By Annette Ermshar
Special to The Outlook
As a society, we can certainly acknowledge the serious impacts that COVID-19, quarantine, and social distancing has had on all of us. However, in my psychology practice, I have been particularly concerned with the rise of mental health issues in older children and adolescents. This age range thrives from being with peers, connecting through social outlets, and feeling validated by their social interactions. In the midst of school closures and stay-at-home orders, adolescents in particular have faced the challenges of continued virtual learning, minimal face-to-face peer interactions, a significant rise in depression, suicidality, and drug use, and uncertainty about their future.
In order to best appreciate how our adolescents are faring during these unprecedented times, it is necessary to understand this phase of development. Adolescence is a pivotal period when their relationships begin to reorganize. Older children and teenagers desire to have more independence and emotional distance from their parents, so they shift their focus to social interactions and broadening and deepening their friendships. Likewise, their sense of identity becomes strongly associated with their peer group as they develop a greater sense of self and learn who they are, what they like, and what image they want to portray.
Teenagers are also exposed to increased social situations and conflicts that they use as learning experiences to develop coping skills and a sense of developing identity. Unfortunately, the pandemic has negatively impacted this developmental process as there has been less opportunity for in-person interactions, to feel like part of a social group, to feel a sense of belonging, and to let emotions out. Consequently, depression among youth and feelings of loneliness, isolation and hopelessness have all spiked. Adolescents have also reported increases in contemplating suicide, associated with escalating internal struggles, which appear to coincide with the impact of COVID-19. According to CDC data, there was a 31% increase in the number of emergency room mental health visits among adolescents ages 12-17 in 2020 when compared to 2019.
Unlike other circumstances that require flexibility and adaptation such as changing schools, moving to another city or the fallout of a natural disaster, the pandemic is unique in that we cannot disconnect from it since there is no distinct beginning, middle or end. There are ongoing challenges that continue to affect us every day, including health concerns, ongoing social distancing, cancelled social and sporting events, and uncertainty about when youth can return to in-person classrooms. In fact, the COVID-19 pandemic has created the largest disruption in education systems in our history, which affects nearly 1.6 billion students in over 190 countries. Teenagers have been forced to adapt to new norms in their academic and social milestones. The process of learning from the confines of their own home has been challenging because it increases social isolation, and also increases parental and sibling conflict due to the stressors of spending significantly more time together in a confined space, with fewer outlets. Our youth are being forced to adapt to significant changes in their world while also experiencing less opportunity for engagement, excitement or novel situations.
Even among the most supportive and understanding families, adolescents report not feeling understood or accepted because they are feeling so disconnected. Unfortunately, these quarantine-related changes have caused a shift to even more reliance on social media and online outlets, which increases the occurrence of cyber bullying, poor self-image, and negative influences from a wider range of peers who may not share their same core values.
In response to these changes, there are a number of symptoms and behaviors that loved ones should be mindful of. When an adolescent is overwhelmed with stress or experiencing depression, they can demonstrate excessive worry or sadness, engage in increased unhealthy eating, sleeping, and/or hygiene habits or withdrawal, or experience difficulties with attention and concentration. Stress and anxiety can also manifest in increased irritability, low frustration tolerance, or more self-destructive and acting-out behaviors perhaps as a “cry for help” to elicit more support.
In the absence of more adaptive coping skills, teens may resort to using substances, self-harm behaviors, or other risky behaviors that represent a change from their previous functioning. Adolescents who experience notable depression or suicidal thoughts may also have sleep disruptions (either reduced sleep or sleep excessively), isolate, shut down emotionally, dissociate/disconnect, have feelings of hopelessness, no longer express themselves or interact with others, and/or no longer show interest in hobbies or activities they used to enjoy. We certainly know that inadequate sleep impacts teenage mental health. According to the National Institute of Health, although teenagers need an average of nine hours of sleep per night, only 3% of students reported actually getting this amount. Researchers found that among teenagers, each hour of sleep lost was associated with 38% increase in the odds of feeling sad and hopeless, 42% increase in considering suicide, 58% increase in suicide attempts, and 23% increase in substance abuse. These findings do not verify that insufficient sleep causes these problems; however, a majority of the research indicates that there is a link between lack of sleep and diminished brain functioning. In turn, this can affect an adolescent’s decision-making, impulsivity and judgment.
Given the rising struggles among youth during COVID-19, it is important to provide a safe space where they can engage in an open dialogue and feel heard and supported. Teletherapy has become more accessible to individuals to ensure they have access to therapy and there are various hotlines and texting forums that provide support to youth in crisis, including the national suicide prevention lifeline.
For parents, guardians, and family members of older children and teenagers, it could be beneficial to schedule regular meeting times to check in, spend quality time together, and create consistency among loved ones. It is also important to find ways to support scheduled times to see their friends and peers, whether it is through video conferencing calls or outdoor meetups. Individuals working with or living with adolescents can also help to teach and reinforce healthy lifestyles with good nutrition and physical activities, encourage teens to stay socially connected, and provide stability to help them cope with stressors as they navigate this new norm.
Annette Ermshar, CEO of Dr. Ermshar & Associates, is a clinical neuropsychologist and holds a Ph.D. Her Pasadena-based private practice focuses on psychological assessment and treatment, neuropsychology and forensic psychology, and she has served as an expert consultant for television and media.