Mental Health Problems for Kids on the Rise with COVID Pandemic

The U.S. surgeon general recently sounded an alarm about a mental health crisis gripping the nation’s children and adolescents.

Intensified by the pandemic, symptoms of depression and anxiety have spiked, as have emergency room visits for mental health issues. ER visits for suspected suicide attempts among adolescent girls jumped more than 50 percent from early 2019 to early 2021, according to Surgeon General Vivek Murthy’s public health advisory.

University Hospitals Rainbow Babies & Children’s child and adolescent psychiatrist Mary Gabriel, MD, explains what’s happening and what can be done about it.

Q. Hasn’t this crisis been years in the making?

A. Even before the pandemic started, kids were already operating with a very small margin of reserve to handle any extra stressors that came their way. We were already seeing a significant rise in mental health concerns in children.

The effects of social media, academic stress, families being pushed to their limit in their ability to cope with stressors, already had set up kids to be in a precarious position. In November 2019, the Ohio Department of Health released a new statistic that suicide was the No. 1 cause of death in 10- to 14-year-olds. It had never reached that before. There has been a steady increase in the number of diagnoses of mental illness. Suicide attempt rates and suicide completion rates have been increasing.

Q. What are some of the root causes that need attention?

A. The contributing factors that need to be addressed regardless of the pandemic are adverse childhood events and social determinants of health (social, economic and environmental conditions that impact health). We need to address social engagements kids encounter that are unhealthy, and support parents who are dealing with their own stressors in life.

We need more resources devoted to accessing  mental healthcare, but we also need to make sure kids have enough food. We need to help families maintain an address and keep them from ending up in a shelter. Let’s help the single parent who is caring for children on their own with supports such as day care. That creates bandwidth for them to tend to their kids, enjoy them and bond with them, creating secure attachment and ultimately increasing resilience in their children.

Q. How has the pandemic amplified mental health problems?

A. The abrupt closure and lockdown were traumatic for children because their whole sense of routine, their sense of stability and belonging were cut off. All of those things support critical developmental stages that children have to go through, and we arrested that.  You don’t just jump ahead and pick up a year and a half later. You have to address things that were arrested at that time.

There are particular populations of children that are really high risk. Children who have intellectual and learning disabilities suddenly had no support and were still expected to perform. Then there are children who live in houses that are not safe. They live in environments that are abusive or neglectful, and they were stuck there. School used to be a reprieve for them, and suddenly they were with their abusers 24/7. That’s traumatizing.  Additionally, the usual child-welfare reporters -- teachers, neighbors, etc. -- were now cut off from these children, leaving no one to bear witness and report the abuse, and the children had no one advocating for them.

There also are children who did not experience overt physical abuse, but maybe emotional or verbal abuse in the forms of not being accepted by their caregivers. Namely LGBTQ children, who struggle with being accepted in their homes and who face threats all the time. They had nowhere to go. That takes a toll and puts them at incredibly high risk.

The repercussions of what’s been going on the last 18 months, almost 2 years now, has really tipped kids over, and they’re not able to compensate despite their best efforts.

Q. What about all the kids who lost a caregiver to COVID-19?

A. They suffered tremendous losses and because of quarantine they weren’t allowed to grieve in ways that we as social beings need to be able to grieve. There was nobody whose arms you could fall into, there was nobody with whom to process and unpack in an informal and organic way, with a counselor, a teacher, with neighbors or whoever. You didn’t have physical access to any of these people. That’s a burden children carry with them, and that doesn’t go away once the pandemic ends.

Q. Is there an age group that’s particularly vulnerable?

A. They all are in their own ways. When you’re in high school, you may understand what’s happening better. But your developmental task is your identity, which comes from socialization, encountering different kinds of people. I tell teenagers, it’s almost like going clothes shopping. You try on a shirt. Does it fit me? Is this who I am?  In the same way, you try on different personas. You’re trying to figure out who you are, what you believe in, and it requires social engagement.

And all they were left with was social media,  which is unvetted, unfiltered and unbalanced. And so, the different clothes you’re offered to try on are skewed in the range of options, not reflective of how we truly are, and thus not true to fit. They’re really distorted. If that’s all you have, you start to feel like you don’t fit anywhere, which is incredibly lonely.

Q. What can individuals do to make kids’ lives better?

A. Caregivers need to be aware of the importance of tending to their own health. Children are completely dependent on adults in their lives. They are very dependent on the well-being of their caregivers. Taking care of yourself and your problems also models to children that self-care is important. Taking time to reflect and recognize where you are, how you’re doing, and seeking out those things that support your well-being are really important skills to have. Children pick up on these messages.

As adults are able to do that, they become secure bases for their children. They model how to be okay and then provide a safe, secure place for their children to attach. We know that having that one stable adult in their life is incredibly protective for a child’s well-being and really defines a lot of their trajectory in life.

Q. What else?

A. I always want to make sure children and adolescents are socially connected in positive  ways.  Whether participating in a community program or being on a team, they are engaged with others and that is incredibly protective. That sense of connection and belonging is so much an anchor in our lives. For kids who are very withdrawn and isolated, who don’t feel connected to anyone, there’s nothing to anchor them. That’s where we contend with suicidality in a lot of kids.

Children as young as 6 we see in the clinic are clinically depressed, and one of the hallmarks of that is feelings of isolation and aloneness.

It’s important that adults recognize how a child is doing, pick up on red flags early so you can intervene and prevent progression toward true mental illness.  I think more emphasis needs to be placed on educating the adults in children’s lives -- parents, teachers, coaches, scout leaders, pastors -- about children’s mental health, what health looks like and the signs to take note of in children who are struggling.

What does a struggling child look like? A lot of it is behavior. Kids, especially who are younger, don’t have the language to express how they’re  feeling, so it manifests in other ways. That irritability, crankiness, frustration can represent adjustment challenges, anxiety and emerging depression.

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