New meta-analysis: Depression and anxiety symptoms have doubled among young people during the pandemic

I’m still busy reading the studies that I missed during my break, and this is certainly an important and depressing one as it shows that an alarming percentage of children and adolescents are experiencing a global-wide mental crisis due to the COVID-19 pandemic

From the press release:

The UCalgary study is a meta-analysis, pooling together data from 29 separate studies from around the world, including 80,879 youth globally. The new findings show that depression and anxiety symptoms have doubled in children and adolescents when compared to pre-pandemic times.

“Estimates show that one in four youth globally are experiencing clinically elevated depression symptoms while one in five have clinically elevated anxiety symptoms,” says Dr. Nicole Racine, PhD, a postdoctoral associate, clinical psychologist and lead author of the paper. Further alarming, these symptoms are compounding over time.

The UCalgary study — which incorporates 16 studies from East Asia, four from Europe, six from North America, two from Central and South America and one from the Middle East — also shows that older adolescents and girls are experiencing the highest levels of depression and anxiety.

“We know from other studies that rates of depression and anxiety in youth tend to ebb and flow with restrictions,” says Dr. Sheri Madigan, PhD, co-author of the paper, a UCalgary clinical psychologist and Canada Research Chair in Determinants of Child Development. “When more restrictions are imposed, rates go up. Being socially isolated, kept away from their friends, their school routines, and social interactions has proven to be really hard on kids.”

She adds: “When COVID-19 started, most people thought it would be difficult at the outset but that kids would be better over time, as they adjusted and got back to school. But when the pandemic persisted, youth missed a lot of milestones in their lives. It went on for well over a year and for young people that’s a really substantial period of their lives.”

For many adolescents that loss was especially impactful. “Once you enter adolescence you begin differentiating from your family members and your peers can actually become your most important source of social support,” says Racine. “That support was greatly reduced, and in some cases absent altogether, during the pandemic.”

Older teens in particular have missed out on significant life events such as graduations, sporting events and various coming of age activities. “These kids didn’t imagine that when they graduated, they’d never get to say goodbye to their school, their teachers or their friends, and now they’re moving on to something new, with zero closure,” says Racine. “There’s a grieving process associated with that.”

As more of the population becomes vaccinated and an end to the pandemic seems near, the question arises: how will our children and adolescents fare? Will they bounce back from this traumatic time, or will the mental health impacts linger?

“At this point we don’t know the answer to that,” says Racine. “I think for most children who have experienced elevated mental health symptoms, some of that will resolve. But there will be a group of children for whom that isn’t the case. For them, this pandemic may have been a catalyst, setting them off on a trajectory that could be challenging. And there’s another group of children who had mental health difficulties pre-pandemic. They might really struggle long term.”

For now, though, the elevated mental health symptoms in youth are rising and that’s a problem that must not be underestimated, Madigan warns. “We’re continuing to see compounding effects of the pandemic,” she says. “It’s disjointing for kids because they can’t predict what their environment is going to look like, and we know when their world lacks predictability and controllability, their mental suffers.”

The UCalgary study recommends that more mental health supports should be put in place to help children and adolescents in this time of need.

“Long before the pandemic we had a youth mental health system that was stretched and lacking resources,” says Racine. “A potential doubling of mental health difficulties will overwhelm that system without a significant increase in resources.”

Madigan agrees, adding: “If we want to mitigate the sustained mental health effects of COVID-19, because of the chronic stressors our youth experienced, we have to prioritize recovery planning now. Not when the pandemic is over, but immediately. Because kids are in crisis right now.”

Abstract of the study:

Importance  Emerging research suggests that the global prevalence of child and adolescent mental illness has increased considerably during COVID-19. However, substantial variability in prevalence rates have been reported across the literature.

Objective  To ascertain more precise estimates of the global prevalence of child and adolescent clinically elevated depression and anxiety symptoms during COVID-19; to compare these rates with prepandemic estimates; and to examine whether demographic (eg, age, sex), geographical (ie, global region), or methodological (eg, pandemic data collection time point, informant of mental illness, study quality) factors explained variation in prevalence rates across studies.

Data Sources  Four databases were searched (PsycInfo, Embase, MEDLINE, and Cochrane Central Register of Controlled Trials) from January 1, 2020, to February 16, 2021, and unpublished studies were searched in PsycArXiv on March 8, 2021, for studies reporting on child/adolescent depression and anxiety symptoms. The search strategy combined search terms from 3 themes: (1) mental illness (including depression and anxiety), (2) COVID-19, and (3) children and adolescents (age ≤18 years). For PsycArXiv, the key terms COVID-19mental health, and child/adolescent were used.

Study Selection  Studies were included if they were published in English, had quantitative data, and reported prevalence of clinically elevated depression or anxiety in youth (age ≤18 years).

Data Extraction and Synthesis  A total of 3094 nonduplicate titles/abstracts were retrieved, and 136 full-text articles were reviewed. Data were analyzed from March 8 to 22, 2021.

Main Outcomes and Measures  Prevalence rates of clinically elevated depression and anxiety symptoms in youth.

Results  Random-effect meta-analyses were conducted. Twenty-nine studies including 80 879 participants met full inclusion criteria. Pooled prevalence estimates of clinically elevated depression and anxiety symptoms were 25.2% (95% CI, 21.2%-29.7%) and 20.5% (95% CI, 17.2%-24.4%), respectively. Moderator analyses revealed that the prevalence of clinically elevated depression and anxiety symptoms were higher in studies collected later in the pandemic and in girls. Depression symptoms were higher in older children.

Conclusions and Relevance  Pooled estimates obtained in the first year of the COVID-19 pandemic suggest that 1 in 4 youth globally are experiencing clinically elevated depression symptoms, while 1 in 5 youth are experiencing clinically elevated anxiety symptoms. These pooled estimates, which increased over time, are double of prepandemic estimates. An influx of mental health care utilization is expected, and allocation of resources to address child and adolescent mental health concerns are essential.

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