key: cord-0955641-ssjcnynn
authors: Micalizio, Lauren; Ravenel, Caroline; Weathers, Thrisann; Shambo, Lacey; Windham, Kayla
title: The Effects of COVID-19 and Depression in Adolescents
date: 2021-08-27
journal: J Nurse Pract
DOI: 10.1016/j.nurpra.2021.08.016
sha: 4b73f64c22ebe80fe8b8d457405f0063411e4d27
doc_id: 955641
cord_uid: ssjcnynn

Adolescents are a vulnerable population profoundly affected by mental health disorders such as anxiety and depression. This has been exacerbated by the COVID-19 pandemic, as they face new challenges with social isolation, abuse and decreased access to care. The purpose of this letter is to discuss the effects of COVID -19 on adolescence, outline signs and symptoms of depression and screening tools clinician can use to identify depression in adolescents.

The COVID-19 pandemic and lockdown has shown to have great psychological impact to the vulnerable population of adolescents. During this time period, adolescents may experience stressful life events, extended confinement within their homes, grief, intrafamilial violence, lack of normal social interaction with peers, and overuse of electronics which can contribute to symptoms of depression¹. In a systematic review by Cambridge University, nearly 60% of participants met the clinical criteria for mental health disorders during COVID-19 ². A recent article in the January 2021 Issue of The Journal for Nurse Practitioners, addressed mental health in teens. The purpose of this letter is to respond to the aforementioned article, and particularly to address the effects of COVID-19 and depression in adolescents, to provide practitioners and readers with resources to screen for anxiety and depression and highlight national resources for teens with mental health disorders.

Adolescence is a critical time for social development and biopsychosocial changes, requiring an increase in social interaction. It is a time for children to begin to create their own identity, gain independence, establish their own coping mechanisms and increase responsibilities ⁷ . COVID-19's lockdown has severely restricted independence and social interactions for teens, and has increased stress in education, relationships and home environments. During the time of lock down, stress within the home amplified as many parents have lost their jobs, while others are learning to navigate their jobs virtually, all while also having to supervise, manage and educate their children. Many homes were not positive environments pre-COVID, but now, with everyone constantly there and all of the added stress, they are very negative environments for children to prosper emotionally and socially ⁵ . This environment can also amplify abuse in abusive households ⁴ . Compared to schools, all houses are restricted by space, and many are J o u r n a l P r e -p r o o f less safe. These environmental, social and emotional changes have led to increased anxiety, depression, PTSD, domestic violence, neglect and substance abuse⁵ .

Since the beginning of the pandemic, cases of teens presenting to the emergency department with depression and anxiety has increased dramatically ³. Practitioners should be on increased alert for signs and symptoms of depression in adolescents and be able to educate parents on what to look out for at home as the pandemic may have had a great psychological impact on their child. Signs such as increased irritability, crying, separation anxiety, loss of interest in previously enjoyed activities, decrease in appetite, and a decrease in academic performance may indicate depression and warrant further investigation. When assessing middle and high-school age adolescents, there may be increases in risk taking behaviors such as alcohol consumption or drugs along with a change in appearance as depression can cause adolescents to disregard personal hygiene habits ³. Many pediatric and adolescent care provider practices vary widely in what they are able to take on when it comes to screenings and addressing psychological difficulties in the youth population. Healthcare teams that care for children and adolescents should be provided guidance, J o u r n a l P r e -p r o o f education, and training on key topic areas such as identification, evaluation of suicide risk, and initial management of adolescent depression ⁸ . Depression screenings for adolescents should start at the age of 12 years and should include a formal assessment, as well as self-evaluation through the PHQ-9 screening tool. These items have the potential to be cost-efficient, while providing means of improving care delivery ⁸ . Once these items are developed, it is imperative for the parents to be aware and know what to do and who to reach out to if an issue arises.

Parents and adolescents can work with providers to develop a standard safety plan as provided by the Suicide Prevention Lifeline and other mental health organizations ⁹ . Items parents should be educated on include signs and symptoms and possible risk factors of depression. If the patient is at high risk for depression, a safety plan for the adolescent should be created with information that includes appropriate contact information, who the adolescent's mental health specialist is, and when to refer to a crisis hotline or go to the closest Emergency Department ⁸ . If the adolescent is not under the care of a specialist, then information to contact the primary care provider should be included. If an incident occurs or there is concern, the adolescent should be referred appropriately at that time. Practitioners should remind patients and families about the possible option of telemedicine visits if they do not feel comfortable visiting the office in person due to COVID-19. Overall, the impact that the pandemic has had on the adolescent population will continue to have an effect on their mental and physical health and well-being. But with the involvement and education of parents and providers, a large impact can be made to provide this population with the best overall outcome.

J o u r n a l P r e -p r o o f

Adolescent psychiatric disorders during the COVID-19 pandemic and lockdown

Increases in depression and anxiety symptoms in adolescents and young adults during the COVID-19 pandemic

Adverse mental health effects of COVID-19 on children and teens. The Brown University child and adolescent psychopharmacology update

Mental health effects of school closures during COVID-19

How is COVID-19 pandemic impacting mental health of children and adolescents?

COVID-19 and obesity in childhood and adolescence: a clinical review

The effects of social deprivation on adolescent development and mental health

Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I

Practice Preparation, Identification, Assessment, and Initial Management

Help yourself. Suicide Prevention Lifeline