A narrative review into the impact of COVID-19 pandemic on senior high school adolescent mental health

A bibliometric analysis of mental health among high school students

Background

In recent years, with the increase in academic pressure and changes in social environment, especially after the outbreak of COVID-19, there has been a significant impact on the mental health of high school students. This trend, which is concerning, requires a systematic bibliometric analysis to develop effective preventive and remedial measures.

Objective

This study aims to identify and analysis the research hotspots, frontiers and emerging trends in the field of high school students' mental health over the past two decades using CiteSpace software. These findings provide important insights that can shape future research agendas and guide targeted interventions to improve the mental health outcomes of this vulnerable group.

Methods

This study utilized the Web of Science Core Collection database as its data source to retrieve literature pertaining to high school students' mental health from January 1, 2004, to January 1, 2023. The initial search yielded 1,764 relevant documents. After manually screening to exclude duplicates, conference proceedings, announcements, and irrelevant documents, a total of 1,748 relevant documents were retained. The research employed the CiteSpace 6.2.R4 tool to evaluate various bibliometric indicators of the included literature, including statistics on institutional and author publication volumes, as well as co-citation analysis.

Results

A total of 1,748 English-language documents were retrieved, showing an upward trend in publications on high school students' mental health from 2004 to 2024. The research hotspots primarily focus on COVID-19 pandemic, depression, bullying, substance abuse, sexual behavior, Physical Education and their relationships with the mental health of high school students. Future research trends may focus on studies investigating the relationships between the use of electronic cigarettes, sleep disorders, internet addiction, and the mental health of high school students.

Conclusion

In addition to the six major research hotspots of COVID-19 pandemic, Depression and stress, Suicidal ideation, Bullying, Sexual behavior and Physical education. Researches should pay more attention to the use of electronic cigarettes, sleep disorders, and Internet addiction among high school students.

Factors affecting depression in adolescents with increased suicidal ideation during the COVID-19 pandemic

This study examines factors influencing depression in adolescents with increased suicidal ideation during the COVID-19 pandemic, based on an ecological model and using data from the Korean Children and Youth Panel Survey, 2018. We selected adolescents whose suicidal ideation increased between the third and fourth years of the pandemic and who identified their parents as their guardians. Factors related to depression in adolescents were analyzed using stepwise multiple regression, while considering personal and environmental characteristics in the family and school domains. All models were significant, and Model 3 explained 26.8% of the variance. In Model 3, personal characteristics-physical activity, sleep quality on school days, and smartphone dependence-affected adolescents' depression. Parents' life satisfaction and a rejective childrearing attitude were also found to be significant factors affecting adolescents' depression, along with school life satisfaction and school type. Our findings can inform evidence-based nursing interventions to reduce depression in adolescents with increased suicidal ideation. They can also contribute to building strategies to promote mental health in schools after the pandemic, forming healthy life habits, and laying the foundation for lifelong health.

Twenty years of emotional-behavioral problems of community adolescents living in Italy measured through the Achenbach system of empirically based assessment (ASEBA): a systematic review and meta-analysis

Background

This is a systematic review and meta-analysis of emotional and behavioral problems among Italian community adolescents in the last 20 years, as assessed through the ASEBA questionnaires CBCL 6-18, YSR 11-18 and TRF 6-18. Research questions address: (1) pooled means of problems' scores in questionnaires scales; (2-3) variations in scores according to sociodemographic and time-related factors, and studies' quality; (4) trends in research with ASEBA instruments along with other outcomes, e.g., psychopathological symptoms.

Methods

A systematic literature review of Scopus, EBSCO, PubMed, Web of Science, and ProQuest databases using the PRISMA 2020 guidelines was conducted on November, 2021, and of grey literature on December, 2021. The quality of studies was assessed through the Newcastle-Ottawa Scale.

Results

Forty-four studies were eligible for the systematic review, of which 34 were included for meta-analysis. Results showed that: (1) emotional-behavioral problems were higher when assessed by the CBCL and lower when assessed by the YSR compared to normative data; (2) there were no gender and age differences, except for higher scores of Anxious/Depression symptoms, in girls. (3) internalizing and attention problems increased over the last two decades. (4) major trends of Italian research investigate adolescents' emotional behavioral problems concerning attachment, comorbid symptoms, especially internet addictions, and eating disorders.

Discussion

Despite some limitations (e.g., low-medium quality of most studies, no data on the TRF, under-representation of some geographical areas, some search-related choices), these data provides Italian practitioners and international researchers of some parameter to evaluate Italian adolescents emotional-behavioral problems. Registered on PROSPERO N. CRD42022299999.

Impact of COVID-19 on the mental health of children and young people: an umbrella review

BACKGROUND

Over the past 3 years, a multitude of studies have highlighted the impact of the COVID-19 pandemic on the mental health of children and young people (CYP). In this umbrella review, we synthesise global evidence on the impact of COVID-19 on the mental health of CYP from existing systematic reviews with and/or without meta-analysis.

METHODS

Adopting the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we evaluated 349 citations and identified 24 eligible reviews with medium to high methodological quality to be reviewed narratively.

RESULTS

Most of the reviews reported a high prevalence of anxiety disorders, depression, suicidal behaviour, eating disorders and other mental health problems. Most studies that used data at multiple time points indicate a significant increase in mental health problems in CYP, particularly in females and older adolescents.

CONCLUSIONS

Multipronged psychosocial care services, policies and programmes are needed to alleviate the burden of mental health problems in CYP as a consequence of the COVID-19 pandemic and associated global health measures.

PROSPERO REGISTRATION NUMBER

CRD42021276312.

Loneliness Trajectories, Associated Factors and Subsequent Health in Children and Young People During the COVID-19 Pandemic: A National Matched Cohort Study

Purpose

Loneliness is common amongst children and young people (CYP) and is an independent risk factor for poor health. This study aimed to i) determine whether subgroups of CYP with different loneliness trajectories (during the second year of the pandemic) exist; ii) examine associations with socio-demographic characteristics and subsequent health; and iii) understand whether associations between loneliness and subsequent health were modified by SARS-CoV-2 infection.

Methods

A total of 5851 CYP (N=3260 SARS-CoV-2 positive and 2591 SARS-CoV-2 negative) provided data on loneliness (via the validated 3-item version of the UCLA Loneliness Scale for Children) at least twice in a 12-month period post PCR index-testing (conducted October 2020-March 2021). Latent class growth analyses were used to identify distinct classes of loneliness trajectories. Multinomial logistic regression was used to identify socio-demographic characteristics associated with class membership. Logistic regression models assessed the odds of reporting impairing symptoms 12-months post index-test.

Results

Four distinct loneliness trajectories were identified: three mostly stable (low, medium, high) and one low-increasing trajectory. Being older, female, living in more deprived areas and testing negative were associated with greater odds of being in the highest vs lowest loneliness trajectory; eg OR for female vs male: 5.6 (95% CI:4.1,7.8); OR for 15-17 vs 11-14 years: 4.5 (95% CI:3.4,6.0). Following higher loneliness trajectories was associated with higher odds of experiencing impairing symptoms 12-months post index-test: ORadjusted (compared to lowest loneliness trajectory) were 15.9 (95% CI:11.9,21.3) (high loneliness), 6.5 (5.3,7.9) (medium loneliness) and 2.3 (1.9,2.8) (low-increasing loneliness). There was no evidence that this association was modified by PCR index-test result.

Conclusion

About 5.3% of CYP were classified into a group experiencing (chronically) high loneliness. Being female, older and from more deprived areas were risk factors of belonging to this group. Results suggest that even small increases from low loneliness levels may be associated with worse health outcomes.

The impact of core self-evaluation on school adaptation of high school students after their return to school during the COVID-19 pandemic: the parallel mediation of positive and negative coping styles

Background

To explore the direct effect of core self-evaluation and the indirect effects of positive and negative coping styles on school adaptation of high school students after their return to school during the COVID-19 pandemic.

Methods

The Core Self-Evaluation Scale, Simple Coping Style Scale, and School Adaptation Questionnaire were used for the psychometric analysis of 500 high school students (229 males and 271 females) one month after their return to school. The bootstrap method was applied for mediation analysis.

Results

A positive correlation was noted between core self-evaluation and school adaptation (r = 0.56), and the predictive effect was significant (β = 0.43). Core self-evaluation positively predicted positive coping styles, which positively predicted school adaptation, while core self-evaluation negatively predicted negative coping styles, which negatively predicted school adaptation. Positive and negative coping styles played a significant mediating role between core self-evaluation and school adaptation. The mediating effect included the indirect effects generated by two pathways: core self-evaluation → positive coping style → school adaptation (95% CI [0.08-0.19]) and core self-evaluation → negative coping style → school adaptation (95% CI [0.03-0.11]).

Conclusion

There is a positive association between the core self-evaluation and school adaptation of high school students after their return to school during the COVID-19 pandemic. It may directly or indirectly affect the school adaptation of high school students after their return to school through positive or negative coping styles. After returning to school, educators should guide students to view themselves positively, cultivate healthy core self-evaluation, and enable them to have good school adaptation.

The relationship between loneliness and problematic smartphone use among adolescents during the COVID-19 pandemic: The mediating role of negative emotions and maladaptive coping

INTRODUCTION

Given the observed increased feelings of loneliness and problematic smartphone use among adolescents during the COVID-19 pandemic, further research was needed to determine whether and how the increased loneliness of adolescents during such major public health crisis events affects the risk of problematic smartphone use among adolescents. This study aimed to examine the relationship between loneliness and problematic smartphone use among Chinese adolescents (aged 10-16 years) during the COVID-19 pandemic and to investigate the possible mediating role of negative emotions and maladaptive coping.

METHODS

A total of 672 Chinese adolescents (Mage  = 13.05, SD = 1.51, 50.4% boys, 93.8% from rural areas, 22.5% of whom were only children) took part in this cross-sectional study in April 2022 by completing the Chinese adolescent version of the Loneliness Scale, the Positive and Negative Affect Scale (subscale), the Ways of Coping Questionnaire, and the Mobile Phone Addiction Index Scale.

RESULTS

The serial mediation model revealed that negative emotions and maladaptive coping independently mediated the relationship between adolescents' loneliness and problematic smartphone use. In addition, the mediation effects of "negative emotions-maladaptive coping" could also mediate the relationship between loneliness and problematic smartphone use.

CONCLUSIONS

Loneliness may be positively related to problematic smartphone use through negative emotions and maladaptive coping among adolescents during major public health crisis events, such as the COVID-19 pandemic.

Anxiety, Depression, and Associated Factors among General Population in Indonesia during COVID-19 Pandemic: A Cross-Sectional Survey

Introduction

The 2019 coronavirus pandemic (COVID-19) has affected the physical and mental health of individuals, families, and communities worldwide including Indonesia. This study aimed to examine anxiety and depression in the general population and factors related to anxiety and depression due to the COVID-19 pandemic.

Methods

This study employed an online cross-sectional survey of 1149 respondents. We assessed self-reports regarding current health conditions and exposure to COVID-19, anxiety, and depression in the general population in Indonesia.

Results

The results showed that 26.6% and 30.5% of the participants experienced mild to severe anxiety and depression, respectively. The ordinal regression test showed that anxiety in the community was significantly related to age, feeling infected with COVID-19, feeling that a friend/colleague is infected with COVID-19, sufficient information regarding COVID-19, and the types of symptoms that are felt (fever, cough, and cold/sore throat, difficulty breathing). Besides, education level, occupation, feeling that family is infected with COVID-19, symptoms experienced, and anxiety were significantly related to depression.

Conclusion

The COVID-19 pandemic has caused anxiety and depression in the general population in Indonesia. This study's results can be a catalyst in providing psychological interventions for the general public facing the COVID-19 pandemic.

Sadness and Loneliness in Adolescents with Physical, Sensory or Health Problems in Low/Middle-Income Countries

Feelings of loneliness and sadness are increasing among the global youth, especially in disadvantaged settings. Young people with disabilities from low-income countries may be at greater risk of experiencing such emotions. This study aims to assess the dependence between difficulties/disability and sadness, loneliness and crying for no reason in young people from low- to middle-income countries and to test the risk of experiencing these emotions in young people with different disabilities versus the overall population. A cross-sectional study was conducted based on the Programme for International Student Assessment for Development survey, with 34,604 participants aged 15 years from seven countries: Cambodia, Ecuador, Guatemala, Honduras, Paraguay, Senegal, and Zambia. Dependent relationships were found between difficulties/disabilities and loneliness, sadness and crying. People with disabilities had a higher prevalence of these emotions. The probability of experiencing sadness, loneliness and crying was higher among people with difficulties/disabilities. Young people with disabilities in low-income countries are at a higher risk of experiencing feelings of loneliness, sadness and crying compared to the general population of the same age.

Psychological problems and associated factors among high school students during COVID-19 pandemic in Sawla town, Gofa zone, southern Ethiopia

Background

Depression, anxiety, and stress (DAS) are common among high school students, and they have a negative impact on their academic performance and future lives. Pandemics, such as coronavirus disease 2019 (COVID-19), exacerbate these issues. Although psychological problems are studied in developed countries, they are overlooked in developing countries such as Ethiopia. Therefore, this study was aimed to assess the prevalence of psychological problems and associated factors among high school students during the COVID-19 pandemic in Sawla town, Gofa zone, southern Ethiopia.

Methods

A facility-based cross-sectional study was conducted among 663 randomly selected high school students from March 1 to 31, 2021. The data was collected using the depression, anxiety, and stress scale (DASS-21) questionnaire and analyzed using SPSS version 26.0. Bivariable and multivariable analyses were computed to identify factors associated with DAS. An adjusted odds ratio with 95% CI was used to see the strength of the association and statistical significance was declared at p-value <0.05.

Results

The overall prevalence of depression, anxiety, and stress were 52.1% [95% CI: 48.3, 55.98], 52.6% [95% CI: 48.8, 56.4], and 22.6% [95% CI: 19.4, 25], respectively. Being rural residence (AOR: 4.88, 95% CI: 3.02, 7.88), living in a prison house or with a husband (AOR: 5.94, 95% CI: 1.65, 21.3), having a lower academic level (AOR: 6.23, 95% CI: 3.42), having poor knowledge about COVID-19 (AOR: 1.75, 95% CI: 1.21, 2.53) and poor COVID-19 prevention practices (AOR: 1.74, 95% CI: 1.09, 2.79) were associated with depression. Similarly, being a rural resident (AOR: 3.73, 95% CI: 2.38, 5.84), being a lower academic level (AOR: 2.54, 95% CI: 1.50, 4.30), having poor knowledge about COVID-19 (AOR: 1.54, 95% CI: 1.08, 2.19), and poor COVID-19 prevention practices (AOR: 2.12, 95% CI: 1.36, 3.32) were associated with anxiety. Furthermore, stress was associated with rural residence (AOR: 2.24, 95% CI: 1.42, 3.53), lower academic level (AOR: 4.70, 95% CI: 2.12, 10.4), and poor knowledge of COVID-19 (AOR: 1.71, 95% CI: 1.13, 2.58).

Conclusions

Depression, anxiety, and stress were all prevalent among high school students in the area. Rural residence, lower academic level, and poor knowledge about COVID-19, as well as poor COVID-19 prevention practices, all increase the likelihood of DAS. As a result, school-based psychological counseling interventions, particularly during pandemics, are critical.

Has the COVID-19 Pandemic Affected Cyberbullying and Cybervictimization Prevalence among Children and Adolescents? A Systematic Review

In light of the alarming results emerging from some studies and reports on the significant increase in aggressive online behaviors among children and adolescents during the COVID-19 pandemic, the current research aimed at providing a more detailed evaluation of the investigations focusing on the cyberbullying prevalence rates published between 2020 and 2023. To this purpose, systematic searches were conducted on four databases (Web of Science, APA PsycInfo, Scopus and Google Scholar), and following PRISMA guidelines, 16 studies were included and qualitatively reviewed. Although studies were characterized by a large variety in cyberbullying operationalization and measurement, and by different methodologies used for data collection, the prevalence rates of the involvement in cyberbullying and/or cybervictimization generally revealed opposite trends: an increase in many Asian countries and Australia and a decrease in Western countries. The findings were also discussed by considering the effects of the COVID-19 pandemic. Finally, some suggestions were provided to policy makers for promoting prevention and intervention anti-cyberbullying programs in school contexts.

Association Between Loneliness, Premenstrual Symptoms, and Other Factors During the COVID-19 Pandemic: A Cross-Sectional Study with Japanese High School Students

Purpose

Adolescence is a period of transition from childhood to adulthood where people are vulnerable to stress. The COVID-19 pandemic continues to cause sustained stress in the population. Since the COVID-19 pandemic, social isolation and loneliness have increased. Loneliness is associated with increased stress, psychological distress, and a higher risk of mental illnesses, such as depression. This study examined the association between loneliness, premenstrual symptoms, and other factors in the era of the COVID-19 pandemic among adolescent females in Japan.

Patients and Methods

A school-based cross-sectional survey of 1450 adolescent female students in Japan was conducted in mid-December of 2021. Specifically, paper-based questionnaires were distributed in class, and the responses were collected. The Premenstrual Symptoms Questionnaire (PSQ), 6-item Kessler Psychological Distress Scale, 3-item Revised UCLA Loneliness Scale (R-UCLA), and Fear of COVID-19 Scale were used as measurement tools. The prevalence of loneliness was defined as a total R-UCLA score ≥ 6.

Results

The prevalence of loneliness was 29.0%. The prevalence of serious psychological distress was also high (8.2%), especially in the lonely group (16.0%). Multivariable regression analysis identified the following factors associated with loneliness: second year (odds ratio [OR] 1.53; 95% confidence interval [CI] 1.09-2.14), longer internet use (OR, 1.11; 95% CI, 1.02-1.20), total PSQ score (OR 1.08; 95% CI 1.06-1.11), and psychological distress (OR 1.05; 95% CI 1.01-1.08).

Conclusion

Adolescent females in Japan showed a high prevalence of loneliness. School year (2nd year), longer periods of internet use, premenstrual symptom severity, and psychological distress were independently associated with loneliness. For clinicians and school health professionals, special concern should be given to the psychological health of adolescent females during the COVID-19 pandemic.

Trends in health behaviors and mental health among Korean adolescents in Korea over 5 years, 2017-2021: focusing on the comparisons before and during the COVID-19 pandemic

Objectives

We investigated recent trends in health behaviors and mental health conditions among Korean adolescents from 2017 to 2021 and compared the changes before and during the coronavirus disease 2019 (COVID-19) pandemic.

Methods

Data analysis was conducted on 289,415 adolescents participating in the Korea Youth Risk Behavior Web-Based Survey, an annual cross-sectional study from 2017 to 2021. All analysis was conducted using sex stratification, and the annual percentage change (APC) was calculated.

Results

Alcohol consumption and smoking decreased in the first year of the COVID-19 pandemic compared with before, except for girls from the low-income level. The prevalence of inadequate physical activity for both boys and girls increased in 2020 compared with the pre-COVID-19 period and decreased again by 2021. The prevalence of obesity in both sexes increased regardless of the period (boys, APC = 8.2%, 95% confidence intervals (CI), 6.4-10.1; girls, APC = 3.3%, 95% CI, 1.8-4.8). The prevalence of stress, depression, and suicidal ideation, plans, and attempts for both sexes decreased in 2020 compared to the pre-COVID-19 period. By 2021, this prevalence had returned to a level similar to before the pandemic. No significant APC changes were observed in the prevalence of mental health.

Conclusions

These findings demonstrate the trends and APCs in health behaviors and mental health conditions among Korean adolescents over the last 5 years. We must pay attention to the heterogeneous and multifaceted features of the COVID-19 pandemic.

Screen time and adolescents' mental health before and after the COVID-19 lockdown in Switzerland: A natural experiment

Background

During the COVID-19 lockdown in 2020, adolescents' mental health was largely undermined. A general increment in screen time was reported. However, the long-term effects of the latter on adolescents' mental health are still little explored.

Methods

In the present natural experiment, we investigated these effects using longitudinal data collected before and after the first lockdown in Switzerland. Data come from 674 Swiss adolescents (56.7% females, Mage = 14.45, SDage = 0.50) during Spring 2019 (T1) and Autumn 2020 (T2) as part of the longitudinal MEDIATICINO study. Self-reported mental health measures included somatic symptoms, inattention, anxiety, irritability, anger, sleep problems, obsessive-compulsive symptoms, loneliness, and depression. Measures for screen-media activities included time spent on the Internet, smartphones, social media, video gaming, instant messaging, and television viewing. They were all assessed at T1 and T2.

Results

Paired-sample t-tests with Bonferroni's correction showed that most mental health problems increased over time with an overall medium effect size (Hedge's g = 0.337). In particular, medium effect sizes were found for anxiety, depression, and inattention; small-to-medium effect sizes were reported for loneliness, sleep problems, and obsessive-compulsive symptoms; and a small effect size was found for somatic symptoms. Screen-media activities increased, with the exception of television viewing and video gaming. The results of the hierarchical regression analyses showed that, controlling for covariates, increased time spent on social media - calculated as the difference between T2 and T1 - was the only screen-media activity significantly associated with worse mental health at T2 (β = 0.112, p = 0.016). More time spent in structured media activities like television viewing diminished levels of inattention (β = -0.091, p = 0.021) and anxiety (β = -0.093, p = 0.014). Among covariates, being female, experiencing two or more life events, having mental health problems at T1, and using screens for homeschooling negatively influenced mental health at T2.

Conclusion

These results align with literature indicating a small but negative effect of social media time on mental health. Underlying mechanisms are manifold, including increased exposure to COVID-19 news, heightened fear of missing out, social comparison, and time-displaced for activities such as physical activity and green time. However, in line with the structured days hypothesis, getting involved in media-structured activities like television viewing might protect against mental health symptoms.

Moderating Role of Resilience Between Depression and Stress Response of Vocational Middle School Students During the COVID-19 Pandemic

OBJECT

In this study, we aimed to explore the influences of stress responses and psychological resilience on depression of vocational middle school students during the initial COVID-19 outbreak in China.

METHODS

An online questionnaire survey on the students of a medical school in Jiangxi Province, China, and obtained 3,532 valid questionnaires. A self-compiled general situation questionnaire, Stress Response of COVID-19 Questionnaire, the Resilience Scale for Chinese Adolescents and Center for Epidemiological Studies Depression Scale (CES-D) were used. Hierarchical regression analysis was used to explore the regulatory role of psychological resilience between stress response and depression.

RESULTS

(1) There were significant differences in gender between vocational middle school students' evaluation (t = 3.07, P = 0.002) and defense (t = 3.28, P = 0.001) of the pandemic. Males had higher cognitive evaluation of the pandemic than females, and females had more defense against the pandemic than males. (2) There is a significant difference between vocational middle school students from different grades in depression level (F = 3.62, P = 0.03), pneumonia defense (F = 13.65, P < 0.001) and pneumonia panic (F = 3.10, P = 0.045). (3) Depression level (F = 7.17, P < 0.001), pneumonia evaluation (F = 2.78, P = 0.04) and pneumonia panic (F = 3.32, P = 0.02) of the students concerning the spatial distance of the pandemic. (4) The severity of urban pandemic affects the evaluation of pneumonia among vocational middle school students. (5) Depression was negatively correlated with psychological resilience and pneumonia evaluation, and positively correlated with pneumonia panic. Psychological resilience was positively correlated with pneumonia evaluation and pneumonia defense, and negatively correlated with pneumonia panic. (6) Psychological resilience could reduce the level of depression caused by pneumonia evaluation and pneumonia panic.

CONCLUSION

There were significant differences in depression level and stress responses in grades, gender and spatial distance of pandemic. Resilience has a significant negative moderator effect on the relationship between pandemic panic and depression. Resilience has a significant positive moderator effect on the relationship between pandemic evaluation and depression.