The Impact of Pandemic Stress on Child Mental Health: A Comprehensive Study

Children are particularly susceptible to the side effects of pandemic stress. They may suffer anxiety, depression, social isolation and disrupted routines as a result.

In this KFF study, parents assessed their child’s impact on various aspects of life using an 8-item scale (no change, mild, moderate, severe). Being severely affected by COVID-19 pandemic was associated with reduced HRQoL and mental health outcomes despite proper age/sex adjustments.

1. Adverse Childhood Experiences (ACEs)

Adverse Childhood Experiences (ACEs), increasingly documented research demonstrates a link between Adverse Childhood Experiences and poor mental health outcomes. Examples may range from physical abuse and neglect, household dysfunction and having family members serve time in prison – with up to two thirds experiencing at least one ACE while one quarter have experienced four or more. Repeated exposure increases your risk for depression, anxiety and other psychological disorders as well as physical issues like heart disease and obesity [1,2,3].

Parental stress and supportive relationships can greatly contribute to child mental health; however, adverse childhood experiences (ACEs) are especially damaging because they have been shown to lead to lifelong difficulties that continue into adulthood; such as increased mental health problems, poor physical health and social functioning as well as higher-risk behaviors like drug or alcohol misuse, prostitution or premature death.

The original ACE study demonstrated that adults experiencing four or more adverse childhood experiences (ACEs) had much higher rates of multiple health risk factors associated with leading causes of death compared to adults without any ACEs. Subsequent research has extended this list of possible ACEs to include domestic violence, neighbourhood crime, imprisonment of family members, financial hardship and discrimination due to race or ethnicity.

Although adverse childhood experiences (ACEs) can result from any event or circumstance, social disadvantage has an enormous influence in their prevalence. Stressful living conditions often limit primary caregivers’ abilities to provide safe environments for their charges.

2. Social Isolation

Children who experienced social isolation were more likely to encounter mental health difficulties by age 12 compared with children without social isolation, in part due to preexisting mental health problems; however, family factors also played a part in the relationship between mental health symptoms and social isolation; for instance, behavioral problems or attention-deficit/hyperactivity disorder (ADHD) symptoms at age 5 were associated with an increased risk of becoming socially isolated by age 12 [source].

Childhood social isolation has been linked with poorer adult health outcomes, partly because early social deprivation affects the hypothalamic-pituitary-adrenal axis. Furthermore, studies have demonstrated how childhood social isolation disrupts development of inhibitory neuron circuits in the medial prefrontal cortex that regulate stress responses and emotion regulation.

This finding is significant because it shows how even short-term social isolation can significantly erode a child’s mental health, especially when combined with preexisting mental health difficulties. Thus, parents need to communicate openly with their children and allow them to express unpleasant emotions like fear and depression without judgment from parents themselves. Furthermore, considering how their own reactions to pandemic might influence children may also prove helpful in understanding behavior change amongst children.

Furthermore, the authors of this study acknowledge that their correlational design does not permit inferences regarding causality; yet their results align with previous research showing a relationship between social isolation and mental health difficulties in children and social isolation being associated with depression during pandemic outbreak. Unfortunately their results fail to take into account effects from other factors like parental mood or financial stress that might have contributed to observed trends in mental health for these children during pandemic outbreak.

3. Disruption in Routines

Before the pandemic hit, children and adolescents in the US already struggled with mental health challenges. A KFF analysis of data from the Youth Risk Behavior Survey in 2021 found that on average 8% of adolescent girls and 10% of boys had anxiety disorders; 4% of girls and 9% of boys experienced depressive disorders; while 6% of adolescent girls and 11% of boys suffered from attention deficit hyperactivity disorder or attention deficit/hyperactivity disorder (ADHD).

Disruptions to routines, like school closures and reduced work access, can have lasting negative impacts on children’s mental health. Whether these disruptions arise out of fear of coronavirus infection or simply inconvenience, they can be especially taxing for those living with preexisting psychiatric disorders.

As reported by Ann and Robert H. Lurie Children’s Hospital of Chicago in 2020, six in ten parents reported that COVID-19 pandemic has negatively impacted their child’s schooling; over half said mental health as well. Furthermore, parents experiencing financial stressors were found to spend less quality time with their kids and show less affection compared to parents without financial stressors.

Impacted populations include low-income families and individuals living with disabilities. While 988 – a national hotline dedicated to supporting individuals addressing their mental health needs – is an important step toward combatting this problem, more must be done to ensure children who require care have access to it.

4. Remote Learning

Before the pandemic hit, both children and teachers were not used to remote learning environments, making learning at home challenging for both. Many teachers and parents interviewed noted their children were less engaged with schoolwork when not physically enrolled in classrooms; many reported feelings of anxiety during this time as a result of not having physical classrooms nearby.

Many parents found it challenging to find childcare while their children attended classes at remote sites, meaning they could no longer go to work or meet other obligations; consequently, this caused many families to struggle financially during the pandemic.

Parents whose students were receiving virtual or combined instruction reported higher instances of wage losses and conflicts between child care obligations and work. This was particularly prevalent among low-income communities where the effects of the pandemic were particularly felt.

Child development specialist Patricia Perez in Chicago has seen first-hand how the switch from in-person teaching to remote learning is impacting her students, including an increase in depression rates among high schoolers and more intense emotional reactions due to these changes than usual.

Teacher and school leaders can relieve some of this strain by creating a structured environment during remote learning, including providing regular group meetings with mental health counselors for students as well as weekly check-ins to discuss any emotional concerns that might be impacting them. Furthermore, it’s also essential that they give sufficient outside assignments so students stay engaged with their work while staying focused and staying engaged with life beyond school.

5. Screen Time

Screens have become the go-to entertainment source for adolescents, with it not uncommon for adolescents to spend up to nine hours each day using them for social media, gaming and watching videos – often at the expense of physical activity, family interaction and face-to-face socialization with peers – leaving little room for physical activity, family interaction and face-to-face socialization with peers; leading them down a path that may eventually result in mental health issues like depression and anxiety.

Multiple studies have reported the adverse impacts of excessive screen time on child and adolescent mental health, specifically depression and anxiety symptoms, cognitive functioning issues, obesity issues, poor school performance and decreased social capital as a result. Screen time can even lead to increased suicide risk which poses a significant public health concern.

Studies examining this link are quite extensive, citing evidence for an association between screen usage and mental health both cross-sectionally and longitudinally. Some have also observed a dose-response effect; more screen time was linked with worse mental health outcomes.

These studies do have some drawbacks, including their reliance on self-reported screen time data which may provide inaccurate results, especially among adolescents who may struggle to accurately recall their screen use. Furthermore, most studies don’t differentiate between different kinds of screens or content.

Although these limitations exist, there is evidence of an association between screen time and lower HRQOL, particularly one high-quality and three medium-quality reviews, with the strongest associations seen in one high-quality and three medium-quality reviews. This may be caused by physical activity being replaced with screen use; studies have also shown how exposure to certain content such as airbrushed models and negative peer relationships on screens can harm mental health in teens, leading them to compare themselves against others and become disenchanted with life itself.

References and further reading

• Martin, A., Volkmar, F. R., & Bloch, M. (Eds.). (2017). Lewis’s Child and Adolescent Psychiatry (5th ed.). Amazon
• American Psychiatric Association. (2022). DSM-5-TR.
• Thapar, A., et al. (Eds.). (2015). Rutter’s Child and Adolescent Psychiatry (6th ed.).
• AACAP: aacap.org
• AAP: aap.org