As lives increasingly return to something resembling what normal used to look like, much remains unknown about the mental health toll the COVID-19 pandemic has taken on everyone—especially children.
In many ways, kids may have adjusted to lockdown and restrictions as well as adults, if not better, experts say. They wore masks, sacrificed birthday parties, sports, and even in-person schooling for months on end.
Kids have faced traumatic events throughout history, but COVID-19 was unprecedented in that it affected every single child in some way.
But that doesn’t mean it was universally the same experience. Some kids, as Paige Lembeck, PhD, a psychologist at the Yale Child Study Center, puts it, “sailed through” the pandemic and enjoyed homeschooling and spending more time with family. Others suffered from the lack of academic, social, and emotional support, which doesn’t work the same way through a screen as it does in person.
For some, the disruptions of the pandemic brought serious distress. Between March and October 2020, hospital emergency department (ED) volume for mental health visits for kids ages 12 to 17 increased 31% compared to the same period the year before, according to the Centers for Disease Control and Prevention (CDC). It was a 24% increase for ages 5 to 11 over the same time period.
National numbers on suicide deaths in 2020 are not available yet, and researchers haven’t clearly linked recent suicides to the pandemic—but pediatric mental health experts are expressing concern. And this isn’t totally new. Even before the pandemic, the rate of depression and anxiety in children was on the rise, notes Yann Poncin, MD, who is medical director of both outpatient clinical services for the Child Study Center and of Yale New Haven Children’s Hospital’s Day Hospital.
Across the country, more children are visiting the ED for mental health, says Dr. Poncin. “And here at Yale, we are seeing more kids in our inpatient unit, and our outpatient clinic is at a very high volume,” he says. “Plus, the severity is worse. We see more kids who have attempted suicide instead of talking about it. We’ve also had more situations where the parents are taken aback, where the child seemed to be doing well and this appeared to come out of nowhere.”
In these cases, the pandemic is assumed to be at least part of the problem, but often it was an added stressor for kids with pre-existing conditions, Dr. Poncin says. “Kids with anxiety, for example, were spending more time ruminating in their heads, rather than being with other kids,” he says.
He describes the experience as “unprecedented in our lifetimes,” noting that even for those who weren’t personally impacted by sickness, the world around them has changed. What remains unclear is whether these trends will reverse as the pandemic winds down.
“We have this desperation to return to normal, but who knows if we will ever get back to how life looked pre-COVID?" says Lembeck. "From a trauma-focused lens, we don’t yet know what the lasting loss is for a child who lost a family member in this period or, to a lesser extent, didn’t get to have a normal senior year.”
Is the pandemic hardest for teens?
Jin Ju Lee, APRN, a psychiatric nurse practitioner at the Child Study Center, says she has been most concerned about teenagers. “The social isolation had a significant impact on them,” she says. “This is their main developmental life stage when they are with peers and figuring out who they are outside of their families. I am seeing a lot more depression and anxiety symptoms in this age group.”
Conversely, Lee says she’s seen some children, including teens, thrive. “Especially for some kids who I was working with already, they love the convenience of being online versus having to come to a therapist’s office. They get to sit on their bed and be near their things or with their dog, instead of coming into a neutral office,” she says.
Dr. Poncin agrees. “I can say anecdotally that there were some kids who have done better during the pandemic. There are organized kids who adjusted to virtual school. They got to sleep more, spend more time with their family, and still communicated with or saw friends,” he says. “These are generally kids who feel good about themselves. They aren’t overly driven by their parents or internally driven by themselves. These are the kids who have been resilient to the pandemic.”
But for many who were predisposed to anxiety, depression, or other mental health issues, the repercussions were sometimes significant, he adds. Much of how a child reacts to any situation has to do with temperament and genetics, Dr. Poncin explains. Family support is another factor.
If a child is starting to suffer a mental health setback, prompt treatment in the form of therapy and possibly medication can make a big difference, and having parents who are mindful, organized, and have the resources to handle that is key, experts say. Even so, services have been harder to come by in the last year, with many therapists and services over-booked to meet the growing demand.
Long-term consequences of the pandemic on children is unclear
It’s too soon, of course, to know about the long-term effects of COVID on children’s mental health, Dr. Poncin says. But as the pandemic fades away and many restrictions are lifted, it will be a relief for the average kid, he says.
“They will feel like the background stress and pressure is over. But what about the kids who didn’t fully get their education and are now falling behind? And what about the kid who is gifted and will be with the other kids who fell behind?” Dr. Poncin asks. “Plus, for those who were socially anxious in school, it may be hard to get back into classes. Normally, with kids who are resistant to going to school, we have them go an hour every other day and ease into it, but we weren’t able to do that when everything was virtual.”
A return to routine and structure—and freedom to see friends and do more things—will help, Dr. Poncin says. “I think we are seeing the peak of the consequences of how the pandemic has gotten kids off-track. Sometimes, you have a delayed trauma effect, but I don’t see that as being a major problem for most kids,” he says.
In some ways, the pandemic may give some young people a new perspective, Dr. Poncin adds. “They suffered challenges, and a kid who thought he hated being in school now sees what being home can be like. So, I think some will think, ‘If I can get through this, I can get through other things.’ This may give them a sense of confidence,” he says.
But aren’t kids ‘resilient'?
Although resiliency is a complicated term with many contributing factors, most kids are “foundationally resilient,” Lee says.
“They absorb things and as long as the adults around them are mindful of what a transition to normal life can look like, and are able to provide different levels of support, my opinion is that over the long-term, they will recover from this strange period of time,” she says.
But Carolina Parrott, LCSW (licensed clinical social worker), of the Child Study Center, says that one piece that often gets missed is how kids will transition to post-pandemic life.
“For some kids, they just got used to this way of life and now we are asking them to make more changes and return to school in person,” she says. “We talk with families about ways to transition kids back to school slowly—this can be hard, as some of the schools prefer that they choose to return in person full time or remain virtual full time.”
More answers will come in the fall
It won’t be known until October or November if kids are doing better than they are now, Dr. Poncin says.
But one thing Dr. Poncin is hopeful about is the way the current crisis has shed a light on the need for enhanced mental health services for children and teens. Part of the reason the emergency departments got so crowded, he points out, is that many community-based services that had been seeing these young people were closed at the start of the pandemic. Even then, the existing services were already over-taxed and not equipped to meet the increased demand, he says.
“In Connecticut, the state is trying to do more to support mental health; there is talk of setting up two new urgent evaluation centers, where kids can go instead of to the ED,” he says. “Plus, there is talk of increasing access to mental health by enhancing the three hubs in which we work with community pediatricians on medical management questions and sometimes psychiatric evaluations.”
As life changes once again, young people may not experience the same feelings as grown-ups in their lives. Now free to remove their masks in most situations and return to their everyday activities, many vaccinated adults are realizing what they liked about pandemic life—whether it was working at home or spending more time with family.
Kids, however, are not always as introspective, but more “present-minded,” Lembeck says.
“But maybe something blooms from this pandemic and they realize things they appreciated,” she says.