First Aid for Quaranteenagers’ Mental Health
General

First Aid for Quaranteenagers’ Mental Health

Adolescence is a confusing, hormone-driven, bumpy ride even in non-pandemic times. Quaranteenagers are those adolescents ages 12-19 who are living through the COVID-19 pandemic. Their mental health distress skyrocketed over the past year as they had to navigate fear, anxiety, depression, remote learning, social isolation, race-related protests, and widespread grief.

First aid for their mental health going forward involves helping them heal psychologically and emotionally. Researchers admit that “while the knowledge base regarding children’s responses to trauma and adverse events, in general, has been expanding, descriptions of their responses during epidemics remain scarce.”  We don’t need numbers and statistics to tell us what we already know: This year teens and their parents have faced unparalleled levels of mental health distress.

Newfound threats to adolescent mental health

COVID demolished the security that we all took for granted.

The COVID-19 pandemic posed multiple unique threats to teens.  First and foremost, it completely destroyed any semblance of ‘normality.’  It brought constant stress that is only now starting to ease after a year and a half.  Most never had any reason to doubt that the world they had when they were young would remain relatively the same as they aged.  COVID demolished the security that we all took for granted.

Teens bore the brunt of this.  They went from social school days, care-free weekends, and gatherings with friends to total lockdown.  They had to continue learning (at least trying to) at home alone – all the pressure of school without the benefit of student camaraderie.  Every aspect of their lives that didn’t already revolve around screens immediately demanded technology.  COVID served a heaping helping of strife while deleting from their lives any semblance of structure and support.

Psychological burdens

Teens thrive when they have a sense of security, routine, and control. Quaranteenagers have not had any of these since March 2020. Nearly half of all U.S. teens experienced new or worsening mental health conditions since the start of the pandemic. During the pandemic, anxiety and depression have skyrocketed in children and adolescents.

  • 6%-43% report depression
  • 9%-37% report anxiety
  • 31% report both anxiety and depression
  • >50% report moderate to severe impact of the pandemic on their mental health

Anxiety and depression have led teens to avoid school and withdraw from their hobbies. Those who didn’t detest school poured themselves into it with a hyper-focus on perfection.  Many found themselves irritable, emotional, and needing extra reassurance from parents. “Meltdowns” and panic attacks became increasingly common, and the fear of teenage suicide looms large for many parents as they try to keep teens safe.

It is heartbreaking to watch your kid go through this. I feel like we have tried everything- medicine, therapy, essential oils, working next to her, weighted blankets, timed work periods, and more. March and April were the worst- including a night where her friends reached out to me saying they were worried about her safety. She was over a month behind in her assignments, having panic attacks late at night, and feeling depressed. – Mother of  16 year-old “C”

Physical symptoms

Pandemic-related anxiety and depression manifested as other types of problems such as sleep disruption, withdrawal from family, aggressive behavior, substance use, self-harm, and disordered eating.

Isolation caused by social-distancing precautions potentially hastened the onset of some teen psychiatric disorders. For many teens, emotional distress presented as stress-related physical symptoms.  Upset stomach and lack of appetite struck many, along with diarrhea and constipation. Headaches and nightmares were also common.

Unequal distribution of mental health risk

Each teen experienced and will process living through the COVID-19 pandemic differently, but some are at greater risk of long-term mental health harm. A 2019 JAMA Pediatrics study found that more than 16% of youth in the United States were already living with a mental health disorder before the pandemic began. Prior to the pandemic, one in five teens had a parent experiencing a mental illness such as anxiety or depression. These teens are at greater risk of developing a mental illness themselves. This study also found that COVID-19 threatened other teens already at greater risk for mental health challenges, including:

  • Youth with pre-existing mental health conditions
  • Teen members of families and communities of color
  • LGBTQ+ youth
  • Adolescents with learning disabilities
  • Teens living in families impacted by violence, substance use, or parental mental illness
  • Adolescents living in communities with lower social and economic resources, particularly those with limited access to reliable internet for remote school

Disrupted development

Our brains go through important maturation during adolescence and do not stop developing until around age 24. Research has shown that toxic stress from adverse childhood experiences can change brain development and change how the body responds to stress long-term. Traumatic experiences early in life can negatively impact mental and physical health well into adulthood.

While living through the COVID-19 pandemic as an adolescent has not yet been classified as psychological trauma, teens may need to recover from a kind of post-pandemic distress. Overnight they lost the structure, routine, and social supports of ‘normal’ life as they knew it. Unemployment, housing, and food insecurity skyrocketed during the past year and a half, adding to both family and adolescent stress.

Pandemic associated-grief

Part of the human response to trauma is grief. No grief is simple, but pandemic-related adolescent grief is particularly complex. Many teens have had to cope with family members getting sick or dying from COVID. This may have been their first experience with death. Even as adults, we are struggling to deal with the devastating numbers of lives lost in this past year. Without the ability to visit loved ones in the hospital during their last days, hold funeral services or other cultural ways of saying goodbye, grief has been even harder on us.

Pandemic teens are also grieving the loss of milestones on their road to adulthood. Adolescence can be an important time for religious, social, and cultural rights of passage such as birthday parties, quinceañeras, getting a driver’s license, going to prom, taking the SATs, and attending graduations.

Teens feel a true sense of loss for missing out on important affirmations that remind them they’re growing up. -Berkeley Center For the Greater Good

Remote learning vs. mental health

With remote learning, teenagers became bored and lonely at home, exhausted by long hours in front of a screen, or panicked about possibly missing out on important learning. A joint NBC and Stanford Graduate School of Education poll reported levels of student engagement with learning reached record lows during the pandemic. Lack of access to reliable internet among economically disadvantaged youth further deepened educational disparities.

Teen mental health and pandemic academic challenges became intertwined in a downward spiral for many teenagers such as a 16-year-old interviewed for this story who requested to remain anonymous:

I developed depression, it was really hard to motivate myself to get work done and I was often working late into the night on homework- like 2 or 3 in the morning.  I would often be a month behind in work in at least 1-2 classes. This made me really stressed, it made me so stressed that I couldn’t do any work and it would lead to me having panic attacks sometimes.

Many teens worked extra jobs to help support their families and remote school made multitasking more feasible. Working high school students are at greater risk for stress, disengagement, and dropping out. Figures are not yet available for the U.S.’s overall dropout rates during the pandemic (2019 was the last year that data was collected), but the National Dropout Prevention Center predicts a doubling or tripling of students falling behind academically and leaving school.

School was the one place many at-risk youths had a chance of being noticed and offered help, both academic and emotional support. Disruptions in the school routine and services have been particularly harmful to adolescents with ADHD and Autism Spectrum Disorders. They have been less able to adjust to lockdown changes, alterations of routines, habits, and rituals, which can lead to increased acting out behaviors and behavioral problems.

Overwhelming social isolation

Adolescence can be a lonely existence, especially among students who are perceived as “different” because of their physical appearance, disability, race, ethnicity, sexual orientation, gender identity, religious beliefs, or other characteristics.  Social isolation during adolescence can influence the development of brain pathways and circuitry necessary for a lifetime of healthy social connections.

Public health research shows that socially isolated youth are at a greater risk for depression, anxiety, self-harm, suicidal thoughts, and substance misuse.

Young people rely more heavily on social relationships and connections for emotional support than adults or younger children may. If they are unable to spend enough time with peers, they feel lonely, isolated, and depressed.  Peer-to-peer interactions are the way teenagers meet their major adolescent social-emotional developmental milestones, such as separating from their family unit and discovering a sense of identity.

During the pandemic, parents reported that their teenagers texted (64%), used social media (56%), played online games (43%), and talked on the phone (35%), every day or almost every day. Very few teens got together in person with friends daily or almost every day, indoors (9%) or outdoors (6%).

Excess screen time

We don’t know how well digital screen socialization replaces in-person contact in terms of meeting adolescent social-emotional developmental milestones. There is some evidence of a loneliness paradox in which tech and social media that should make us more socially connected actually increase our loneliness. According to one survey, half of the people attending virtual social gatherings did not feel any less lonely, and 10% of attendees actually felt more lonely after the virtual social gathering.

The pandemic isolated adolescents from their usual sources of support, connection, and healthcare.

Pandemic precautions also disrupted access to mental health services. Prior to the pandemic, one out of every three teens receiving mental health services obtained them through their schools. Teen mental health suffered from a severe lack of access to usual outlets for reducing stress such as sports, community service, and other extracurricular activities.

The pandemic rapidly overwhelmed our nation’s already limited supply of mental health care providers for teens and adolescents. ERs around the country reported an increase in visits from young people with mental health concerns because they (or their parents) had nowhere else to turn. Even before the pandemic, half of the estimated 7.7 million US children with a treatable mental health disorder did not receive needed treatment from a mental health professional.

Quaranteenagers in survival mode

Teenagers and their families have been living for more than a year in “survival mode.” We don’t know what the future holds in terms of COVID-19. What we do know is that today’s quaranteenagers are different because they survived adolescence in a pandemic. Adults can help teens find their way back to safety and emotional wellbeing from their pandemic experiences. Three main ways to help teens recover and grow from the pandemic are to teach mental health literacy, cultivate concrete coping skills, and help them restore social connections and structure.

1. A learning opportunity for mental health literacy

Processing difficult emotions or experiences requires you to be able to name them and talk about them. Prior to the pandemic, teens did not receive enough information or education about how to understand or talk about mental illness.

One silver lining of the COVID-19 mental health havoc is that many teens are now better equipped to talk about their own mental health and recognize what they need to stay well. The pandemic normalized mental health struggles and destigmatized seeking help for both parents and their teens.

Another bright spot in the gloom of COVID-19 mental health distress is the massive expansion in resources, online mental health support communities, and telecounseling.

The vast majority of mental illnesses start emerging in the teen years and there’s a lot of confusion that can come with trying to figure out what’s normal vs what might be a warning sign that something isn’t right. And that can be super overwhelming! – Liz Babkin, medical student and teen mental health advocate

Teaching teens more about mental health gives them the language and the tools necessary for asking for help. It also helps them better support struggling friends or family members. NAMI’s “Ending The Silence” video is another educational tool that has been shown to effectively change students’ knowledge and attitudes towards mental health conditions and seeking help. Encouraging quaranteenagers to talk through their anger, fear, sadness, frustration, and loneliness can help them heal.

It is about giving them space to have these conversations on their own time-frame… If teens are wanting to process, validating their experience is important (“that sounds hard. I’m sorry you had to go through that”) while also being mindful not to minimize how they are feeling (“you had it good… imagine how it felt to be X?”) or trying not to problem-solve if they are only looking for an active listener. – Jill Frame, LCSW

Validating your teen’s feelings helps them to develop healthy self-esteem, feel more confident, and learn the practice of empathy. These building blocks of emotional intelligence can pave the way for a healthy transition to adulthood.

2. Cultivate concrete coping skills 

Beyond growing mental health literacy, the pandemic forced teenagers to expand the range of tools in their coping toolbox. As an adult, you can help teens see themselves as survivors. Have them identify how they adjusted to living in a time of uncertainty, stress, and isolation. The skills and tools they used during the pandemic can continue to serve them going forward.

As adolescents begin to add back in activities and social commitments to their lives, help them build a supportive structure with healthy habits and self-care.

  • Managing screen time
  • Getting enough exercise
  • Healthy eating
  • Getting enough sleep
  • Spending time with others
  • Making time to relax

Structure remains a key part of adolescents’ sense of security. Many teens lost their comforting structured existence during the pandemic. Helping them rebuild a scaffolding of activities while prioritizing sleep, exercise, and social connection will provide routine and structure for healing.

3. Restoring social connections

Quaranteenagers’ abrupt disconnection from their primary social outlets and peers will impact their return to in-person and group social settings. Socializing in person for many teenagers will entail an expanding social life that can feel terrifying. This is particularly painful for teens living with Social Anxiety Disorder or Generalized Anxiety Disorder.

I have been talking to a lot of teens (and adults!) about the strategy of ‘dipping their toes’ back in rather than feeling obligated to ‘full-on jump or cannonball.’ It’s OK to say ‘no’ if they are feeling overwhelmed or anxious and aren’t yet ready to be around a lot of people – it’s also important to begin deliberately working towards being more social so as to minimize the risk of increasing anxiety by prolonging social isolation.- Jill Frame, LCSW

Quaranteenagers can become resilient survivors

Living through COVID-19 threatened teens mental health in unprecedented ways. Prolonged stress, uncertainty, disruption of routine, removal of their coping mechanisms, and increased social isolation challenged teens to find new coping skills and ways of talking about their mental health.

In a post-vaccination world, we all are wondering how to heal from COVID-19 mental health distress. Parents and adults can reinforce coping skills teens discovered during the pandemic. We all must continue destigmatizing mental health with advocacy and education like NAMI’s Ending the Silence campaign. To keep those most at risk safe, we need to stay vigilant on our watch for warning signs of mental illness. While it may be years until we understand the pandemic’s long-term mental health effects for quaranteenagers, our job today is to stay close, available, supportive, and ready to listen.

Resources

Ali, M.M., West, K., Teich, J.L., Lynch, S., Mutter, R. and Dubenitz, J. (2019), Utilization of Mental Health Services in Educational Setting by Adolescents in the United States. J School Health, 89: 393-401. https://doi.org/10.1111/josh.12753

Benton, T. COVID19 and Children’s Mental Health. National Disability Forum, April 2021. Accessed May 2021: https://www.ssa.gov/ndf/documents/T%20Benton%20-%20NDF%2004-15-21%20-%20FINAL.pdf.

Foster K. One-third of children of parents with severe mental illness are at risk of developing severe mental illness.

Freed GL, Singer DC, Gebremariam A, Schultz SL, Clark SJ. How the pandemic has impacted teen mental health. C.S. Mott Children’s Hospital National Poll on Children’s Health, University of Michigan. Vol 38, Issue 2, March 2021. Available at: https://mottpoll.org/reports/how-pandemic-has-impacted-teen-mental-health.

Holt-Lunstad, J. The double pandemic of social isolation and COVID-19: Cross-sector policy must address both. Health Affairs Blog. https://www.healthaffairs.org/do/10.1377/hblog20200609.53823. Accessed April 28, 2021.

Jiao, W. Y., Wang, L. N., Liu, J., Fang, S. F., Jiao, F. Y., Pettoello-Mantovani, M., & Somekh, E. (2020). Behavioral and Emotional Disorders in Children during the COVID-19 Epidemic. The Journal of pediatrics221, 264–266.e1. https://doi.org/10.1016/j.jpeds.2020.03.013

Lam, L.T. Mental health literacy and mental health status in adolescents: a population-based survey. Child Adolesc Psychiatry Ment Health 8, 26 (2014). https://doi.org/10.1186/1753-2000-8-26.

Loades, M. E., Chatburn, E., Higson-Sweeney, N., Reynolds, S., Shafran, R., Brigden, A., Linney, C., McManus, M. N., Borwick, C., & Crawley, E. (2020). Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19. Journal of the American Academy of Child and Adolescent Psychiatry59(11), 1218–1239.e3. https://doi.org/10.1016/j.jaac.2020.05.009

National Dropout Prevention Center. https://dropoutprevention.org/. Accessed April 30, 2021.

Pontz, E. How to support teen’s mental health during Covid19 and beyond. Berkley Center for Greater Good. https://greatergood.berkeley.edu/article/item/how_to_support_teens_mental_health_during_covid_and_beyond. Accessed April 12, 2021.

Reupert, A.E., J Maybery, D. and Kowalenko, N.M. (2013), Children whose parents have a mental illness: prevalence, need and treatment. Medical Journal of Australia, 199: S7-S9. https://doi.org/10.5694/mja11.11200

Schlegl, S., Maier, J., Meule, A., & Voderholzer, U. (2020). Eating disorders in times of the COVID-19 pandemic-Results from an online survey of patients with anorexia nervosa. The International journal of eating disorders53(11), 1791–1800. https://doi.org/10.1002/eat.23374

Smile, SC. Supporting children with autism spectrum disorder in the face of the COVID-19 pandemic.

Whitney DG, Peterson MD. US National and State-Level Prevalence of Mental Health Disorders and Disparities of Mental Health Care Use in Children. JAMA Pediatr. 2019;173(4):389–391. doi:10.1001/jamapediatrics.2018.5399

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