A new study suggests the overall impact of the COVID-19 pandemic on young Americans' mental health may not have been as significant as many have feared, but the impact varied.
The study, published this week in JAMA Network Open, found that the pandemic was associated with only minor changes in youth mental health overall. And while certain groups of US children saw increases in feelings of distress, symptoms of depression, and externalizing behaviors (such as acting out), some children who entered the pandemic period with documented mental health issues actually saw some improvement.
"Our research shows that the pandemic's impact on children varied depending on their individual characteristics, and average changes in the youth population do not fully capture these differences," first author Courtney Blackwell, PhD, of Northwestern University's Feinberg School of Medicine, said in a study press release.
Researchers with the National Institute of Health (NIH)-funded Environmental influences on Child Health Outcome (ECHO) program say their findings, which add some nuance to the widespread narrative that the pandemic and related containment measures exacerbated mental health issues in US youth, could help future efforts to support youth during social disruptions.
Gains in those with mental health problems
The study included a socioeconomically diverse cohort of US children ages 6 to 17 from nine ECHO Cohort study sites in the United States who had a Child Behavior Check List (CBCL) School Age assessment conducted before the pandemic (January 2015 to March 12, 2020) or during the pandemic (March 13, 2020, to August 31, 2022). The CBCL is a widely used questionnaire to assess behavioral and emotional problems.
Of the 1,229 children included in the study, 51.7% identified as White, 31.6% as Black, 12.0% as multiracial, 9.6% as Hispanic, and 3.3% as another race. Just over half (50.9%) were girls, and 18.7% came from households at or below 130% of the poverty level.
Using the CBCL data, researchers measured prepandemic to midpandemic changes in internalizing, externalizing, depression, anxiety, and attention-deficit/hyperactivity disorder (ADHD) scores. They also analyzed differences in outcome trajectories by children's sociodemographic characteristics and prepandemic mental health problems. They hypothesized that the pandemic was associated with increases in youth mental health problems.
Our research shows that the pandemic's impact on children varied depending on their individual characteristics, and average changes in the youth population do not fully capture these differences.
But overall, the analysis found that youth experienced minor decreases in externalizing problems, anxiety, and ADHD, and minor increases in depression. When the researchers looked at mental health changes by sociodemographic characteristics, they found that Black children from lower-income families experienced small declines in internal distress, depression, and ADHD compared with higher-income White youth, girls showed a slight increase in externalizing behaviors compared with boys, and children older than 12 saw increased feelings of distress and symptoms of depression compared with younger children.
Most surprisingly, the researchers found that youth with borderline or clinically meaningful prepandemic CBCL scores experienced decreases across all measured outcomes, with the biggest decreases seen in externalizing problems and ADHD.
"It may be that, for these children, a break from school-related stressors and demands benefited their mental health," said study senior author Kaja LeWinn, ScD, of the University of California San Francisco.
Findings could help identify at-risk kids
The authors say that while addressing youth mental health is warranted given the documented prepandemic increases in mental health problems in US youth, their findings suggest that future efforts should focus on individual characteristics.
"By identifying which individual characteristics were associated with improvements and which were associated with declines in mental health, we can better target interventions to those most at risk while also identifying potential resiliency factors that can help protect youth mental health even during times of great social and economic crisis," Blackwell said.
They also suggest that future studies should investigate school closures and other pandemic-related social restrictions to get a more complete picture of the pandemic's impact on youth.
