A Tsunami of Concern: The Lasting Impacts of COVID Isolation and School Closures on Youth Mental Health

The COVID-19 pandemic disrupted lives in many ways across countries, cultures and age groups. Those years brought not only infectious risks but also a series of factors undermining the mental health of our youth.

In an attempt to mitigate the spread of the virus, lockdowns, quarantine measures, and school closures were implemented, at various levels, worldwide. At the time, these measures were deemed necessary to safeguard public health. However, the impact of these actions on the younger generation has been profound, and in some cases, damaging to their psychological health and development. A large amount of concerning information has been emerging regarding the delayed effects of COVID isolation and school closures on today’s young people, encompassing mental health, socialization access and skills, academic performance, and suicide. Compounding these issues are the recent deregulation of cannabis, its ease of access, and increased use among teenagers. This perspective aims to provide an overview of these impacts, paying special attention to the role of COVID isolation and cannabis use in youth suicide. Post hoc analyses questioning the necessity of school closures are tempting, but fraught with difficulty. What is clear, however, is that resources supporting youth mental health were insufficient to prevent the consequences of the pandemic isolation, and that insufficiency persists today.

Mental Health: The Silent Pandemic

The mental health of young people is an issue of ongoing and accelerating concern. The isolation brought about by the pandemic has contributed to a mental health crisis among the youth which is now echoing years after schools have reopened. Many studies and reports suggest that isolation and loneliness are associated with increased depression and anxiety prevalence among youth.¹ A large survey of the UK population showed that clinically significant levels of mental distress rose from 18.9% in 2018–19 to 27.3% in April 2020, one month into UK lockdown. The same survey found increases were greatest in 18 to 34 year-olds, women, and people living with young children.² It is essential to consider the long-term consequences of this mental health crisis, which could persist long after the pandemic ends.

Declining Socialization Skills: The Lost Art of Connection

Another concerning aspect of COVID isolation and school closures is the impact on the acquisition and development of basic socialization skills. Human interaction is fundamental for the development of these skills and the abrupt interruption of in-person socialization opportunities may have long lasting detrimental consequences. Young children and adolescents need to learn these essential social skills through peer interaction, which includes understanding social cues, working on ‘in-the-moment’ conflict resolution, and witnessing and fostering empathy.

Isolation during the pandemic deprived children of these crucial learning experiences. Social isolation has also been association with numerous negative outcomes across the lifespan including depression, poor sleep quality, impaired executive function, accelerated cognitive decline, unfavorable cardiovascular function, impaired immunity, altered hypothalamic pituitary-adrenocortical activity, a pro-inflammatory gene expression profile, and earlier mortality.³

Furthermore, the timing of the pandemic came about just as studies started to link evidence between increased screen time with negative developmental and psychological outcomes. While technology can be a valuable tool for staying connected, excessive screen time can have adverse effects on social and psychological development and has been shown to be associated with lower psychological well-being, including less curiosity, lower self-control, more distractibility, more difficulty making friends, less emotional stability, being more difficult to care for, and inability to finish tasks.⁴ It is essential to strike a balance between the use of technology for socialization on one hand, and in-person interaction on the other.

Scholastic Challenges: The Impact on Learning

One of the most visible impacts of COVID isolation and school closures is the disruption of education. The abrupt shift to remote learning challenged students, parents, and educators alike. It exposed the digital divide, where not all students had access to the necessary technology and internet connectivity for effective online learning. This digital divide disproportionately affected vulnerable and marginalized communities, exacerbating educational inequalities.⁵

Studies have shown that prolonged school closures can lead to learning loss, particularly in core subjects such as math and reading.⁶ Examining US household search activity for online learning resources during the pandemic closures revealed that areas of the country with higher income, better internet access and fewer rural schools saw substantially larger increases in search intensity.⁷

One aspect to consider is the link between remote learning and academic performance. Many students have struggled to adapt to remote learning, and the impact on academic achievement has been disproportionately higher among minority students, students in low-income communities, and children who speak English as a second language. Furthermore, math learning scores are more likely to be affected than language and arts scores by pandemic changes.⁸

The disruption of traditional learning environments has also had an impact on students’ motivation and engagement. Surveys among college students have documented a significant decrease in motivation in the context of online educational options during the pandemic.^9,10 This decreased motivation could have long-term consequences on educational attainment and career prospects.

COVID Isolation and Youth Suicide: A Disturbing Connection

Perhaps one of the most alarming consequences of COVID isolation among young people is the potential link to increased suicide rates. The isolation, stress and uncertainty brought about by the pandemic have created a perfect storm for mental health crises, and suicide is an extreme manifestation of these challenges.

Data from the first year of the pandemic showed that male youth, aged 5 to 12 years, and 18 to 24 years, non-Hispanic AI/AN youth, Black youth, and youth who died by firearms, experienced significantly more suicides than expected.¹¹ Further analyses of the suicide cases show that youth who were impacted by COVID experienced significantly more isolation, school problems, depression, and anxiety disorder diagnoses.¹²

These trends are deeply concerning and require urgent attention from policymakers, healthcare providers, and educators.

Cannabis Use and Youth Mental Health: A Complex Relationship

The role of cannabis use in youth mental health during COVID isolation is a complex and controversial topic. Cannabis is one of the most commonly used psychoactive substances among young people, and its potential role in exacerbating mental health issues should not be ignored.¹³

While some studies have suggested a link between cannabis use and an increased risk of mental health problems, including depression and anxiety,¹³ the relationship between cannabis use and suicide is less clear. It is wise to approach this topic with caution and rely on evidence-based research. A large population-based Finnish study found an association between youth cannabis use and self-harm later in life but not with suicide.¹⁴ A US epidemiological survey of adolescents found cannabis use associated with higher odds of depression and depression severity, and depression and cannabis use was independently associated with higher odds of suicide attempt.¹⁵ Another large study looking at youth ages 10 to 24 with mood disorders found that cannabis use is a risk marker for self-harm, all-cause mortality, death by unintentional overdose and homicide.¹⁶

Finally, a meta-analysis of studies looking at adolescent (18 and younger ) cannabis use and young adult (18 to 34) mental health outcomes concluded with a warning that high prevalence of adolescents consuming cannabis generates a large number of young people who could develop depression and suicidality attributable to cannabis.¹⁷ These results should alert us to the possibility of long term consequences of adolescent cannabis use.

The Importance of a Holistic Approach to Youth Mental Health

Addressing the multifaceted impact of COVID isolation and school closures on youth mental health requires a multiprong approach. Policymakers, educators, parents, and healthcare providers must collaborate to provide comprehensive support to mitigate the negative consequences of these many factors.

1. Mental Health Services

Access to mental health services must be prioritized. Schools can play a crucial role in identifying and addressing mental health issues among students, but parents, providers and friends may all need to play a part. Telehealth services can also improve access to mental health support, particularly in underserved communities and studies have shown good acceptability both by parents¹⁸ and youth, but reliable and well distributed technology infrastructure is not present.¹⁹ A complicating factor is the shortage of mental health care providers. Recognizing this issue, the American Board of Pediatrics and the American Psychiatric Association, among others, have called for policies to increase the number of physicians ‘in training’ pursuing fields focusing on youth mental health. The shortage of providers, however, is an enormous problem not likely to be solved solely with an increase in psychiatrists, and other strategies are being put forth. These include shifting the skill sets of today’s pediatricians, adding more focus and attention to mental health topics, rotations, lectures, and skills that they learn during their residency training years, so that they are better equipped to handle these issues in their primary care offices. Downstream changes in compensation, workflow and career satisfaction, however, may influence these plans.

2. Socialization Opportunities

Schools should prioritize opportunities for socialization and emotional development. Social and emotional learning (SEL) programs can help students develop essential skills for building healthy relationships and address social withdrawal and anxiety.²⁰

3. Academic Support

Academic support should be augmented, and interventions should be implemented to address learning gaps caused by school closures. Individualized learning plans, small group learning sessions, and tutoring programs can be effective in helping students catch up. This is particularly important for low-income students but may be more challenging in school districts with budgetary restraints.

4. Digital Equity

Efforts to bridge the digital divide are essential to ensure all students have access to online learning resources. This includes providing devices and internet connectivity to underserved communities.²¹

5. Substance Use Prevention

Substance use prevention programs should be integrated into school curricula. It is essential to educate students about the risks associated with cannabis and other drugs and to provide resources for those struggling with substance use. One example of such a program is the School-based Prevention Intervention and Resources Initiative (SPIRIT) supported by the Missouri Department of Mental Health’s (DMH) Division of Behavioral Health (DBH).

6. Community Engagement

Community-based organizations and local governments can play a vital role in providing extracurricular activities and support services for young people. These programs can help combat social isolation along with providing a sense of belonging.²² Expansion of such services with an increased emphasis on participation may yield tremendous benefits to our youth.

Conclusion

The tsunami of bad news following the years of COVID isolation and school closures on the mental health of young people is a call to action. The mental health challenges, declining socialization skills, academic setbacks, and increased suicide rates are alarming trends that demand our collective attention and response. While this paper does not provide new scientific research, it highlights the existing body of knowledge and emphasizes the need for evidence-based interventions and comprehensive support for young people.

Addressing these challenges requires a collaborative effort from policymakers, educators, healthcare providers, parents, and communities. It is crucial to prioritize the mental and emotional well-being of young people, not only during the pandemic but also in its aftermath. By taking proactive measures to support our youth, we can mitigate the long-term consequences of this crisis and build a more resilient and mentally healthy generation to inherit a better and happier world.