Prepandemic Risk Factors of COVID-19-Related Concerns in Adolescents During the COVID-19 Pandemic

Pediatric and adolescent HIV viral load coverage and suppression rates in the context of the COVID-19 pandemic in 12 PEPFAR-supported sub-Saharan African countries in 2019 and 2020

The early period of the COVID-19 pandemic limited access to HIV services for children and adolescents living with HIV (C/ALHIV). To determine progress in providing care and treatment services, we describe viral load coverage (VLC) and suppression (VLS) (<1000 copies/ mL) rates during the COVID-19 pandemic in 12 United States President's Emergency Plan for AIDS Relief (PEPFAR)-supported countries. Data for children (0-9 years) and adolescents (10-19 years) on VLC and VLS were analyzed for 12 sub-Saharan African (SSA) countries between 2019 (pre-COVID-19) and 2020 (during COVID-19). We report the number of viral load (VL) tests, and percent change in VLC and VLS for patients on ART. For 12 countries, 181,192 children had a VL test during the pre-COVID-19 period compared with 177,683 December 2020 during COVID-19. VLC decreased from 68.8% to 68.3% overall. However, 9 countries experienced an increase ranging from a 0.7%-point increase for Tanzania and Zimbabwe to a 15.3%-point increase for Nigeria. VLS increased for all countries from 71.2% to 77.7%. For adolescents the number with a VL test increased from 377,342 to 402,792. VLC decreased from 77.4% to 77.1%. However, 7 countries experienced an increase ranging from 1.8% for Mozambique to 13.8% for Cameroon. VLS increased for all countries from 76.8% to 83.8%. This analysis shows variation in HIV VLC across 12 SSA countries. VLS consistently improved across all countries demonstrating resilience of countries during 2020. Countries should continue to improve clinical outcomes from C/ALHIV despite service disruptions that may occur during pandemic response.

Changes in Adolescents' COVID-19-Health-Related Stress, Parent-Adolescent Relationships, and Mental Health During the COVID-19 Pandemic: The Effect of Personality Traits

Previous studies investigated short-term effects of COVID-19 on families. However, much is unknown about how families with adolescents fared throughout the pandemic, as well as factors that might explain interindividual differences in adjustment. The current study used latent change score models to investigate associations between changes in adolescents' mental health, parent-adolescent relationship quality, and COVID-19-health-related stress from Fall 2019 to Spring 2021, and whether personality predicted changes in adolescents' mental health, relationship quality, and stress. Participants were 242 adolescents (Mage = 11.56, SD = 0.44, 50% girls). Parent-adolescent negative interactions decreased from before the pandemic to the first lockdown, and stronger decreases (both in this period and between Fall 2020 and Spring 2021) were associated with simultaneous stronger increases in mental health. From Spring to Fall 2020, decreases in stress were stronger for less extraverted adolescents and were associated with better mental health. More agreeable adolescents reported a stronger decrease in stress between Fall 2020 and Spring 2021. The findings suggest that it is important to consider heterogeneity in designing future intervention and prevention programs. Especially adolescents with existing problems and from multi-problem families might be at risk for adverse consequences during pandemic-like situations.

Pre-existing parental stress and youth internalizing symptoms predict parent-reported COVID-related stress in military families

Understanding the extent to which youth and families experienced COVID-related stress requires accounting for prior levels of stress and other associated factors. This is especially important for military families, which experience unique stressors and may be reluctant to seek outside help. In this prospective study, we examined the role of pre-pandemic family factors in predicting parent and youth stress during the COVID-19 pandemic. Participants were 234 families with at least one active-duty parent and a 3rd or 5th-grade child. Findings revealed that preexisting factors predicted youth and family COVID-related stress. Specifically, heightened pre-pandemic parental stress and youth internalizing symptoms were significant predictors of COVID-related stress. Implications for mental health professionals and other organizations supporting military parents and families during the COVID-19 pandemic as well as other times of upheaval are discussed.

Factors influencing psychological concerns about COVID-19 in South Korea: direct and indirect damage during the early stages of pandemic

BACKGROUND

COVID-19 pandemic has led to psychological concerns, the distribution of which across populations may differ depending on whether pandemic-related damage is direct or indirect. This study aims to investigate concerns associated with direct and indirect damage according to population characteristics, and identify relatively vulnerable groups that are particularly affected by concerns.

METHOD

This cross-sectional study used data from the 2020 Korea Community Health Survey, which collected data based on a complex sampling design. A total of 208,106 responses from individuals aged ≥ 19 were collected via in-person interviews. The items related to COVID-19 concerns were measured by Likert scales ranging from 1 to 5 and categorized into two types: direct concerns, which pertained to infection or death, and indirect concerns, which pertained to criticism, vulnerability, and economic damage, through factor analysis. We compared the means and effect size of direct concerns, indirect concerns, and overall concerns using weighted mean, ANOVA, and multiple regression analysis.

RESULTS

Exploratory and confirmatory factor analyses supported a two-factor structure for psychological concerns about COVID-19 (CFI = 0.99, TLI = 0.97, SRMR = 0.02, RMSEA = 0.06), which were divided into direct and indirect concerns. Mean scores were 3.62 for direct concerns and 4.07 for indirect concerns. Direct concerns were higher in females (B = .26); the elderly (B = .15); those diagnosed with hypertension or diabetes (B = .04; B = .06); those with few assistants during quarantine (B = .15); and those whose neighbors responded inappropriately to COVID-19 (B = .07). Indirect concerns were lower among the elderly (B = -.04), and higher among young; married (B = .25); pink- or blue-collar workers (B = .08; B = .06); and those who felt that the city responded inappropriately to COVID-19 (B = .02).

CONCLUSION

The prevalence of concerns regarding direct and indirect damage caused by the COVID-19 pandemic differed according to population characteristics. Some factors had a marked influence on direct and indirect concerns. Our findings could inform psychological interventions and policies for future pandemics. Customized interventions are needed to prevent negative psychological concerns and improve mental health.

Adolescent psychological adjustment and social supports during pandemic-onset remote learning: A national multi-wave daily-diary study

In spring 2020, U.S. schools universally transitioned to online learning due to the COVID-19 pandemic's onset, thus creating a natural experiment for examining adolescents' risk and resilience during an ongoing school crisis response. This longitudinal study used a daily-diary approach to investigate the role of social support in the link between remote learning and psychological well-being across 64 days among a national sample of adolescents (n = 744; 42% Black, 36% White, 22% Other ethnicity/race; 41% boys; 72% eligible for free/reduced-priced lunch; Mage=14.60, SDage=1.71, age-range = 12-17 years). On days when youth attended remote learning, they reported lower daily positive affect, more daily stress, and higher parent social support. There were no significant differences in the effect of remote learning on affect or stress by race or economic status. On days when youth experienced more parent support, they reported lower daily stress and negative affect and higher daily positive affect. On days when youth experienced more peer support, they reported higher daily positive affect. Overall, the study highlights the impact of pandemic-onset remote learning on adolescents' psychological well-being and emphasizes the need for future research on school crisis contingency planning to address these challenges.

Trajectories of social withdrawal and social anxiety and their relationship with self-esteem before, during, and after the school lockdowns

The closure of schools during the COVID-19 pandemic affected adolescents' social withdrawal and social anxiety. Yet, self-esteem may have acted as a protective factor during this period. This study aimed to compare the trajectories of social withdrawal and social anxiety before (Year 1), during (Year 2 and 3), and after (Year 4) the closure of schools imposed by the COVID-19-related lockdowns, and to investigate the association of self-esteem with these trajectories. Participants were 844 (50.6% boys) Portuguese adolescents (mean age 12.70 years, SD = 1.14). The Social and Emotional Competencies Evaluation Questionnaire (QACSE) was used to assess social withdrawal and social anxiety, while The Global Self-Esteem scale of the Self-Description Questionnaire II was used to measure self-esteem. Growth curve analysis showed that social withdrawal and social anxiety had more negative trajectories during the year in which the school closures occurred. In addition, adolescents reported higher social withdrawal after the lockdowns than before the pandemic. Higher self-esteem was associated with a more positive trajectory in social withdrawal. Therefore, the results showed the negative of impact of the closure of schools on adolescents' social anxiety and social withdrawal, and that self-esteem was a protective factor during these challenging and adverse events.

COVID-19 Distress Impacts Adolescents' Depressive Symptoms, NSSI, and Suicide Risk in the Rural, Northeast US

OBJECTIVE

Widespread concern exists about the impacts of COVID-19 and related public health safety measures (e.g., school closures) on adolescent mental health. Emerging research documents correlates and trajectories of adolescent distress, but further work is needed to identify additional vulnerability factors that explain increased psychopathology during the pandemic. The current study examined whether COVID-19-related loneliness and health anxiety (assessed in March 2020) predicted increased depressive symptoms, frequency of non-suicidal self-injury (NSSI), and suicide risk from pre-pandemic (late January/early February 2020) to June 2020.

METHOD

Participants were 362 middle and high school adolescents in rural Maine (M age = 15.01 years; 63.4% female; 76.4% White). Data were collected during a time in which state-level COVID-19 restrictions were high and case counts were relatively low. Self-reports assessed psychopathology symptoms, and ecological momentary assessment (EMA) was used to capture COVID-19-related distress during the initial days of school closures.

RESULTS

Loneliness predicted higher depressive symptoms for all adolescents, higher NSSI frequency for adolescents with low pre-pandemic frequency (but less frequent NSSI for adolescents with high pre-pandemic frequency), and higher suicide risk for adolescents with higher pre-pandemic risk. Health anxiety predicted higher NSSI frequency for adolescents with high pre-pandemic frequency, and secondary analyses suggested that this pattern may depend on adolescents' gender identity.

CONCLUSIONS

Results underscore the impact of COVID-19 on adolescent mental health, with benefits for some but largely negative impacts for most. Implications for caretakers, educators, and clinicians invested in adolescent mental health are discussed.

Wellbeing, social media addiction and coping strategies among Chilean adolescents during the pandemic

Introduction

During the COVID-19 pandemic, adolescents had to deal with a range of mental health problems that has increased social media addiction levels with adverse effects on life satisfaction. Previous studies have explored coping mechanisms to deal with this addiction problem, but did not consider the need to simultaneously cope with different dimensions. Therefore, our study aimed to examine the moderating effect of various coping mechanisms on the relationship between social media addiction and adolescent life satisfaction.

Methods

Self-report questionnaires were applied to 1290 secondary school students (age mean = 16.03, SD = 1.27, range: 14 to 19; and 57% female). An exploratory and a confirmatory factor analysis were performed to determine the factor structure of the Brief-Cope 28 scale. Then, a descriptive and correlational analysis of the variables and a multiple linear regression analysis was performed.

Results

We found that the social media addiction risk was negatively associated with life satisfaction, adaptive strategies were positively correlated to life satisfaction, and maladaptive strategies were negatively correlated to it. Also, a moderation model was evaluated in which four stress management strategies, namely acceptance and perspective-taking, seeking socio-emotional support, active coping, and maladaptive strategies all conditioned the relationship between social media addiction risk and life satisfaction after controlling for demographic variables and the specific strategies of using comedy, religion and substance use. Results indicate additive and multiplicative effects of management strategies for stressful situations in the studied relationship. Seeking socio-emotional support and active coping were positively related to life satisfaction and maladaptive strategies were negatively associated with it. Multiplicative effects indicate that the relationship between the social media addiction risk and life satisfaction depends only on the acceptance and perspective taking that adolescents report. When adolescents reported having low or average levels of acceptance and perspective taking, there was a negative correlation with general life satisfaction, a connection that grew markedly stronger. In contrast, no connection between social media addiction and life satisfaction was detected for adolescents who report higher levels of acceptance and perspective-taking.

Discussion

Abuse of social media and the use of maladaptive stress coping strategies were risk factors that decreased life satisfaction among adolescents during the COVID-19 pandemic period.

COVID-19 Restrictions Resulted in Both Positive and Negative Effects on Digital Media Use, Mental Health, and Lifestyle Habits

While studies have reported effects on digital media during the COVID-19 restrictions, few have included data prior to the pandemic, and most have only measured screen time. We therefore investigated changes in specific digital media activities, as well as mental health and lifestyle habits, in a longitudinal study of adolescents spanning from before the pandemic (T1) to one month into restrictions (T2) and one year later when schools had reopened (T3). Adolescents (16-19 years) rated smartphone use, problematic/addictive media use, negative experiences (e.g., victimization), mental health (i.e., irritability, stress, and closeness), and protective lifestyle habits (i.e., sleep and exercise). Results showed initial decreases in irritability and negative digital experiences, increases in sleep and exercise, as well as a decrease in closeness during remote learning (T2). However, these changes returned to, or superseded, their initial levels at follow-up (T3). There were also increases in digital media use and stress at T3. Conclusively, by investigating specific digital media activities and collecting data both prior to and during different phases of the pandemic, we were able to find both positive and negative effects.

Understanding adolescent stress during the COVID-19 pandemic

Longitudinal studies across the globe documented significant increases in psychological stress and mental health problems among adolescents during the COVID-19 pandemic. Health concerns, school disruptions, and social disconnection were major sources of stress. High levels of perceived stress predicted worse mental health outcomes, with girls, older adolescents, and socio-economically marginalized youth experiencing more pronounced mental health deteriorations. However, social support from family and peers was a protective factor against increased stress and accompanying mental health problems. We urge policymakers and other key decision-makers to improve the availability and financing of mental health services and support programs for adolescents to address the wave of mental health challenges following the pandemic.

Adolescent Distress: Is There a Vaccine? Social and Cultural Considerations during the COVID-19 Pandemic

The COVID-19 pandemic had an unprecedented impact on mental health. In particular, the impact on adolescents was likely significant due to vulnerability factors linked to this developmental stage and pre-existing conditions of hardship. The present work aimed at grasping the particular effects of the pandemic on social and cultural aspects of adolescence, providing a cross-sectional picture of this historical moment of contemporary youth culture. Further research is needed to verify the findings.

Efficacy of coping mechanisms used during COVID-19 as reported by parents of children with autism

The COVID-19 pandemic's alterations to daily life have been especially challenging for families with Autism Spectrum Disorder (ASD), worsening the core features of ASD and overall mental health. With the increased need for effective coping, the current retrospective study used data from a survey regarding parent reports of how often their child with ASD used certain coping strategies (frequency), as well as the extent to which they felt their child benefitted from their use (efficacy) in mitigating stress during the pandemic. This retrospective study Repeated measures ANOVAs were conducted to evaluate whether there were significant differences in both frequency and efficacy ratings for each coping strategy, for the entire sample as well as for three children's age groups. Using Spearman's rank-order correlations, correlation coefficients between the frequency and efficacy of each coping strategy were explored. Results revealed that maladaptive strategies were used more frequently than adaptive strategies, while parent routine as the most frequently used and efficacious for all age groups. Additionally, for adaptive strategies, humor and focusing on the positive had the strongest correlations between frequency and efficacy ratings amongst all age groups. Of the maladaptive strategies, repetitive behaviors, rumination, and isolation had the strongest correlations for the youngest, middle, and oldest age groups, respectively. Further, for each age group, the adaptive coping strategies had stronger correlations between frequency and efficacy than the maladaptive ones. It is our hope that the results of this study will lay the foundation for developing adaptive coping strategies to alleviate stress in children with ASD. Further investigations using a larger cohort are warranted to determine effective coping strategies for individuals with ASD across a range of situations, including acute stressors (such as future public health emergencies and natural disasters), as well as common daily stressors.

Trajectories of adolescent perceived stress and symptoms of depression and anxiety during the COVID-19 pandemic

Adolescents might be particularly affected by the drastic social changes as a consequence of the COVID-19 pandemic, given the increased stress-sensitivity and importance of the social environment in this developmental phase. In order to examine heterogeneity during the pandemic, the current study aimed to identify whether subgroups of adolescents could be distinguished based on their levels of perceived stress and symptoms of depression and anxiety. In addition, we examined which prepandemic factors predicted these trajectories. Adolescents were assessed before the pandemic (N = 188, M_age = 13.49, SD = 0.81) and at three timepoints during the pandemic (i.e., eight, ten, and 15 months after the start of the pandemic in the Netherlands). Results showed no support for distinct trajectories of perceived stress, adolescents experienced stable moderate levels during the pandemic. In contrast, results showed three trajectories for depression and anxiety. The majority of adolescents reported stable low or moderate levels and one small subgroup reported high levels of depression and anxiety that decreased during the pandemic. Certain prepandemic factors predicted higher initial levels of stress and symptoms of depression and anxiety during the pandemic. To support adolescents with prepandemic vulnerabilities, strategies could be developed, for instance enhancing adolescents’ social support.

Non-Suicidal Self-Injury in Adolescence: The Role of Pre-Existing Vulnerabilities and COVID-19-Related Stress

For many adolescents, the COVID-19 pandemic represents a uniquely challenging period, and concerns have been raised about whether COVID-19-related stress may increase the risk for self-injurious behaviors among adolescents. This study examined the impact of pre-existing vulnerabilities on the occurrence and frequency of Non-Suicidal Self-Injury (NSSI) through COVID-19-related stress, and whether the impact of COVID-19-related stress on NSSI was buffered by the perceived social support during the pandemic. Participants were 1061 adolescents (52.40% females; Mage = 15.49 years, SD = 0.76) from a two-wave longitudinal study, which included assessments before the COVID-19 onset and one year later the declaration of the pandemic. Path analyses showed that adolescents with a prior history of NSSI, higher levels of internalizing symptoms, and poor regulatory emotional self-efficacy before the COVID-19 pandemic reported higher levels of COVID-19-related stress which in turn increased their risk to engage in NSSI. Besides, the findings did not support the role of social support as a moderator of the association between COVID-19 related stress and the occurrence/frequency of NSSI. These findings suggest that enhanced stress perception may serve as a key pathway for the continuation and development of NSSI among vulnerable adolescents facing adverse life events.

Impact of the COVID-19 pandemic on mental health and family situation of clinically referred children and adolescents in Switzerland: results of a survey among mental health care professionals after 1 year of COVID-19

The aim of this study was to assess the impact of the COVID-19 pandemic on mental well-being of clinically referred children and adolescents and on their families from the perspective of mental health care professionals in Switzerland during the first year of the pandemic. Psychiatrists and psychologists for children and adolescents participated in an anonymous survey conducted online in April/May 2021. The survey was completed by 454 mental health care professionals, most of them working in outpatient clinics for child and adolescent psychiatry or in independent practices. Most participants indicated an important increase of referrals for depression (86.8% of respondents), anxiety disorders (81.5%), crisis interventions (76.2%), psychosomatic disorders (66.1%), suicidality (63.8%), and behavioral addictions, e.g., excessive gaming (64.6%). In contrast, referrals or treatment demands for disorders such as autism spectrum disorder or psychosis showed no substantial change or a slight decrease, respectively. According to 69% of respondents, patients experienced the highest psychological burden in January/February/March 2021. Family problems very frequently reported by mental health professionals were parents' worries about loneliness/isolation of the child (49%), child's education and academic future (33%), increased media use due to missing options of recreational activities (37.6%), as well as multiple stresses of mothers (36.3%). To conclude, the pandemic has substantially changed the pattern of disorders and the number of clinical referrals of children and adolescents with mental health problems, which has serious consequences for the treatment supply in Switzerland.

Network analysis of depressive and anxiety symptoms in adolescents during the later stage of the COVID-19 pandemic

Network analysis is an effective approach for examining complex relationships between psychiatric symptoms. This study was designed to examine item-level relationships between depressive and anxiety symptoms using network analysis in an adolescent sample and identified the most central symptoms within the depressive-anxiety symptoms network model. Depressive and anxiety symptoms were assessed using the Patient Health Questionire-9 (PHQ-9) and Generalized Anxiety Disorder Screener (GAD-7), respectively. The structure of depressive and anxiety symptoms was characterized using "Strength" and "Bridge Strength" as centrality indices in the symptom network. Network stability was tested using a case-dropping bootstrap procedure. Finally, a Network Comparison Test (NCT) was conducted to examine whether network characteristics differed on the basis of gender, school grade and residence. Network analysis revealed that nodes PHQ2 ("Sad mood"), GAD6 ("Irritability"), GAD3 ("Worry too much"), and PHQ6 ("Guilty") were central symptoms in the network model of adolescents. Additionally, bridge symptoms linking anxiety and depressive symptoms in this sample were nodes PHQ6 ("Guilty"), PHQ2 ("Sad mood"), and PHQ9 ("Suicide ideation"). Gender, school grade and residence did not significantly affect the network structure. Central symptoms (e.g., Sad mood, Irritability, Worry too much, and Guilty) and key bridge symptoms (e.g., Guilty, Sad mood, and Suicide ideation) in the depressive and anxiety symptoms network may be useful as potential targets for intervention among adolescents who are at risk for or suffer from depressive and anxiety symptoms.

Educational Concerns, Health Concerns and Mental Health During Early COVID-19 School Closures: The Role of Perceived Support by Teachers, Family, and Friends

This study investigated whether school closures and health-related uncertainties in the early phases of the COVID-19 pandemic posed risk factors for adolescents’ mental health and whether perceived social support by parents, teachers, and friends functioned as protective factors. In particular, we argued that perceived social support would buffer negative associations between educational and health concerns and mental health. Based on a person-centered approach, we first examined resilience profiles. These profiles reflect configurations regarding the levels of these risk and protective factors and levels of mental health. Second, we analyzed whether these risk and protective factors predicted adolescents’ mental health differently by using a variable-centered approach. The sample consisted of 1’562 adolescents (Mage = 16.18, SD = 1.48, range = 14-20 years; 72% females) in lower and higher secondary education from three regions: German-speaking part of Switzerland, N = 486; Italian-speaking part of Switzerland, N = 760; and Northern Italy N = 316. Results from the person-centered approach revealed three latent profiles characterized by low (19%), average (47%), or high resilience (34%). Lower resilience was associated with higher educational concerns, lower perceived social support, and lower mental health, while high resilience was characterized by lower concerns, higher support, and higher mental health. Importantly, educational concerns varied more between profiles than health concerns, and perceived teacher and family support varied more than perceived friend support. Corroborating these findings, the variable-centered approach (i.e., a path analysis) revealed that educational concerns were a stronger predictor than health concerns and pointed to a higher relative importance of perceived family support for adolescents’ mental health relative to perceived teacher and friend support. Taken together, the findings suggest that adolescents’ educational concerns and perceived family support, respectively, were stronger risk and protective factors for their mental health during school closures related to the COVID-19 pandemic. Finally, adolescents from regions being more exposed to the COVID-19 pandemic, namely, Italian-speaking part of Switzerland and Northern Italy, were more likely classified in the low or the average rather than in the high resilience profile compared to students from the region with lower exposure, that is, the German-speaking part of Switzerland.

Adolescence Amid a Pandemic: Short- and Long-Term Implications

Members of the Society for Research on Adolescents COVID-19 Response Team offer this commentary to accompany this special issue of the Journal of Research on Adolescence regarding the impact of the pandemic on adolescents' social, emotional, and academic functioning. In addition to outlining the critical need for scholarly collaboration to address the global impact of this crisis on adolescent development, we argue that a broad investigative lens is needed to guide research and recovery efforts targeting youth development. We then use this broad lens to consider dimensions of the pandemic impact relative to developmental implications within community and policy contexts, educational contexts, social contexts, and family contexts. Finally, we describe guideposts for setting a global, shared research agenda that can hasten research to recovery efforts surrounding the pandemic and youth development.

The Impact of the COVID-19 Pandemic on Adolescent Emotional, Social, and Academic Adjustment

The COVID-19 pandemic has had a strong impact on adolescents worldwide. This special issue aimed to increase our understanding of the factors that explain interindividual differences in how adolescents are affected by the pandemic. The special issue includes 21 empirical articles from four continents on the role of the pandemic in changes in emotional, social, and academic adjustment during adolescence. The studies demonstrate that many adolescents experienced increased depressive symptoms, negative affect, and loneliness, and lower academic adjustment during the pandemic, particularly those that were already at risk before the pandemic. At the same time, many adolescents had individual, family, and community resources that made them resilient and helped them to continue to function well despite the adverse circumstances.