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June 1, 2021

Children and Teens Struggling with Mental Health During COVID-19 Pandemic

Author Affiliations
  • 1Consulting Editor, JAMA Health Forum and JAMA
JAMA Health Forum. 2021;2(6):e211701. doi:10.1001/jamahealthforum.2021.1701

For many US children and adolescents, disruptions and challenges related to the COVID-19 pandemic have exacted a considerable toll on their emotional and mental health, according to an issue brief from the Kaiser Family Foundation (KFF). The brief points to evidence indicating that adolescents, young children, LGBTQ young people, and children of color may be especially vulnerable to pandemic-related mental health consequences, such as anxiety and depression.

A number of factors potentially contribute to worsening mental health outcomes in children and adolescents, the KFF brief explains, including school closures, social distancing, and stay-at-home orders, which could lead to loneliness and isolation. Among parents, pandemic-related stresses and difficulties, such as job insecurity and loss, may contribute to poor mental health, which itself might be a contributing factor to negative mental health outcomes for their children.

At the same time, use of pediatric mental health services declined sharply after the onset of the pandemic. For example, among US children younger than 18 years enrolled in Medicaid or the Children’s Health Insurance Program (a group that includes nearly 40% of all US children), the number of those who received mental health services was halved between February and October 2020, from 145 per 1000 beneficiaries to 72 per 1000 beneficiaries—despite the fact that use of other types of health care services began to rebound.

Even before the onset of the pandemic, researchers documented a rise in recent years of poor mental health outcomes among adolescents, including persistent feelings of sadness and hopelessness or suicidal thoughts. According to a KFF analysis of data from the National Survey on Children’s Health, in 2018 and 2019, 7% of high school students (1.8 million) had depression and 13% (3.1 million) had anxiety. In addition, suicide was the second leading cause of death among adolescents aged 12 to 17 years, accounting for 1580 deaths, and nearly 1 in 5 (19%) had serious thoughts of suicide in 2019, up from 14% in 2009.

Shortly after the pandemic began, the KFF brief explains, more than 1 in 4 high school students reported worsened emotional and cognitive health, and in a more recent survey, only one-third said they were able to cope with such sources of stress as strained mental health and peer relationships.

Private insurance claims show that in 2020, even though the number of all health care claims for 13- to 18-year-olds was lower than in 2019, mental health–related claims for teens—including such diagnoses as depression, anxiety, and adjustment disorder—increased dramatically. In addition, claims for substance use disorders and overdoses increased as a proportion of all medical claims for 13- to 18-year-olds during 2020.

The KFF issue brief also points to a worsening of mental health among young children during the pandemic, possibly as a result of stresses in their home environment or pandemic-related disruptions in their routine. More than 1 in 5 parents of children aged 5 to 12 years reported that their offspring showed an overall worsening of mental or emotional health; 9.2% said their children showed elevated symptoms of psychological stress, 6.3% reported observing elevated symptoms of anxiety, and 4.4% said they saw more signs of depression.

In addition, claims of obsessive compulsive disorder and tic disorders increased as a proportion of all medical claims for 6- to 12-year-olds during 2020, according to an analysis of claims submitted to private insurers. However, the proportion of claims for attention-deficit/hyperactivity disorder—the top mental health diagnosis among this age group among all medical claims—decreased in 2020 compared with 2019, perhaps because decreased in-person instruction prevented teachers from observing potential signs of the disorder.

LGBTQ youth and children of color might be especially vulnerable to mental health concerns, the authors noted.

For example, self-reported anxiety and depression were more common among LGBTQ teens and young adults (aged 13-24 years) compared with their non-LGBTQ counterparts (43% vs 18%), as were unmet mental health care needs (25% vs 11%). However, the KFF authors caution, even before the pandemic, LGBTQ youth had comparatively high risks for depression, suicidal thoughts, and substance use; thus, how much of this disparity might be attributed to pandemic-related stresses is uncertain.

Similarly, although children of color had higher rates of mental illness and also were less likely than White children to receive care or have access to school health services before the pandemic, these disparities in access might have been amplified by suspension of or limitations on school services during the pandemic. In addition, the authors note that the pandemic’s stresses on Black and Latino adults—including higher rates of illness and death from COVID-19, negative financial impacts, and poor mental health outcomes—“may have adverse mental health effects on children from these communities.”

The American Rescue Plan Act that was enacted in March 2021 allocates funding for children’s mental health services, including $80 million for mental health care access, $20 million for youth suicide prevention, and $10 million for the National Child Traumatic Stress Initiative. It also offers federal support to states for community-based mobile crisis intervention services. The COVID-19 Mental Health Research Act, introduced in March, proposes funding research targeting the mental health consequences of the pandemic, including research on the effects of the coronavirus pandemic on the mental health of specific populations, including children, members of racial and ethnic minority groups, and others.

The brief also points to the need for policy makers, clinicians, educators, parents, and researchers to take a long-term view of the effects of the COVID-19 pandemic and related family stresses on the mental health of children and adolescents, noting that “poor mental health outcomes and access to care issues among children and adolescents are likely to persist beyond the pandemic.”

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Article Information

Published: June 1, 2021. doi:10.1001/jamahealthforum.2021.1701

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Stephenson J. JAMA Health Forum.

Corresponding Author: Joan Stephenson, PhD, Consulting Editor, JAMA Health Forum (Joan.Stephenson@jamanetwork.org).

Conflict of Interest Disclosures: None reported.

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