Risk and Protective Factors for Prospective Changes in Adolescent Mental Health during the COVID-19 Pandemic

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Abstract

The restrictions put in place to contain the COVID-19 virus have led to widespread social isolation, impacting mental health worldwide. These restrictions may be particularly difficult for adolescents, who rely heavily on their peer connections for emotional support. However, there has been no longitudinal research examining the psychological impact of the COVID-19 pandemic among adolescents. This study addresses this gap by investigating the impact of the COVID-19 pandemic on adolescents’ mental health, and moderators of change, as well as assessing the factors perceived as causing the most distress. Two hundred and forty eight adolescents (M age = 14.4; 51% girls; 81.8% Caucasian) were surveyed over two time points; in the 12 months leading up to the COVID-19 outbreak (T1), and again two months following the implementation of government restrictions and online learning (T2). Online surveys assessed depressive symptoms, anxiety, and life satisfaction at T1 and T2, and participants’ schooling, peer and family relationships, social connection, media exposure, COVID-19 related stress, and adherence to government stay-at-home directives at T2 only. In line with predictions, adolescents experienced significant increases in depressive symptoms and anxiety, and a significant decrease in life satisfaction from T1 to T2, which was particularly pronounced among girls. Moderation analyses revealed that COVID-19 related worries, online learning difficulties, and increased conflict with parents predicted increases in mental health problems from T1 to T2, whereas adherence to stay-at-home orders and feeling socially connected during the COVID-19 lockdown protected against poor mental health. This study provides initial longitudinal evidence for the decline of adolescent’s mental health during the COVID-19 pandemic. The results suggest that adolescents are more concerned about the government restrictions designed to contain the spread of the virus, than the virus itself, and that those concerns are associated with increased anxiety and depressive symptoms, and decreased life satisfaction.

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Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China

Cuiyan Wang, Riyu Pan, Xiaoyang Wan … (2020)

Background: The 2019 coronavirus disease (COVID-19) epidemic is a public health emergency of international concern and poses a challenge to psychological resilience. Research data are needed to develop evidence-driven strategies to reduce adverse psychological impacts and psychiatric symptoms during the epidemic. The aim of this study was to survey the general public in China to better understand their levels of psychological impact, anxiety, depression, and stress during the initial stage of the COVID-19 outbreak. The data will be used for future reference. Methods: From 31 January to 2 February 2020, we conducted an online survey using snowball sampling techniques. The online survey collected information on demographic data, physical symptoms in the past 14 days, contact history with COVID-19, knowledge and concerns about COVID-19, precautionary measures against COVID-19, and additional information required with respect to COVID-19. Psychological impact was assessed by the Impact of Event Scale-Revised (IES-R), and mental health status was assessed by the Depression, Anxiety and Stress Scale (DASS-21). Results: This study included 1210 respondents from 194 cities in China. In total, 53.8% of respondents rated the psychological impact of the outbreak as moderate or severe; 16.5% reported moderate to severe depressive symptoms; 28.8% reported moderate to severe anxiety symptoms; and 8.1% reported moderate to severe stress levels. Most respondents spent 20–24 h per day at home (84.7%); were worried about their family members contracting COVID-19 (75.2%); and were satisfied with the amount of health information available (75.1%). Female gender, student status, specific physical symptoms (e.g., myalgia, dizziness, coryza), and poor self-rated health status were significantly associated with a greater psychological impact of the outbreak and higher levels of stress, anxiety, and depression (p < 0.05). Specific up-to-date and accurate health information (e.g., treatment, local outbreak situation) and particular precautionary measures (e.g., hand hygiene, wearing a mask) were associated with a lower psychological impact of the outbreak and lower levels of stress, anxiety, and depression (p < 0.05). Conclusions: During the initial phase of the COVID-19 outbreak in China, more than half of the respondents rated the psychological impact as moderate-to-severe, and about one-third reported moderate-to-severe anxiety. Our findings identify factors associated with a lower level of psychological impact and better mental health status that can be used to formulate psychological interventions to improve the mental health of vulnerable groups during the COVID-19 epidemic.

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Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19

Maria Loades, Eleanor Chatburn, Nina Higson-Sweeney … (2020)

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.

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A review of sex differences in peer relationship processes: potential trade-offs for the emotional and behavioral development of girls and boys.

Amanda J Rose, Karen Rudolph (2006)

Theory and research on sex differences in adjustment focus largely on parental, societal, and biological influences. However, it also is important to consider how peers contribute to girls' and boys' development. This article provides a critical review of sex differences in several peer relationship processes, including behavioral and social-cognitive styles, stress and coping, and relationship provisions. The authors present a speculative peer-socialization model based on this review in which the implications of these sex differences for girls' and boys' emotional and behavioral development are considered. Central to this model is the idea that sex-linked relationship processes have costs and benefits for girls' and boys' adjustment. Finally, the authors present recent research testing certain model components and propose approaches for testing understudied aspects of the model.