The Pandemic’s Toll on Teen Mental Health
The Centers for Disease Control and Prevention released a report last week warning that adolescent hospitalizations due to Covid-19 were on the rise. The media picked up the message and ran with it. But it isn’t true. The CDC misrepresented the data and played down a more important finding that provides further evidence that pandemic-control measures are likely having a serious adverse impact on young people’s mental health.
The CDC truncated its analysis at the precise date—April 24—that would cast an increase in teen hospitalization in the worst possible light. The 10% rise in early March that attracted so many headlines was similar to rises in other age groups and had declined sharply by late April. Adolescent hospitalizations for Covid-19 were back down to 0.6 per 100,000 by late May, before the CDC report was published, and well below the rate of 2.6 for the adult U.S. population. Moreover, Covid cases among children in 2021 have now fallen by 84% and hospitalizations are down by 69% since January, thanks largely to adult vaccination.
But while the CDC oversold the teen Covid narrative, it failed to emphasize the most troubling aspect of its study: 20% of teen hospitalizations in the study between Jan. 1 and March 31, 2021, were for psychiatric emergencies, not Covid. Although pandemic-related closures have made it difficult to study the mental health of children during the past year, the available data point to a crisis. Lockdowns and school closures have led to greater incidences of obesity and eating disorders, according to experts at the Stanford Children’s Health network. Since the start of the pandemic, overall health-care utilization rates have been low and many “elective” visits, including mental-health services, were unavailable.This exacerbated what the CDC has identified as a pre-existing mental-health treatment gap for children in the U.S.
Quantifying the pandemic’s mental-health burden is also difficult because some three million children nationwide who might have received counseling and social services through their schools this year never attended a class or logged in. Referrals to child services were down in some places by as much as 50% in 2020, indicating major blind spots in awareness of child neglect. School systems were previously common sources of referrals for suspected child abuse and mental-health service agencies.
Capturing subtle declines in mental health is difficult. Suicides and emergency-department visits quantify only extreme outcomes, but the trends for both in California are alarming. Data from Children’s Hospital of Oakland show a 66% increase in 10- to 17-year-olds screening positive for active or recent suicidal ideation in its emergency department between March and October 2020.
The proportion of children seeking emergency mental-health services who required immediate hospitalization, including for eating disorders, rose 75% in 2020 compared with 2019. Twenty-one percent of adolescents treated in the Children’s Hospital of San Francisco emergency department in January 2021 expressed active or recent suicidal ideation, up from 14% in January 2020. These data reflect the highest proportion of suicidal adolescents ever recorded at the hospital.
“We’ve never seen numbers like this in such a short period of time,” a spokesman for John Muir Medical Center in Walnut Creek, Calif., told a reporter for the Bay Area’s KGO-TV in May 2020. “I mean we’ve seen a year’s worth of suicide attempts in the last four weeks.”
The pandemic may have taken a heavier mental toll on young people than it has on adults. Preliminary data released by written request from the California Department of Public Health show 134 people under 18 died by suicide in the Golden State in 2020, up from 108 in 2019, a 24% increase. At the same time, adult suicide in California declined by 11% in 2020. Of California’s 62,000 Covid deaths since the pandemic’s start, only 23 have been people under 18.
CDC data also show a rise in the proportion of mental-health-related emergency-department visits for children in 2020 compared with 2019: 5- to 11-year-olds saw a 24% increase, and 12- to 17-year-olds a 31% increase. The Children’s Hospital Association reported a nearly 20% rise in admissions for suicide attempts and a more than 40% increase in admissions for children with disruptive behavior disorders.
In late May, Colorado Children’s Hospital issued a press release declaring a “state of emergency” due to demands for pediatric mental-health services, with mental-health emergency-department visits up 90% in 2021 compared with 2019. Children recovering from suicide attempts were placed in surgical beds for lack of space. Connecticut reported a similar surge. Data on emergency-department utilization and hospitalizations are likely catching only the tip of the iceberg of teen despair.
California has the lowest rates of children returned to in-person learning of all 50 states. In the Bay Area, public middle- and high-school students spent little or no time in their school buildings this year. Public-school students, who returned to in-person school at lower rates than private-school students and have less access to resources such as club sports or mental-health providers, may be most affected.
Public-health leaders in West Coast cities are just starting to discuss the effects of prolonged school closures on the mental health of children. It isn’t enough. They must make it their highest priority to return children to their school buildings full time next year. To recover or maintain mental health, young people need access to extracurricular activities, counselors, teachers and peers. Every state should invest in mental-health services for children and start looking at their mental-health data.
As the vaccinated proportion of the population increases and the pandemic ebbs across the U.S., a different crisis demands immediate attention. The nation’s health and education leaders must focus now on helping young people get past what has been a long, dark year.
Dr. Gandhi is an infectious-disease physician and professor of medicine at the University of California, San Francisco. Dr. Noble is an emergency physician and director of Covid Response at the UCSF Parnassus Emergency Department.
Dr. Leslie Bienen,
a public-health researcher at Oregon Health and Science University-Portland State University School of Public Health, contributed to this article.
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