‘We’re not in a good place’

Experts: Pandemic has amplified mental health issues for youth

The number of young people dealing with mental health issues has been increasing for at least a decade, and the pandemic has made it worse, experts say.

Melissa Santos, the senior pediatric psychologist at Connecticut Children’s Medical Center, said while the mental health crisis came to light for many during the pandemic, it had already existed for teens and adolescents.

“COVID put a spotlight on it and amplified it,” Santos said. “We have seen an increase, but it wasn’t good before the pandemic, and we were definitely struggling before the pandemic with a large number of kids needing services and a large number of kids not being able to access services. But COVID definitely put a spotlight on it.”

Statistics show an uptick in mental health problems among youth for more than a decade.

More than one in three high school students experienced persistent feelings of sadness or hopelessness in 2019, a 40 percent increase since 2009. Also in 2019, about one in six youth reported making a suicide plan in the past year, a 44 percent increase in 10 years, according to the Centers for Disease Control and Prevention.

From 2010 to 2020, suicide was the second leading cause of death for Connecticut residents ages 15 to 24 and the third leading cause of death for those ages 10 to 14, the CDC reports.

The annual average of Connecticut children ages 12 to 17 who experienced major depressive episodes increased to 13.9 percent during 2016 to 2019, compared to 8.9 percent in 2004 to 2007, according to the U.S. Substance Abuse and Mental Health Services Administration,

Experts attribute the rise in youth mental health struggles to a number of things, though there is general agreement that the COVID-19 pandemic made the situation worse.

“Objective data is showing rates of anxiety disorders, rates of mood disorders are increasing,” said Margaret McClure, the chairwoman of Fairfield University’s psychology department. “The number of visits to emergency rooms for suicidal (thoughts), suicide attempts, non-suicidal selfinjury are all increasing.”

“A lot of pressure on young people”

Christopher Burke, the executive director for Newport Healthcare Connecticut, said the pre-existing youth mental health crisis was exacerbated by the pandemic, with its stayhome orders and online schooling.

“The uptick preceded the pandemic, but the reasons are not definitive,” he said.

He believed the enormous amounts of technology teens are consuming are also having an effect.

“This tech use comes at the expense of in-person interpersonal relationships with friends and family, something that was also amplified by isolating stayhome orders during the pandemic,” he said.

Burke said the increased use of technology also means that teens are immersed in a too-fast-paced media culture.

“(This) can leave some young minds feeling helpless, again, magnified with the inherent fears of a global crisis like the pandemic,” he said. “Kids were getting constant news, sometimes factual, sometimes not, that was rather alarming at the start of COVID. This can certainly affect their mental health, creating anxiety and depression in previously unaffected kids.”

McClure said even professionals can not fully understand and account for all the reasons the mental health issues among youth are on the rise, but growing up with technology is one of them. While there are positives to that, she said, there is a lot more pressure on young people when they have to compare themselves to everyone on the internet.

“You’re not even comparing yourself to real, live people that you see in your history class,” she said. “You’re comparing yourself to these online, carefully constructed personas. That’s a lot of pressure on young people.”

Middle and high school aged children are where experts are really seeing the increase, McClure said, adding it is a part of development where they are trying to find themselves and their place. She said this generation is also growing up in a time where, because of mass shootings, even schools are not a place where they feel safe.

McClure said students experiencing these issues can have a hard time focusing or getting motivated to do school work.

While there is no single factor that contributes to the rise, young people have grown up in a world where they deal with myriad issues, from school shootings to hate crimes to access to 24/7 media and all that comes with it, said Nance Roy, a clinical professor of psychiatry at the Yale School of Medicine and the chief clinical office of The Jed Foundation, a national nonprofit that aims to protect emotional health and prevents suicide.

“There’s so many environmental factors that our young people are growing up with and living in a world that, frankly, doesn’t feel safe,” she said. “I sometimes think I’d be more worried if we weren’t seeing kids being anxious. There’s good cause to be anxious. We’re not in a good place and this is the fallout.”

She said there’s been a continual rising trend on mental issues for at least the past decade, adding suicide rates increased every year for people 10 to 24 years old since 2007.

Roy said there has been a notable increase in the lower end of that age range ending up in the emergency room with acute mental health issues.

“I’m not sure that they are at the biggest risk, but they certainly are a growing number,” she said.

Pandemic leads to more issues for youth

Santos said there has been a significant rise in demand for mental health services at Connecticut Children’s Medical Center

“One of the things that COVID has shown us as well, is we are all trying to manage our mental health. Even if you don’t get diagnosed with a mental health condition I think we are all, or a majority of people, are dealing with types of stress, symptoms of anxiety or symptoms of sadness,” she said.

Studies about youth mental health coming out from the pandemic, such as one by The Journal of the American Medical Association, are showing depression and anxiety issues have doubled over the pandemic, said Franc Hudspeth, the chair of Sacred Heart University’s counselor education program.

“We went from a place where 10 or 11 percent (of young people said they had those issues) to 20, 25 percent,” he said. “That goes along with suicidal ideations. There’s data that supports that as well.”

Hudspeth said there are large increases in suicide attempts and trips to emergency rooms for mental health related issues during the pandemic.

“We really begin to see this dramatic increase as the first shutdown happened,” he said. “It seems to be this dramatic increase is more connected to all the things that have happened in the last two, two-and-ahalf years during the pandemic.”

Hudspeth said young people were taken away from their routine and socialization. He said sudden shifts to remote learning in the beginning of the pandemic was a rough period for America’s youth, and inconsistencies continued as schools shut-down for COVID-19 outbreaks the following school year.

If everything just went to online education and stayed that way, Hudspeth said, young people would get accustomed to it. But going back and forth has impacted student learning and mental health.

McClure said the isolation that came with pandemic lockdowns took away social support networks and face-to-face contact. She said studies at Fairfield University have shown that people who used social media more often than others before the pandemic had a harder time during it.

Even when students returned to school, the issues persisted. Burke said going back to school was celebrated as a return to normal, but many kids and teens were not fully prepared for this sudden reimmersion.

“Interpersonal skills were lacking from being away from friends for so long,” he said. “Academic skills and appropriate classroom behavior were lost with classes done via Zoom. Many kids are still struggling to catch up both academically as well as socially.”

Roy and Hudspeth said economic, housing, employment and food security issues at home also contributed to the rise in mental health issues over the pandemic.

“All those inconsistencies are the foundation of anxiety,” Hudspeth said. “It’s kind of a compounding effect.”

Hudspeth said stress and anxiety can go hand-inhand with depression, as young people start to feel things are overwhelming and unable to change.

“It all feeds into each other,” he said. “If you look at anxiety and depression, they’re not mutually exclusive.”

‘We have an opportunity’

Hudspeth said routine and stability will help address some of the mental health issues young people are experiencing. Getting exercise, vaving a regular sleep and school schedule and limiting screen-use can help.

Hudspeth said getting mental health care carries less stigma than it used to, so parents and teachers have been better at recognizing mental health issues in young people and reporting them. He said a lot of focus in the past year or so has been put on how the pandemic and the changes that came with it are impacting children.

“There’s been a big change in education,” he said. “There’s been a better focus on … trauma-informed education and how (it) is different than typical education.”

Hudspeth said training people in mental health first aid, the skills to respond to the signs of mental illness and substance use, is another way to take a community approach to assisting youth in mental health struggles.

Burke said it is important to recognize the importance of early intervention. He said treatment accessibility and affordability have never been more important to address this growing need.

“Parents need to know who to turn to in a crisis and where to get the help their child needs,” he said.

McClure said this younger generation is a lot more open to talking about mental health struggles, which is a big step forward. She said there is an opportunity to put together supportive programs in schools to continue those important conversations.

“I would love to see mental health be part of the typical health curriculum in high school,” she said, adding young people she talks to often do not know what to do or say if their friend discloses something about their mental health. “We have an opportunity to also give them the tools — to also be supports for each other.”

Training teachers and other staff about mental health warning signs and how to manage those types of issues is another approach that can be taken, McClure said. But there are already a lot of resources available and nobody struggling should be afraid to ask for help.

“Don’t feel like you should suffer in silence and endure,” she said. “Definitely ask for help, because there are people that really want to help.”

Roy said addressing the issue is a challenge, made worse by teachers and mental health professionals leaving their fields at an increasing rate.

Hudspeth said people working in the mental health field have long waiting lists.

“That’s nationwide and even in other countries,” he said. “There’s not enough therapists out there to see all the people that need to be seen.”

Hudspeth said it is projected that need for therapists will increase 25 percent over the next decade, along with a 12-to-15 percent increase in demand for social workers.

Roy said the push to include social-emotional learning in school curriculum would be beneficial.

“The challenge is getting teachers to add one more thing to their already heavy workload,” she said.

Roy said teachers will need education and support to include that in their curriculum. She said increasing mental health services in K-12, such as a school psychologist, is helpful.

“But our approach at Jed is much more of a public health approach where everyone on campus has a role to play in supporting mental health,” she said. “It’s not just about getting direct clinical services.”

Roy said it involves everyone offering a warm hand to someone they see beginning to struggle. Simply reaching out and knowing what to say is helpful, she said, as is knowing what resources to direct students with more acute issues to.

“We’re really talking, both in the (K-12 grades) and on college campuses, about developing a culture of caring and compassion, where there’s really no wrong door for a student to walk through for support,” she said. “You can add all the counselors in the world, and unless you’re taking a broader approach ... that’s not by itself going to rectify the situation.”

Santos said it is important to note that COVID-19 going away is not going to mean the mental health issues go away.

“We know from research that crises like this last for a long time. The data from Sept. 11, the people that lost people or were exposed to Sept. 11, still have a higher rate of depression and anxiety 20 years later,” she said. “People need to understand that we still have a long road in terms of dealing with mental and the kids’ mental health crises. I think it’s great that we are investing and talking about it and normalizing the discussions on it, but I still think we have a long way to go.”

Justin Paget / Getty Images Experts are concerned about a growing mental health crisis among children and adolescents triggered by prolonged isolation, uncertainty and grief during the coronavirus pandemic.