COVID-19 pandemic impacted mental health

Due to a lack of pre-COVID comparative data and non-representative sampling, few researchers were able to clearly identify changes in mental health caused by the COVID-19 environment. However, a study in Belgium compared the registration of mental health problems in primary care during and before the pandemic. They found a relative increase in registered mental health problems during the pandemic, as well as relatively more care provided to patients with mental health problems.[63]

Young people, people with pre-existing mental health disorders, and people who are financially disadvantaged have been found to face an increase in declining mental health.[64] Some demographics appear to have been under researched (e.g., culturally and linguistically diverse populations and indigenous peoples), while some research methodologies have not been utilized (e.g. there was a lack of qualitative and mixed-methods studies).[65]

COVID-19 also impacted the availability of therapy and mental health services to those who were already receiving treatment. A cross-sectional online survey found that 42% of children lost access to all therapy services during the pandemic, and 34% were able to receive at least on therapy service via telehealth. Over 40% of parents expressed regressions in their children's motor, behavior, social, and communication skills which they attributed to the changes in therapy services.[66]

Obsessive–compulsive disorder

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Obsessive-compulsive disorder (OCD) is a psychiatric disorder that is extremely common in developing and developed countries alike.[43] The social and collective perception of OCD as an illness albeit, is subjective and varies cross-culturally. As such, data relating to the impact of the COVID-19 pandemic upon sufferers of OCD is skewed because of different cultural influences on behavior and 'relationships between beliefs'.[67] Those living with OCD have been subject to socioeconomic, pandemic-related stressors, as COVID-19 has been covered across social media and the 24/7 news cycle since its outbreak. These media outlets emanate fear, and the probability of contamination in conjunction with regulatory quarantines and periods of isolation, trigger precautionary compulsions in OCD patients. Such behavior is driven by the 'psychological distress' of governmental control and social restrictions.[68]

Post-traumatic stress disorder

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Emotions of high stress and loneliness are contributing factors of post-traumatic stress disorder (PTSD) and the COVID-19 pandemic has provided individuals with conditions in which these symptoms foster. COVID-19 has affected social structures across cultures, and for people living with PTSD, global measures that regulate the body by means of school closures, border restrictions, social distancing, mask wearing and hand washing, expose the 'population to feelings of intense fear and helplessness'.[69] A study on the psychological distress experienced by health care workers across 21 countries reveals a PTSD prevalence of 21.5%. The Middle East and Europe were both countries of interest in this study, indicating the cross-cultural impact that COVID-19 has had upon PTSD.[70]

PTSD in Children

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Studies from previous years and epidemics reported that children who were isolated were much more likely to develop PTSD.[55][58] PTSD in children can have long-term consequences on brain development and affected kids are more likely to develop psychiatric disorders.[52][56][57]

Autism spectrum disorder

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Pandemic lockdowns impacted mental health outcomes for children with Neurodevelopmental disorders, such as ASD, creating challenges including the lack of understanding about the pandemic and the ability to complete school work.[57][71] Children on the autism spectrum were more likely to become agitated by the changing environment.[57][71]

Attention deficit/hyperactivity disorder

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Adolescents and children with attention deficit hyperactivity disorder (ADHD) struggled with staying confined in only one space, creating difficulties for caregivers to find activities that were engaging/meaningful to them.[57]

The impact of COVID-19 restrictions and isolation impacted on children's abilities to use successful coping mechanisms and management techniques for ADHD. Issues of diagnosis and treatment were also prevalent. Primarily, clinicians faced the problem of differentiating between situational and persistent ADHD symptoms in children and adolescents, who did not have the same environmental triggers (i.e. social spheres) which allowed their symptoms to be best evaluated.[72] Those wanting to be evaluated for expression of ADHD symptoms were subject to extensive wait lists for clinical analysis as a result of staff shortages during the pandemic. Those that were offered a positive diagnosis were then further restricted by the limited non-medication based treatment options, such as behavioural and educational therapies.[72] Those children and adolescents already living with diagnosed ADHD were also facing substantial challenges. Studies conducted during the pandemic showed that social isolation and homestay directives led to an increased reliance on screen-time to manage attention problems. A 75% increase in online gaming participation was observed.[43] In some instances, gaming may represent an unhealthy coping mechanism for ADHD youth and has already been demonstrated to exacerbate poor management of symptoms.[43] Furthermore, this excessive screen-time was prolonged by the use of Zoom for learning. Children with ADHD were required to simultaneously process auditory and visual cues during these online classes, leading to 'distracted connection'[43] and mental overstimulation.

Anxiety and depression

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An increase of mental health issues such as depression and anxiety during the COVID-19 pandemic is a commonly held perception worldwide. Whilst this is true for several western cultures and societies it does not encompass all of the minorities within these cultures. In a study conducted by Giurgescu et al. (2022),[73] it was concluded that levels of perceived anxiety and depression had increased for pregnant African American women during the pandemic. Further to this, they also concluded that pregnant African American women experienced higher levels of loneliness that increased their levels of perceived anxiety, stress, and depression. The higher levels of anxiety and depression within this minority can be attributed to several social factors they have had to experience in their lifetime. The history of underlying social inequity and oppression may have paved the way for a higher mortality and morbidity rate, job loss and food and housing insecurities. Although the COVID-19 pandemic has affected rates of mental health amongst most western cultures, the people within these demographics are likely to be impacted by historical, social and biological factors that have led to high levels of depression and anxiety irrespective of COVID-19.[74]

Impact on children

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See also: Impact of the COVID-19 pandemic on domestic violence

Children and families also had psychological effects due to the COVID-19 pandemic. A study looking at children between the ages of 5-11 and their caregivers in the UK found that more than 30% of caregivers reported changes in their children's behavioral and emotional states.[75] 61.4% stated their children had an increase in frustration and some of the other symptoms reported were irritability, restlessness, anger, anxiety, sadness, worry and being more likely to argue with the rest of the family. During the pandemic there was a significant increase in the amount of time children spent on screens, and less on physical activity and sleeping. More than half of the caregiver's reported their psychological distress levels increased during the lockdown, which was significantly related to child symptoms.[75]

On October 19, 2021, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children's Hospital Association declared a "national emergency" for children's mental health.[76]

One study reported that many children who were separated from caregivers during the pandemic experienced a crisis. Children who were isolated or quarantined during past pandemics were more likely to develop acute stress disorders, adjustment disorders and experience grief, with 30% of children meeting the clinical criteria for PTSD.[77] A meta-analysis of 15 studies performed reported that 79.4% of children and teenagers suffered negative consequences: 42.3% were irritable, 41.7% had symptoms of depression, 34.5% struggled with anxiety, and 30.8% had problems with inattention. Many young people struggled with boredom, fear, and sleep problems.[54]

A collection of 29 studies posted in August 2021 by Jamanetwork[78] showed that the prevalence of symptoms of depression and anxiety had doubled during COVID-19. They had also found that older adolescents were affected more and it was the most prevalent in girls.

In an October 2020 global study, negative emotions experienced by students included boredom (45.2%), anxiety (39.8%), frustration (39.1%), anger (25.9%), hopelessness (18.8%), and shame (10.0%). The highest levels of anxiety were found in South America (65.7%) and Oceania (64.4%), followed by North America (55.8%) and Europe (48.7%). The least anxious were students from Africa (38.1%) and Asia (32.7%). A similar order of continents was found for frustration.[79]

School closures caused anxiety for students with special needs as daily routines are disrupted and therapy and social skill groups halted. Others who incorporated school routines into their coping mechanisms experienced an increase in depression and difficulty in readjusting to normal routines. Closures limited mental health service availability, along with educators' ability to identify at-risk youth.[80]

LGBTQ Youth

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A National survey that focuses on LGBTQ youth mental health was conducted by The Trevor Project in 2021.[81] This survey highlights some of the specific challenges faced by LGBTQ youth during the Coronavirus pandemic in 2020, like increased restraints on expressing their gender expression and sexuality. The data collected was from about 35,000 LGBTQ people aged 13–24 years old. 45% of youths surveyed were people of color and 38% were transgender or nonbinary. Overall, 70% of LGBTQ youth "stated that their mental health was "poor" most of the time or always during COVID-19", as well as 80% of youths aged 13–17, and 81% of youths aged 18–24, said that COVID-19 negatively impacted their mental health.[81] COVID happened so quickly that it was a difficult adjustment for some LGBTQ youth to have to go back to living at their parent's houses full time, especially when some families of LGBTQ kids were not as accepting of them.[82]

Only 1 in 3 LGBTQ youth found their homes to be supportive, and 81% of youths aged 13–17, and 81% of youths aged 18–24, reported that they experienced a more stressful living situation.[81] Many college aged kids came out for the first time while they were at school, so when they had to go back home they had to decide whether or not to tell their parents, who could be potentially unsupportive or even abusive.[82] Younger kids were isolated at home with no access to their friends, guidance counselors, or teachers who were their only potential support systems.[82][83] 50% of youths aged 13–17, and 42% of youths aged 18–24, said COVID-19 impacted their ability to express their sexual orientation.[81] 65% of youths aged 13–17, and 52% of youths aged 18–24, said that COVID-19 impacted their ability to express their gender identity.[81]

72% of LGBTQ youth reported "symptoms of generalized anxiety disorder" and 62% of LGBTQ youth reported "symptoms of major depressive disorder".[81] In regards to suicide, it was reported that 42% of LGBTQ youth "seriously considered attempting suicide in the past year".[81][82] 48% of this being youths aged 13–17 and 34% were youths aged 18–24.[81] The percentages of attempted suicides were 31% of Native/Indigenous youth, 21% of Black youth, 21% of multiracial youth, 18% of Latinx youth, 12% of Asian/Pacific Islander youth, and 12% of white youth. Overall, 20% of LGBTQ youths aged 13–17 and 9% of LGBTQ youths aged 18–24 attempted suicide.[81]

Impact on Students

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K-12

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Schools have been able to play the role of a safety net in many cases where adults look out for the mental health status of their students. In schools teachers and adults are able to be on the look out and recognize physical/emotional distress, signs of physical abuse, and/or sudden significant or subtle changes in behavior.[84] Should they recognize any apparent disruptions, teachers are able to intervene and provide their students with the necessary resources to help them.[84]

However, during the COVID-19 pandemic, with students and teachers out, this system has not been in place. When schools shut down, teachers had to resort to online learning where they were no longer able to see how students were doing physically/mentally and weren't able to provide them with the help they needed. With the lack of resources to help students, it resulted in a drastic increase in depression and anxiety rates, increasing by over 20%. Since students were suffering mentally, it became challenging for them to have the motivation to do their school work.[85]

As COVID-19 mitigation efforts began to ease up and students return to the classroom, teachers have noticed an increase in crying and disruptive behavior in this population of students and also increased occurrences in violence and bullying.[86] Mental health professionals call for schools and education institutions everywhere to implement a number of health promotion programs in their schools that may teach students how to prevent succumbing to adverse mental health issues and how to cope with the reality and continuing effects of COVID-19 so that it does not get in the way of their education and future endeavors.[87]

Higher education

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Studies conducted in the first stages of the pandemic found the age group of the average higher education student (i.e. 18–24-year-olds) among the most affected in terms of mental health.[88][89]

The Higher Education Policy Institute conducted a study that reported that 63% of students claimed that their mental health had worsened, and that 38% demonstrated satisfaction with the mental health service access.[90] Physical harm such as overdose, suicide and substance abuse reached an all-time high. Academic stress, dissatisfaction with the quality of teaching and fear of infection were associated with higher depression scores.

Involvement in a steady relationship and living with others were associated with lower depressive scores. Research reported that psychological stress following strict confinement was moderated by levels of the pre-pandemic stress hormone cortisol and individual coping skills. Stay-at-home orders that worsened self-reports of stress also increased cognitive abilities including perspective taking and working memory.[91] However, that greater emotion regulation (measured pre-pandemic) was associated with lower acute stress (measured by the Impact of Event Scale-Revised) in response to the early pandemic in the US during lockdown.[92] Students who experienced a death of a close family member, a known stressor, were more likely to decide to stay home and attend college virtually.[93]

Isolation from others and lack of contact with mental health services worsened symptoms. The specific level of impact on students reflected their demographic backgrounds: students from low-income households and students of color experienced greater mental health and academic impacts. Students who struggle with mental health also struggled academically.[94] Students from high-income households and those in successful school districts were more likely to have to mental health (and other) resources.[95]

A study in Belgian higher education students found the following factors to be associated with higher scores of depression during the COVID-19 pandemic: academic stress, dissatisfaction with the quality of teaching, fear of being infected, higher levels of frustration and boredom, inadequate supplies of resources, inadequate information from public health authorities, insufficient financial resources and perceived stigma.[96] These factors were in line with a review that identified a comprehensive set of mental health stressors playing a role in people who were quarantined to limit the transmission of pathogens similar to COVID-19.[43]

Individuals with a known history of psychiatric disorders were more vulnerable to experience heightened levels of distress during lockdown measures.[97] Specifically, researchers saw an increase in the amount of eating disorders related vulnerabilities.[98] Social isolation that accompanies lockdown and stay at home measures for many resulted in a decrease in physical movement and activity, an increased amount of food in the home, and an increased time spent with a screen. There was an increase of 10% of student's perception of their body and the description of their weight as a risk factor for acquiring an eating disorder and exhibiting symptoms during the months between January 2020 and April 2020.[98] After lockdown ended, student's levels of physical activity remained below their pre-pandemic levels, even for those attending colleges that resumed in-person instruction.[93]

Studies showed that although college students did not have significant increases in their BMI, the rates in which college students were concerned about gaining weight and subsequent increases in their BMI significantly increased.[98]

An international survey conducted in Norway, USA, UK, and Australia at the end of 2020 found that university students in higher education had poorer mental health than non-students.[99]

A research study conducted by the Centers for Disease Control and Prevention (CDC) looked into data gathered from a nationwide survey of high school students during the COVID-19 pandemic. The data collected revealed disturbingly high incidences of worsening mental health, with 37.1% of students saying they experienced poor mental health during the pandemic, and 31.1% reporting poor mental health during the first 30 days after the original survey. Also students reported that 12 months before the survey how they were feeling with 44.2% saying they experienced persistent feelings of sadness or hopelessness, while 19.9% had deeply considered attempting suicide, and 9.0% had attempted suicide.[100] Based on the data, the pandemic increased stress, anxiety and depression amongst high school students mainly because of social isolation, online learning difficulties, and familial conflicts.

This study sheds light on the importance of being connected to school, family, and community groups especially during a time of prime development. Students who were able to maintain these aspects of life were found to have lower rates of poor mental health and suicidal thoughts/behaviors.[100]