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Mental health is an important part of overall adolescent well-being. It not only impacts thoughts, emotions and behaviors, but it can take a toll on one’s physical health. Mental health is a complicated continuum that is influenced by things that are often out of an individual’s control – like the COVID-19 pandemic. Even before the pandemic, 40% of U.S. children experienced a mental illness at some point before their 18th birthday,[i] and 36.7% of high school students in 2019 reported persistent feelings of sadness or hopelessness in the past year (up 40% in 10 years).[ii] Recently released data from the Centers for Disease Control and Prevention (CDC) suggests that the mental health of youth has only worsened since the onset of the pandemic.iii

“As the pandemic raged on, there was a growing amount of concern among not just public health officials, but everyday Americans, about what the mental health implications would be – especially amongst our kids,” said Kristin Mattson, MPH, MCHES, ORAU health education specialist.  “People were speaking up about what they were experiencing. Even before we were able to quantify the increase in poor mental health, we knew it was happening, and it enhanced everyone’s focus on promoting and implementing audience-tailored strategies that we know can improve mental health and emotional well-being.”.

Kristin Mattson has spent the majority of her career at ORAU working on health communication campaigns related to health and wellbeing. Her work has included supporting communication and marketing of CDC Healthy Schools’ tools and resources and leading an investigation into Adverse Childhood Experiences (ACEs) in Appalachia. The latter project helped identify factors that can increase resiliency in youth to mitigate the negative effects of ACEs for CDC’s National Center for Injury Prevention and Control.

A Morbidity and Mortality Weekly Report (MMWR) supplement released on April 1, 2022, by the CDC highlighted just how much had changed for U.S. high school students’ mental health during the COVID-19 pandemic.[iii] The report described findings from a 2021 nationwide survey, the Adolescent Behaviors and Experiences Survey (ABES), which found that 44.2% of high school students were now reporting persistent feelings of sadness or hopelessness.iii While not a direct comparison, this suggests mental health is getting worse given an increase from the previously reported 36.7% in 2019 from the Youth Risk Behavior Survey (YRBS).

Michelle Schaur, MPH, also a health education specialist at ORAU, has been supporting the CDC’s Office of Minority Health and Health Equity’s efforts to build the capacity of local and national organizations serving communities of color to respond to the COVID-19 pandemic and future health issues. The organizations supported by this initiative, which engage communities to identify local needs related to the COVID-19 pandemic, confirm the concern about mental health among youth.

“Top-of-mind concerns for communities have shifted to include requests for local mental health resources and messaging that normalizes the feelings of social isolation, boredom, grief and stress that are commonly reported by youth during the COVID-19 pandemic,” Schaur said.

Common disruptions and adverse experiences encountered by many youth during the pandemic include school closures, social isolation, difficulty completing homework and family loss or illness. For some individuals, those consequences have been more severe and include family economic hardship, parental and personal job loss, emotional or physical abuse by a parent or other adult at home, reduced access to health care, homelessness and hunger.[iv] Some racial and ethnic minority and LGBTQ+ youth have experienced a disproportionate burden of these adverse experiences, which can negatively impact overall health and well-being. iv For example, according to the ABES survey findings, prevalence of emotional abuse by a parent or other adult in the home was higher among high school students who identified as LGBTQ+ (about 75%) compared with students who identified as heterosexual (50%).iv Also, the same survey found Black students were most likely to report hunger, with nearly a third reporting that there was not enough food in their home during the pandemic. iv

Perceived racism is also an important determinant of health that can negatively impact youth mental well-being.[v],[vi] According to the ABES survey, higher prevalence of perceived racism at school was reported among high school students with poor mental health than those who never experienced poor mental health (38.1% vs. 23.6%).vii Approximately one-third (35.6%) of all U.S. high school students reported perceived racism, but perceived racism was highest among Asian (63.9%), Black (55.2%), and multiracial students (54.5%).[vii]  

The social isolation, boredom, grief, economic insecurity and disruption in health care services experienced by youth during the pandemic are known risk factors for the development of both mental health conditions such as depression and substance use disorders.[viii] However, until the ABES survey, little was known about substance use among youth during the pandemic.  The survey data highlighted that, in addition to increased feelings of sadness or hopelessness, approximately one in three high school students who ever used alcohol or other drugs reported using these substances more during the pandemic.[ix] The prevalence of substance use was typically higher among non-Hispanic American Indian or Alaska Native students; older students; and gay, lesbian or bisexual students than among students of other racial or ethnic groups, younger students and heterosexual students. These differences in substance use among youth are consistent with those found in other nationally representative surveys of high school students conducted before the pandemic.[x],[xi]

The MMWR supplement report also revealed a silver lining: only 28.4% of students who felt close to persons at school experienced poor mental health during the pandemic versus 45.2% who did not feel close to persons at school.iii  This suggests youth that feel connected to persons at school may be somehow protected against poor mental health, and supports further research to explore the relationship between mental health among youth and school connectedness.

“We call these protective factors,” Mattson said. “There are many things that can be done to protect people and decrease the possibility that they will experience negative outcomes in response to stressful or traumatic events. One of the biggest protective factors we identified as part of our ACEs in Appalachia work was the presence of a supportive adult in a child’s life; and, it didn’t have to be a parent. It could be any adult that they were able to connect and feel safe with, like a coach or teacher.”

A better understanding of the impact of these adverse experiences on mental health, the drivers of the health disparities among some racial and ethnic minority and LGBTQ+ youth, and the protective role of social connectedness with family, community, and school can help guide local communities’ efforts to improve mental health among youth in the U.S.

“To effectively address the current mental health concerns of youth during and after the pandemic, these findings speak to the important role schools play in facilitating linkages to services that help students address the adverse experiences they face during the ongoing pandemic,” Schaur said. “Trainings for staff and students that promote cultural awareness, inclusivity and safe school environments for all students will also be an important part of a comprehensive strategy to promote adolescent mental health and well-being. In addition, we must continue research efforts to learn how we can eliminate health disparities. While doing so, it is imperative that we involve and incorporate perspectives from the populations we are studying into the design of any formative research activities or health interventions.”

Mental health issues, particularly among adolescents, are complicated. More needs to be done to connect young people to the mental health resources they need.

[i] https://doi.org/10.1016/j.jaac.2010.05.017  

[ii] https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/dash-mental-health.pdf

[iii] https://www.cdc.gov/mmwr/volumes/71/su/su7103a3.htm?s_cid=su7103a3_w  

[iv] https://www.cdc.gov/mmwr/volumes/71/su/su7103a5.htm?s_cid=su7103a5_w

[v] https://doi.org/10.1016/j.socscimed.2012.11.031

[vi] https://doi.org/10.1080/13557858.2012.730609

[vii] https://www.cdc.gov/mmwr/volumes/71/su/su7103a4.htm?s_cid=su7103a4_w

[viii] https://doi.org/10.1016/j.jsat.2020.108212

[ix] https://www.cdc.gov/mmwr/volumes/71/su/su7103a2.htm?s_cid=su7103a2_w

[x] https://doi.org/10.15585/mmwr.su6901a5

[xi]  https://doi.org/10.15585/mmwr.su6901a7