Reviewed by Danielle Ellis, B.Sc.

In a recent study published in JAMA Network Open, researchers evaluated the impact of coronavirus disease 2019 (COVID-19) on the mental health of secondary school children in the United Kingdom (UK). They also investigated the relationships between individual, home, friendship, and school (e.g., school community, operational elements of the school, the larger school context) variables and secondary school students' mental health challenges and psychiatric well-being before and during the pandemic.

Study: Young People’s Mental Health Changes, Risk, and Resilience During the COVID-19 Pandemic. Image Credit: Monkey Business Images/Shutterstock.com

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic has substantially influenced young people's mental health, leading to a rise in the incidence of mental health issues. Disruptions to school and social contacts, pandemic-related fears, family sickness, economic repercussions, mourning, and limited access to mental health care have all worsened this. Understanding these determinants is critical for shaping policy choices and treating the mental health issues that young people encounter, especially in difficult situations.

About the study

The present study investigated whether secondary school students' mental health challenges and mental well-being altered during COVID-19 and the risk and resilience variables.

Students aged 11 to 13 in the United Kingdom were recruited in two batches (enrolled in 2016 and 2017, respectively). The participants were tracked for three years, including the COVID-19 pandemic for the second cohort alone. The My Resilience in Adolescence (MYRIAD) randomized controlled trial (RCT) was used to collect follow-up data from two sample cohorts.

The researchers included mainstream secondary schools in the UK, with head teachers and social-emotional-type learning (SEL) strategies, and the schools were not deemed insufficient in their most recent official inspection. In all, the researchers approached 5,663 schools, of which 532 were interested; however, only 84 agreed to participate.

The first cohort comprised 864 pupils from 12 schools, whereas the second comprised 6,386 children from 72 schools. The SARS-CoV-2 outbreak was designated a pandemic following the completion of all evaluations by the first cohort (between September 2018 and January 2020) but not the second (between September 2019 and June 2021). The second cohort experienced COVID-19 waves, which included three countrywide lockdowns.

The researchers investigated the relationships between school, friendship, family, and individual traits and kids' mental health. Changes in students' depression risk [as measured by the Center for Epidemiological Studies-Depression (CES-D) scale]; behavioral, social, and emotional difficulties [as measured by the Strengths and Difficulties Questionnaire (SDQ)]; and psychiatric health [as measured by the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS)] were among the outcome measures.

Adjustments to lockdown and return to school were only examined in the second cohort using two newly designed items inquiring about how children experienced the lockdowns and their return to school following the lockdowns. Household assets, studying conditions, home connectivity, and home disputes were among the student-level characteristics associated with the home environment.

Friendships were among the student-level characteristics associated with the social milieu during the lockdown. The school community, obtaining help for specific educational needs or impairments, white pupils, and operational school characteristics were all school-level influences.

Results

An increased risk of depression, behavioral, social, and emotional difficulties, and deterioration in mental health were linked to COVID-19 in the study of 7,250 school students who were not exposed and exposed to COVID-19 during evaluation. Individual, friendship, school, and household traits were connected to risk and resilience.

The average age of the research participants was 14 years; 3,947 (55%) were female, and 5,378 (73%) self-identified as white. Data for analysis were submitted by 89% of the first cohort and 46% of the second cohort. The depression risk [adjusted mean difference (AMD) of 1.9]; behavioral, social, and emotional issues (AMD, 0.8); and psychiatric health (AMD, 2.1) rose in both groups but to a higher amount in pandemic-exposed adolescents.

Having someone to talk to during lockdown, being connected at home, and a strong school atmosphere were protective during COVID-19. Female sex and a low risk of mental health concerns at baseline were connected to worsening mental health. Compared to no attendance while resuming school, partial attendance at school during the COVID-19-related lockdown was related to improved adjustment. Household assets, studying conditions, home disputes, and the amount of time kids spent in school during lockdown were not connected with improvements in mental health.

Conclusions

Overall, the study findings showed that COVID-19 has had a considerable influence on school-age adolescents' mental health outcomes, demonstrating the importance of a thorough knowledge of individual and societal determinants. Gender, home connectivity, friendships, and school atmosphere were found to be important contributors to changes in pediatric mental health.

Supportive interactions and interventions are critical for supporting student mental health. Those exposed to the pandemic, especially girls, those who did not have perceived friendships, and those with a low beginning risk were more likely to have their mental health deteriorate. Higher levels of student-rated school atmosphere were linked to resistance to such degradation.

However, due to academic expectations and uncertainty about future intentions, the protective impact of a healthy school atmosphere may diminish over time. Policies and treatments should target good home and school settings, stimulate peer friendship, develop school climate and home connectivity, minimize full school closures, and consider individual differences to guard against poor mental health throughout the pandemic. Schools should be kept open wherever feasible, and future studies should examine why girls struggled more when schools reopened.

Journal reference:

• Montero-Marin J, Hinze V, Mansfield K, et al. Young People’s Mental Health Changes, Risk, and Resilience During the COVID-19 Pandemic. JAMA Netw Open. 2023;6(9):e2335016. doi:10.1001/jamanetworkopen.2023.35016 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2809780