The Impact of COVID-19 on Adolescent Mental Health

Adolescence is a critical developmental period when rates of mental disorders increase significantly. Adolescents are extremely vulnerable to disruptions in the support and stability of their environments. The COVID-19 pandemic severely disrupted core youth-serving institutions (e.g., school, team sports, extracurricular activities) that are important socializers. The pandemic also increased the usual home stressors (e.g., poverty, domestic violence, and parental substance abuse) as well as adding new ones such as enforced isolation, caring for ill family members, and loss and bereavement of family and friends.

Not surprisingly, the pandemic increased the rates of major depression and anxiety in youth, especially in girls and older adolescents, compared with pre-pandemic surveys. A review of 116 articles (total N=127,923 children and adolescents) on the mental health impacts of COVID-19 on youth found that, worldwide, youth were experiencing significantly more depressive and anxiety symptoms, including suicidal and self-destructive behaviors, than pre-pandemic.¹

The studies varied sufficiently in their measures and timing (early vs. later 2021) to preclude a firm number on the magnitude of the increase, but they largely agree that mandated pandemic contagion control policies that limited social interactions were especially associated with more depressive and anxiety symptoms in youth. Older adolescents, in particular, had higher rates and most frequently expressed fears that the pandemic would negatively impact their lives. Children and adolescents who were “different” (e.g., LGBTQ+, mixed race, minority, or disabled) had higher rates than white and Asian subjects in most studies. Additional risk factors included neurodiversity, poverty, cancer, and chronic medical conditions. Protective factors included activities such as hobbies, listening to music, prayer, and developing routines. High levels of physical and outdoor activity were specifically associated with better mental health.

Major Depressive Disorder in Adolescents by Race/Ethnicity

The National Survey of Drug Use and Health (NSDUH), a nationally representative survey that collects data on sociodemographic variables, substance use, and behavioral health treatment, uses validated diagnostic instruments for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnoses.² The NSDUH conducted a cross-sectional analysis of a nationally representative sample (n=10,743) of noninstitutionalized U.S. adolescents (aged 12-17 years) collected during 2021. The NSDUH objective was to estimate the prevalence of major depressive disorder (MDD) in adolescents by racial and ethnic groupings and to assess disparities in types and quantity of mental health treatment received across groups during the first full year of the pandemic (2021). The referent group was white adolescents (although the authors explicitly note that race and ethnicity are socially constructed categories without a scientific foundation).

Approximately one in five (20 percent) of adolescents experienced MDD in 2021. The prevalence of MDD varied across racial and ethnic groups ranging from 14.5 percent (Black) to 26.5% (mixed race). Compared with white adolescents, those of minority racial/ethnic groups received significantly less treatment and less intensive forms of treatment. For example, only 21.1 percent of mixed-race adolescents with MDD received any form of treatment compared with 45.1 percent of white adolescents.

Thus, during the first full year of the pandemic, there was a significant increase in clinically depressed children and adolescents. However, only about 20 percent of U.S. adolescents diagnosed with MDD received adequate treatment. Demographic, social, and economic factors proved powerful influences on who received treatment, the type of treatment received, and the sufficiency of that treatment. In general, kids with the greatest risk factors received the fewest and least efficacious services.

Effects of School Closures

Another critical factor that emerged from this research is the impact of the closure of schools and the transition to remote schooling. Schools provide important stabilizing and socializing influences on youth through the imposition of routines, opportunities for peer socialization, exposure to non-family role models, participation in extracurricular activities, and team sports. Teachers and school guidance counselors are also mandated reporters who may be the first to notice signs of child abuse. Closure of schools may also increase food insecurity for lower socioeconomic status youth as well as impede access to after-school programs and referrals to community-based child and family resources. In addition to these losses, surveyed youth reported increased stresses related to concerns about the impact on their education, missing out on educational and social opportunities, and being overwhelmed because of having to catch up on missed lessons.

Unlike the de-institutionalization movement of the 1960s to the 1990s, which forcibly transferred a chronic clinical population from inpatient settings to ill-prepared outpatient services, the dramatic increase in youth depression represents a new clinical population that is also not receiving adequate mental health services. The failure to provide adequate treatment to almost 80 percent of depressed youth, especially females, older, mixed-race, and LGBTQ+ adolescents, bodes poorly for the long-term mental health of the COVID-19 generation.

Thus, examination of COVID-19-related increases in adolescent depression underscores the contributions of government policies, education policies, minority status, gender identity, treatment availability, and family stressors to the increased prevalence of major depression in youth and the social inequities in access to adequate treatment. Unfortunately, the current “broken” MH system of care only has a very limited capacity to address most of these factors.