COVID and Teens: A Commentary

Erin N Gerhart, CRNP;  Hatim Omar, MD;

Lehigh Valley Health Network, LVPG, Allentown, PA 18103, USA.

 Correspondence: Email: Hatim.Omar@lvhn.org

Received: 25/5/2021; Accepted: 10/6/2021

Key words: anxiety, teens depression, trauma.

[citation: Gerhart, Erin. & Omar Hatim (2021). COVID and Teens: A Commentary. DHH, 8(2): http://www.journalofhealth.co.nz/?page_id=2557].

The COVID-19 pandemic has disrupted many parts of adolescent’s lives. Basic issues of adolescence include physical changes, sexual issues and experiences, peer relationships and pressures, substance use and abuse, and future planning. Puberty is a time of rapid physical, cognitive, and developmental changes. When trauma occurs during this period, consequences can be long lasting and maybe seen for many years after. The pandemic has impaired the natural development and will lead to a rise in mental health illnesses for many years to follow.

The occurrence of psychiatric disorders normally increases during adolescence. There are higher rates of depression, anxiety, and eating disorders as peer pressure creates the need to attain the “ideal” image.  (Neinstein et al, 2016). Sleep patterns alter from increased independence, intense school and sports schedules, and emergence of technology. In the past year, we have seen an increase in these disorders above what is normally expected in this age group, largely due to the lack of social interactions from quarantining and the pandemic.

The brain undergoes major development during puberty and is not fully complete until late adolescence. The limbic system is the part of the brain that recognizes risk taking. The prefrontal cortex controls the executive functions of reasoning, advanced thought, and impulse control. As the teenager grows, signals in these areas become transmitted more efficiently and connections between different parts of the brain increase. Teenagers often rely on the emotional centers of their brains for making decisions until these regions are fully developed thus making them vulnerable to problems in regulating emotions and behavior. As connections increase, the prefrontal cortex starts to communicate with other parts of the brain allowing for enhanced planning and problem solving, and better control of emotions and impulses. Cognitively, as the teenager ages, there is increasing ability to reason, greater understanding of love and personal beliefs, and the ability to think about how they are perceived by others.

Adolescence is also the time of identity development, when they discover who they are and what their role in life is. Factors that affect their self-esteem include approval of others and their own personal successes. Through the pandemic, teenagers have lacked the tools for personal success – sporting events and social clubs were cancelled, and schools went all virtual. Less interactions with others and less opportunities to create, find what they like, and be successful. It is now more difficult to become independent when job and activity opportunities have been so limited.

Teens have also become more dependent on social media to connect with friends. This has led to an altered perception of what is normal. In a database review done by Sheen et al (2020), there has been consistent reports of significant increases in screen time during the pandemic. This increase in screen time has the potential to affect positive body image. Filters on snapchat, Instagram etc. show perfect, blemish free faces of people leading happy lives. The teenager sitting at home with acne on their face and feeling sad, now feels even more anxious and sad as they perceive their situation as not normal. It has been harder to develop a positive image and subsequently harder to like oneself. The pandemic also altered sleep patterns in teens with less nighttime sleep which is crucial to brain development.

From a brain maturation standpoint, adolescence is a very important time. The COVID-19 pandemic has affected this development and thus increased rates of anxiety, depression, and eating disorders in teenagers (Schwartz and Costello, 2021). Those who have been away from their peers due to quarantines and school closures have developed increase in depression and now we are seeing more and more social anxiety as teenagers rejoin their peers in school and social settings. With this uptick in mental health diagnoses, there has been a lack of resources in our community. We have witnessed waiting lists of over 6 months long for most places, and many are not even accepting new patients. This difficulty to get in anywhere leads to increased frustration, stress, and depression in both the teenager as well as the parent. As the teenagers grow, and more difficulties arise as a side effect of the pandemic, the mental health needs will also continue to grow. We are at a crucial point in history to address this need. There has always been lack of adequate resources to help teens cope and deal with mental health issues and that has become much worse during the pandemic. The health care system is in dire need of expanding resources, especially comprehensive approach programs that address the developmental, physical and mental health needs in one setting.

References

Neinstein LS, Katzman DK, Callahan ST, Gordon CM, Joffe A, and Rickert VI (2016). Adolescent and Young Adult Health Care, A Practical Guide. Wolters Kluwer, Philadelphia PA.

Schwartz MD, Costello KL. Eating Disorders in Teens During the COVID-19 Pandemic. Society for Adolescent Health and Medicine 2021. https://doi.org/10.1016/j.jadohealth.2021.02.014

Sheen A, Grace Ro, Kagadkar F, Dos Santos A, Zeshan M. Screen time in the context of COVID-19: the good, the bad, and the ugly. Journal of the American Academy of Child and Adolescent Psychiatry 2020; 59 (10) p. s255.