Photo by Dustin Belt on Unsplash
Globally, we are living during a period of our history which, undoubtedly, given what we thought was advanced medical and technological knowledge and practice, we could not imagine we would face in our lifetime. Indeed, we are living and experiencing what one can consider being a global trauma resulting from the COVID-19 pandemic. While a major focus for response has been to “slow the spread” of the disease itself and take measures to protect public physical health, this unexpected and unprecedented experience has a profound effect on students and their mental health and development. As we live through this pandemic, many may be experiencing significant stress, fear, anxiety, depression, frustration, feelings of overwhelm, anger, or mixed emotions, including relief, and strong emotional responses (e.g., crying spells, panic attacks, anger outbursts, etc.). The Center of Disease Control and Prevention (CDC) has identified that the stress related to an infectious disease outbreak can cause fears and worry about your own health/possibility of infection and that of those you love; financial stress; changes in sleeping or eating habits; difficulties sleeping or concentrating; worsening chronic physical or mental health problems; increased use of tobacco, alcohol or other substances; or loss of supports you normally rely upon, such as the loss of mental health supports often provided by schools during the COVID- 19 Quarantine (CDC, 2020).
While necessary measures to “flatten the curve” of rates of infection were implemented, the quarantine and social distancing had a significant impact on all of our mental health and functioning. Adolescents are especially vulnerable, given that this stage in life is when social and personal identity development is paramount. Social distancing and the quarantine-related school closures halted opportunities for high-school-aged students to solidify their interpersonal relationships, build and maintain their sense of connection and belonging, and disrupted their sense of who they fundamentally are, and the roles they adopt, within the context of these social groups. Given that socialization is a key milestone of adolescent development and that social interactions have been significantly disrupted as a result of the pandemic, along with the stress associated with the trauma that we all are experiencing, adolescents may be especially vulnerable to increased mental health problems, may experience worsening problems related to existing mental health concerns, and are placed at greater risk for future mental health concerns. Data based on diagnostic interviews from the National Comorbidity Survey Adolescent Supplement (NCS-A), indicated a lifetime prevalence of any mental disorder among U.S. adolescents aged 13-18 estimated that 49.5% of adolescents had a mental disorder and of those, an estimated 22.2% had a severe impairment (Merikangas, et. al., 2010). Simon and colleagues indicated data from a June 2020 survey from the Centers for Disease Control and Prevention of 5412 adults indicated that 40.9% reported “at least one adverse mental or behavioral health condition” including depression, anxiety, post traumatic stress, and substance abuse. Rates in June 2020 were increased 3-4 times from 2019 (Simon, et.al., 2020). It is likely that the adolescent prevalence of mental disorders has increased since the pandemic although data remains to be collected to determine prevalence in adolescents for 2020.
Although students are back to school, either in-person, virtually, or through a combination of both and access to school-based mental health services have increased since the quarantine, the emotional, mental, and social fall-out of the pandemic is on-going. Any of the feelings one may be experiencing, such as anger, sadness, anxiety, fear, overwhelm, confusion or uncertainty, are valid and unfortunately, not unexpected, given these abnormal and traumatic, circumstances. Sleep problems, worries about the future, sedentary habits as a result of the quarantine, increased substance use and abuse, depression, anxiety disorders, and increased use of social media in the attempt to remain connected have all increased in incidence within the adolescent population. Increased social media use during quarantine potentially left adolescents particularly vulnerable in that it has been linked to increased anxiety, feelings of powerlessness, and “catastrophizing” situations when misinformation and COVID-19 themed jokes or memes potentially contributing to the pandemic not being taken seriously, could, in turn, lead to increased infection, distress, and trauma (Thakur, A., 2020). Feelings of isolation, boredom, low mood, and potential depression have been linked to the pandemic (Venkatesh, A. 2020).
Additionally, the disruption of normal routines, which is important for a sense of normalcy, predictability, positive social engagement, and security, have all been related to the pandemic-related stress and trauma. Ultimately, the experiences of trauma can adversely impact one’s ability to learn and fully engage in the academic process. Difficulties with organization, maintaining focus and attention, initiating, and completing work, and the brain’s overall ability to absorb, integrate, and apply new knowledge and information is known to be significantly impaired when one is experiencing or has experienced, a significant trauma. Grief and loss may also be significant experiences at this time. Of concern is that normal grief and distress responses can be transformed into prolonged grief, major depressive disorder, and symptoms of Post-Traumatic Stress Disorder (Simon, et.al, 2020). As a mental health provider, I have noticed that for high school students, the grief and loss over what many had hoped would be exciting, fun, and celebratory high school years have been subdued and restricted by the necessary mandates of social distancing. Music programs, athletics, and related sporting events, drama programs, and other activities where socialization and social connection are so integrated have been dramatically changed in their structure and format, greatly restricting participation, and in turn, impacted engagement and a sense of belonging. Other mental health-related benefits of participation in such activities, such as increased self-esteem, self-worth, self-confidence, and sense of identity for those who relate strongly to their roles in these activities (e.g., as a musician, athlete, actor, etc.) were adversely impacted as a result of quarantine restrictions and subsequent loss and/or restrictions of these activities.
While all students have experienced the fall-out, I cannot fail to address the grief and loss that Seniors, in particular, experience in that long-anticipated tradition of celebration related to the achievement of graduation and the associated marks of this developmental milestone, such as Prom, the final year of clubs, organizations and activities, Honors Banquets, graduation parties, and so on, have been either eliminated or at best, greatly modified and/or restricted. While necessary for the preservation of the overall greater good of public health, and reduction of the spread of the virus, these changes are undoubtedly related to feelings of sadness, anger, disbelief, and “bargaining” (i.e., the “if only” thoughts), associated with the grief and loss response, and may even lead to prolonged grief, depression, anxiety, or trauma-related disorders.
Ultimately, the impact of the COVID-19 pandemic on adolescent mental health cannot be ignored. Awareness and acknowledgment are the first steps to obtaining support if needed. If you are experiencing any of the above mental health concerns, please reach out to an adult you trust for support. Positive and supportive connections to others, and ultimately, a sense of belonging, are among the most important protective factors for resilience and positive mental health.
If you or a loved one experience significant and prolonged mental-health related symptoms including increased feelings of sadness, suicidal thoughts or self-harm behaviors, substance use, hopelessness, isolation, withdrawal from friends and family, anxiety, panic, anger, changes in appetite or sleeping patterns, please do not hesitate to seek help from a qualified mental health professional. We are here to help and please know that your mental health is part of your physical health. While many separate mental health factors from physical health, I see them as one in the same: both interact with each other and both contribute to an overall sense of well-being. As a fully trained and licensed masters-level school social worker, I am happy to provide support and additional resources if needed. It is so important to remember that you are not alone, that there is help available, and you deserve to feel safe, secure, connected, and to experience an overall sense of well-being.