The impact of the COVID-19 pandemic on adolescent mental health: a natural experiment

Abstract

Despite widespread concern about the impact of COVID-19 on adolescent mental health, there remains limited empirical evidence that can causally attribute changes to the pandemic. The current study aimed to overcome existing methodological limitations by exploiting a serendipitously occurring natural experiment within two ongoing, multi-phase cluster randomized controlled trials. Depressive symptoms (primary outcome), externalizing difficulties and life satisfaction (secondary outcomes) were assessed at baseline (phase 1 [pre-COVID-19 group]: September – October 2018, phase 2 [COVID-19 group]: September – October 2019) and 1-year follow-up (pre-COVID-19 group: January – March 2020, COVID-19 group: February – April 2021). Participants in phase 1 ( N = 6419) acted as controls. In phase 2, participants ( N = 5031) were exposed to the COVID-19 pandemic between the baseline and follow-up assessments providing a natural experimental design. The primary analysis used a random intercept linear multivariable regression model with phase (exposure to the COVID-19 pandemic) included as the key predictor while controlling for baseline scores and individual and school-level covariates. Depressive symptoms were higher and life satisfaction scores lower in the group exposed to the COVID-19 pandemic. Had the COVID-19 pandemic not occurred, we estimate that there would be 6% fewer adolescents with high depressive symptoms. No effect of exposure to the pandemic on externalizing difficulties was found. Exploratory analyses to examine subgroup differences in impacts suggest that the negative impact of the COVID-19 pandemic on adolescent mental health may have been greater for females than males. Given the widespread concern over rising adolescent mental health difficulties prior to the pandemic, this paper quantifies the additional impacts of the pandemic. A properly resourced, multi-level, multi-sector public health approach for improving adolescent mental health is necessary. Following in-principle acceptance, the approved Stage 1 version of this manuscript was preregistered on the OSF at https://doi.org/10.17605/OSF.IO/B25DH . This preregistration was performed prior to data analysis.

The impact of universal, school based, interventions on help seeking in children and young people: a systematic literature review

“…Studies included in this review all occurred prior to the Covid-19 pandemic, due to the dates the search was undertaken. For many countries, the pandemic resulted in increased rates mental health difficulties in young people [ 81 , 82 ], as well as disruption to schooling and education [ 83 ] and the ability to access services for mental health support [ 84 ], all of which are relevant to the topic in this review. Future studies exploring universal, school-based, help-seeking interventions, should account for these wider factors, along with other structural barriers, previously highlighted in the literature [ 8 , 79 ].…”

Perceived stress, coping strategies, and mental health status among adolescents during the COVID-19 pandemic in Switzerland: a longitudinal study

“…Previous studies indicated a larger impact of the pandemic on girls [ 6 , 14 , 18 , 35 – 37 ], including large longitudinal studies with pre-pandemic comparison data [ 41 – 43 ]. Although we lack pre-pandemic comparison data, [ 6 , 14 , 18 , 35 – 37 ], our results showed that girls perceived more COVID-related stress and our study additionally shows that this extends to the second pandemic year.…”

“…Indeed, a large longitudinal study that included pre-pandemic comparison data indicated a stronger effect of the pandemic on girls’ total mental health difficulties, emotional symptoms, hyperactivity symptoms, and conduct problems as compared to boys [ 42 ]. Another longitudinal study with pre-pandemic data reported similarly evidence that the Covid-19 pandemic had a negative impact on girls’ but not on boys’ externalizing difficulties [ 41 ]. Considering the unprecedented and extraordinary nature of the pandemic, more research is needed to clarify the pandemic’s impact on externalizing symptoms, especially in girls.…”

The association between academic pressure and adolescent mental health problems: A systematic review

“…In many countries, including the UK, there is evidence that rates of depression, anxiety, selfharm and suicide are rising among adolescents (Kõlves and de Leo, 2016;Rodway et al, 2020;Sadler et al, 2018). This rise was apparent before the COVID-19 pandemic which has led to a further increase in depressive symptoms among adolescents (Mansfield et al, 2022). Identifying modifiable risk factors for these mental health problems could inform public health interventions to reduce their rising incidence.…”