Anxiety, depression in kids double during pandemic; teens, girls most at risk: study

CALGARY – Yet another study has come out showing just how much our kids’ mental health has suffered through the pandemic.

According to a meta-analysis from the University of Calgary, which took from studies around the world and followed a combined 80,879 kids, symptoms of anxiety and depression doubled in children and teens when compared to pre-pandemic times.

The school recently published its latest research in the medical journal JAMA Pediatrics and says it’s further proof of a worldwide mental health crisis.

“Estimates show that one in four youth globally is experiencing clinically elevated depression symptoms while one in five has clinically elevated anxiety symptoms,” shared Dr. Nicole Racine, a clinical psychologist and the lead author of the paper.

Older teens and girls were found to be experiencing the highest levels of anxiety and depression.

Dr. Sheri Madigan, a U of C clinical psychologist and Canada Research Chair in Determinants of Child Development, says rates fluctuated when the COVID-19 restrictions changed where they lived.

“When more restrictions are imposed, rates go up. Being socially isolated, kept away from their friends, their school routines, and social interactions have proven to be really hard on kids,” said Madigan, who co-authored the paper.

“When COVID-19 started, most people thought it would be difficult at the outset but that kids would be better over time, as they adjusted and got back to school. But when the pandemic persisted, youth missed a lot of milestones in their lives. It went on for well over a year and for young people that’s a really substantial period of their lives.”

Racine and Madigan say symptoms are compounding in kids as the pandemic goes on, and a major continuer is the fact that kids aren’t able to predict what comes next.

“It’s disjointing for kids because they can’t predict what their environment is going to look like, and we know when their world lacks predictability and controllability, their mental suffers,” explained Madigan.

And neither doctor can say if or when kids will bounce back.

In any case, the U of C team is suggesting more supports be put in place for kids struggling with their mental health

“Long before the pandemic, we had a youth mental health system that was stretched and lacking resources. A potential doubling of mental health difficulties will overwhelm that system without a significant increase in resources,” said Racine.

“If we want to mitigate the sustained mental health effects of COVID-19, because of the chronic stressors our youth experienced, we have to prioritize recovery planning now. Not when the pandemic is over, but immediately. Because kids are in crisis right now,” added Madigan.

Suicidal crises, mental fatigue: Kids grapple with reentry

After two suicidal crises during pandemic isolation, 16-year-old Zach Sampson feels stronger but worries his social skills have gone stale.

Amara Bhatia has overcome her pandemic depression but the teen feels worn down, in a state of “neutralness.” Virginia Shipp is adjusting but says returning to normal “is kind of unnormal for me.’’

After relentless months of social distancing, online schooling and other restrictions, many kids are feeling the pandemic’s toll or facing new challenges navigating reentry.

A surge in teen suicide attempts and other mental health crises prompted Children’s Hospital Colorado to declare a state of emergency in late May, when emergency department and hospital inpatient beds were overrun with suicidal kids and those struggling with other psychiatric problems. Typical emergency-department waiting times for psychiatric treatment doubled in May to about 20 hours, said Jason Williams, a pediatric psychologist at the hospital in Aurora.

Other children’s hospitals are facing similar challenges.

In typical times, the activities that come as the school year ends — finals, prom, graduations, summer job-seeking — can be stressful even for the most resilient kids. But after more than a year of dealing with pandemic restrictions, many are worn down and simply don’t “have enough in the tank of resilience’’ to handle stresses that previously would have been manageable, Williams said.

“When the pandemic first hit, we saw a rise in severe cases in crisis evaluation,’’ as kids struggled with “their whole world shutting down,’’ said Christine Certain, a mental health counselor who works with Orlando Health’s Arnold Palmer Hospital for Children. ‘’Now, as we see the world opening back up, … it’s asking these kids to make a huge shift again.’’

At some children’s hospitals, psychiatric cases have remained high throughout the pandemic; others have seen a more recent surge.

At Wolfson Children’ Hospital in Jacksonville, Florida, behavioral unit admissions for kids in crisis aged 13 and younger have been soaring since 2020 and are on pace to reach 230 this year, more than four times higher than in 2019, said hospital psychologist Terrie Andrews. For older teens, admissions were up to five times higher than usual last year and remained elevated as of last month.

At Dayton Children’s Hospital in Ohio, admissions to the mental health unit increased by 30% from July 2020 through May, totaling almost 1,300. The hospital doubled the number of available beds to 24 and dropped the minimum age for treatment to 9 years from 12 years, said Dr. John Duby, a hospital vice president.

“The overwhelming demand for pediatric mental health services is putting an unprecedented strain on pediatric facilities, primary care, schools and community-based organizations that support kids’ well-being,” said Amy Knight, president of the Children’s Hospital Association.

Dr. Alison Tothy, medical director of the pediatric emergency department at the University of Chicago’s Comer Children’s Hospital, said her ER has seen kids in crisis daily since last year, struggling with suicidal thoughts, cutting and other self-harm behaviors, depression and aggressive outbursts. Kids are stabilized and referred elsewhere for treatment.

“Families are coming to us because we are, in some cases, the last resort. Outpatient resources are scarce,’’ and parents say they can’t get an appointment for two months, she said.

In Florida, waits for outpatient treatment are even longer and many therapists don’t accept kids insured through Medicaid, Andrews said.

At Children’s Hospital Colorado, emergency department visits for behavioral health problems were up 90% in April 2021 over April 2019 and remained high in May. Though the pace slowed in June, hospital authorities are concerned about another spike when school resumes.

Williams said issues the hospital is treating are “across the board,’’ from children with previous mental health issues that have worsened to those who never struggled before the pandemic.

Like many states, Colorado doesn’t have enough child and teen mental health therapists to meet demand, an issue even before the pandemic, Williams said.

Children who need outpatient treatment are finding it takes six to nine months for an appointment. And many therapists don’t accept health insurance, leaving struggling families with few options. Delays in treatment can lead to crises that land kids in the ER.

Those who improve after inpatient psychiatric care but aren’t well enough to go home are being sent out of state because there aren’t enough facilities in Colorado, Williams said.

Sampson says “just a lot of stuff’’ triggered his first crisis last August. The Jacksonville, Florida, teen struggled with online education and spent hours in his room alone playing video games and scrolling the internet, drawn to dark sites that “made my brain hurt.’’

He revealed his suicidal thoughts to a friend, who called the police. He spent a week in the hospital under psychiatric care.

Both his parents have worked in mental health jobs but had no idea how he was struggling.

“We had realized he had been spending more time isolating, not really tending to showering and that type of stuff, but we were in the middle of a pandemic. No one was really doing those things,’’ said his mother, Jennifer Sampson.

The teen started virtual psychotherapy but in March his self-destructive thoughts resurfaced. Hospital psychiatric beds were full so he waited a week in a holding area to receive treatment, his mother recalled.

Now on mood stabilizers, he’s continuing therapist visits, has finished sophomore year and is looking forward to returning to in-person school this fall. Still, he says it’s hard motivating himself to leave the house to go to the gym or hang out with friends.

“I definitely find my social skills are rusty,’’ Sampson said.

“I feel that this is going to be something that we’re dealing with for quite a while,’’ his mother said.

That’s likely true, too, for those who haven’t reached a crisis point.

Bhatia, a 17-year-old self-described “stereotypical introvert’’ with clinical anxiety, also worries about returning to the classroom for senior year.

The Oakland, California, teen says the pandemic began as almost a welcome change. Being social takes effort, and isolation allowed her to recharge. Still, she had bouts of depression, got frustrated with virtual school and missed her friends.

She used to be a hugger but has become “a bit more of a germaphobe” and says the few times she’s been hugged since social distancing restrictions lifted, she froze.

The pandemic has left her worn down, “like running a marathon, and I’m finally reaching the end and I’m just getting so tired at this point.’’

“I think I don’t have the energy for happiness,’’ she said.

For 18-year-old Shipp, also of Oakland, the pandemic hit in her senior year as she was planning a trip to Europe and anticipating college in the fall. Neither happened and she described 2020 as a year of negative thinking, stuck in her room alone with her thoughts.

“I felt depressed and anxious and very scared for the future,’’ she said.

As a Black woman, she wanted to join marchers protesting George Floyd’s murder but decided close contact with strangers was too risky.

She doesn’t know anyone who got very sick or died, but says she worried about COVID-19 “every single day.’’ Shipp used meditation to help relieve stress.

She recently got vaccinated and learned college at Cal Poly in Pomona will be in person in the fall. But she’s not sure she’s completely ready.

“It’s still a little weird because now, all of a sudden … you don’t need to wear the mask? It’s like jumping into the water too fast,’’ Shipp said. “The normalcy is kind of unnormal for me.’’

Experts say student mental wellness should be top priority as kids return to class

Catherine Monias can’t wait for the day she sees the buses pull up outside her office and the kids from her remote Manitoba First Nation stream back into the hallways following months of their schools being forced closed by COVID-19.

But it will be slightly different for the children from the Garden Hill First Nation, a fly-in community about 600 kilometres northeast of Winnipeg. Monias said education leaders have had to make one of the toughest decisions since the pandemic began: all students will be repeating their grade in the coming school year.

“It’s been rough,” said Monias, the Indigenous community’s education director.

“This year, with the full lockdown, we feel like we didn’t accomplish the grade level that they should be in for the next school year.”

Educators across the country are making plans to have students return to classes full time next fall. Many parents are worried what more than a year of disrupted schooling has meant for their children.

Experts say kids’ social and emotional needs and patience with academic achievements will be paramount when classroom doors reopen.

“They have just lived through something that is unprecedented,” said Tracy Vaillancourt, an education professor at the University of Ottawa, who specializes in research on children’s mental health.

“They are going to need a bit more care and attention than they have in the past.”

Vaillancourt is working with others on a report about the pandemic’s effects on children. The team recently warned the Ontario government that “we are on the cusp of a generational catastrophe.”

Kids have been in and out of classrooms as waves of infection caused school shutdowns. Many have moved to online or remote classes, but that’s not possible everywhere, and even that option is not always ideal.

Back in Garden Hill, Monias knows well how the families of about 1,200 students struggled when the elementary and high school first were closed in March 2020.

She is raising three school-aged grandchildren following the death of her son.

Many of her grandchildren’s classmates didn’t have access to laptops, tablets or smartphones. Monias researched the cost of getting laptops to kids that needed them. It would have been more than $1.2 million.

Even for children who did have the technology, the internet bandwidth in the community is too weak to broadcast classes successfully.

The First Nation’s students went back to classes last fall, but that ended soon after as infection rates surged. The military flew in to help get spread of the virus under control and the schools were turned into isolation centres.

“These last 15 months have been harrowing,” Monias said.

Teachers handed out educational packages door to door, but Monias said it became clear that if they wanted the kids to have their best foot forward by graduation, they needed to hold them back.

“I want to see my people prosper and be in good health and my community to prosper.”

Vaillancourt said she has not heard of any other schools making the same choice, but added that Garden Hill’s situation is unique and leaders there know what’s best for those students.

Educators for decades have tended not to have students repeat a grade, because it’s felt that can create stigma for the child in the classroom later on, she said.

What’s of utmost importance right now, she said, is giving children stability and supporting their mental well-being. That is unlikely to be achieved if they stay in the same grade, she suggested.

“If we focus on their social and emotional needs first, and get them well and healthy and ready to learn, they are going to catch up pretty quickly.”

Laurie French, president of the Canadian School Boards Association, said a one-size-fits-all strategy won’t work in most cases. She doesn’t expect to see many other schools following Garden Hill’s lead.

“We need to consider each student’s situation … and what is the right choice for them,” said French, who added she disagrees with those who say the school year has been a write off.

She encourages parents to talk with teachers and school boards if they are worried.

Boards also need to work with public health partners, French said. All plans needs to be geared to meet the needs of kids in a specific community.

The pandemic has underscored disparities in education for children who are marginalized, living in racialized communities or whose schools can’t afford to purchase computers or tablets, she said.

“The gap has widened during this.”

Schools also need to look at what changes during the pandemic have worked, French suggested.

Some students have thrived learning online and classes that wouldn’t have been an option were available.

“Before we rush back to normal, let’s really think about what normal we really want to rush back to.”