Adolescent Behavioral Health: The Current State of Teen Mental Health after Two Years of Pandemic Mitigation Measures

The Impact of Virtual School, Social Distancing, and Decreased Peer Interaction on Youth and Teens

When the pandemic arrived in the U.S. in late February, 2020, no one knew what to expect. The first places to enact real public health mitigation measures were the Bay Area in California and the Seattle are in Washington State.

That was the first time most of us heard the terms shelter-in-place, social distancing, essential travel, essential workers, and virtual school in the context of public health.

Then, when the White House announced their 15 Days to Slow The Spread guidance on March 15^th of 2020, these terms became part of our daily life. With some exceptions, the entire nation went into what we now think of as the original COVID lockdown. Since that term is both inaccurate and loaded with baggage – no one was locked down, and lockdown is what happens in prison, not what happens when we stay home to protect the health of ourselves and others – we’ll use the phrase pandemic mitigation measures to describe the various rules, guidance, and advisories enacted at the local, state, and federal level since the beginning of the pandemic.

Soon after we entered the first phase of pandemic mitigation measures, adolescent mental health experts warned us of the dangers these measures posed to youth and adolescent mental health, development, education, and overall wellbeing. They warned the lack of social contact, the disruptions to daily routine, the absence of extracurricular activities, and missing important school and social milestones would have a negative impact on almost all components of youth and teen life.

Now it’s February 2022.

We’ve lived with mitigation measures for almost two years. We have the evidence from dozens of studies on the state of your and adolescent mental health during 2020 and 2021. It’s time to answer the question:

Did the pandemic have an adverse effect on youth and teen mental health?

News From the Top: The Surgeon General’s Report

While studies on the impact of mitigation measure on teen mental health began to appear in late 2020 and early 2021, confirmation that the pandemic out our youth and teens at risk came in the form of a Surgeon General’s Advisory (SGA) published in December, 2021.

In short, the SGA confirmed what all the experts warned. The pandemic – and the related mitigation measures – did have a significant negative impact on the mental health of our youth and teens. We’ll start this review of the current state of teen mental health with the big-picture, worldwide statistics published in the SGA.

Worldwide Youth Mental Health: 2021 Compared to 2019

• General Mental Health:
  • Symptoms of anxiety and depression increased by 100%
    • 20% of children and teens reported depressive symptoms
    • 25% of children and teens reported anxiety symptoms
  • Symptoms related to behavioral disorders such as ADHD increased moderately
• Psychiatric Emergencies (United States):
  • Emergency rooms visits for mental health issues for adolescents 12–17 increased 31%
  • Emergency rooms visits for suspected suicide attempts increased:
    • 51% for adolescent girls
    • 4% for adolescent boys

We’ll get into more detail below, but those statistics give us a good picture of the broad strokes: depression, anxiety, and general mental health symptoms are up for youth worldwide. And in the U.S., those increases are accompanied by increases in rates of suicidal ideation and suicide attempts.

Those statistics set the stage.

Next, for the benefit of parents reading this article, we’ll share two additional components of the SGA. First, we’ll share the general pandemic-related mental health risk factors identified in the report, and second, we’ll share the specific groups of youth at risk of experiencing negative pandemic-related mental health issues.

Pandemic Related Mental Health Risk Factors: General

1. Presence of a mental health disorder before the pandemic
2. Living in an urban area
3. Living in an area with severe COVID-19 outbreaks (rural or urban)
4. Parents or loved ones who are frontline/essential workers
5. Significant disruptions in daily life
6. Presence of adverse childhood experiences (ACEs), which include:

• • • Abuse
    • Neglect
    • Witnessing or directly experiencing community violence
    • Discrimination
    • Financial instability, food insecurity, and/or housing instability
    • Trauma, such as losing a family member, friend, or caregiver to COVID-19

Those are the general factors that put youth or teens at risk of developing mental health problems related to the pandemic.

PARENTS OF YOUTH AND/OR TEENS WHO MEET ANY OF THESE CRITERIA SHOULD WATCH THEIR CHILDREN CLOSELY FOR ANY SIGNS AND SYMPTOMS OF MENTAL HEALTH ISSUES

Now we’ll look at the specific groups of youth at risk due to pandemic-related mitigation measures.

Pandemic Related Mental Health Risk: Specific Groups

1. Children/teens with developmental disabilities.

• • • This includes diagnoses such as attention-deficit hyperactivity disorder

2. Children/teens from racial and ethnic minority groups.

• • • This includes Black, Hispanic, Asian, or other minority groups

3. Children and teens with more than one risk factor.

• • • For example, depression and a family member in a frontline job

4. Children with developmental disabilities who lost a parent or caregiver to COVID-19
5. Youth vulnerable to discrimination in the healthcare system, including:

• • • People of color
    • LGBTQI+ youth/youth with LGBTQI+ parents
    • Youth in immigrant households

PARENTS OF YOUTH AND/OR TEENS WHO MEET ANY OF THESE CRITERIA SHOULD WATCH THEIR CHILDREN CLOSELY FOR ANY SIGNS AND SYMPTOMS OF MENTAL HEALTH ISSUES

Those are the general risk factors, and specific groups pandemic mitigation measures put at risk of developing mental health complications. Next, we’ll share specific statistics on the increase in prevalence of stress, mental health disorders, and other pandemic-related complications in youth and teens.

Anxiety and Depression Among Teens After Two Years of COVID

To set the stage, we’ll start with a general report on teen stress during the pandemic. A study published by NBC News that contained data from 75,000 students attending 86 high schools in the U.S. Here’s what the report revealed:

• 56% of high school students said their stress levels increased in 2020, compared to 2019

High school students identified their primary sources of stress:

• Grades: 68%
• Workload/Homework: 60.7%
• Time Management: 49%
• College/Future: 44.5%
• Lack of play/social/relax time: 40.4%
• Parental Expectations: 33.2%
• Mental Health Issues: 31.5%
• Friends and Cliques: 19.1%
• Extracurricular activities: 11.5%

That makes it clear: our teens are stressed out.

But did that stress lead to an increase in the symptoms of mental health disorders?

Two large-scale studies – links in the bullets below – indicate yes, that stress did indeed lead to an increase in mental health problems for youth and teens.

Here’s the data.

Anxiety

• 82.88% (68,584) of teens who took a Mental Health America (MHA) anxiety screen reported moderate severe anxiety symptoms.
• 57.4% of studies examined in a meta-analysis showed teens experienced increased anxiety symptoms
  • 59.6% reported increased rumination
  • 13.4% reported severe anxiety
  • 3.2% met criteria for post-traumatic stress disorder (PTSD)

Depression

• 90.20% (68,584) of teens who took a Mental Health America (MHA) depression screen reported moderate to severe anxiety symptoms.

Major Depressive Episodes (MDE)

• Aa 15.08% of youth 12-17 reported at least one major depressive episode (MDE) in the past year.
• MDE among youth increased by 306,000 from last year’s dataset.
  • That’s an increase from 10% to 27%
• MDE prevalence is lowest in the District of Columbia (11.36%) and highest in Oregon (18.62%)

Severe Depressive Episodes (Severe MDE)

• 10.6% of youth (or over 2.5 million youth) report severe major depression
• Severe MDE among youth increased by 197,000 from last year’s dataset
• Severe MDE is lowest in the District of Columbia (7.3%) and highest in Wyoming (14.8%)

In addition, researchers identified small increases in the prevalence of:

• Non-suicidal self-injury (NSSI), a.k.a. self-harming behavior
• Suicidal ideation
• Suicide attempts

NOTE: IF YOUR TEEN OR CHILD TALKS ABOUT SUICIDE, OR YOU THINK THEY’RE AT RISK OF HARMING THEMSELVES OR OTHERS, CALL 911 IMMEDIATELY. DO NOT WAIT.

Click here to view our resources on suicide and suicidal ideation among teens.

Those are the latest numbers we have, and they paint a picture that supports the Surgeon General’s Advisory: our teens are at risk on multiple levels right now, and they need our help. In order to help them, though, we need to know what to look for. In the next section of this article, we’ll review the signs and symptoms of anxiety and depression, so parents can watch for any problems and act quickly when they see problems.

Anxiety and Depression Among Teens: Signs and Symptoms

We’ll start with the symptoms of anxiety, since that’s the mental health disorder that appeared or increased most often in youth and teens during the pandemic. To read our detailed guide on anxiety among teens, click here.

Here’s a quick definition of an anxiety disorder:

“Persistent, excessive fear or worry in situations that are not threatening.”

Experts in adolescent mental health categorize the symptoms of anxiety as both physical and emotional. To meet a clinical threshold, symptoms must be present more often than not for four months or more.

Emotional Symptoms of Anxiety

• Significant fear of typical daily situations
• Extreme irritability
• Daily restlessness
• Anticipating negative outcomes for future events
• Agitation
• Daily nervousness

Physical Symptoms of Anxiety

• Increased heart rate
• Rapid breathing (hyperventilation)
• Sleeping too little or sleeping too much
• Persistent fatigue
• Headaches
• Shaking, tremors, physicals tics
• Unusual/excess sweating
• Upset stomach
• Frequent/excessive trips to the restroom at home, at school, or in public situations

PARENTS WITH YOUTH AND/OR TEENS WHO SHOW ANY OF THESE SIGNS AND SYMPTOMS SHOULD WATCH THEIR CHILDREN CLOSELY FOR ANY SIGNS AND SYMPTOMS OF MENTAL HEALTH ISSUES

However.

It’s important to remember that any teen might display some of these symptoms sometimes. But when a symptom like fear of social situations persists for days or weeks, or a symptom like a recurring headache appears – with no physical cause – for weeks on end, these are red flags and may indicate the presence of an anxiety disorder.

Now we’ll present the signs and symptoms of depression among teens. First, though, a quick definition:

“[Depression is] …an overwhelming feeling of sadness, isolation, and despair that last two weeks or longer at a time.”

Parents who suspect their teen has depression should focus on this part of the definition:

Depressive symptoms present every day for two weeks or more are a warning sign of major depressive disorder.

Teen Depression: Signs and Symptoms

• Constant sad or low mood
• Daily crying
• Constant feelings of hopelessness or pessimism
• Unusual levels of irritability
• Unusual levels anger or hostility
• Persistent sense of hopelessness or worthlessness
• Withdrawing from friends, family, and favorite activities
• Withdrawing from extracurricular activities
• Daily fatigue/tiredness
• Difficulty communicating with family, friends, or teachers
• Restlessness/agitation
• Problems with concentration, decision-making, memory
• Problems finishing or following through on tasks or responsibilities at school/home
• Difficulty following through on tasks at home or at school
• Changes in eating or sleeping habits
• Extreme weight gain or loss
• Minor physical ailments that do not improve
• Thinking about, talking about, or attempting suicide (See above: if you think your teen is in danger of harming themselves or someone else, call 911 immediately.)

PARENTS WITH YOUTH AND/OR TEENS WHO SHOW ANY OF THESE SIGNS AND SYMPTOMS SHOULD WATCH THEIR CHILDREN CLOSELY FOR ANY SIGNS AND SYMPTOMS OF MENTAL HEALTH ISSUES

However. That advice comes with a caveat similar to the one we attached to the symptoms of anxiety:

Depressive symptoms must present every day for two weeks to meet clinical criteria warning for a depressive disorder. This means that a child or teen who has a disappointment on Monday but bounces back by Friday is probably not clinically depressed. But a disappointment on a Monday followed by more than two weeks of low or depressed mood is a red flag for a depressive disorder.

What Parents Can Do

The first thing most parents need to realize is that their children are not immune from developing a mental health disorder: millions of children and teens around the world develop disorders such as anxiety and depression each year.

The next thing parents need to realize is that evidence-based treatment for mental health disorders works. Again, millions of children and teens around the world receive treatment for anxiety and depression – and they learn to manage the symptoms of their disorder and live complete and fulfilling lives.

With that said, any parent of a child or teen who observes the signs and symptoms of anxiety and depression we list about should arrange for a full psychiatric evaluation administered by an experienced, qualified, licensed mental health professional. These evaluations, knowns a biopsychosocial assessments, allow a trained expert to identify or rule out the presence of a clinical mental health disorder.

If a mental health disorder is present, they’ll likely recommend professional treatment at one of the following levels of care:

• Outpatient
• Intensive Outpatient (IOP)
• Partial Hospitalization (PHP)
• Residential Treatment (RTC)

The level of care the assessing therapist recommends – if the diagnose a mental health disorder – depends on the severity of the symptoms. At all levels of care, teens receive the support they need to develop the skills necessary to manage the symptoms of their disorder and participate in daily life at home, with friends, and at school.

Parents of teens who show the symptoms we list above should understand that the sooner a teen who needs treatment gets appropriate treatment, the greater their chances are of treatment success.

Finding Help: Resources

If you’re seeking treatment for your teen, please navigate to our page How to Find the Best Treatment Programs for Teens and download our helpful handbook, A Parent’s Guide to Mental Health Treatment for Teens.

In addition, the American Academy of Child and Adolescent Psychiatry (AACAP) is an excellent resource for locating licensed and qualified psychiatrists, therapists, and counselors in your area. Both the National Institute of Mental Health (NIMH) and the National Alliance on Mental Illness also provide and high-quality online resources, ready and waiting for you right now.