48) increased the likelihood of anxiety. However, Chen et al. [20][19] did not identify a significant correlation between the COVID-19 and anxiety among adolescents.

3. Depression

Five studies (31%) addressed depression among non-special populations and identified an association between the pandemic and depression [15][18][19][21][22][17,25,27,28,30]. One study in China conducted by Duan et al. [15][17] identified an association between depression and COVID-19 related addiction in using social media, such as smartphone addiction (OR = 1.844, 95% CI: 1.29 to 2.811), and internet addiction (OR = 3.107, 95% CI: 1.252 to 7.708). Guo et al. [23] identified an association between COVID-19 related stress and depression (β = 0.33, t = 11.49, p < 0.001). However, the study conducted by Chen et al. in China [20][19] failed to establish a significant correlation between depression and COVID-19 related factors.

4. Other Psychological Disorders/Distress

Of the studies, several considered various other forms of psychological disorders and other forms of psychological distress, such as burdensomeness, belongingness, psychological distress, stress and trauma, and drug abuse. One study in the United States [14][16] revealed that specific motivation to practice social distancing led to burdensomeness and belongingness among adolescents. Another study in the Philippines [22][27] identified that 16.3% of respondents experienced psychological impairments as moderate or severe due to the pandemic. A Chinese study by Zhang et al. [19][30] found that negative coping skills are risk factors for stress and trauma among junior high and high school students. A Canadian study [24][31] recognized the increased frequency of drug usage, such as alcohol and cannabis among adolescents during the pandemic.

5. Special Populations

Special populations among adolescents were assessed in several studies. These special population included Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) adolescents, adolescents diagnosed with anorexia nervosa, pre-pandemic maltreated adolescents, seniors, females, and adolescents diagnosed with obsessive-compulsive disorder (OCD). Through 31 synchronous text-based chats, LGBTQ adolescents expressed difficulty maintaining mental health wellness due to being forced to stay at home with unsupportive family members, and due to the lack of socialization that helps with identity [25][22]. Adolescents diagnosed with anorexia nervosa reported 70% increases in poor eating habits and increases in thoughts associated with eating disorders [26][21]. Pre-pandemic maltreated adolescents experienced higher rates of post-traumatic stress disorder (PTSD) (effect size beta = 0.16~0.27) and higher rates of anxiety (effect size beta = 0.32~0.47) [23]. Of the two studies [17][27][24,26] that specifically evaluated seniors, both studies established associations between poor mental health outcomes, such as psychological issues and anxiety, and factors related to the COVID-19 pandemic. Both studies that discussed gender-related data [22][27][26,27] established higher rates of COVID-19 related anxiety among females. The study [28][29] that evaluated various groups of youth, including adolescents that were diagnosed with OCD, established a worsening of symptoms (44.6%) for patients, who completed primary treatment and for patients, who were currently in psychiatric treatment.

6. Impact on Mental Health

There was conclusive evidence to support the potential negative impact of the pandemic on adolescent mental health. The stressors and motivations to practice social distancing due to the COVID-19 pandemic seem to be difficult for adolescents to process, which results in poor mental health outcomes [14][16]. The inefficient ability to process difficult circumstances, such as the pandemic are due to negative coping skills, which are risk factors for depression, stress and trauma among various ages of adolescents [19][30]. The lack of positive coping skills among adolescents is not unusual because adolescent must be provided with the tools to cope in order to be resilient and mentally well during periods of adjustments. However, the exposure to and practice of positive coping skills can lead to mentally well adolescents, who can easily adjust to rapid changes. Social support was another major factor identified in determining the mental sustainability of adolescents during periods of crisis, such as the pandemic. Adolescents had perceived high rates of low to moderate social support during the pandemic, which contributed to increases in anxiety and depression [18][28]. Despite the concept of social support being expressed from the point of view of adolescents, which may or may not be bias, adolescents are still experiencing authentic forms of psychological challenges, such as anxiety and depression associated with the lack of social support and the pandemic. Due to these challenges, it is imperative that support be greatly implemented in homes. Studies have shown that the implementation of social support leads to positive mental health outcomes [18][28]. Addiction is another concern for adolescent mental health during the pandemic. Due to stay-at home orders, school closures, or new at home learning methods, students are seeking ways to connect and to socialize in manners that may not be productive for optimal health. The result of these behaviors are smartphone addiction and internet addiction. Both forms of addiction lead to poor mental health outcomes for adolescents. Despite being forced to remain at home, adolescents were identified as still engaging in drug use during the pandemic. Rather adolescents were increasing their use of alcohol and cannabis during the pandemic with 49.3% engaging in drug use alone [19][30]. An earlier study [29][32] showed the link between the lack of positive coping skills and the possible neurobiological pathways that may associate stress with the craving for drug use.

7. Impact on Mental Health of Special Populations

As the non-special populations of adolescents experience mental health challenges, the special populations are experiencing a worsening of conditions, or experiences during the pandemic, which are a result of physical and psychologically COVID-19 related factors. These adolescents are forced to deal with unsupportive families due to sexual orientation, with the lack of social and medical support in connection to various pre-pandemic disorders, with an added stress concerning their futures, and with dealing with new and old stress from previous traumas [23][25][26][27][28][30][21,22,23,26,29,33]. These groups of adolescents have always experienced more challenges, but the pandemic has significantly affected the quality of life of these adolescents.
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