A new study finds that while the overall impact of the COVID-19 pandemic on the mental health of young Americans may not have been as great as many feared, its effects have been varied.
The study, published this week in JAMA Network Open, found that the pandemic has only modest changes to young people's overall mental health: While certain groups of US children have seen increases in feelings of distress, depressive symptoms, and externalizing behaviors (such as acting out), some kids who entered the U.S. with mental health issues during the pandemic actually saw improvements.
“Our study shows that the pandemic's impact on children varies based on their individual characteristics, and that average changes across a youth population may not fully capture these differences,” first author Courtney Blackwell, PhD, of Northwestern University Feinberg School of Medicine, said in the study's press release.
Researchers from the National Institutes of Health (NIH)-funded Environmental Influences on Child Health Outcomes (ECHO) program say their findings add some nuance to the widely held belief that the pandemic and associated containment measures have exacerbated mental health problems among young people in the U.S., and could inform future efforts to support young people during social upheaval.
Benefits for people with mental health problems
The study included a socially and economically diverse cohort of US children aged 6–17 years from nine ECHO cohort study sites in the US who completed Child Behaviour Checklist (CBCL) school-age assessments before (January 2015–March 12, 2020) or during the pandemic (March 13, 2020–August 31, 2022). The CBCL is a widely used questionnaire to assess behavioural and emotional problems.
Of the 1,229 children surveyed, 51.7% were white, 31.6% were black, 12.0% were mixed race, 9.6% were Hispanic, and 3.3% were other races. Just over half (50.9%) were girls, and 18.7% came from homes earning less than 130% of the poverty level.
The researchers used CBCL data to measure changes in scores for introversion, extroversion, depression, anxiety, and attention-deficit hyperactivity disorder (ADHD) from pre- to mid-pandemic. They also analyzed differences in children's sociodemographic characteristics and outcome trajectories by pre-pandemic mental health problems. The researchers hypothesized that the pandemic would be associated with an increase in youth mental health problems.
Our research shows that the impact of the pandemic on children varies depending on their individual characteristics, and average changes across a youth population do not fully capture these differences.
But overall, the analysis found small decreases in externalizing problems, anxiety, and ADHD, and small increases in depression among youth. When the researchers looked at changes in mental health by sociodemographic characteristics, they found that black children from low-income families had small decreases in internalizing distress, depression, and ADHD compared with higher-income white youth, that girls had small increases in externalizing behaviors compared with boys, and that children aged 12 and older had increases in feelings of distress and symptoms of depression compared with younger children.
Most surprisingly, the researchers found that youth with borderline or clinically significant pre-pandemic CBCL scores experienced declines in all outcomes measured, with the largest declines seen in externalizing problems and ADHD.
“For these children, relief from school-related stress and demands may have had a positive impact on their mental health,” said the study's lead author, Kaja Lewin, Sc.D., Ph.D., of the University of California, San Francisco.
The findings could help identify at-risk children.
The authors note that addressing youth mental health is warranted, given the documented increase in mental health problems among U.S. youth prior to the pandemic, but their findings suggest future efforts should focus on individual characteristics.
“By identifying which individual characteristics are associated with better mental health and which are associated with worsening mental health, we can better target interventions to those most at risk, while also identifying potential resilience factors that may help protect young people's mental health even in times of major social and economic crisis,” Blackwell said.
They also recommend that future studies should investigate school closures and other pandemic-related social restrictions to get a fuller picture of the pandemic's impact on young people.
