Knowledge for Practice:

COVID-19 and Adolescent Mental Health

Catherine Clements, Emilee Cox, Sofia Mejia, Mysticka Robinson, Kylie Tindal

Dr. Woo

University of South Carolina

Abstract
 Due to COVID- 19 there have been an increase in mental health issues in adolescents.

This includes stress and anxiety, depression, eating disorders, and signs of abuse have increased

during this time. Due to how recent this pandemic is there was not a lot of research done on the

mental health of adolescents in America, but there have been studies done in China and Australia

that helped show a better understanding of the mental health effects of the pandemic. There were

many studies that showed that the effects of COVID-19 will create lasting impacts on these

adolescents, the dramatic disruption to the routine of these adolescence and how that can cause

short-term and long-term consequences of COVID-19 stressors (Athanasio, Oliveira, & Simone-

e-Silva, 2020). They also found links between the developmental delays that the pandemic is

causing and an increase in mental health issues, they are faced with undeveloped cognitive

mechanisms that inhibit self-regulation and increase in mental health issues during this

developmental stage (Ellis, Dumas, & Forbes, 2020). COVID-19 has caused massive changes in

everyone’s lives, but for adolescents this was supposed to be a time where they would be able to

grow relationships, grow developmentally, and have fun but the pandemic put that on pause.

The findings from these studies show that this pandemic caused an increase in mental health

issues, stunted the development of many adolescents, and that there have been kids who were

forced to stay in dangerous living situations.

 Introduction

Adolescents are impressionable people, who are constantly changing, growing, and

developing and many of them are already facing mental health issues on a regular basis. With

this pandemic, we are facing something many of us have never faced before- it causes us stress,

uncertainty and chaos. For adolescents, this stress is even more extreme because of significant

developmental characteristics (Ellis, Dumas, & Forbes, 2020). We also must take into account

the amount of children who have unfortunate home lives and how this pandemic impacts their

mental and physical health (Miranda, Athanasio, Oliveira, & Simoes-e-Silva, 2020). Studies are

pointing to ways to alleviate negative effects like loneliness such as time with family and friends

and physical activity, as well as getting back to a routine.

COVID-19 has been known to cause a lot of physical side effects, but what most people

do not realize is that there are many other psychological side effects that come with COVID-19.

Isolation within adolescents can cause their anxiety and stress levels to increase because they do

not have any structure and are isolated from their friends (Ellis, Dumas, & Forbes, 2020). For

this study we will be using the study done by the Canadian Journal of Behavioral Science, which

found that 43% of adolescence say that they are very concerned about the pandemic as well as

stating that their measures of depression, loneliness, and stress due to COVID-19 related fear and

physical distancing has increased (Ellis, Dumas, & Forbes, 2020). We are also using the study by

Miranda, Athanasio, Oliveria, & Simoes-e-Silvia where they discussed the dramatic disruption to

the routine of these adolescence and how that can cause short-term and long-term consequences

of COVID-19 stressors (Athanasio, Oliveira, & Simone-e-Silva, 2020). We used these studies

and their results to help us answer our problem.

 The importance of focusing on mental health in adolescents who have been affected by

COVID-19 is necessary when thinking of the many factors that present themselves. Adolescents

may have personal factors such as not living in a safe living environment. Not all homes are safe

places, and some children might be more exposed to varied types of abuses. (Miranda,

Athanasio, Oliveira, & Simoes-e-Silva, 2020) A factor such as this could be detrimental to a

child’s mental health. Having to be home with your abuser could make a child depressed or

anxious and it could even cause larger problems later in the future as well.

The pandemic stress has undoubtedly caused feelings of depression and loneliness, more

often concerning adolescents. They are faced with undeveloped cognitive mechanisms that

inhibit self-regulation and increase in mental health issues during this developmental stage (Ellis,

Dumas, & Forbes, 2020); which makes it even harder to build connections with their peers

during the uncertainty of it all. The particular moment we are being faced with has uprooted

many from their everyday lifestyle. Adolescents have experienced a drastic routine disruption

due to the closure of schools and absence of outdoor activities (Athanasio, Oliveira, & Simone-e-

Silva, 2020).

While the pandemic continues to be ongoing, particularly in the United States which is

further behind other countries in its response and containment of the COVID-19 virus, social

workers in schools and those who work with adolescents require an understanding of how the

pandemic is affecting their mental health and wellbeing. As it touches on nearly every aspect of

life, attention must be paid to a variety of domains. Background characteristics like age and

developmental stage must be taken into consideration as adolescence is a period of life

associated with personal growth and socialization taking place outside the home and within peer

groups. Personal characteristics like past experiences of psychological problems must also be
examined as potential risk factors for increased incidence of depression and anxiety during

periods of isolation from peers as a result of online schooling (Ellis, Dumas, & Forbes, 2020).

Additionally, adolescents facing adversities as a result of poverty, trauma, and multiple losses are

coping with additional stressors that may result in poorer mental health outcomes. It is with these

conditions in mind that we hope to explore the experiences of adolescents during the COVID-19

pandemic and seek to answer the question of what are the factors that lead to anxiety and

depression among adolescents during the COVID-19 pandemic?

Literature Review

The purpose of our literature review is to examine and evaluate different factors affecting

child and adolescent mental health during the COVID-19 global pandemic. When researching

this topic, we searched a variety of keywords including child and adolescent mental health,

pandemic, and COVID-19. The amount of literature, focusing specifically on COVID-19, is

sparse due to it being such a recent moment in history, however numerous articles compare the

current crisis to previous periods in history which resulted in similar situations for children.

Events including the SARS and H1N1 pandemics as well as the “Great Recession” of 2008

required similar quarantine and isolation protocols as well as resulting in economic downturn.

This review will evaluate five studies that assess the multitude of mental health factors that

present themselves in adolescents. The thematic findings include pre-existing risk factors, health

concerns, isolation, and loneliness as factors contributing to anxiety and depression.

Findings

Preexisting Risk Factors

Adolescence has often been labeled by developmental theorists as a period of storm and

stress. This is due in part, to the physical and chemical changes occurring in the brain from early
adolescence, which results in a ‘mismatch’ whereby emotionality is heightened in response to

real and/or perceived stressors. As adolescents strive for independence from their parents, the

time spent with peers increases dramatically, and for the first time, friends rather than parents

become the primary source of interaction and influence. (Magson et al., 2020) Without the

opportunity of building those relationships at school, this can lead to development complications.

At the community level, disruptions to normally operating resources expose already

disadvantaged children and adolescents to worsened mental health outcomes. Closures and

reduction of services like inpatient, day-care, and outpatient mental health facilities; reduced

supervision and intervention from child protective services and youth welfare agencies; as well

as overall reduced social and leisure activities like sport and religious groups can be harmful for

already marginalized or otherwise vulnerable children (Fegert et al., 2020). Children from low-

income families may be relying on schools for healthy meals, playgrounds for physical exercise,

and mental health support systems; therefore, the closures and quarantining preventing children

from accessing these services lead to increased depression and anxiety (de Miranda et al., 2020).

Adolescents belonging to at-risk socioeconomic groups tend to be more likely to show higher

depressive symptoms and a lower state of belonging.

Changes to family structure and routine have also presented themselves as disruptive and

potentially harmful. Within families, parents and guardians face increased pressure as work from

home or face exposure in the workplace, manage childcare, and take over some homeschooling

responsibilities. Low socioeconomic status is already a risk factor for poor mental health in

children which is worsened by the financial hardship and stress faced by families who may be

seeing reduction in wages or job loss as a result of the pandemic (Fegert et al., 2020). Following
the recession in Greece, a study found that adolescent mental health worsened overall, but

disproportionately impaired adolescents from low socio-economic groups (Fegert et al., 2020).

Parental mental illness and substance use is also a risk for mental health problems in

children, which may be worsened by the many stressors and hardships parents are facing (Fegert

et al., 2020). Increases in domestic violence and child maltreatment as a result of economic

recessions is well-studied as perpetrators may “increase existing controlling behaviors” in order

to “regain a sense of control” (Fegert et al., 2020, p. 3). Many authors explained the factors that

contribute to poor mental health argued that the in-home scenario produced by the pandemic

could erupt abuse (de Miranda et al., 2020). This forces at-risk adolescence into a precautionary

mindset amongst the shutdowns. Unfortunately, during quarantine, complaints may not be as

frequent, for there is no escape from perpetrators (de Miranda et al., 2020). A study following the

“Great Recession” found the incidence of abusive head trauma doubled (Fegert et al., 2020). The

widespread and severe nature of this problem prompted UN secretary general Antonio Guterres

to remark on the “horrifying global surge in domestic violence” during the current pandemic

(Fegert et al., 2020, p. 3).

Health Concerns

One of the major factors in increased mental health issues during the COVID-19

pandemic is pre-existing health concerns. This includes but is not limited to anxiety, depression,

stress, and physical health challenges. The prevalence of generalized anxiety disorder increased

during the COVID-19 pandemic with higher amounts reported in younger youth (Hawke et al.,

2020) This is due to the fact that many youths are concerned about getting the virus and what

that will do to affect their daily lives or the people around them. Even when youth experienced

one symptom that is associated with the common cold there was a link to the deterioration of
mental health (Hawke et al., 2020). Children are worried about getting the virus or spreading it to

others that even when they experience common cold symptoms their mental health deteriorates

because of the anxiety surrounding COVID-19.

Derangement of mental health services, as well as regulations on travels and quarantine,

might prevent patients from attending group interventions or obtaining prescriptions or other

medications (de Miranda et al., 2020). It is crucial to maintain access to those supports and

services which is why we see a shift toward online pharmacies and telehealth. Adolescents with

neurodevelopmental disorders, including ADHD and Autism, struggle more during the pandemic

due to a lack of routine and structure, which may have helped to improve their mental health

before the virus struck. In fact, increased irritability was shown in adolescence with ADHD

during the pandemic in comparison to their normal behaviors (de Miranda et al., 2020).

Pre-existing physical health challenges have played a major role in the deterioration of

mental health as well. Youth who have been identified with pre-existing physical health

conditions have also been identified with an increase in health anxiety during the pandemic

(Hawke et al., 2020). This can be due to the fact that they are worried about how the virus will

affect their physical health and if it will make their physical health worse, or if they are

diagnosed with COVID-19, will their symptoms be worse than others? The COVID-19

pandemic has been known to exacerbate mental health challenges in those who are physically ill

and those who have anxiety, depression, and medical traumas. Anxiety has been linked to the

worsening of these medical conditions (Hawke et al., 2020). Due to the pandemic anxiety has

been at an all-time high, people are worried about contracting the virus and how that will affect

their health. This is leading to the worsening of their conditions because they are hyper-focused
on their bodies, meaning that they are adding more stress in their life which is negatively

affecting their ability to take care of themselves.

Another prime example of this is adolescents with eating disorders. While adolescents

with previous mental health disorders may experience exacerbated symptoms, adolescents with

eating disorders such as anorexia nervosa may be prevented from getting meal supervision and

have their weight control affected (de Miranda et al., 2020). In this study, the pediatric

population encompassed both children and adolescents; although there was no consistency of

milestones differing between the two phases. Whether it is mental health concerns or physical

health concerns, adolescents' struggles with anxiety and depression have been heightened due to

the COVID-19 pandemic.

Quarantine-Associated Concerns: Isolation and Loneliness

One of the first things we did as a nation and as a world to prevent the spread of COVID-

19 was go into quarantine, which necessitated social isolation. School closures, home

quarantining and social distancing among other things are likely to result in increased loneliness

in children and adolescents (Loades et al., 2021). The same authors also state “Social isolation

and loneliness increased the risk of depression, and possibly anxiety at the time at which

loneliness was measured and between 0.25 and 9 years later.” Since we know there are obvious

links between loneliness and mental health, this study was conducted to see what is known about

the link between loneliness and mental health of previously healthy children and adolescents, and

also to see if social isolation and quarantining are predictive of future mental health issues

(Loades et al., 2021).

While these restrictions have been challenging for people of all ages, they may be

particularly difficult for adolescents, who at this developmental stage rely heavily on their peer
connections for emotional support and social development. Children were asked multiple

questions ranging from “Have you had any difficulties switching to online learning?” to “How

emotionally distant or connected do you feel with those close to you along with those in society.

Items scores were averaged to provide a mean score ranging from 1 to 6, with higher scores

indicating greater social connectedness. The Cronbach’s alpha value in the current study was

high. (Magson et al., 2020) The pre-pandemic to intra-pandemic increase in depressive

symptoms and anxiety and decrease in life satisfaction found in the current study is generally

consistent with previous retrospective and cross-sectional studies in both adult and adolescent

samples, which have reported perceived increases in depression, anxiety, and loneliness due to

the effect of COVID-19. (Magson et al., 2020)

One study in particular was done about social isolation and mental health during

infectious disease in general and found that one-third of parents whose children had been socially

isolated due to disease containment measures expressed that their child needed mental health

care because of their pandemic related experiences (Loades et al., 2021). The same article also

says, “On the PTSD Checklist Civilian Version, 28% of children who had experienced

isolation/quarantine scored about the cut-off for PTSD, compared to 5.8% of those who had not

experienced isolation/quarantine.” All studies done in this research period found a clear link

between loneliness and mental health in children and adolescents. Loneliness was associated

with mental health problems up to nine years later and was most strongly associated with

depression (Loades et al., 2021).

Limitations

While conducting our research, finding sources was not an easy task. Two of the major

search engines we used were Google Scholars and the USC Library Database. Terms and phrases
that were used to conduct our search were COVID-19 effects on adolescents in the US, COVID-

19 mental health issues in children, adolescents, mental health, pandemic, COVID-19, anxiety,

depression, health, youth, and child and adolescent mental health. When considering adding any

limitations, we looked for articles based in the United States along with studies based within the

year that COVID was discovered until now. The difficult part about the search was finding

studies within the United States. There was a lot of research in other countries such as China and

Australia. We thought it would be best to do our research on the United States being that we

found the most sources for this country along with feeling that we could show how our

adolescents were affected during the pandemic.

Another complication was also finding peer reviewed articles as well. There were a lot of

suggestions when it came to a child’s mental health during the pandemic but most of them were

not credible. Once we narrowed down the articles that met the criteria based around our question,

we were able to use them for our research. The two search engines we used were helpful in a

way or removing the articles and journals that we did not need. They were able to narrow down

the search by allowing more than one keyword search.

There were some complications along the way when we started reading the articles into

depth. There were articles that only touched on the subject in just one sentence. There were also

articles that maybe had a paragraph that spoke about two portions of the research needed. To

help with the search process, we all found two sources that spoke about the subject the most. We

then met collectively and spoke about the articles we all found and decided which five we felt

were best for the research. Once we completed this, we were able to then read and dissect each

article to bring together the overall research for the topic.

 Along the same lines, due to the ongoing nature of the pandemic, several of the articles

reviewed were less scientifically rigorous. Since practitioners need an understanding of what

children and adolescents are facing now and the nature of the pandemic has halted some

academic and research capabilities, a couple of the articles we chose were systematic or narrative

reviews. The limitation of these kinds of inquiries is that they are not generalizable to the current

pandemic and may lose some of their scientific rigor. However, the benefit of this research is it

gets information into the hands of those who need it in a more rapid manner, which is of chief

importance for the continued health and wellbeing of children and adolescents. It also allows for

the use and contextualization of information from previous time periods where there were similar

circumstances like the H1N1 and SARS epidemics which both required some sort of quarantine

and isolation measures. For these reasons, despite their limitations, this is why we chose to

include these kinds of articles in our review of the literature.

Review Conclusion

Current research into the acute phase of the pandemic coupled with research from

previous widespread health crises and economic recessions is valuable, though a more rigorous

and in depth understanding of the current pandemic and its mental health effects is necessary.

Hardly any of the studies on the current pandemic were large or systematic, limiting their

generalizability. Being that almost all five of the studies we reviewed were written during the

early phase of the pandemic, very few systematic studies were performed in general. Of the

literature examined, there were three main themes throughout: preexisting risk factors, health

concerns, and quarantine associated isolation and loneliness. They all related back to the mental

health of adolescents, more specifically the exacerbation of anxiety and depression. What is clear

is that children and adolescents who are already vulnerable or marginalized are at the greatest
risk for incidence of or worsened anxiety and depression including those with preexisting health,

mental health, and developmental concerns; low socioeconomic status; previous exposure to

abuse; and extended periods of reduced socialization including quarantine and online schooling.

More research is necessary as the impact of the pandemic is global, but the responses and

severity have widely varied by location. Questions of long-term psychopathology and

developmental considerations must also be answered.

Recommendations
Based on the literature reviewed previously, this is still an ongoing topic that is still being

researched. The isolation of adolescents during COVID-19 impacts the many age groups

differently. Between the new changes of parents being home and children being confined to

schooling online, the adjustment was not easy and it took a mental toll on everyone. A way for

families to migrate back to their normal would be cutting back on their screen times and having

more family time. They could do this through game nights, karaoke, collective cooking, or any

fun activity of their choice. Having that one on one time together without the stressors of the

school or work could be a good place to start de-stressing.

Another way of transferring back into a normal way of living would be to take a moment

to be outside. Being able to have the moment of fresh air away from the feeling of being trapped

inside the house could be a positive way of change. Stepping away from the home and outside

could make all the difference. Having this outlet could possibly help adolescents and even

parents feel a sense of freedom from the daily confinements of their responsibilities. Getting sun

and fresh air could also help the brain release serotonin as well which helps with a calm and

focused feeling.

Developing new hobbies could also be a great focus as well to help with achieving a new

normal during COVID-19. Trying out new activities could possibly take their minds off of the
anxiety and depression of being at home and into a safe space of creating something interesting.

Having the energy to focus their attention on a new hobby would also allow them a new way of

expressing themselves. Instilling self-care during these times is something very important to

show a child that their views and voice are not being stifled within the home.

When thinking of ways to help easy the mind of a child during a world-wide pandemic

would be simply talking as a family. Having a set portion of time during the day to express their

feelings along with any concerns they may have all the difference. Communication is key and

having time to communicate as a family without the technology makes it so much more personal.

Being able to disconnect from socials and reconnect as a family is refreshing within itself.

Especially when life just becomes too overwhelming and it is hard to escape from the outside

worries of COVID.

One major way adolescents could learn how to regain a sense of normalcy would be

creating a new way of living with COVID. Being able to create a new structured life could be the

first step to feeling as life is getting back on track. Doing activities like waking up in the morning

for school or work, eating breakfast as a family, dedicating a certain time of the day for outside

play, and even setting time out for homework and then leisure time. Having a new structured

way of living may help children adapt to their new norm after some time. Children could even

visit a small group of friends while following the CDC guidelines by always wearing a mask and

not being too close together. Even if they’re six feet apart from their friends, it’s still better than

being alone without being able to see them. When they can’t visit each other outside, there could

be a set time on weekends to have scheduled zoom calls with their friends as well. Building a life

around COVID is a recommendation we suggest strongly. We must learn how to live with

COVID and learn how to create and implement a new life around it.
 Conclusion

As we reviewed our chosen studies and dove deeper into the mental health scenario

caused by the pandemic and social distancing, we’ve seen a dramatic rise in mental health

concerns in adolescents. Stress responses vary from person to person, and the stress and anxiety

for adolescents has become more extreme due to certain developmental characteristics, isolation

and loneliness, preexisting risk factors, and health concerns, and more. Additionally, children

and adolescents who are already vulnerable due to low socioeconomic status, living situations

with abusive parents or guardians, and existing health and mental health concerns are even more

at risk for negative outcomes as a result of the pandemic. While the pandemic is ongoing, social

workers and other practitioners in the field working with children and adolescents need to be

aware of the many varying factors affecting their mental health. These consequences are not

likely to end even as more of the country becomes vaccinated and schools begin returning to

normal operations. As such, understanding the short and long-term mental health effects of

quarantine, isolation, and the threat of a global pandemic will continue to be necessary for years

to come.
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