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Youth still suffering from mental health impact of COVID

One impact of COVID on youth was increased rates of emergency department visits and hospitalizations for self-harm.
Dr. Amanda Sherman, clinical psychologist and mental health lead with the District School Board of Niagara.

Short term impacts of lockdowns and school closures during three years of the pandemic show that youth, in particular, have been and may still be suffering from mental health issues, said Dr. Amanda Sherman, clinical psychologist and mental health lead with the District School Board of Niagara.

Social isolation, being disconnected from peers and disconnection from extended family during a time when young people, “particularly in the adolescent period when, developmentally, teenagers want to spend more time with their peers than with their parents,” was difficult, said Sherman,

She was speaking at a Zoom presentation last week to members of the Niagara Council of Women, politicians, school administrative staff and members of the public.

Increased screen time seemed to be a natural, however unintended consequence of lockdowns and school closures. Sherman referenced a study which showed, pre-COVID, children spent an average of 162 minutes per day on screens. “During the pandemic, there was an increase in screen time of about 84 minutes daily,” she said. “This was during the weekday, and this really hasn’t changed too much, post-pandemic.”

Youth decreased their physical activity by 20 per cent, said Sherman, in large part due to cancelled extracurriculars and sports clubs.

A disruption to routines, to sleep, and to nutrition, and the idea of coping with uncertainty “was really hard for everyone, and caused anxiety and increased parental stress,” said Sherman. “Intimate partner violence went up, which of course impacts children and youth,” during a time when decreased access to support was available.

All of this has impacted the mental health of children and young people. Sherman explained that good research takes time, and that Canadian research on this topic is just starting to be published.

In the first year of the pandemic, a meta-analysis that included 29 studies involving 80,000 children showed that nearly 25 per cent of children and adolescents reported clinically elevated depression symptoms. Sherman explained that these symptoms are defined as “sadness, hopelessness, and low mood. Twenty-one per cent reported clinically significant symptoms of anxiety, so excessive worry and fear,” she said.

Sherman acknowledged that child and youth mental health had been a challenge pre-COVID, but said that there is still strong evidence for a slight increase in depressive and anxiety symptoms from what children and youth were experiencing.

“Youth who were already experiencing depression before the pandemic likely would have had much difficulty coping with the additional stressor of the pandemic. That would explain why their depression symptoms increased. But then youth who didn't experience depression before the pandemic would have had less experience with stress, and they might have had more difficulty coping with these new and unfamiliar stressors, which would also cause increases in depression symptoms.”

“Higher rates of depressive and anxiety symptoms were particularly true for girls, and girls from moderate to high income families,” said Sherman.

Another impact of COVID on youth resulted in increased rates of hospital emergency department visits and hospitalizations for self-harm. “When we talk about self-harm, there are many definitions that are used, but really, we tend to think of self-harm as self-injury that is not intended to be suicidal.”

Sherman noted that hospital visits from female youth were higher than visits from male youth. “Not to say that males weren't also impacted, but the effects were stronger in females and older adolescents.”

In the first eight months of the pandemic there were increased incidents of eating disorders, specifically anorexia. In a study of six children's hospitals in Canada, research showed from pre-pandemic to during the pandemic, the number of new diagnoses that the children's hospitals were making increased from 25 to 41 cases per month. And among those children and youth newly diagnosed with anorexia, the number that had to be hospitalized because their symptoms were so severe, increased from about 7.5 youth per month to 20 youth per month.

They also found that among these youths who were newly diagnosed, the severity of their disease was significantly greater than what they were seeing in newly diagnosed youth before the pandemic. “So for anorexia, that means a faster progression of the illness, more weight loss and a more profound bradycardia, which is a dangerously low heart rate.”

While it is too early to determine long-term impacts of COVID on the mental health of young people, Sherman offered some insights as to what she is seeing in the schools.

“One challenge that we are still having is getting kids back to school, particularly students who struggle with anxiety. Many students have real challenges coming to school or staying at school the whole day, and that really does have to do with the fact that we got used to only online learning and for some students who struggle very much with anxiety having that online learning option that they never had before, it's been quite a challenge for them to shift.”

Sherman hears from educators that many students are having a hard time self regulating their behaviour. “Self-regulation is generally the ability to manage our emotions and behaviour.”

“Coping is a skill that young children learn as they develop, but many students, for whatever reason, are not coming to school with this skill, and as a result they spend more of their day in a state of either hyper-arousal, which is a state of very high energy, anxiety, and anger,” she explained — a ‘fight or flight’ mode.

Other students are in a state of hypo-arousal “where they seem like they're shut down. They might seem like their mood is low. They might seem passive or withdrawn, even frozen in extreme circumstances.”

Despite the higher numbers of students experiencing issues Sherman described she said  there has not been a significant increase in the number of students referred to school social workers compared to last year, “but what they are reporting is an increase in the complexity and acuity of the issues that students and families are dealing with.”

Sherman noted that schools provide social workers and youth counsellors, and that, in the elementary grades, part of the physical education curriculum is devoted to mental health literacy.

For support outside of school, families can access Pathstone Mental Health, which provides walk-in clinics, and a crisis and support line. Pathstone is now the centralized intake for child and youth mental health care, and families no longer have to call Contact Niagara first.