Pandemic’s negative mental health effects felt among all age groups

Since the first death in the United States on Feb. 29, 2020, a total of 1,076,549 Americans have died as a result of the SARS-CoV-2 virus.

Of those, 75% of deaths were in people aged 65 years and older, while fewer than 1% were in those aged 0 to 17 years, according to Statista, a market and consumer data provider.

While the severity of COVID-19 differs by age, the pandemic has left a lasting effect on the mental health among all age groups.

According to the CDC, 4.7% of U.S. adults report regular feelings of depression, but just 10.6% of individuals report depression to a clinician. Globally, according to the WHO, the prevalence of anxiety and depression has increased by 25% due to the COVID-19 pandemic.

“We started to see a little bit of an increase in these issues [with depression] even before the pandemic occurred, but we know that the pandemic has absolutely exacerbated all of it for so many different reasons,” Anisha Abraham, MD, acting chief of the division of adolescent medicine at Children’s National Hospital in Washington, D.C., told Healio.

Regardless of age, the COVID-19 pandemic has affected the mental health of all Americans.

Pediatric populations

On Oct. 13, 2022, the American Academy of Pediatrics, in accordance with the Academy of Child and Adolescent Psychiatry and the Children’s Hospital Association, urged the Biden administration to declare a federal national emergency for the mental health of all U.S. children. The announcement was made exactly a year after the three organizations declared a national state of emergency in child and adolescent mental health, on Oct. 13, 2021.

The AAP’s letter said that in declaring a federal national emergency for the mental health of U.S. children, it would “galvanize existing critical funding streams and support to help ensure that all children and adolescents can access the full continuum of mental and behavioral health care from promotion and prevention to early identification and treatment.”

“We, as providers, continue to be very concerned about the mental health challenges that young people are facing,” Abraham said. “We know that many of these issues preexisted the pandemic, but the pandemic has exacerbated them. And so, we're seeing a dramatic increase in young people coming into our emergency rooms for suicide attempts.”

Abraham said pediatricians are also seeing double the number of children being hospitalized, as well as double the number of children reporting an eating disorder. In addition, pediatricians are seeing high rates of concerns over depression, anxiety and loneliness in children, Abraham said.

“There is a real strong need to continue to say that this is an emergency, that we need to galvanize support and put in a real kind of workforce strategy that not only prioritizes how to train professionals, but also provides trauma informed care and provides resources that are necessary,” Abraham said.

It is necessary to do this now, Abraham added, because if the issue is not addressed, young people and children will continue to be affected for generations to come.

Effects of school closures

By March 11, 2020, more than 1 million American students had been impacted by a school closure because of the COVID-19 pandemic, Education Week reported. By March 25, exactly 2 weeks later, all U.S. public school buildings were closed. On May 6, Maryland became the last of 48 states to announce that none of its public schools would reopen for the remainder of the year.

Classes were conducted online for students who were sequestered from their friends and educators, while Americans were urged to stay at home to prevent the spread of the virus. It was estimated that during the first year of the COVID-19 pandemic, one in four youths globally experienced clinically elevated depression symptoms, and one in five youths experienced clinically elevated anxiety symptoms, Racine and colleagues reported in JAMA Pediatrics.

“Kids felt more isolated; there's this loss of milestones. Having connections can be really important, and in many ways during the pandemic, kids lost that,” Abraham said. “Also, the ability to get in and to see providers was a little bit more challenging, and certainly, there were [fewer] resources.”

Now, halfway through the 2022-2023 school year, all U.S. public schools have fully reopened. However, poor mental health outcomes are still prevalent among U.S. children.

Rebekah Fenton, MD, MPH, FAAP, a pediatrician at Alivio Medical Center in Chicago, told Healio that when she is asking children when their mental health issues started, they say they are still struggling with issues from several years ago. However, challenges to access prevented them from getting the support they need earlier.

Fenton said children she has treated have struggled with returning to school, as well as the impact of what they have missed and the trauma surrounding that.

“[We had] this initial sense of, ‘Oh, once they're back [in school] things would hopefully be OK,” Fenton said. “And now we're actually seeing these after-effects that are continuing to affect anxiety and mood.”

Fenton said one of the common things she and colleagues are seeing today is many children having trouble with focusing while in school. In the past, pediatricians would diagnose this as ADHD, which commonly presents at a younger age, she said. Yet that is not the case with children recently.

“It's actually anxiety that is leading to difficulty focusing and having panic attacks in school, or just getting so overwhelmed by the amount of work,” Fenton said. “[Many children] have mentioned that school online was a lot easier, because there was not as much expectation as far as workload. And so they're having a harder time adapting to what otherwise may have been fairly normal workloads in high school because of ... that huge interruption of ... the typical routine.”

Fenton said one of the first things any adolescent should do to help with their negative mental health is to find a trusted adult in whom to confide, whether that be a parent, a teacher or a therapist.

“Certainly, [children are] not necessarily always interested in talking about everything all the time,” Fenton said. But she hopes they can find someone to tell if they are having a tough time or who would notice if they are struggling or not interacting the way they used to.

Older adults

Adults aged 50 years and older are the most at-risk population for severe COVID-19, as well as hospitalizations and deaths, according to the CDC. As of Dec. 7, 2022, a total of 1,004,397 Americans aged 50 years and older have died due to complications from COVID-19, according to Statista.

“Older adults lost family members, including spouses or friends, during the pandemic. And when these losses occurred, they were often alone in their grief,” Kathleen Cameron, BSPharm, MPH, the senior director of the National Council on Aging, told Healio.

Cameron said that increases in alcohol and substance use have become more commonplace among older adults due to social isolation and depression.

“Certainly, we know that many experienced social isolation and loneliness that led to mental health issues, including depression, as well as perhaps substance use, exacerbation of existing substance use or the start of new substance uses, particularly alcohol, which is the most common substance used by older adults,” she said.

Cameron said that the CDC has reported “startling statistics” regarding drug- and alcohol-related deaths among older Americans, which saw an increase during the pandemic.

“There was an 18% increase in alcohol-induced deaths in the senior population [between the years of 2019 and 2020]; some of that definitely was impacted by the pandemic,” Cameron said.

Cameron said the largest increases in alcohol, prescription and illicit drug use are occurring in the older adult population in the U.S. Because of the pandemic, many older adults who already had issues with alcohol and drug use lost their support systems.

“They were going to [Alcoholics Anonymous] meetings or other types of support groups, like a peer support group, or they had been meeting regularly with a counselor,” she said. “In the beginning of the pandemic, those touch points didn't exist for a while, until some of them moved to virtual delivery.”

However, for older adults, technological means for support and care was not always an option for them.

“A lot of [older adults], for instance, are technologically challenged a little bit. Technology is not something that they feel comfortable with. So, they're resorting back to talking on the phone, not necessarily video, which isolates them even more, because they're not able to see people face-to-face,” Anabel Basulto, a licensed marriage and family therapist with Kaiser Permanente, in Southern Calif., said in an interview with Healio.

Social isolation is estimated to affect up to 40% of adults aged 60 years and older, researchers reported in a study published in Geriatrics. The study also stated that prior to the pandemic, just 28% of older adults reported feeling socially isolated in the National Health and Aging Trends study.

“A lot of these seniors feel isolated,” Basulto said. “They are afraid of engaging in activities at the senior center because you have new [variants] popping up. They don't know what's safe and not safe. Now, they're just really starting to reconnect.”

It was not every older adult who felt this way, Cameron noted. There were and are many older Americans who have shown strength in the face of the pandemic, she said.

“It’s not all doom and gloom,” Cameron said. “There were many older adults who handled the pandemic quite well, being resilient. Many of them lived through quite a bit in their life and built up almost a tolerance or acceptance of hardships, and some came through the pandemic quite fine. They kind of saw it as another challenge that they'd have to get through and overcome.”

References:

AAP-AACAP-CHA declaration of a national emergency in child and adolescent mental health. https://www.aap.org/en/advocacy/child-and-adolescent-healthy-mental-development/aap-aacap-cha-declaration-of-a-national-emergency-in-child-and-adolescent-mental-health/. Published Oct. 19, 2022. Accessed Jan. 13, 2023.

CDC museum COVID-19 timeline. https://www.cdc.gov/museum/timeline/covid19.html. Updated Aug. 16, 2022. Accessed Jan. 13, 2023.

COVID-19 pandemic triggers 25% increase in prevalence of anxiety and depression worldwide. https://www.who.int/news/item/02-03-2022-covid-19-pandemic-triggers-25-increase-in-prevalence-of-anxiety-and-depression-worldwide. Published March 2, 2022. Accessed Jan. 13, 2023.

Depression. https://www.cdc.gov/nchs/fastats/depression.htm. Updated Dec. 30, 2022. Accessed Jan. 13, 2023.

Drug and alcohol deaths on the rise among older Americans. https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/20221130.htm. Published Nov. 30, 2022. Accessed Jan. 13, 2023.

Factors that affect your risk of getting very sick from COVID-19. https://www.cdc.gov/coronavirus/2019-ncov/your-health/risks-getting-very-sick.html. Updated Oct. 19, 2022. Accessed Jan. 13, 2023.

Health organizations urge the Biden Administration to declare a federal national emergency in children’s mental health. https://www.aap.org/en/news-room/news-releases/aap/2022/health-organizations-urge-the-biden-administration-to-declare-a-federal-national-emergency-in-childrens-mental-health/. Published Oct. 13, 2022. Accessed Jan. 13, 2023.

MacLeod S, et al. Geriatrics. 2021;doi:10.3390/geriatrics6020052.

Number of coronavirus disease 2019 (COVID-19) deaths in the U.S. as of Jan. 4, 2023, by age. https://www.statista.com/statistics/1191568/reported-deaths-from-covid-by-age-us/. Updated Jan. 11, 2023. Accessed Jan. 13, 2023.

Racine N, et al. JAMA Pediatr. 2021;doi:10.1001/jamapediatrics.2021.2482.

The coronavirus spring: The historic closing of U.S. schools (A timeline). https://www.edweek.org/leadership/the-coronavirus-spring-the-historic-closing-of-u-s-schools-a-timeline/2020/07. Published July 1, 2020. Accessed Jan. 13, 2023.