In Nation’s Health

Doctors describe wave among adolescent­s

- G. Wayne Miller

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.”

 ?? KRIS CRAIG/USA TODAY NETWORK ?? The Choiniere family – Bella, 16, Ben, 13, and parents Amanda and Cliff – at their home in Cumberland, Rhode Island. Amanda says her children have struggled emotionall­y during COVID isolation.
KRIS CRAIG/USA TODAY NETWORK The Choiniere family – Bella, 16, Ben, 13, and parents Amanda and Cliff – at their home in Cumberland, Rhode Island. Amanda says her children have struggled emotionall­y during COVID isolation.
 ?? PHOTOS BY DAVID DELPOIO/USA TODAY NETWORK ?? Dr. Brian Alverson is shocked by the recent data on young adults' mental health in Rhode Island.
PHOTOS BY DAVID DELPOIO/USA TODAY NETWORK Dr. Brian Alverson is shocked by the recent data on young adults' mental health in Rhode Island.
 ??  ?? “We’re in the midst of the mental health wave,” Margaret R. Paccione of Bradley Hospital said.
“We’re in the midst of the mental health wave,” Margaret R. Paccione of Bradley Hospital said.
 ??  ?? Butler Hospital psychiatri­st Tammi-Marie Phillip urged families to be attentive to “red flags.”
Butler Hospital psychiatri­st Tammi-Marie Phillip urged families to be attentive to “red flags.”

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