First published in the Feb. 3 print issue of the San Marino Tribune.
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.
With the long period of school closures and changes in schedules and social opportunities, adolescents in particular have faced significant challenges, including virtual learning, a significant duration of more limited face-to-face peer interactions, a significant rise in depression, suicidality, drug use and uncertainty about their future.
In terms of development, adolescence is a pivotal period when relationships begin to reorganize. Older children and teenagers desire to have more independence and emotional distance from their parents. They shift their focus to peer interactions, and broadening and deepening their friendships. 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. 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 in 2020 and 2021. Adolescents have also reported increases in contemplating suicide, which is associated with escalating internal struggles and appear to coincide with the impact of COVID-19. According to CDC data, there has been a 31% increase in the number of emergency room mental health visits among adolescents ages 12-17 when compared to pre-pandemic 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, like ongoing health concerns, cancelled social and sporting events, and uncertainty about ongoing in-person learning. In fact, the COVID-19 pandemic has created the largest disruption in education systems in our history. This affects nearly 1.6 billion students in more than 190 countries.
Teenagers across the board have been forced to adapt to new norms in their academic and social milestones. The process of learning from the confines of home has been especially 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 experience 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 excess sleep), social isolation, emotional disconnectedness, dissociation, feelings of hopelessness, reduced communication, and reduced 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. Research suggests 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 dialog 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.
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 who holds a doctorate degree. Her Pasadena-based private practice focuses on psychological assessment and treatment, neuropsychology and forensic psychology. She has served as an expert consultant for television and media.
This is the first installment of a three-part column.