USA TODAY US Edition
In Nation’s Health
Doctors describe wave among adolescents
Doctors describe “massive pandemic of mentally ill adolescents.”
CUMBERLAND, R.I. – As the coronavirus pandemic stretched from days to weeks to months without end, the mental health of Amanda Choiniere’s daughter Isabella, 16, and son, Ben, 13, began to suffer. Homeschooling, social isolation and the transformation of life to the netherworld they and many other children now inhabit exacted a price.
“When a 13-year-old and a 16-yearold can no longer play sports that they usually play or interact with friends they usually hang out with on a normal basis, that impacts, of course, their mental health status,” said Choiniere, who works, remotely now, for Adoption Rhode Island.
Ben, who attends middle school, finds himself frequently frustrated, his mother said.
“We all know already how hard middle school is for anybody, never mind if you compact it with being home and having to try and learn and having learning disabilities on top of it,” Choiniere said. “There’s lots of not understanding, lots of mom needing to be next to him the entire day to make sure that he’s OK.”
Isabella, her mother said, is taking college-level classes at high school, “and she puts extra pressure on herself and wants to be a perfectionist. Because she’s had to do it from home and not gotten that extra help at school – and I’m also working full-time, from home, and can’t give her that 100% – it’s been a little bit tough.”
And, at times for Bella, more than a little.
“We even had to utilize (Bradley) Hospital at one point, because it became that significant,” Choiniere said. “She was feeling pretty helpless, and while we have a very open relationship with communication, she even felt like she couldn’t talk to my husband and I.”
The children of Amanda and Cliff Choiniere, a produce merchandiser for Seabra Foods, are adopted: biological siblings, they came to their family from difficult circumstances that the pandemic exacerbated.
“So, yeah, the pandemic has hit us hard,” Amanda told The Journal. “My kiddos, both Bella and Ben, have pretty rough trauma histories, as well as complex medical needs. For the past year, they have been home, and their life has sort of stopped.”
‘Pandemic’ of mental illness
Dr. Brian Alverson understands the difficulties facing the Choiniere family and many others. As the director of the Division of Pediatric Hospital Medicine at Hasbro Children’s Hospital, he has witnessed what he described to The Providence Journal, part of the USA TODAY Network, as “a massive pandemic of mentally ill adolescents,” many of them admitted to Hasbro Children’s.
“And when I say massive, I don’t want to understate this,” said Alverson, who is also a professor of pediatrics at the Alpert School of Medicine at Brown University.
He referred to a recent Friday “when I looked at the census of the hospital. Three-quarters of the hospital was adolescents who wanted to hurt themselves because of mental illness.”
With a capacity of 87 beds at Hasbro Children’s, 65 or so of the inpatients were young people in psychiatric crisis, most of them awaiting transfer to Bradley or Butler hospitals or other psychiatric programs, which themselves are seeing unprecedented demand during the pandemic.
The root causes, Alverson said, can be found in the same withering of existence that has affected the Choiniere children.
“Adolescence emphasizes the needs for socialization,” he said. “It’s important developmentally to reach this period when you need to rely on friends as much as you do previously on family. It’s a time to explore outside the family domain” – a time “to go to each others’ houses and have these experiences, learn how to get along, how to fight, how to disagree, how to fall in love. Those are all normative.”
Or were, until March 14 of last year, when schools closed and mounting cases of COVID forced an end to many
During the interview, Alverson referenced an article that ran in the November issue of the Journal of the American Academy of Child & Adolescent Psychiatry, the profession’s gold-standard publication. “Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19” depicted a crisis that has been called The Mental Health Wave (one afflicting adults, too).
“Children and adolescents are experiencing a prolonged state of physical isolation from their peers, teachers, extended families, and community networks,” the authors wrote. “Duration of quarantine, fear of infection, boredom, frustration, lack of necessary supplies, lack of information, financial loss, and stigma appear to increase the risk of negative psychological outcomes.
“Social distancing and school closures may therefore increase mental health problems in children and adolescents, already at higher risk of developing mental health problems compared to adults at a time when they are also experiencing anxiety over a health threat and threats to family employment/income.”
In an email, Rhode Island Health Department spokesman Joseph Wendelken said his office has “not observed an increase in the number of suicides to date” but the proportion of emergencydepartment visits among Rhode Islanders age 10 to 17 “relating to suicidal thoughts and actions was approximately two times higher during March to June 2020 when compared to March to June 2019. 7.3% of youth (emergency department) visits in March to June 2020 were relating to suicidal thoughts and actions compared to 3.5% of youth ED visits in March to June 2019.”
Further data was not immediately available.
Social bonds broken
Dr. Margaret R. Paccione director of clinical innovation at Bradley Hospital, outlined the circumstances children have faced for nearly a year now.
“How do you explain to a young child that they can’t go to their after-school program or can’t see other kids or play with other kids?” she said. “How can children develop relationships with other kids or adults if they have masks and can’t read facial expressions?
“And when you get a little bit older, how do kids date or form relationships when social distancing is in place or schools for the most part are remote? All these experiences are really, really vital to child and adolescent development, and so you subtract out those experiences, and it’s been a really challenging year.”
Paccione said she and her colleagues are describing the situation as “the mental health wave following the COVID wave. What we’re seeing is a bump up of child anxiety, depression and suicidality. And we’re seeing that in the emergency rooms and we’re seeing it in outpatient services. We’re seeing it in the schools. We’re in the midst of the mental health wave – and we’re even bracing ourselves for more to follow.”
Suicidal thoughts – ideation – are a particular concern to the Bradley staff, and Paccione said the hospital has several programs to help educate children, parents, teachers, clergy, librarians, health-care professionals and others about risks and warning signs –and to debunk myths.
Observing behaviors, listening, and talking candidly are critical, she said.
Heed ‘red flags’
Child and adolescent psychiatrist Dr. Tammi-Marie Phillip is unit chief of the Adolescent Unit at Butler Hospital, a Care New England center. The unit has 15 beds, and Phillip said it has been “running at capacity” for months.
“It’s definitely hit crisis levels,” the psychiatrist said. “Back in the fall is when we really noticed that there was a huge uptick in the number of kids needing inpatient beds and higher-level-ofcare services. I remember being on meetings and there would be 20 to 30 kids every day in different [emergency departments] around the state waiting for an inpatient bed.
“And that was something that we hadn’t seen before, for sure, not to that level in any way, shape or form. We would get kids on the unit who had been waiting in emergency rooms for a week or a week and a half before even coming to us to start treatment.”
Symptoms run the gamut, Phillip said.
“We’ve been seeing significant depressive symptoms and anxiety symptoms a lot,” she said. “And a higher frequency of kids who are coming in because of suicide attempts –and very serious suicide attempts. … We’ve been seeing more irritability and aggression in the home. We’ve been seeing more psychosis as well.”
Phillip’s advice? Pay attention to “red flags,” as she called them.
“If your child seems more anxious, is having more physical complaints, more trouble with sleep, they’re more isolative, not communicating with you as much, check in with your pediatrician and say, ‘Hey, I’m seeing this with my child. I’m concerned.’
“I think the earlier we can intervene, the better it is for everyone involved. And just keeping up that communication with kids as parents. Just trying as hard as we can to keep communicating with our kids and knowing the only way we’re going to get through this is together.”
‘No one is going to judge you’
The children of Amanda and Cliff Choiniere shared their feelings with The Journal using their mother’s email.
“It’s hard not being able to hang out with my friends,” 13-year-old Ben wrote. “I really miss playing soccer.”
Wrote his 16-year-old sister, Bella: “It’s been really hard for me to have to stay at home and not see my friends, because as a teenager, I want to just hang out with my friends. I also haven’t been able to go to school. This has made it tougher for me to learn. All of this has made my anxiety really high and things have just been hard!”
But, she added: “I know that this is what I have to do though to protect myself from COVID!”
These days, the Choinieres receive services from Woonsocket-based Community Care Alliance “that address both our family’s needs and each individual child’s needs,” Amanda Choiniere said.
The mother had this message for other families in distress:
“I know many people get embarrassed by reaching out. I will tell you as a professional that I had to put all of that aside and say, ‘It’s important for my family to get the services we need, because we need to be an intact family that’s healthy.’ And so reaching out was important. No one is going to judge you for reaching out. Don’t ever hesitate.”