Juvenile mental health and coronavirus, Covid-19 and psychic symptoms

Mental health and emotionality in times of coronavirus

Covid has changed lives and affected the emotional world of many people

Shortly before writing these lines, a young teacher asked me for help and advice because a 16-year-old student of his class had come very close to taking his own life. After a long conversation with the teacher and before he was taken to the hospital, that teenager asked this question: What do I do now?

This question prompted me to do a review in available scientific studies, and a survey of school principals. The results, which are about to be published, were presented at the Gran Sasso International Forum. I will summarize them below.

I will focus on three aspects:

1. Impact of the pandemic on youth emotionality

    Effects of the pandemic on youth emotional health in scientific studies

    Results of a survey to school principals about students' emotional health

2. Psychological and spiritual interpretation of the effect of the pandemic on emotional health

    Factors that cause emotional distress in young people

    Three crises of youth emotional world preceding the pandemic

3. Promoting a new resilience to take advantage of the coronavirus crisis

    Strategies to counteract the 3 crises that affect young people's emotioanl health

    Building a secure personality on the pillars of happiness

Conclusions on the emotional health of young people in the face of the pandemic

1. Impact of the pandemic on youth emotionality

The topic of youth emotional health is useful for prevention in mental health, considering that half of all mental illnesses begin around age 14, and, by age 24, three-quarters of mental disorders have already begun. These disorders include depression, anxiety, and post-traumatic stress syndrome, which are directly related to emotional health.

It is too early to draw firm conclusions, as the pandemic is not only recent, but ongoing. However, enough is already known to try to prevent further damage and to think, so to speak, about how to rebuild long-damaged youth.

The number of young people worldwide, aged 0-19 years, affected by the pandemic is estimated at about 2.59 billion. I will discuss some medical and psychological studies and then a survey of school principals and chaplains in 6 countries.

Effects of the pandemic on youth emotional health in scientific studies

The aspects related to youth emotional health on which I have found the greatest consensus in the various scientific studies are:[1]

  • predominance of negative emotionality: sadness, fear, worry, irritability;
  • increased anxiety and depression in school and university age;
  • increased eating disorders;
  • greater impact on adolescent women;
  • increased consumption of pornography as a relief from internal distress;
  • younger children exhibited more somatic symptoms;
  • greater separation of good and bad students due to online studies;
  • globalization of news has encouraged contagion of negative emotions.

Symptoms that have increased most clearly with the pandemic in the child and adulthood population, in several places starting with China, are:

  • restlessness;
  • irritability;
  • anxiety;
  • depression;
  • attachment difficulties;
  • lack of attention;
  • increased screen time.

Results of a survey to school principals about students' emotional health

Interestingly, in very different places around the world, something simile seems to have happened. And also that in several schools precautionary and supportive measures were taken from the beginning. The questions proposed were:

  1. What have you noticed in the emotional world of young people?
  2. Have you seen an increase in abnormal emotional reactions such as anxiety and depression?
  3. Have there been more attempts at self-harm?
  4. Has the pandemic allowed for more transcendent questions to be asked, such as about the meaning of life?
  5. Were there more risky behaviors that often accompany low emotional states: alcohol, drugs, etc.?
  6. Did you notice the influence of family circumstances?
  7. How did interpersonal relationships with peers develop at different stages?
  8. Did you see differences by age and gender?

It is confirmed that the pandemic had a strong impact on the emotional health of young people. According to testimony, the first period of confinement or lockdown was better coped with than the second, perhaps because of the novelty. The return to school was a relief, but more relational problems were noted, such as difficulties integrating into the group. I would now like to highlight a few aspects that struck me the most.

On the first question, I received the following letter from the director of a school in Estonia:

We didn't notice a big impact on the emotional world. Perhaps because Estonia is a country with a small population, we haven't seen the alarming number of sick people and deaths in other countries. And the press is generally less emotional than in other cultures. Social calm was maintained and there was never a tight lockdown: it was possible to go out on the streets and the state encouraged people to get out and move around. The country is almost 100% inter-net connected. No more cases of depression or anxiety were noted, perhaps because these problems existed-no before the pandemic. Instead, there was a relapse of depressive or anxiety symptoms in those who were beginning to feel better.

For contrast, I copy the response from a school in Chile, a country that is going through a social crisis and where the pandemic was experienced with extreme intensity:

The increase in abnormal emotional reactions among students aged 13 to 18 has been very evident. We had 5 girls in 2021 hospitalized for depression and eating disorders.

Countries, culture, and how the pandemic is managed influence, but the impact of the pandemic on emotional health did not respect boundaries.

Generally, more diagnosed cases of depression or anxiety were not reported, but a major increase in sadness as a mood state was seen. I was told by one school that they had not noticed an increase, as the problem was already very severe before the pandemic.

In the fourth question on more transcendent aspects, the answers surprised me because I expected the pandemic to raise larger issues. It seems that it did not. I transcribe some of the responses:

"A significant number of teens expressed, in some way, a desire to 'enjoy, enjoy because the world is coming to an end.'"

"Those opportunities to value the everyday more are not being taken. This leads them to wait for life to normalize so they can 'feel good again.'"

"They have difficulty going deeper, and when they do go deeper they find it very difficult to achieve certain ideals."

The chaplain of a COVID inpatient center wrote to me:

Those who have an inner approach to life question the meaning of life and become transformed. Those who have an epidermal or superficial approach to life have a harder time changing, no matter how difficult the circumstances.

Risk-taking behaviors appear to have increased, especially since the end of confinement measures. Alcohol and drug use decreased at first, probably due to greater parental control, since they were confined to the home; and since the places where they used to consume were closed.

Family was considered an important factor. Isolation in the early period seems to have had a positive effect on many youth, giving them the opportunity to share, eat, and play with siblings and parents.

Unfortunately, an increase in divorces was noted, leading to an increase in sadness, anxiety, insecurity, and hostile reactions among the youth. I would like to highlight one of the responses:

Family support has been essential to getting through this unscathed. Those who did not have it immersed themselves in fictional virtual realities in search of companionship.

I report other responses on this question, which complete the picture on the importance of what they refer to as family. They touch on three pillars of the emotional world: meaning of life and happiness, authority in the family, and success and failure:

When we meet with families of pupils with emotional difficulties, we see that the dynamice are generally similar. Overwhelmed moms, parents who are a little more removed from the situation and who, in the first instance, want the school to take care of everything. They generally want their kids to be 'happy,' but in the end that means getting good grades so they can go to study whatever they want, at the best university.

When there is a lack of authority, even when both parents are present, there are problems like excessive consumption of unfiltered technology or parties with liquor.

The low tolerance for frustration and immediacy we live in, which is often provided by parents, is complicating the interpersonal relationships of younger students.

2. Psychological and spiritual interpretation of the effect of the pandemic on emotional health

From all that we have said, another question arises: how much of the impact we observe in young people is due to the coronavirus? What has actually happened?

The continuity with a number of pre-pandemic factors seems clear. For example, it is known that the rate of depression was increasing more in young people than in other population groups[2]. I mention in special way the following points, which are also reflected in scientific studies:

  • Family problems
  • Use of screens and social networks
  • Insecure identity: existential, relational, sexual
  • Low self-esteem and low frustration tolerance
  • Addictions
  • Depression
  • Suicide

A fundamental problem is the unstructured family. In several countries, 2 out of 3 children are born out of wedlock; and 6 out of 10 of the few marriages that do form break up after a longer or shorter period of time. This causes a wound in the hearts of children and young people and makes it difficult for them to grow up with a healthy affectivity and learn to distinguish love.

Then there are the social networks and screens, which are educating young people, sometimes replacing the family. Some data indicate that children between the ages of 5 and 11 spend about 2 hours a day on screens; between the ages of 11 and 18, this rises to 3.5 hours. It is estimated that teenagers spend an average of 1560 hours per year on social media, which is equivalent to the time spent in school. This, which also causes a decrease in sleep time, can be a stress factor, combined with the need to check many times the various "likes" received, which increases cortisol, with all its negative consequences for health[3].

Screens are like a mask: both elements hide part of the personality and can serve as an excuse not to show oneself, to avoid contact, to hide one's emotionality.

Factors that cause emotional distress in young people

Among many other factors that cause intense emotional distress in young people, I emphasize three:

  1. Drug addiction. Marijuana is the most commonly used drug among youth and is associated, like other substances, with altered emotionality (apathy, or lack of emotionality), depression, and suicidal tendencies[4]. Addiction reflects the existential emptiness and reluctance for everything, which people try to fill with "artificial paradises", according to Frankl's expression.
  2. Weak identity, in one's own existence, in one's relationship with others, and in an essential dimension: sexuality. We see in the United States and other countries a large number of young people, especially girls, who doubt their sex, who have their puberty blocked. The lines for a dialogue seem to me to be well laid out in the Congregation for Catholic Education's 2019 document, Male and Female Created Them. As a scholarly basis, a good review is the Mayer Report on Sexuality and Gender, 2016.
  3. Pornography, which increased during the pandemic, negatively impacting the affective hearts of youth[5]. With pornography, it is easy for a young person to confuse the fiction of sexuality with reality, love is replaced by immediate and anonymous pleasure, gender violence increases. In schools, this leads to more hyperactive behavior and inattention.

Pornography is part of a larger phenomenon, which is the trivialization of sexuality. As Pope Francis has written, " In our own day, sexuality risks being poisoned by the mentality of “use and discard”" [6].

Three crises of youth emotional dimension preceding the pandemic

I conclude this paragraph by suggesting that the impact of the coronavirus pandemic on youth emotional health is greater because it is coupled with three earlier crises: 

- Crisis of emotionalism: the confusion and unfamiliarity with emo emotionality itself, which is equivalent to living with a stranger in one's own home.

- Crisis of coherence, both individual and societal, in the face of major problems, including pandemic management.

- Crisis of meaning or significance and, as a result, making suffering and illness even more obscure.

3. Promoting a new resilience to take advantage of the coronavirus crisis

Evidence from past pandemics and epidemics suggests that many mental difficulties can appear years after the traumatic event. Pathological stress, detachment, insomnia, and anger can be experienced up to three years after a quarantine.

All of this encourages us to think about prevention strategies and new resiliencies or ways of resurrecting from the wound.

We can take advantage of the coronavirus crisis, which is not a punishment from God. The etymology of the word crisis, which in Greek refers to decision and in Latin to change, mo- strates that one can emerge from a crisis more mature and optimistic, or more insecure and unhappy.

Strategies to counteract the 3 crises that affect young people's emotional health

1. Teach about one's emotions. This was the goal set by Fred Rogers in the United States with his children's television program, A Beautiful Day in the Neighborhood. A film based on this program was released in 2019. A journalist, Lloyd Bogel, insolent and bitter in all his interviews and always angry, is assigned to do an interview with Rogers for The Esquire, which will finally be published in 1998. 

The journalist, little by little, is transformed, changing his emotional world, which was damaged by a strong conflict with his father, whom he had not forgiven.

In the journalist's transformation, 4 points stand out: naming the feeling; talking about what you feel; followed by the need to be accepted unconditionally from before birth; and the need to forgive.

2. Encourage decision-making and change; or, in other words, an awareness of being free and responsible to move forward in life. This awareness leads to a deepening of the value of time, the management of which has been mentioned as an important factor for resilience in the pandemic. 

It requires the effort of parents, educators, and society to make it easier for young people to disconnect from external stimuli, from networks, and to pay more attention to what is important, with a focused awareness, which is one way of understanding mindfulness.

3. Seeking the meaning of life, being happy: Emily Esfahani, inspired by Viktor Frankl, speaks of four pillars of happiness:

    - Sense of belonging: young people need to love and feel loved, someone who affirms their worth even before they are born. The natural environment is the family, which welcomes them as a gift and accompanies them in their growth and reaffirms their self-esteem. Authorities participate in this positive task if they are consistent with goodness and truth.

    - Purpose: To have a project or meaning in life that guides one's steps. This is also where the driving force of emotional intelligence comes into play: self-control and the ability to wait, precisely because "I have a purpose." This theoretical statement has been confirmed in the current pandemic, where the beneficial effect of self-control in reducing mental stress has been demonstrated[7].

    Having a great purpose leads to wanting it. Here's how one student responded about online learning at a distance because of the lockdown:

    "The truth is, it doesn't matter if the classes are online; if I want to learn, I learn, and if I don't want to, I don't."

    I think that statement is essentially true. When we really want something, when love moves us, everything becomes easier. If there is no desire to do things, if there is no love, every circumstance is an excuse to put things off.

    - Transcendence: going out of oneself, to others and to God, making room for transcendent experiences. This was intuitively applied by one teacher in this crisis:

    At the beginning of an online class, I told the students to go outside for a few minutes, without music or phones, in silence. They came back happier and more relaxed. They commented that they had wanted to go outside for a long time...but without going outside. Some of them need - concluded the teacher - a little push.

    These "little nudges" could be a walk, reading a novel, a piece of music, contemplation of nature, meditation, etc. 

    What is needed in many countries is an education that is more open to contemplation, art, beauty, goodness..., that opens the door to transcendence.

    - Narrative: the way we tell ourselves about our lives, with what has happened and our wounds. It means knowing our history and coming to terms with it, knowing that, without being able to change it, we can interpret it differently with a more positive attitude.

    Building a secure personality on the pillars of happiness

    These four pillars help build a more secure personality, which is essential for resilience. So many young people who do not have an easy life and have suffered great wounds can gain the strength to rise again if they are given confidence. And this requires consistent, joint action by families, educators, various religious ministers, policy makers, etc. 

    The resilience strategies to overcome the pandemic proposed so far, with effort and very well done, include sports activities, face-to-face or networked socialization spaces, time management and social and family relationships, help from parents, teachers and pediatricians, etc.[8].

    A comprehensive approach that looks to the future can continue to deepen. There is a need for more security for each young person, based on the value each has as a person. And this security is obtained and confirmed, as the studies cited above show, in the family.

    The conviction that it is possible to be better people can grow in young people and in everyone.

    Conclusions on the emotional health of young people in the face of the pandemic

    I hope that some of the ideas from this research give answers to the question of that young man who tried to take his own life, mentioned at the beginning, and to many others who do not reach that extreme of suffering, but ask themselves, "what do I do now?"

    We can help young people get back on their feet with a positive attitude. And that consists of fostering authentic stimuli, an appreciation of goodness, beauty and truth. This is what fills a heart and makes a person feel good, which is accompanied by good deeds and good thoughts, with good individual and social outcomes.

    The affective heart is characterized as the place of desire, decision, truth, and encounter. There are many possible questions: What do I desire and why? Am I able to choose a worthwhile project? Do I always opt for the truth that sets me free? Do I go out to meet others and consider the possibility of helping and serving? For believers, it is easier to find God in all four components.

    I conclude with the words of Pope Francis: "Even worse than this crisis is the tragedy of squandering it by closing in on ourselves"[9].

    Wenceslao Vial

    [1] There are all the references in the publication. Some examples: Elizabeth A. Rider, Eman Ansari, et al, Mental health and wellbeing of children and adolescents during the covid-19 pandemic, «British Medical Journal», 2021, 374: n1730; Jane Pirkis, et al, Suicide trends in the early months of the COVID-19 pandemic: an interrupted time-series analysis of preliminary data from 21 countries, «The Lancet Psychiatry», 2021, 8: 579–88; Marcela Larraguibel, Rodrigo Rojas-Andrade, et al, Impact of the COVID-19 Pandemic on the Mental Health of Preschoolers and School Children in Chile, «Revista Chilena de Psiquiatría y Neurología de la infancia y la adolescencia», Vol. 32, Nº 1, pp. 12-21; Scarlett Mac-Ginty, Álvaro Jiménez-Molina, et al, Impact of the COVID-19 pandemic on the mental health of university students in Chile, ivi, pp. 23-37; Carlo Buzzi, Maurizio Tucci, et al, The psycho-social effects of COVID-19 on Italian adolescents' attitudes and behaviors, «Italian Journal of Pediatrics», 2020 May 24, 46(1).

    [2] The prevalence of depression among 13-18 year olds in the United States is 11%. Females have increasingly severe episodes. The suicide rate has been increasing for more than 10 years and is the second leading cause of death in adolescents: cfr. Leslie Miller, John V. Campo, Depression in Adolescents, «New England Journal of Medicine», 2021; 385: 445-449.

    [3] Cfr. Pooja S. Tandon, Chuan Zhou, Association of Children’s Physical Activity and Screen Time With Mental Health During the COVID-19 Pandemic, «JAMA Network Open», 2021, 4(10): e2127892; Gadi Lissak, Adverse physiological and psychological effects of screen time on children and adolescents: Literature review and case study, «Environmental Research», 2018 Jul, 164: 149-157.

    [4] Leslie Miller, John V. Campo, Depression in Adolescents in «New England Journal of Medicine», 2021; 385: 445-449.

    [5] Cfr. Cristina Camilleri, Justin T. Perry, Stephen Sammut, Compulsive Internet Pornography Use and Mental Health: A Cross-Sectional Study in a Sample of University Students in the United States, «Frontiers in Psychiatry», 2021 Jan 12, 11:613244.

    [6] Francis, Apostolic Exhortation Amoris Laetitia, n. 153.

    [7] Tatjana Schnell, Henning Krampe, Meaning in Life and Self-Control Buffer Stress in Times of COVID-19: Moderating and Mediating Effects With Regard to Mental Distress, «Frontiers in Psychiatry», 2020 Sep 23.

    [8] Cfr. Michela Deolmi, Francesco Pisani, Psychological and psychiatric impact of COVID-19 pandemic among children and adolescents, «Acta Bio Medica: Atenei Parmensis», 2020, Vol. 91, N. 4: e2020149; Shweta Singh, et al, Impact of COVID-19 and lockdown on mental health of children and adolescents: A narrative review with recommendations, «Psychiatry Research», 293, 2020, 113429.

    [9] Francis, Homily, May 31, 2020, Solemnity of Pentecost, St. Peter's Basilica.