A lost generation? COVID-19 and adolescent mental health
Authors: Gertrud Sofie Hafstad, Else-Marie Augusti
Journal: The Lancet Psychiatry (2021)

Media headings about the mental health of the adolescent population during the COVID-19 pandemic have projected serious short-term and longer-term consequences of the pandemic and the measures taken to limit the spread of the virus. Headlines suggesting that there is a so-called lost generation of youth, deprived of central developmental opportunities due to the pandemic, have reached a wide audience. It is thus timely to ask: is the current generation of adolescents really lost? Ingibjorg Thorisdottir and colleagues1Thorisdottir IE Asgeirsdottir BB Kristjansson AL et al.Depressive symptoms, mental wellbeing, and substance use among adolescents before and during the COVID-19 pandemic in Iceland: a longitudinal, population-based study.Lancet Psychiatry. 2021; (published online June 3.)https://doi.org/10.1016/S2215-0366(21)00156-5Summary Full Text Full Text PDF PubMed Scopus (166) Google Scholar are among the first to tackle this question with empirical data at an adolescent population level with their excellent study on trajectories of prepandemic symptoms of depression at two time points (2016 and 2018), compared with depressive symptoms during the COVID-19 pandemic. With two large and representative Icelandic samples comprising nearly 60 000 13–18-year-olds, they present unique and highly needed data. Thorisdottir and colleagues showed that depressive symptoms increased (β 0·57 [95% CI 0·53 to 0·60]) and mental wellbeing worsened (−0·46 [–0·49 to −0·42]) significantly during the pandemic, and more so than one could expect based on the observed trends in adolescent mental health deteriorating over the past decade. Although observed change could not entirely be attributed to the pandemic and preventive measures, the present study clearly shows that gauging the mental health status of adolescents over time is of imminent importance. This is especially the case when facing a global crisis like a pandemic. Adolescents are at a vulnerable stage of development, with the majority of mental disorders emerging during adolescence.2de Girolamo G Dagani J Purcell R Cocchi A McGorry PD Age of onset of mental disorders and use of mental health services: needs, opportunities and obstacles.Epidemiol Psychiatr Sci. 2012; 21: 47-57Crossref PubMed Scopus (340) Google Scholar Rates of psychological distress among adolescents seem to be increasing. For example, the prevalence of depression increased from 8·7% in 2005 to 13·2% in 2017 among US adolescents aged 12 to 17 years.3Twenge JM Cooper AB Joiner TE Duffy ME Binau SG Age, period, and cohort trends in mood disorder indicators and suicide-related outcomes in a nationally representative dataset, 2005-2017.J Abnorm Psychol. 2019; 128: 185-199Crossref PubMed Scopus (725) Google Scholar This finding is supported by the results of Thorisdottir and colleagues' study, which showed that the prevalence of depressive symptoms was increasing from 2016 to 2018, and then increased somewhat more from 2018 to the numbers reported during the COVID-19 pandemic in 2020. A comprehensive meta-analysis of population-based studies on mental health trajectories before and during the pandemic showed similar trends (preprint).4Robinson E Sutin AR Daly M Jones A A systematic review and meta-analysis of longitudinal cohort studies comparing mental health before versus during the COVID-19 pandemic.medRxiv. 2021; (published online March 8.) (preprint).https://doi.org/10.1101/2021.03.04.21252921Google Scholar Thus, caution should be applied when interpreting this increase as a result of the pandemic alone. Rather, the pandemic might have exacerbated trends already present in the adolescent population, thereby highlighting the status of adolescents' mental health. We suggest that this hypothesis needs further study in other large and representative samples of adolescents well into the future. Some groups of adolescents are more at risk for presenting with mental health problems than others. Risk and resilience factors are therefore imperative to map in studies like that by Thorisdottir and colleagues. As pointed out by both Pierce and colleagues5Pierce M McManus S Jessop C et al.Says who? The significance of sampling in mental health surveys during COVID-19.Lancet Psychiatry. 2020; 7: 567-568Summary Full Text Full Text PDF PubMed Scopus (273) Google Scholar and Holmes and colleagues6Holmes EA O'Connor RC Perry VH et al.Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science.Lancet Psychiatry. 2020; 7: 547-560Summary Full Text Full Text PDF PubMed Scopus (3689) Google Scholar in their position papers early in the COVID-19 pandemic, it is of utmost importance to capture vulnerable groups in these types of population-based studies. However, because adolescents from high-risk groups tend to opt out from surveys like that used in the present study, this is a demanding task. The result is that the true impact of the pandemic might be underestimated. Except for gender and age, the present study unfortunately does not analyse subgroups of adolescents with different susceptibility and protective factors. Similar research conducted in Norway suggests that some groups of adolescents, such as adolescents living in separated families, are disproportionately at risk for increased symptoms of mental health problems during times of crisis such as the COVID-19 pandemic.7Hafstad GS Sætren SS Wentzel-Larsen T Augusti E-M Adolescents' symptoms of anxiety and depression before and during the COVID-19 outbreak—a prospective population-based study of teenagers in Norway.Lancet Reg Health Eur. 2021; 5100093Summary Full Text Full Text PDF Scopus (93) Google Scholar Surveillance of mental health trajectories in girls and boys across age groups, as well as in different groups of the adolescent population, will enable more targeted intervention efforts to alleviate psychological illness. Likewise, resilience factors need to be addressed in rigorous studies on mental health, as many adolescents adapt well in times of stress and crisis. Therefore, to inform policy makers and other important stakeholders, this dual focus should be one of the main purposes of population-based, representative studies. Although concerns about adolescents' mental health and wellbeing during the pandemic are partly confirmed by the present study, it is also a reminder to be cautious when communicating assertive arguments about the negative effects of the pandemic on adolescents' mental health. Rather, we argue that future efforts need to address the prepandemic as well as the pandemic-related increasing trend of mental health problems in the adolescent population. Moreover, the present study together with other similar studies7Hafstad GS Sætren SS Wentzel-Larsen T Augusti E-M Adolescents' symptoms of anxiety and depression before and during the COVID-19 outbreak—a prospective population-based study of teenagers in Norway.Lancet Reg Health Eur. 2021; 5100093Summary Full Text Full Text PDF Scopus (93) Google Scholar, 8Bignardi G Dalmaijer E Anwyl-Irvine AL et al.Longitudinal increases in childhood depression symptoms during the COVID-19 lockdown.Arch Dis Child. 2020; (published online Dec 9.)https://doi.org/10.1136/archdischild-2020-320372Crossref PubMed Scopus (145) Google Scholar shows the importance of closely monitoring indicators of risk and resilience, as it enables timely efforts to mitigate the risk for development of mental disorders during adolescence. To conclude, the true picture of wellbeing among young people is likely to be more complex than that portrayed in the news headlines. We declare no competing interests. Depressive symptoms, mental wellbeing, and substance use among adolescents before and during the COVID-19 pandemic in Iceland: a longitudinal, population-based studyOur results suggest that COVID-19 has significantly impaired adolescent mental health. However, the decrease observed in substance use during the pandemic might be an unintended benefit of isolation, and might serve as a protective factor against future substance use disorders and dependence. Population-level prevention efforts, especially for girls, are warranted. Full-Text PDF