New federal data confirms what teachers and parents have been worrying about for months: The pandemic is taking a striking toll on children鈥檚 mental health.
New show the proportion of emergency department visits related to mental health crises has increased dramatically for young children and adolescents since the pandemic started.
From this March through October, the share of mental health-related hospital emergency department visits rose 24 percent for children ages 5 to 11 and 31 percent among adolescents ages 12 to 17, when compared to the same period in 2019, the based on a federal health surveillance program. While the CDC does not record whether a patient reported a mental health emergency as a result of a disaster, all of the mental health emergencies included stress, anxiety, acute posttraumatic stress disorder, or panic. As the chart below shows, the share of mental health visits for every 100,000 pediatric hospital emergency visits each week rose steadily beginning about three months into the pandemic:
While the rising proportion of mental health visits may stem in part because parents tended to avoid taking their children to hospitals more generally during the pandemic, CDC analysts noted they think the findings 鈥渓ikely underestimate the total number of mental health-related health-care visits,鈥� because they did not include urgent mental health visits in schools or non-emergency department settings. Federal researchers also noted that girls were significantly more likely to have mental health emergencies than boys, though the number of mental health emergency visits increased for both boys and girls.
The combination of disrupted routines, fear of sickness or family loss, and economic and housing mobility all have proven to be significant stressors for adults as well as children. But developmentally, the social isolation caused by repeated and sudden quarantines and widespread may prove the heaviest burdens for young and older adolescents, who are going through now thought to be as intense as the cognitive growth seen in toddlers.
鈥淲e don鈥檛 know exactly what this pandemic is going to do to kids because it鈥檚 unprecedented,鈥� said Deanna Barch, a professor and chair of the department of psychological and brain sciences at Washington University. 鈥淏ut I think the things that are emerging are mostly around social isolation, and that contributing to kids feeling depression and anxiety. ... People are social in general, but kids are particularly susceptible, because this is an important time for developing peer relationships. Kids who have not been able to return to school or been able to socialize, a lot of them are feeling pretty isolated and very sad and upset about that.鈥�
While prior studies have found mixed benefits from social media on students鈥� mental health, it鈥檚 not yet clear whether building students鈥� online support systems can effectively buffer their social isolation during quarantine.
Signs of 鈥楬opelessness鈥�
Even before the pandemic, educators reported rising concern about students鈥� mental health. At schools that provided mental health services in 2019, school leaders reported . Suicide among young people reached a 30-year high as of , with rates for young adolescents ages 10-14 more than tripling since 2007, to 2.5 deaths per 100,000.
It鈥檚 not clear yet what portion of the emergencies this spring and fall came from panic attacks, attempted suicides, or other mental health emergencies, but Barch, who is part of an ongoing federal study of adolescent development, said adults often underestimate the severity of children鈥檚 mental health problems. Children as young as 9 report , she found, and 1 in 10 said they purposely cut, pinched, or burned themselves even when they weren鈥檛 suicidal. Overwhelmingly, the parents and teachers around them didn鈥檛 know about their suicidal ideas or self-harm.
鈥淚t鈥檚 obviously normal for kids to be upset ... but I think this is such an unusual situation that we don鈥檛 have any really clear way to distinguish between what is a 鈥榥ormal reaction鈥� to this situation,鈥� Barch said. 鈥淚n the range of upsetedness, this is just such a weird situation that, you know, you could argue every kid and every adult needs some help right now.鈥�
鈥淜ids may not necessarily spontaneously self-report that they鈥檙e feeling an increase in depression or anxiety,鈥� she said. 鈥淚t certainly can sound similar to what adults articulate鈥擨 wish I鈥檇 never been born, people are better off without them, feelings of hopelessness, like there鈥檚 nothing to look forward to鈥攂ut parents and teachers are also going to need to look out for behavior changes, like becoming quiet or withdrawn ... that may show a trigger.鈥�
Distanced Supports
Nisha Sachdev, an adjunct professor in public health at the George Washington University and senior associate at the Center for Health and Health Care in Schools, advised schools to think about in the current remote learning and socially distanced in-person classes.
For example, trauma-informed instruction strategies, such as setting up clear structure and routines, helping students develop emotional resilience, and conducting emotional check-ins, can be more difficult to do when classes by necessity change from in-person to virtual and back again with swells in the rates of coronavirus infections. But Sachdev and center director Olga Price advised schools to focus on maintaining and strengthening connections among students and their peers and supportive adults, from telehealth counseling services to phone-buddy networks among students.
For more on how districts can recognize and respond to stress, trauma, and mental health problems in students in the wake of COVID-19, please see our special report and downloadable guide for teachers during remote learning.
Chart Source: National Syndromic Surveillence Program, CDC
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