The impact of the coronavirus pandemic on the mental health of children and teens revealed itself in grim numbers this year to child and adolescent psychiatrist Gary Maslow. Children or young adults coming into his hospital after deliberately overdosing on Tylenol was once such a rarity that even two instances within a six-month period once seemed a lot to him. “This past spring,” he said, “it was happening two a week.”
“It has been about a 15-fold increase of children and young adults coming to our hospital because of such serious suicide attempts,” said Maslow, an associate professor in the Duke Department of Psychiatry & Behavioral Sciences and co-director of the Division of Child & Family Mental Health & Community Psychiatry. Maslow and other Duke experts recently shared their concerns in an online media seminar on the mental health crisis among children and teens.
Emerging research shows that COVID-19 — the fear it engendered, the lives it took and the isolation it caused — exacerbated the fragile mental health of many children and adolescents. While a third of 224 Seattle-area youths ages 7 to 15 in a longitudinal study by Harvard’s Stress & Development Lab reported clinically concerning depression, anxiety and behavioral issues before COVID-19, the rate shot up to two-thirds after the pandemic.
“We have seen a nearly two-fold increase in depressive symptoms and anxiety symptoms among children and adolescents — nearly 20% of kids experiencing depression that’s impairing them, nearly 25% of kids experiencing anxiety that’s impairing them,” said psychiatrist Nathan Copeland, an assistant professor in the Duke Department of Psychiatry & Behavioral Sciences and an attending child and adolescent psychiatrist at the Duke Center for Autism and Brain Development. “We already had a pediatric population that was in crisis for mental health reasons, then we had this event that raised the temperature.”
“It’s unlike anything I’ve experienced in doing this for 20 years,” said Maslow. “The worst outcome is children dying by suicide. That is happening but that is the beginning. There’s a large amount of distress happening that doesn’t rise to that level.”
That distress is likely to rise now that kids are back in school. “Academic pressure, academic performance are frequently reported as the greatest source of stress. School can also be a place that kids experience peer victimization and bullying,” said Copeland. “In Durham, what we have seen is that when school starts, compared to when kids are on break, there’s a 60% increase in the rate of pediatric mental health emergency department visits during that academic time.”
Copeland advises parents to watch for behavior changes in their children, saying, “One of the most common things that we see among kids is increased irritability, increased anger. If you have a kid that is having difficulty in other ways … consider, could there be some other condition going on?”
“During the pandemic and even before, I think a lot of us were saying we need to be checking in on each other. So, for parents to be asking their kids if they’re feeling sad, if they’re feeling worried. While it can be difficult for parents, I think there needs to be a role for bringing up suicidal ideation or suicidal thoughts,” he said.
Specific to parents of teens, Copeland said, “But if you have a teenager where you’re noticing very big changes — they used to do well in school, but they’re not doing well in school anymore. They used to have a lot of friends, those friends are changing, or they’re seeing a reduction in the number of friends they have. They used to have activities, which they enjoyed doing, and now we’re not seeing those same activities anymore. When you start seeing from lots of different angles that your teenager is getting worse, that’s when we really start worrying.”
Teachers across Georgia have been voicing concerns about the mental well-being of their students, and many districts used federal COVID-19 relief funds to shore up their counseling and psychological services. Still, with one school psychologist on average in Georgia for every 6,390 students, the state has a long way to go. Even when families can afford private help for their kids, they have to look far and wide as Georgia has eight psychiatrists per 100,000 children. The recommended ratio is 47 per 100,000.
So, what can parents and teachers do? First off, according to the experts, take care of themselves. “The notion for parents, for caregivers, for teachers, is to put on your own oxygen mask first,” said Maslow. “So, from a prevention side, supporting teachers, supporting parents, camp counselors, the people on the front lines of supporting kids, if we go back to what we really need, that’s the place to start.”
