The Impact of Covid 19 on Mental Health and Wellness in Children and Adolescents

Earlier this month, we addressed the importance of primary care providers supporting the mental health of youth and families. As more adults, children, and adolescents become vaccinated, minimizing the exposure to the COVID-19 virus is within reach. However, the pandemic’s impact on pediatric mental health will likely last for months and even years for vulnerable patients in your practices. According to the Centers for Disease Control, the period between April through October 2020 showed the rate of mental health related emergency room visits rose 24% in children and 31% in adolescents. One in seven parents reported worsening of their child’s behavioral health issues since the beginning of the pandemic in March 2020.

The American Academy of Pediatrics has published guidance to providers on supporting the emotional needs of children and adolescents related to the pandemic. Primary care providers can evaluate the impact of the pandemic on their patients and families by exploring the following topics during visits in the primary care setting.

The pandemic has highlighted health disparities and our most vulnerable populations have faced some of the greatest challenges. Patients and families from under-served communities and youth with special health care needs are at increased risk for emotional and behavioral issues stemming from the pandemic. Focusing on determinants of health in the areas below can enhance your ability to emotionally support your patients.

Social determinants of health
Remember to ask about changes in the family household during the last year. It may help identify the need for resources or interventions. Has there been a change in employment? Are parents having difficulty with food insecurity or housing issues? Food Insecurity has been linked with maternal depression, child behavior problems, and childhood depression and anxiety. Given the primarily virtual world we live in, families with difficulty connecting to the internet may experience higher levels of stress and isolation. Their children may have trouble participating in online learning or telehealth visits.

Parent/ Caregiver well-being
If possible, ask parents about their own mental health. Those who address their emotional well-being improve their ability to parent and care for their families. Consider assessing for depression, anxiety, domestic violence, and substance issues. According to a poll of adults 21 and over, 23% are consuming alcohol to cope with pandemic related stress. In those adults with children under the age of seven, stress related consumption rose to 52%. Additionally, overburdened families are at the highest risk for episodes of domestic violence.

Barriers to access
Talk to parents and caregivers about their ability to access services. Are there transportation or childcare issues? Children with special health care or mental health needs often depend on routinely scheduled therapies and professionals to support growth and well-being. Primary care providers are powerful advocates for their patients and may be able to assist families with securing needed services.

C I T A T I O N S
Leeb RT, Bitsko RH, Radhakrishnan L, Martinez P, Njai R, Holland KM. Mental Health–Related Emergency Department Visits Among Children Aged <18 Years During the COVID-19 Pandemic — United States, January 1–October 17, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1675–1680. DOI: http://dx.doi.org/10.15585/mmwr.mm6945a3

Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, Rubin GJ. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020;395(10227):912-920. doi: 10.1016/S0140-6736(20)30460-8.