Introduction

Although the COVID-19 emergency may be over, the excruciatingly long period of uncertainty has had a profound psychological effect on everyone by inciting mass hysteria, economic burden, and personal losses.¹ Youth, in specific, have demonstrated vulnerability to the effects of the pandemic as their education, health and well-being were disrupted during critical stages of their development.¹ Thus, the purpose of this article is to draw attention to the significant impact COVID-19 has had on youth mental health.

Consequences of the Quarantine

To control the spread of COVID-19, many countries across the world were required to enact early quarantine measures, which imposed a multitude of consequences on people’s mental health and well-being. The disease produced mass hysteria, anxiety, and distress, which only intensified as individuals had to spend more time indoors, remain isolated from their friends and/or families, and had to deal with familial and/or financial losses.^1,2 As a result of the quarantine, youth, in particular, had to deal with emotional challenges that were compounded by social isolation, family stress, and/or a higher likelihood of experiencing abuse and systemic racism.^1,2

According to results from a survey conducted by HEADSTRONG from April 20, 2020 to June 24, 2020, the main challenges that Canadian youth faced during the pandemic were: feelings of isolation and loneliness (48%), closures of in-person schools and transitioning to remote learning (33%), limited access to mental health and other health-related supports (9%), fears of acquiring COVID-19 for oneself or loved ones (2%), lack of employment opportunities (1%), and other challenges (6%).¹

The livelihoods of children and adolescents were severely disrupted due to the closures of schools, recreation centres, and activities.³ Routine schedules provided by schools and extracurricular activities are essential in maintaining physical activity, regulating sleep cycles, and fostering social interactions—all of which are important protective factors for youth mental health.^3-6 Due to the considerable adjustments that came with adapting to home-based online learning—the alternative method of curriculum delivery—these closures likely negatively impacted students’ learning outcomes.¹ There is a heightened concern that social isolation, in combination with reduced access to mental health and support services and fewer opportunities to engage in protective activities, may have drastic short- and long-term implications on youth mental health and substance use.^7-9 Many researchers believe that this confluence of variables, along with the fear of spreading the disease and other social and economic issues, has produced the “perfect storm” that could lead to the onset of mental health illnesses in youth.^7,10,11

A large cross-sectional study conducted by Cost et al. found that within four months of the implementation of COVID-19 emergency measures, over two-thirds of Canadian children and adolescents experienced a decline in six mental health domains (depression, anxiety, irritability, attention, hyperactivity, and obsession/compulsions).³ They attributed such deterioration to stress related to social isolation, including both the loss of opportunities for social connection and the cancellation of significant events (e.g., graduations, school trips, vacations).³ These findings add to earlier research conducted in Brazil, China, Germany, India, Italy, Spain, and the United States by reporting on the mental health status change during COVID-19 in children and adolescents.³

Longitudinal data reporting on mental health consequences of COVID-19 among youth suggest that increased depressive symptoms and worsening of mood symptoms in youth during the early phase of the pandemic were associated with stricter lockdown measures.^7,12,13 A mixed-methods study found an increase in externalizing symptoms (tantrums, disobedience, attitude problems) at the beginning of the pandemic.¹⁴ A similar study conducted among American children ages 7-15 revealed that this rise in externalizing symptoms is strongly correlated with reduced in-person/digital socialization and parental and peer support.¹⁵

Marginalized youth, including young refugees, youth living in rural areas, Indigenous youth, racialized youth, youth with disabilities, and youth of the LGBTQ2S+ community, were disproportionately impacted by the pandemic.^1,16,17 Those without secure housing were unable to safely practice social distancing. Additionally, students from low-income households were negatively impacted by school closures as some lacked reliable internet connection or the equipment needed to participate in virtual classes.¹⁶ School closures also imposed adverse effects on some youth who indicated having regular conflicts at home, which could have led to them experiencing more anxiety and potential exposure to violence. This could have caused increased stigma and discrimination against certain groups, further preventing them from accessing essential health services.¹⁷

Coping with Social Isolation

To report on a few positive outcomes of the pandemic, some young people insisted that the pandemic restrictions allowed them time to perform tasks and participate in activities for which they were previously too busy, such as setting personal goals, engaging in family activities at home, and connecting with friends and relatives.¹ However, other youth found themselves even more worried and overburdened because they were unable to manage or were unaware of the services that may have helped them.¹ Because young people experience stressful situations differently, it is critical that they are directed to a variety of community services according to their unique individual needs.¹ Schools must also take charge and assume a crucial role in disseminating pertinent coping resources.¹

Something Good

Due to the broad implementation of COVID-19 lockdown measures, there has been a quick transition of current mental health treatment services toward digital health, such as telehealth and tele-practice.⁷ It is unclear if digitally provided services can sufficiently meet the needs of all youth or will instead worsen already-existing disparities among vulnerable young populations.^7,18 However, virtual services and care provide a unique opportunity for greater access, especially for those inhabiting regions with limited access to in-person services.^7,19 For example, a few pilot studies investigating the effectiveness of mindfulness, art therapy and philosophy interventions delivered virtually for children and adolescents have demonstrated high levels of feasibility and encouraging preliminary findings on youth well-being.^7,20-22