Research shows young people’s mental health varied during the pandemic

The COVID-19 pandemic has caused significant disruptions to the daily lives of children and families around the world, which has been linked to a range of mental health problems among young people. But a new study from the National Institutes of Health’s Environmental influences on Child Health Outcomes (ECHO) Program presents a more nuanced picture, suggesting that mental health has improved for certain groups of children and adolescents.

Research led by Courtney K. Blackwell, Ph.D., and Kaja LeWinn, ScD, found that the pandemic had minimal impact on children’s mental health. Impacts included small decreases in externalizing problems, anxiety, and depression. However, average findings may not tell the full picture.

This work is published in JAMA Network Opened.

“Our study shows that the impact of the pandemic on children varied based on their individual characteristics, and that average changes in the childhood population do not fully capture these differences,” said lead author Dr. Blackwell of Northwestern University’s Feinberg School of Medicine.

The study found that children who had clinically significant mental health problems before the pandemic experienced notable improvements in their mental health, particularly for ADHD symptoms and externalizing problems like aggression and rule breaking. Other factors like income, race, age, and gender had a small impact on changes in youth’s mental health, with some groups experiencing a decrease and others an increase in symptoms. For example, this study found that:

• In black children, there was a small decrease in inner distress and symptoms of depression and ADHD compared to white children.

• Children from lower income families (below 130% of the federal poverty level) showed decreases in depression and ADHD symptoms, while children from higher income families (350% of the federal poverty level and above) showed small increases in internalizing symptoms.

• Girls showed a slight increase in externalizing behavior, such as aggressive behavior, compared to boys.

• Children over 12 years of age showed an increase in internalized feelings of stress and symptoms of depression compared to younger children, whose internalizing symptoms did not change.

“Perhaps most surprisingly, some children we expected to do worse during the pandemic, such as those with more significant behavioral problems before the pandemic, improved. It may be that for these children, a break from school-related stressors and demands improved their mental health,” said Dr. LeWinn, senior author of the study from the University of California San Francisco.

What happened during the study

Most existing research has focused on the first year of the pandemic and included children from outside the U.S. or focused primarily on teens. This ECHO study included 1,229 youth ages 6 to 17 from nine ECHO Cohort study sites across the U.S. Youth were socioeconomically diverse: 51.7% identified as White, 31.6% as Black, 12.0% as multiracial, and 3.3% as some other race; 9.6% identified as Hispanic; and 18.7% came from households at or below 130% of the federal poverty level.

Researchers examined changes in mental health scores on the Child Behavior Checklist, a parent-reported measure of youth behavior and mental health. They compared scores from before the pandemic (January 1, 2015, to March 12, 2020) with scores during the pandemic (March 13, 2020, to August 31, 2022). They also looked at how these changes varied by various sociodemographic factors and pre-existing mental health conditions.

“By identifying which individual characteristics were associated with improvements and which with deteriorations in mental health, we can better target interventions to those most at risk. At the same time, we can identify potential resilience factors that could help protect young people’s mental health, even in times of major social and economic crisis,” said Dr Blackwell.

According to Dr. LeWinn, future research could examine the impact of school closures on mental health, particularly for marginalized or vulnerable youth.

“Importantly, any improvements in mental health we observed in this study are greatly overshadowed by the significant and negative impact of the pandemic on educational outcomes. However, our work suggests that by using long-term data that includes pandemic-related school disruptions, we can gain unique insights into how schools are affecting children’s mental health,” said Dr. LeWinn.

Provided by Environmental influences on children’s health outcomes