Abstract
Objectives
The increase in mental health problems among adolescents is a vital public health issue in the United States. It is crucial to understand how this concerning trend was exacerbated by the COVID-19 pandemic. Using a national representative sample, we assessed the impact of COVID-19 on mental health and access to mental health care access among adolescents.
Methods
Data was extracted from the 2019 and 2022 National Survey of Children’s Health (NSCH), an annually collected survey on the health and well-being of adolescents in the U.S. A total of 31,258 adolescents ages 12–17 years were included in this analysis. The two primary outcomes were reports of (1) mental health problems (yes/no) and (2) mental healthcare access (yes/no) in the past 12 months. We ran separate multiple logistic regression models to assess the changes in mental health problems and access to mental health care from 2019 to 2022.
Results
Overall, our results indicated a higher prevalence of adolescent mental health problems reported in 2022 (30.6% 95% CI: 29.4–31.9%) than in 2019 (26.9%, 25.2–28.6%) (p = 0.001). Results of a regression model showed that adolescents who identified as non-Hispanic Black, had parents with higher education levels and who experienced childhood adverse events were more likely to have parent-reported mental health problems (all p < 0.001). Results of the regression model on access to mental health care indicated that adolescent girls were more likely to have access to mental health care than boys (AOR = 2.15, 95% CI:1.80–2.58). Adolescents from families with higher income, with insurance coverage, living in neighborhoods with more amenities, urban areas, and those who experienced adverse childhood events were all more likely to have accessed mental health care than their counterparts. (all p < 0.05).
Conclusions
We found the prevalence of mental health problems in adolescents increased while the prevalence of access to mental health care decreased from 2019 to 2022, before and during the COVID-19 pandemic. This trend should be closely monitored. And special efforts are needed to help those adolescents who are affected.
Keywords: Adolescents, Mental health, Access to health
Introduction
Mental health problems among adolescents represent a pressing public health concern in the United States [1]. Between 2011 and 2020, persistent feelings of sadness and hopelessness, along with suicidal thoughts and behaviors, increased by approximately 40% among youth [2]. The COVID-19 pandemic has exacerbated this troubling trend, prompting the U.S. Surgeon General to declare a national youth mental health crisis in 2022 [3]. The U.S. Preventive Task Forces recently announced updated recommendations for regular anxiety screenings among youth aged 8–18 years and regular depression screenings among adolescents aged 12–18 [4]. Moreover, Healthy People 2030, the federal initiative with data-driven evidence to improve the nation’s health, highlights objectives to improve children’s health and well-being, such as ensuring access to timely healthcare services and promoting positive health behaviors [5]. Despite these efforts, few or no detectable changes have been observed in enhancing mental health status among adolescents, such as reducing suicide attempts and increasing the proportion of adolescents who had a preventive health care visit during the past year [5].
Unattended mental health problems in adolescents are often associated with other health and behavioral risks, such as increased risk of drug use, violence, and other risky behaviors [6–9]. A growing number of studies have linked the current youth mental health crisis with biological, social, and structural contributors [10–12]. These factors include but are not limited to early puberty, unique brain/behavioral developmental stages, stigma, discrimination, social media use, and online bullying [9–13]. Several COVID-19-specific stressors, such as social isolation, academic disruption, parents losing their jobs, parents or caregivers, physical or emotional abuse at home, and social media negativity, have also been linked to unprecedented mental health crises among adolescents [14, 15]. Furthermore, social determinants of health, such as poverty, poor access to care, food insecurity, homelessness, and lack of access to health care and educational opportunities, have been identified as factors that lead to mental health inequalities and challenges in youth [16–19]. However, we are unsure about what changes have occurred regarding mental health status and mental health care before and during the outbreak of COVID-19 among adolescents in the U.S.
The release of the 2022 National Survey of Children’s Health (NSCH) survey offers an opportunity to compare the data illuminating adolescent mental health status and access to health one year before (2019) and the year during the COVID-19 pandemic (2022). While several studies have examined adolescent mental health during the COVID-19 pandemic, few have provided direct, population-based comparisons of mental health indicators and access to care from before to during the pandemic using nationally representative data [20–25]. For example, Lee et al. used NSCH data to explore the relationship between adverse childhood experiences and emotional resilience, finding that higher resilience was associated with lower emotional distress during the pandemic. However, their study did not focus on changes in prevalence or care access over time. Our study addresses this gap by offering a direct year-to-year comparison between 2019 and 2022, with a specific emphasis on both mental health outcomes and access to mental health services among adolescents.
While several studies have examined adolescent mental health during the COVID-19 pandemic, few have provided direct, population-based comparisons of mental health indicators and access to care before and during the pandemic using nationally representative data [20–25]. Among the limited studies using such data, Lee et al. analyzed NSCH data to examine the relationship between Adverse Childhood Experiences and emotional resilience. Their findings demonstrated that adolescents with higher resilience reported significantly lower levels of emotional distress during the pandemic, highlighting the protective role of resilience in mitigating the psychological impact of adversity [25]. However, their study did not assess changes in the prevalence of mental health problems or access to care over time. Our study addresses this gap by providing a direct year-to-year comparison between 2019 and 2022, with a specific focus on both mental health outcomes and access to mental health services.
Although many studies have documented the acute mental health impacts of the COVID-19 pandemic on adolescents, such as increased anxiety, stress, and depression during its early phases [20–24], fewer have explored how these mental health challenges and access to care evolved as pandemic-related restrictions were lifted in 2022. This transitional period encompassed key changes, including the return to in-person schooling after prolonged remote learning, the lifting of mask mandates and social distancing guidelines, and the re-establishment of pre-pandemic norms in educational and healthcare settings [26, 27]. By comparing NSCH data from 2019 (pre-pandemic) and 2022 (later-pandemic), our study provides timely insights into how adolescent mental health and access to care changed during this critical phase.
Therefore, this study aimed to (1) assess the prevalence of mental health problems and access to mental health care among U.S. adolescents one year before and during the COVID-19 pandemic and (2) examine differences in these outcomes between the 2019 and 2022 survey years, as well as variations by sociodemographic characteristics, including age, sex, race/ethnicity, household income, parental education, insurance coverage, adverse childhood experiences (ACEs), and neighborhood conditions.
Methods
Data source
We used data from the 2019 and 2022 National Survey of Children’s Health (NSCH), an annual, nationally representative survey of children and adolescents aged 0–17 years conducted across all 50 U.S. states and the District of Columbia. The NSCH is administered in English and Spanish and provides comprehensive information on various aspects of children’s health and well-being, including sociodemographic characteristics, physical, mental, and oral health, healthcare access, family structure, and neighborhood context. In the NSCH, mental health problems are defined as the presence of one or more Mental, Emotional, Developmental, or Behavioral (MEDB) issues, or meeting the Children with Special Health Care Needs (CSHCN) Screener criteria for emotional, behavioral, or developmental concerns. This definition captures significant difficulties in emotional, behavioral, or cognitive functioning that interfere with a child’s daily life [28].
All data were parent- or guardian-reported by individuals familiar with the child’s health status and healthcare needs. Details on the NSCH survey design and data collection are available elsewhere [29]. This study was exempt from Institutional Review Board (IRB) review, as it used publicly available de-identified data [28].
Measures
In this study, the independent variable was the survey year. We treated 2022 as the year during the pandemic and 2019 as the year before the pandemic. The year 2019 was used as the reference year.
Outcomes
We examined two outcomes in this analysis among adolescents 12–17 years old: (1) Mental health problems (yes/no), which was based on responses to the question ‘Does this child have a mental, emotional, developmental or behavioral problem?’ (2) Mental healthcare access (yes/no), which was based on the responses to the question ‘During the past 12 months, has this child received any treatment or counseling from a mental health professional,?’ The response options included ‘Received mental health care’, ‘No, but needed to see an MH professional’, and ‘No, no need to see an MH professional’, Adolescents were classified as having received mental health care if they selected the first response, coded as 1; they were classified as not having received it if they selected the other two responses, coded as 0.
Covariates
Covariates were selected based on relevant mental health literature [16–19, 30–37] and data availability in the NSCH. We included sociodemographic information such as age (12, 13, 14, 15, 16, and 17 years), sex (male, female), race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, non-Hispanic Asian American, and others), parents’ highest education (less than high school, high school, some college, and college or above), household income (about Federal Poverty Level [FPL]: 0–99%, 100–199%, 200–399%, and ≥ 400% FPL), insurance coverage (no insurance, private insurance, public insurance, and both public and private), and adverse childhood experiences (no, one, and two or more points).
Neighborhood conditions were assessed by four variables: (1) neighborhood amenities (a score of 0–4 indicating the number of amenities a neighborhood had—parks, recreation centers, sidewalks, or libraries); (2) poor neighborhood conditions (a score of 0–3, neighborhood where there is litter or garbage on the street or sidewalk, poorly kept or rundown housing, or vandalism such as broken windows and graffiti); and (3) supportive neighborhood (yes/no), which was based on a response of ‘Definitely agree’ or ‘Somewhat agree’ to the following questions: ‘To what extent do you agree with these statements about your neighborhood or community?’ a) People in this neighborhood help each other; b) We watch out for each other’s children in this neighborhood; c) When we encounter difficulties, we know where to go for help in our community.’ If the participant definitely agreed with item number one and somewhat agreed or definitely agreed with items two and three, they were categorized as ‘Yes’ or living in a supportive neighborhood. (4) Safe neighborhood (yes/no), which was based on a response of ‘Definitely agree’ or ‘somewhat agree’ to the following statement: ‘This child is safe in our neighborhood.’ 5) Urban/rural residence location.
Statistical analysis
First, we characterized the sample characteristics in 2019 and 2022 NSCH. We then calculated the weighted rates of the two outcomes—mental health problems and mental health care access. Next, we ran two logistic regression models to assess the difference in the prevalence of the two outcome variables before and during the pandemic, controlling for sociodemographic and community-level factors. Data analysis was conducted in Stata 16 (StataCorp). We assessed the collinearity of covariates and did not find collinearity (VIF < 2). Sampling weights were incorporated into all the analyses to obtain national estimates. Where applicable, adjusted odds ratios (AORs) are presented. A significance level of 0.05 was used in the study.
Results
A total of 31,258 adolescents aged 12–17 years were included in this analysis: 12,230 from the 2019 NSCH and 19,028 from the 2022 NSCH. Of these, parents or guardians reported mental health problems for 10,218 adolescents—3,706 in 2019 and 6,512 in 2022.
Mental health problems
Table 1 presents the characteristics of adolescents with parent-reported mental health problems. Across both years, Non-Hispanic Black adolescents had the highest prevalence of reported mental health problems among all racial/ethnic groups (30.5% in 2019 and 35.2% in 2022). Adolescents with two or more adverse childhood experiences (ACEs) and those with either public or private health insurance had particularly high rates of mental health problems (40.5% in 2019 and 49.4% in 2022).
Table 1.
Characteristics of adolescents with mental health problems: A comparison between 2019 and 2022 NSCH
| Variables | 2019 (total sample = 12,230) | 2022 (total sample = 19,028) | ||||||
|---|---|---|---|---|---|---|---|---|
| Sample | Mental health problems | Sample | Mental health problems | |||||
| n a | % b | % b | p | n a | % b | % b | P | |
| Age | 0.761 | 0.005 | ||||||
| 12 | 1,780 | 17.1 | 25.6 | 2,625 | 16.5 | 28.9 | ||
| 13 | 1,856 | 16.8 | 29.3 | 2,787 | 17.2 | 26.3 | ||
| 14 | 1,864 | 16.8 | 25.6 | 3,011 | 17.2 | 32.3 | ||
| 15 | 2,142 | 16.4 | 25.7 | 3,341 | 16.5 | 32.8 | ||
| 16 | 2,247 | 16.4 | 27.8 | 3,518 | 16.4 | 29.7 | ||
| 17 | 2,341 | 16.5 | 27.3 | 3,746 | 16.1 | 34.0 | ||
| Sex | 0.012 | 0.943 | ||||||
| Male | 6,320 | 51.2 | 29.2 | 9,150 | 51.1 | 30.6 | ||
| Female | 5,910 | 48.8 | 24.4 | 9,878 | 48.9 | 30.7 | ||
| Race/ethnicity | < 0.001 | < 0.001 | ||||||
| Non-Hispanic white | 1,396 | 26.2 | 23.4 | 3,021 | 27.3 | 26.6 | ||
| NH black | 8,619 | 49.9 | 30.5 | 12,075 | 46.6 | 35.2 | ||
| Hispanic | 797 | 13.8 | 24.3 | 1,349 | 14.1 | 27.4 | ||
| NH Asian Americans | 616 | 4.7 | 11.7 | 1,226 | 4.9 | 11.9 | ||
| Other | 802 | 5.4 | 29.8 | 1,357 | 7.1 | 35.8 | ||
| Family income | 0.512 | 0.097 | ||||||
| < 100% FPL | 1,260 | 17.5 | 29.4 | 2,467 | 18.4 | 32.4 | ||
| 100–199% FPL | 1,922 | 21.3 | 26.3 | 3,107 | 19.9 | 33.1 | ||
| 200–399 FPL | 3,858 | 29.8 | 27.2 | 5,442 | 29.1 | 28.9 | ||
| >=400% FPL | 5,190 | 31.4 | 25.4 | 8,012 | 32.7 | 29.7 | ||
| Parent Education | 0.110 | < 0.001 | ||||||
| Less than high school | 335 | 11.8 | 20.7 | 637 | 10.1 | 19.7 | ||
| High school | 1,624 | 19.2 | 25.8 | 2,815 | 19.8 | 31.7 | ||
| Some college or technical school | 2,942 | 21.6 | 29.3 | 4,313 | 21.6 | 33.9 | ||
| College or higher | 7,329 | 47.4 | 27.7 | 11,263 | 48.5 | 31.0 | ||
| Insurance type | < 0.001 | < 0.001 | ||||||
| No insurance | 620 | 7.8 | 16.0 | 833 | 7.5 | 21.6 | ||
| Private | 2,167 | 27.2 | 30.7 | 4,205 | 28.6 | 36.5 | ||
| Public only | 8,776 | 60.6 | 25.0 | 12,682 | 59.1 | 28.6 | ||
| Both public and private | 441 | 4.5 | 49.7 | 863 | 4.7 | 44.5 | ||
| Adverse childhood experiences | < 0.001 | < 0.001 | ||||||
| None | 6,374 | 49.8 | 18.8 | 9,534 | 48.4 | 20.9 | ||
| One | 2,847 | 23.7 | 27.3 | 4,462 | 26.0 | 30.5 | ||
| Two or more | 2,829 | 26.5 | 40.5 | 4,725 | 25.6 | 49.4 | ||
| Safe community | 0.012 | 0.001 | ||||||
| No | 367 | 5.9 | 38.4 | 644 | 4.7 | 40.9 | ||
| Yes | 11,575 | 94.1 | 25.8 | 17,812 | 95.3 | 30.3 | ||
| Poor conditions | 0.4 | 0.611 | 0.4 | 0.006 | ||||
| None | 9,385 | 72.2 | 26.1 | 14,481 | 76.9 | 29.5 | ||
| 1 | 1,678 | 16.9 | 26.2 | 2,489 | 14.3 | 32.5 | ||
| 2 | 556 | 6.8 | 29.2 | 847 | 4.9 | 36.5 | ||
| 3 | 310 | 4.0 | 32.2 | 631 | 3.8 | 39.8 | ||
| Amenities | 0.021 | 0.364 | ||||||
| None | 1,832 | 13.8 | 27.3 | 2,052 | 10.2 | 33.9 | ||
| 1 | 1,465 | 11.7 | 29.8 | 1,968 | 12.0 | 32.5 | ||
| 2 | 2,082 | 15.6 | 30.8 | 3,157 | 18.1 | 30.0 | ||
| 3 | 2,619 | 21.5 | 28.4 | 4,270 | 23.1 | 31.1 | ||
| 4 | 4,232 | 37.4 | 23.3 | 6,846 | 36.6 | 29.5 | ||
| supportive community | < 0.001 | < 0.001 | ||||||
| No | 4,782 | 45.1 | 30.9 | 7,480 | 45.5 | 33.5 | ||
| Yes | 7,075 | 54.9 | 23.2 | 10,849 | 54.5 | 28.4 | ||
| Residence location | 0.350 | 0.369 | ||||||
| Rural | 1,382 | 11.6 | 24.5 | 14,218 | 12.9 | 31.9 | ||
| Urban | 7,005 | 88.4 | 26.5 | 3,132 | 87.1 | 30.3 | ||
(a) Unweighted frequency (b) weighted percentage
Adolescents living in safe communities (25.8% in 2019 and 30.3% in 2022) and supportive communities (23.2% in 2019 and 28.4% in 2022) were less likely to be reported as having mental health problems compared to those in unsafe or unsupportive environments (p < 0.05 for all comparisons).
Overall, the prevalence of parent-reported adolescent mental health problems was significantly higher in 2022 (30.6%, 95% CI: 29.4–31.9%) than in 2019 (26.9%, 95% CI: 25.2–28.6%) (p = 0.001).
Access to mental health care
Table 2 summarizes the characteristics of adolescents with access to mental health care. In both years, girls were more likely than boys to have parent-reported access to care (56.2% vs. 42.5% in 2019; 57.3% vs. 35.7% in 2022; p < 0.001). Adolescents whose parents had higher levels of education (52.4% in 2019 and 51.8% in 2022), and those with multiple ACEs (55.6% in 2019 and 53.0% in 2022), also had higher access to care (p < 0.01 for all).
Table 2.
Characteristics of adolescents having access to mental health care: A comparison between 2019 and 2022 NSCH
| Variables | 2019 (total sample = 3,706) | 2022(total sample = 6,512) | ||||||
|---|---|---|---|---|---|---|---|---|
| Sample | Access to mental health care | Sample | Access to mental health care | |||||
| n a | % b | % b | p | n a | % b | % b | P | |
| Age | 0.145 | 0.001 | ||||||
| 12 | 508 | 16.2 | 40.3 | 842 | 15.6 | 35.7 | ||
| 13 | 532 | 18.3 | 48.9 | 874 | 14.8 | 43.8 | ||
| 14 | 560 | 16.0 | 47.6 | 1025 | 18.2 | 44.4 | ||
| 15 | 643 | 15.6 | 43.7 | 1148 | 17.6 | 48.8 | ||
| 16 | 723 | 16.9 | 55.4 | 1238 | 15.9 | 51.3 | ||
| 17 | 740 | 16.8 | 55.0 | 1385 | 17.9 | 52.4 | ||
| Sex | < 0.001 | < 0.001 | ||||||
| Male | 1993 | 55.7 | 42.5 | 3242 | 51.0 | 35.7 | ||
| Female | 1713 | 44.3 | 56.2 | 3270 | 49.0 | 57.3 | ||
| Race/ethnicity | 0.250 | 0.046 | ||||||
| Non-Hispanic white | 398 | 22.8 | 53.2 | 943 | 23.7 | 43.7 | ||
| NH black | 2749 | 56.7 | 48.1 | 4482 | 53.5 | 48.7 | ||
| Hispanic | 231 | 12.5 | 41.4 | 392 | 12.6 | 41.1 | ||
| NH Asian Americans | 78 | 2.0 | 67.1 | 171 | 1.9 | 27.9 | ||
| Other | 250 | 6.0 | 45.5 | 524 | 8.3 | 50.3 | ||
| Family income | 0.397 | 0.001 | ||||||
| < 100% FPL | 454 | 19.2 | 43.5 | 907 | 19.5 | 37.2 | ||
| 100–199% FPL | 635 | 20.9 | 47.8 | 1117 | 21.5 | 46.9 | ||
| 200–399 FPL | 1180 | 30.2 | 48.1 | 1876 | 27.4 | 44.9 | ||
| >=400% FPL | 1437 | 29.8 | 53.0 | 2612 | 31.7 | 52.7 | ||
| Parent Education | 0.0053 | < 0.001 | ||||||
| Less than high school | 82 | 9.1 | 63.3 | 151 | 6.5 | 27.8 | ||
| High school | 518 | 18.4 | 36.8 | 1010 | 20.5 | 39.7 | ||
| Some college or technical school | 959 | 23.6 | 44.3 | 1573 | 23.9 | 45.6 | ||
| College or higher | 2147 | 48.9 | 52.4 | 3778 | 49.1 | 51.8 | ||
| Insurance type | 0.119 | 0.021 | ||||||
| No insurance | 151 | 4.6 | 33.7 | 223 | 5.2 | 29.0 | ||
| Private | 892 | 31.0 | 53.9 | 1773 | 33.6 | 46.2 | ||
| Public only | 2374 | 56.1 | 46.0 | 3950 | 54.4 | 47.9 | ||
| Both public and private | 237 | 8.2 | 51.9 | 459 | 6.8 | 49.6 | ||
| Adverse childhood experiences | 0.005 | < 0.001 | ||||||
| None | 1426 | 35.3 | 42.1 | 2270 | 33.0 | 39.6 | ||
| One | 900 | 24.3 | 47.9 | 1593 | 25.8 | 44.7 | ||
| Two or more | 1333 | 40.4 | 55.6 | 2570 | 41.2 | 53.0 | ||
| Safe community | 0.657 | 0.686 | ||||||
| No | 171 | 8.5 | 53.0 | 305 | 6.3 | 44.7 | ||
| Yes | 3456 | 91.5 | 48.7 | 6046 | 93.7 | 46.9 | ||
| Poor conditions | 0.892 | 0.297 | ||||||
| None | 2,742 | 71.0 | 48.9 | 4,832 | 74.0 | 45.4 | ||
| 1 | 555 | 16.7 | 47.1 | 887 | 15.2 | 50.4 | ||
| 2 | 188 | 7.5 | 51.7 | 332 | 5.9 | 53.8 | ||
| 3 | 135 | 4.9 | 54.5 | 294 | 5.0 | 48.8 | ||
| Amenities | 0.038 | 0.001 | ||||||
| None | 560 | 14.0 | 37.9 | 703 | 11.2 | 37.5 | ||
| 1 | 472 | 12.9 | 53.4 | 737 | 12.7 | 42.1 | ||
| 2 | 655 | 17.9 | 51.8 | 1,110 | 17.7 | 42.2 | ||
| 3 | 840 | 22.7 | 43.4 | 1,529 | 23.3 | 45.9 | ||
| 4 | 1,179 | 32.4 | 53.3 | 0.781 | 2,220 | 35.1 | 54.2 | 0.868 |
| supportive community | 1665 | 52.3 | 49.6 | 2922 | 49.6 | 46.9 | ||
| No | 1938 | 47.7 | 48.5 | 3396 | 50.4 | 46.5 | ||
| Yes | ||||||||
| Residence location | 0.002 | 0.140 | ||||||
| Rural | 406 | 10.8 | 37.3 | 1097 | 13.5 | 41.4 | ||
| Urban | 2103 | 89.2 | 50.8 | 4820 | 86.5 | 46.5 | ||
(a) Unweighted frequency (b) weighted percentage
Overall, the proportion of adolescents reported to have access to needed mental health care was slightly lower in 2022 (46.3%, 95% CI: 43.9–48.7%) than in 2019 (48.6%, 95% CI: 45.0–52.3%), although this difference was not statistically significant (p = 0.291).
Multivariable analysis of mental health problems
Results from the logistic regression model (Table 3) showed that adolescents in 2022 had significantly higher odds of having reported mental health problems compared to 2019 (AOR = 1.28, 95% CI: 1.13–1.44). Compared to Non-Hispanic White adolescents, Non-Hispanic Black adolescents had higher odds (AOR = 1.65, 95% CI: 1.36–2.00), while Asian American adolescents had lower odds (AOR = 0.53, 95% CI: 0.36–0.76) of mental health problems.
Table 3.
Logistic regression model: mental problems among U.S adolescents
| Variables | AOR | 95% CI | P | |
|---|---|---|---|---|
| Year 2022 (vs. Year 2019) | 1.28 | 1.13 | 1.44 | < 0.001 |
| Age (vs. 12 yrs old) | 0.583 | |||
| 13 | 0.90 | 0.72 | 1.13 | 0.363 |
| 14 | 1.01 | 0.81 | 1.26 | 0.948 |
| 15 | 0.96 | 0.77 | 1.19 | 0.686 |
| 16 | 0.99 | 0.80 | 1.23 | 0.918 |
| 17 | 1.09 | 0.88 | 1.35 | 0.453 |
| Female | 0.89 | 0.79 | 1.00 | 0.055 |
| Race/ethnicity (vs. non-Hispanic white) | < 0.001 | |||
| NH black | 1.65 | 1.37 | 2.00 | < 0.001 |
| Hispanic | 0.87 | 0.67 | 1.12 | 0.274 |
| NH Asian Americans | 0.53 | 0.36 | 0.76 | 0.001 |
| Other | 1.27 | 0.99 | 1.64 | 0.065 |
| Family income (vs. <100% FPL) | 0.373 | |||
| 100–199% FPL | 0.89 | 0.71 | 1.12 | 0.314 |
| 200–399 FPL | 0.92 | 0.74 | 1.13 | 0.413 |
| >=400% FPL | 1.01 | 0.82 | 1.25 | 0.929 |
| Education (vs. < high school) | < 0.001 | |||
| High school | 1.43 | 0.99 | 2.07 | 0.057 |
| Some college or technical school | 1.72 | 1.20 | 2.47 | 0.003 |
| College or higher | 2.02 | 1.40 | 2.92 | 0.000 |
| Insurance type (vs. no insurance) | < 0.001 | |||
| Private | 1.89 | 1.39 | 2.57 | < 0.001 |
| Public only | 1.41 | 1.05 | 1.90 | 0.024 |
| Both public and private | 2.94 | 2.00 | 4.30 | < 0.001 |
| Adverse childhood experiences (vs. zero) | < 0.001 | |||
| One | 1.64 | 1.43 | 1.90 | < 0.001 |
| Two or more | 3.24 | 2.76 | 3.80 | < 0.001 |
| Safe community | 0.75 | 0.53 | 1.06 | 0.101 |
| Poor conditions (vs. zero) | 0.904 | |||
| 1 | 1.03 | 0.85 | 1.23 | 0.784 |
| 2 | 0.99 | 0.73 | 1.36 | 0.969 |
| 3 | 0.90 | 0.64 | 1.25 | 0.520 |
| Amenities (vs. zero) | 0.174 | |||
| 1 | 1.23 | 0.97 | 1.56 | 0.087 |
| 2 | 1.16 | 0.94 | 1.42 | 0.168 |
| 3 | 1.14 | 0.95 | 1.38 | 0.166 |
| 4 | 1.01 | 0.84 | 1.22 | 0.891 |
| supportive community | 0.83 | 0.73 | 0.94 | 0.003 |
| Urban residence | 1.23 | 1.06 | 1.42 | 0.007 |
Adolescents whose parents had higher educational attainment and those who experienced ACEs were also more likely to have reported mental health problems (p < 0.001 for all). Urban residence was associated with increased odds of mental health problems (AOR = 1.23, 95% CI: 1.06–1.42), whereas having insurance and living in a supportive community were protective (AOR = 0.83, 95% CI: 0.73–0.94 for supportive communities; p < 0.001 for insurance coverage).
Multivariable analysis of mental health care access
Table 4 presents findings from the regression model on mental health care access. Adolescents aged 16–17 years were more likely to have access compared to those aged 12–13 years (p < 0.05). Girls were significantly more likely than boys to access mental health care (AOR = 2.15, 95% CI: 1.80–2.58). Other factors associated with greater access included higher household income, insurance coverage, more neighborhood amenities, urban residence (AOR = 1.33, 95% CI: 1.06–1.67), and having experienced ACEs (p < 0.05 for all).
Table 4.
Logistic regression model for mental health care among U.S. Adolescents
| Variables | AOR | 95% CI | P | |
|---|---|---|---|---|
| Year 2022 (vs. year 2019) | 0.86 | 0.70 | 1.04 | 0.113 |
| Age (vs. 12 yrs old) | 0.037 | |||
| 13 | 1.42 | 0.98 | 2.05 | 0.063 |
| 14 | 1.20 | 0.85 | 1.71 | 0.302 |
| 15 | 1.37 | 0.97 | 1.94 | 0.074 |
| 16 | 1.69 | 1.19 | 2.41 | 0.004 |
| 17 | 1.58 | 1.13 | 2.23 | 0.008 |
| Female | 2.15 | 1.80 | 2.58 | < 0.001 |
| Race/ethnicity (vs. Non-Hispanic white) | 0.201 | |||
| Non-Hispanic black | 1.00 | 0.74 | 1.35 | 0.991 |
| Hispanic | 0.68 | 0.45 | 1.03 | 0.068 |
| Non-Hispanic Asian Americans | 0.77 | 0.37 | 1.62 | 0.492 |
| Other | 0.93 | 0.63 | 1.36 | 0.710 |
| Family income (vs.<100% FPL) | 0.014 | |||
| 100–199% FPL | 1.31 | 0.91 | 1.90 | 0.145 |
| 200–399 FPL | 1.44 | 1.02 | 2.04 | 0.037 |
| >=400% FPL | 1.79 | 1.24 | 2.59 | 0.002 |
| Education (vs. < High School) | 0.845 | |||
| High school | 0.64 | 0.35 | 1.16 | 0.140 |
| Some college or technical school | 0.90 | 0.50 | 1.61 | 0.730 |
| College or higher | 1.36 | 0.76 | 2.45 | 0.300 |
| Insurance type (vs. no insurance) | < 0.001 | |||
| Private | 2.85 | 1.61 | 5.07 | < 0.001 |
| Public only | 1.64 | 0.94 | 2.87 | 0.082 |
| Both public and private | 3.05 | 1.62 | 5.75 | 0.001 |
| Adverse childhood experiences (vs. zero) | < 0.001 | |||
| One | 1.30 | 1.03 | 1.66 | 0.029 |
| Two or more | 1.91 | 1.47 | 2.47 | < 0.001 |
| Safe community | 1.25 | 0.75 | 2.08 | 0.386 |
| poor conditions (vs. zero) | 0.358 | |||
| 1 | 1.13 | 0.87 | 1.48 | 0.368 |
| 2 | 1.45 | 0.92 | 2.27 | 0.106 |
| 3 | 1.07 | 0.67 | 1.70 | 0.787 |
| Amenities (vs. zero) | 0.002 | |||
| 1 | 1.38 | 0.97 | 1.96 | 0.071 |
| 2 | 1.31 | 0.96 | 1.80 | 0.090 |
| 3 | 1.18 | 0.89 | 1.57 | 0.245 |
| 4 | 1.73 | 1.31 | 2.29 | < 0.001 |
| Supportive community | 0.90 | 0.74 | 1.08 | 0.262 |
| Urban residence | 1.33 | 1.06 | 1.67 | 0.014 |
Discussion
Examining changes in mental health problems and access to mental health care before and during the COVID-19 pandemic is crucial to help develop mental health strategies to buffer the impacts caused by public health infectious disease emergencies such as the COVID-19 pandemic. To the best of our knowledge, this study is among the few to compare the prevalence of mental health problems and mental healthcare access, specifically among a nationally representative sample of adolescents aged 12–17 years before and during the COVID-19 pandemic. Overall, compared with 2019, our study revealed a similar prevalence of access to mental health services and a significantly greater prevalence of mental health problems in adolescents during the COVID-19 pandemic. Our study also provides nuanced information on sociodemographic changes associated with mental health problems and mental health service utilization under the influence of the COVID-19 pandemic.
First, our study adds to the substantial body of literature reporting on the negative impact of the COVID-19 pandemic on youth mental health [35–41]. For example, Chavira et al. [38] reviewed several mental health studies implemented in a variety of settings and drew conclusions on the worsening of mental health conditions among children and adolescents globally. In the U.S., the declining trend in adolescent mental health has been documented by a longitudinal study examining the impact of COVID-19 during four different phases of the pandemic [38]. Additionally, as declared in a recent CDC report, more than one-third of high school students reported that they had experienced poor mental health during the COVID-19 pandemic in general [2]. Future research needs to follow the trends and patterns of adolescent mental health during the post-COVID-19 pandemic period, establish a better monitoring system, and utilize more evidence-based programs to help adolescents facing mental health issues.
Second, we were able to present a more nuanced picture of youth mental health and the COVID-19 pandemic by examining demographic characteristics. Our research indicated that non-Hispanic black adolescents were more likely to have mental health problems during the COVID-19 pandemic than adolescents of other races/ethnicities. Our study echoes an extensive national study conducted during the COVID-19 pandemic, which revealed that the pandemic has disproportionately impacted people of color, exacerbating poor mental health conditions [7]. We also found that the overall prevalence of mental health illness is more significant for black adolescents than for their white counterparts. Previous literature has reported that mental health disparities among racial/ethnic minority groups could be attributable to structural racism, barriers to screening, poor access, lack of insurance, discrimination, and stigma in mental health [30, 40–50]. Moreover, although Asian adolescents in this study were found to have the lowest prevalence of mental health issues across all ethnic groups, the prevalence might be underestimated due to cultural stereotypes and discrimination associated with poor mental health or a lack of sensitive screening tools [49]. Because mental health disparities can stem from inequalities in the healthcare system, policy efforts should be made to enhance access to and improve the quality of mental healthcare for diverse groups of American adolescents. Specifically, funds that could support the training of mental health specialists in the language and cultural competency of working with ethnic minority adolescents in family, school, and community settings should be allocated promptly [51, 52].
Notably, mental health service utilization varied according to the demographic characteristics of participants. Adolescents from high-income families were significantly more likely to access mental health services than their peers from low-income households. Similarly, those living in neighborhoods with more amenities reported greater access to care. These findings are consistent with prior research indicating that limited access to resources is associated with an elevated risk of mental health problems in adolescence. This disparity may extend across the life course [53, 54]. One of the most significant challenges in addressing this mental health inequality is the shortage of trained providers who could meet the mounting needs of adolescents, particularly those from disadvantaged backgrounds. While this was exacerbated during the pandemic, there is an ongoing need for a comprehensive approach to adolescent mental health that includes families, schools, and neighborhoods [55–58]. Interventions grounded in the World Health Organization’s social determinants of health (SDoH) framework, which emphasizes societal, environmental, and healthcare access factors, could offer a promising pathway toward reducing disparities. Expanding provider training through the lens of the WHO SDoH model may help close longstanding gaps in adolescent mental health care [59–61].
We also noted that older adolescents (aged 16–17 years) were more likely to have access to mental health care than were those aged 12–14 years. Early puberty among adolescents needs to be taken into consideration when developing mental health initiatives or educational interventions. In particular, early maturing girls are more likely to be victims of mental health dilemmas, such as increased risk of depression, substance use, and early sexual behavior [16]. However, little research has been conducted to elucidate the link between early development and depression, stress, or other mental health problems. Schools should consider psychoeducation a priority for staff professional development, and this training should incorporate the recognition of early signs, early prevention, and early intervention in K-12 schools.
Finally, our study revealed that previous adverse experiences in childhood may increase the risk of mental health problems. Notably, our study revealed that girls were more likely to have access to mental health care than boys [62]. Our findings also indicated that teenage boys had a greater prevalence of mental health problems than girls both before and during the COVID-19 pandemic. Our study echoes a research project in the UK in which teenage boys’ mental health was more adversely affected by COVID-19 than girls’ mental health. This study specifically discussed how the COVID-19 lockdown had a more negative impact on mental health among boys and how it could have worsened the mental health crisis for teenage boys [47]. There has been a rising trend in males seeking mental health support across age ranges, and for adolescent boys, attention has not been given to mental health support. Future studies should explore the problems that have caused mental health issues among boys and provide treatment plans that are tailored to teenage boys.
This study has several limitations. First, the cross-sectional study design of the NSCH cannot infer causalities, limiting the ability to attribute differences in mental health directly to the impact of COVID-19. Second, the NSCH relies on parent- or caregiver-reported data, which may not fully capture adolescents’ actual mental health status. These reports can be influenced by the respondent’s mental health literacy, awareness, and sociodemographic background. Future research should consider the use of multilevel modeling and theory-driven approaches to better explore the complex relationships between social determinants of health (SDOH) and adolescent mental health. Despite these limitations, this study contributes to the national evidence base on adolescent mental health trends and highlights important demographic disparities. As social determinants of health have important links to mental health cites, future research can integrate social determinants into analyses of mental health, allowing for a more detailed understanding of how the pandemic may have altered the influence of these determinants.
The implications of this research in a post-pandemic world are that understanding how mental health changed during the COVID-19 pandemic, we can be better prepared to allocate resources in future times of social upheaval. It can also inform strategies to better serve adolescent mental health needs in the current environment. Compared with pre-pandemic times, adolescents’ mental health problems have significantly increased, and their access to mental health has decreased. By understanding how mental health changed during the COVID-19 pandemic, we can be better prepared to allocate resources in future times of social upheaval. The results of our study can also inform strategies that serve adolescent mental health needs in the current environment. To meet the increasing mental health needs of this vulnerable group, we need to consider forging a tighter mental health support alliance that involves adolescents themselves, family, schools, neighborhoods, and communities. It is imperative to intervene early so that emerging mental health symptoms do not turn into crises. Although schools are crucial for identifying several mental health occurrences among adolescents, many schools face challenges in engaging mental health providers, and few meet the recommended ratios of students to mental health counselors, psychologists, nurses, and social workers. The lack of school mental health staff can pose significant harm to students who need immediate mental health support. To alleviate this barrier, legislative action should be considered to increase financial support for school-based mental health services for students aged 12–17. Supporting and funding school telehealth services could also help to ameliorate the lack of school mental health resources. It is essential to ensure that every adolescent has access to affordable and culturally competent mental health care. Tailored programs should be considered for younger adolescents, minority adolescents, and those with limited resources.
Abbreviations
- CDC
Centers for Disease Control and Prevention
- NSCH
National Survey of Children’s Health
Author contributions
Conceptualization—L.X., Methodology— L.X., and H. L.; Validation—L.X., WL., and H. L.; Formal analysis—L.X., W.L., and H.L; Writing original draft preparation— L.X., W.L., D.T., S.M, and H. L.; Writing—review and editing, L.X., W.L., D.T., S.M, and H. L.; Supervision— L.X.; Project administration— L.X. All authors have read and agreed to the published version of the manuscript.
Funding
This research received funding support from the National Institutes of Health (1U54MD017979-02) awarded to Dr. Wenhua Lu at the City University of New York School of Medicine. The content is solely the authors’ responsibility and does not necessarily represent the official views of the National Institutes of Health.
Data availability
No datasets were generated or analysed during the current study.
Declarations
Ethics approval and consent to participate
The Institutional Review Board (IRB) review is exempt for this study because it uses publicly available data.
Competing interests
The authors declare no competing interests.
Consent for publication
Yes.
Disclosures
The authors do not have any conflicts of interests regarding this submission.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
- 1.Kapadia F. Adolescent mental health and Well-Being: A public health of consequence, February 2024. Am J Public Health. 2024;114(2):158–60. 10.2105/AJPH.2023.307543 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Centers for Disease Control and Prevention. Youth risk behavior survey data summary & trends report: 2013–2023. U.S. Department of Health and Human Services; 2024.
- 3.Office of the Surgeon General (OSG). Protecting youth mental health: the U.S. Surgeon general’s advisory. Washington (DC): US Department of Health and Human Services; 2021. [PubMed] [Google Scholar]
- 4.US Preventive Services Task Force, Mangione CM, Barry MJ, et al. Screening for anxiety in children and adolescents: US preventive services task force recommendation statement. JAMA. 2022;328(14):1438–44. 10.1001/jama.2022.16936 [DOI] [PubMed] [Google Scholar]
- 5.U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Healthy People 2030: Child Health Objectives. Accessed 5. June 2024, https://odphp.health.gov/healthypeople/objectives-and-data/browse-objectives/children
- 6.Hallfors DD, Waller MW, Ford CA, Halpern CT, Brodish PH, Iritani B. Adolescent depression and suicide risk: association with sex and drug behavior. Am J Prev Med. 2004;27(3):224–31. 10.1016/j.amepre.2004.06.001 [DOI] [PubMed] [Google Scholar]
- 7.Hertz MF, Kilmer G, Verlenden J, et al. Adolescent mental health, connectedness, and mode of school instruction during COVID-19. J Adolesc Health. 2022;70(1):57–63. 10.1016/j.jadohealth.2021.10.021 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Jones SE, Ethier KA, Hertz M, et al. Mental health, suicidality, and connectedness among high school students during the COVID-19 Pandemic — Adolescent behaviors and experiences survey, united states, January–June 2021. MMWR Suppl. 2022;71(Suppl–3):16–21. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Clayton HB, Lowry R, August E, Everett Jones S. Nonmedical use of prescription drugs and sexual risk behaviors. Pediatrics. 2016;137(1):e20152480. 10.1542/peds.2015-2480 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.American Psychological Association. Kids’ mental health is in crisis. Here’s what psychologists are doing to help. Retrieved 2. February 2024 from https://www.apa.org/monitor/2023/01/trends-improving-youth-mental-health
- 11.Mills KL, Goddings AL, Clasen LS, Giedd JN, Blakemore SJ. The developmental mismatch in structural brain maturation during adolescence. Dev Neurosci. 2014;36(3–4):147–60. 10.1159/000362328 [DOI] [PubMed] [Google Scholar]
- 12.Stepanous J, Munford L, Qualter P, et al. Social environment and brain structure in adolescent mental health: A cross-sectional structural equation modelling study using IMAGEN data. PLoS ONE. 2023;18(1):e0280062. 10.1371/journal.pone.0280062. Published 2023 Jan 5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Jones SE, Ethier KA, Hertz M et al. Mental health, suicidality, and connectedness among high school students during the COVID-19 Pandemic — Adolescent behaviors and experiences survey, united states, January–June 2021. MMWR Suppl 2022;71(Suppl-3):16–21. 10.15585/mmwr.su7103a3 [DOI] [PMC free article] [PubMed]
- 14.KFF. The implications of COVID-19 for mental health and substance use, retrieved 3. March 2024 from https://www.kff.org/mental-health/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/
- 15.NIH. COVID-19 Pandemic Associated With Worse Mental Health and Accelerated Brain Development in Adolescents, retrieved 12. Jan 2024 from https://www.nimh.nih.gov/news/science-news/2023/covid-19-pandemic-associated-with-worse-mental-health-and-accelerated-brain-development-in-adolescents
- 16.Triplett NS, Luo M, Nguyen JK, Sievert K. Social determinants and treatment of mental disorders among children: analysis of data from the National survey of children’s health. Psychiatr Serv. 2022;73(8):922–5. 10.1176/appi.ps.202100307 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Yang P, Hernandez BS, Plastino KA. Social determinants of mental health and adolescent anxiety and depression: findings from the 2018 to 2019 National survey of children’s health. Int J Soc Psychiatry. 2023;69(3):795–8. 10.1177/0020764022111903 [DOI] [PubMed] [Google Scholar]
- 18.Westphaln KK, Fry-Bowers EK, Birchfield JW, Lee E, Ronis SD. Examining the relationship of family social capital and use of pediatric primary health care services in the 2016-19 National survey of children’s health. J Pediatr Health Care. 2022;36(4):347–57. 10.1016/j.pedhc.2021.12.002 [DOI] [PubMed] [Google Scholar]
- 19.Calthorpe LM, Pantell MS. Differences in the prevalence of childhood adversity by geography in the 2017-18 National survey of children’s health. Child Abuse Negl. 2021;111:104804. 10.1016/j.chiabu.2020.104804 [DOI] [PubMed] [Google Scholar]
- 20.Racine N, McArthur BA, Cooke JE, Eirich R, Zhu J, Madigan S. Global prevalence of depressive and anxiety symptoms in children and adolescents during COVID-19: A meta-analysis. JAMA Pediatr. 2021;175(11):1142–50. 10.1001/jamapediatrics.2021.2482 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Loades ME, Chatburn E, Higson-Sweeney N, et al. Rapid systematic review: the impact of social isolation and loneliness on the mental health of children and adolescents in the context of COVID-19. J Am Acad Child Adolesc Psychiatry. 2020;59(11):1218–e12393. 10.1016/j.jaac.2020.05.009 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Lee J. Mental health effects of school closures during COVID-19. Lancet Child Adolesc Health. 2020;4(6):421. 10.1016/S2352-4642(20)30109-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Magson NR, Freeman JYA, Rapee RM, Richardson CE, Oar EL, Fardouly J. Risk and protective factors for prospective changes in adolescent mental health during the COVID-19 pandemic. J Youth Adolesc. 2021;50(1):44–57. 10.1007/s10964-020-01332-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Hawes MT, Szenczy AK, Klein DN, Hajcak G, Nelson BD. Increases in depression and anxiety symptoms in adolescents and young adults during the COVID-19 pandemic. Psychol Med. 2022;52(14):2549–57. 10.1017/S0033291720005358 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Lee HY, Kim I, Kim J. Adolescents’ Mental Health Concerns in Pre- and During COVID-19: Roles of Adverse Childhood Experiences and Emotional Resilience. Child Psychiatry Hum Dev Published Online July. 2024;17. 10.1007/s10578-024-01726-x [DOI] [PubMed]
- 26.World Health Organization. (2025). Timeline: who’s COVID-19 response. Retrieved 4 Apr 2025. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/interactive-timeline
- 27.Wolf K, Schmitz J. Scoping review: longitudinal effects of the COVID-19 pandemic on child and adolescent mental health. Eur Child Adolesc Psychiatry. 2024;33(5):1257–312. 10.1007/s00787-023-02206-8 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28.United States Census Bureau. National Survey of Children’s Health (NSCH). Updated June 9. 2023. Accessed June 20, 2024. https://www.census.gov/programs-surveys/nsch/about.html
- 29.Census Bureau US, US Department of Commerce. 2022 National Survey of Children’s Health: methodology report. Accessed April 17, 2024. https://www2.census.gov/programs-surveys/nsch/technical-documentation/methodology/2022-NSCH-Methodology-Report.pdf
- 30.Lu W, Child, Adolescent Mental Disorders and Health Care Disparities. Results from the National survey of children’s health, 2011–2012. J Health Care Poor Underserved. 2017;28(3):988–1011. 10.1353/hpu.2017.0092 [DOI] [PubMed] [Google Scholar]
- 31.Ogbuanu C, Goodman D, Kahn K, et al. Factors associated with parent report of access to care and the quality of care received by children 4 to 17 years of age in Georgia. Matern Child Health J. 2012;16(Suppl 1):S129–42. 10.1007/s10995-012-1002-2 [DOI] [PubMed] [Google Scholar]
- 32.Jarlenski M, Baller J, Borrero S, Bennett WL. Trends in disparities in Low-Income children’s health insurance coverage and access to care by family immigration status. Acad Pediatr. 2016;16(2):208–15. 10.1016/j.acap.2015.07.008 [DOI] [PubMed] [Google Scholar]
- 33.Kim W. Child and adolescent psychiatry workforce: a critical shortage and National challenge. Acad Psychiatry. 2003;27(4):277–82. [DOI] [PubMed] [Google Scholar]
- 34.Hodgkinson S, Godoy L, Beers LS, Lewin A. Improving mental health access for low-income children and families in the primary care setting. Pediatrics. 2017;139(1):e20151175. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 35.Waid J, Kelly M. Supporting family engagement with child and adolescent mental health services: A scoping review. Health Soc Care Community. 2020;28(5):1333–42. 10.1111/hsc.12947 [DOI] [PubMed] [Google Scholar]
- 36.Toure D, Kimar G, Walker C, Turman J, Su D. Barriers to pediatric mental healthcare access: qualitative insights from caregivers. J Soc Serv Res. 2022;4:485–95. [Google Scholar]
- 37.Lebrun-Harris LA, Ghandour RM, Kogan MD, Warren MD. Five-Year Trends in US Children’s Health and Well-being, 2016–2020. JAMA Pediatr. 2022;176(7):e220056. doi: 10.1001/jamapediatrics.2022.0056. Epub 2022 Jul 5. Erratum in: JAMA Pediatr. 2022;:null. Erratum in: JAMA Pediatr. 2023;177(3):323. PMID: 35285883; PMCID: PMC8922203. [DOI] [PMC free article] [PubMed]
- 38.Chavira DA, Ponting C, Ramos G. The impact of COVID-19 on child and adolescent mental health and treatment considerations. Behav Res Ther. 2022;157:104169. 10.1016/j.brat.2022.104169. Epub 2022 Jul 31. PMID: 35970084; PMCID: PMC9339162. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 39.Ros-DeMarize R, Chung P, Stewart R. Pediatric behavioral telehealth in the age of COVID-19: brief evidence review and practice considerations. Curr Probl Pediatr Adolesc Health Care. 2021;51(1):100949. 10.1016/j.cppeds.2021.100949 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 40.Rosen M.L., Rodman A.M., Kasparek S.W., Mayes M., Freeman M.M., Lengua L.J.… McLaughlin K.A. Promoting youth mental health during the COVID-19 pandemic: A longitudinal study.PLoS One. 2021;16(8). [DOI] [PMC free article] [PubMed]
- 41.Salerno JP, Devadas J, Pease M, Nketia B, Fish JN. Sexual and gender minority stress amid the COVID-19 pandemic: implications for LGBTQ young persons’ mental health and Well-Being. Public Health Rep. 2020;135(6):721–7. 10.1177/0033354920954511 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 42.Saunders NR, Kurdyak P, Stukel TA, et al. Utilization of Physician-Based mental health care services among children and adolescents before and during the COVID-19 pandemic in ontario, Canada. JAMA Pediatr. 2022;176(4):e216298. 10.1001/jamapediatrics.2021.6298 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 43.Schleider JL, Mullarkey MC, Fox KR, et al. A randomized trial of online single-session interventions for adolescent depression during COVID-19. Nat Hum Behav. 2022;6(2):258–68. 10.1038/s41562-021-01235-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 44.Shirotsuki K, Sugaya N, Nakao M. Descriptive review of internet-based cognitive behavior therapy on anxiety-related problems in children under the circumstances of COVID-19. Biopsychosoc Med. 2022;16(1):3. 10.1186/s13030-021-00233-y. PMID: 35012584; PMCID: PMC8744388. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 45.Graber JA. Pubertal timing and the development of psychopathology in adolescence and beyond. Horm Behav. 2013;64(2):262-9. 10.1016/j.yhbeh.2013.04.003. PMID: 23998670. [DOI] [PubMed]
- 46.Albert PR. Why is depression more prevalent in women? J Psychiatry Neurosci. 2015;40(4):219–21. 10.1503/jpn.150205. PMID: 26107348; PMCID: PMC4478054. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 47.The Guardian. How Covid lockdowns hit mental health of teenage boys hardest. Retrieved Mar 9. 2024 from https://www.theguardian.com/society/2024/mar/23/how-covid-lockdowns-hit-mental-health-of-teenage-boys-hardest
- 48.Eboigbe LI, Simon CB, Wang YS, Tyrell FA. The compounded effect of the dual pandemic on ethnic-racial minority adolescents’ mental health and psychosocial well-being. Curr Opin Psychol. 2023;52:101626. 10.1016/j.copsyc.2023.101626. Epub 2023 Jun 27. PMID: 37384949; PMCID: PMC10293782. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 49.Smitherman LC, Golden WC, Walton JR. Health disparities and their effects on children and their caregivers during the coronavirus disease 2019 pandemic. Pediatr Clin North Am. 2021;68(5):1133–45. 10.1016/j.pcl.2021.05.013. PMID: 34538304; PMCID: PMC8445754. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 50.Misra S, Jackson VW, Chong J, et al. Systematic review of cultural aspects of stigma and mental illness among Racial and ethnic minority groups in the united states: implications for interventions. Am J Community Psychol. 2021;68(3–4):486–512. 10.1002/ajcp.12516 [DOI] [PubMed] [Google Scholar]
- 51.McGuire TG, Miranda J. New evidence regarding Racial and ethnic disparities in mental health: policy implications. Health Aff (Millwood). 2008 Mar-Apr;27(2):393–403. 10.1377/hlthaff.27.2.393. PMID: 18332495; PMCID: PMC3928067. [DOI] [PMC free article] [PubMed]
- 52.Lee S, Juon HS, Martinez G, et al. Model minority at risk: expressed needs of mental health by Asian American young adults. J Community Health. 2009;34(2):144–52. 10.1007/s10900-008-9137-1 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 53.Perry MF. Confidential telehealth care for adolescents: challenges and solutions identified during the COVID-19 pandemic. Curr Pediatr Rep Published Online June. 2023;12. 10.1007/s40124-023-00288-1 [DOI] [PMC free article] [PubMed]
- 54.Hodgkinson S, Godoy L, Beers LS, Lewin A. Pediatrics. 2017;139(1):e20151175. 10.1542/peds.2015-1175. Epub 2016 Dec 12. PMID: 27965378; PMCID: PMC5192088. Improving Mental Health Access for Low-Income Children and Families in the Primary Care Setting. [DOI] [PMC free article] [PubMed]
- 55.Baena S, Jiménez L, Lorence B, Hidalgo MV. Family functioning in families of adolescents with mental health disorders: the role of parenting alliance. Child (Basel). 2021;8(3):222. 10.3390/children803022. Published 2021 Mar 13. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 56.Allen KA, Greenwood CJ, Berger E, et al. Adolescent school belonging and mental health outcomes in young adulthood: findings from a Multi-wave prospective cohort study. School Mental Health. 2024;16:149–60. [Google Scholar]
- 57.Barnhart S, Bode M, Gearhart MC, Maguire-Jack K, Supportive, Neighborhoods. Family resilience and flourishing in childhood and adolescence. Child (Basel). 2022;9(4):495. 10.3390/children9040495. PMID: 35455539; PMCID: PMC9030551. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 58.Butler AM, Kowalkowski M, Jones HA, Raphael JL. The relationship of reported neighborhood conditions with child mental health. Acad Pediatr. 2012;12(6):523–31. 10.1016/j.acap.2012.06.005./ [DOI] [PMC free article] [PubMed] [Google Scholar]
- 59.Glenn J, Kleinhenz G, Smith JM, et al. Do healthcare providers consider the social determinants of health? Results from a nationwide cross-sectional study in the united States. BMC Health Serv Res. 2024;24:271. 10.1186/s12913-024-10656-2 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 60.Chelak K, Chakole S. The role of social determinants of health in promoting health equality: A narrative review. Cureus. 2023;15(1):e33425. 10.7759/cureus.33425. Published 2023 Jan 5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 61.World Health Organization. Social Determinants of Mental Health, Retrieved from https://www.who.int/publications/i/item/9789241506809 Feb 2025.
- 62.Anderson KN, Swedo EA, Trinh E, et al. MMWR Morb Mortal Wkly Rep. 2022;71(41):1301–5. 10.15585/mmwr.mm7141a2. Published 2022 Oct 14. Adverse Childhood Experiences During the COVID-19 Pandemic and Associations with Poor Mental Health and Suicidal Behaviors Among High School Students - Adolescent Behaviors and Experiences Survey, United States, January-June 2021. [DOI] [PMC free article] [PubMed]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Citations
- Hodgkinson S, Godoy L, Beers LS, Lewin A. Pediatrics. 2017;139(1):e20151175. 10.1542/peds.2015-1175. Epub 2016 Dec 12. PMID: 27965378; PMCID: PMC5192088. Improving Mental Health Access for Low-Income Children and Families in the Primary Care Setting. [DOI] [PMC free article] [PubMed]
- Anderson KN, Swedo EA, Trinh E, et al. MMWR Morb Mortal Wkly Rep. 2022;71(41):1301–5. 10.15585/mmwr.mm7141a2. Published 2022 Oct 14. Adverse Childhood Experiences During the COVID-19 Pandemic and Associations with Poor Mental Health and Suicidal Behaviors Among High School Students - Adolescent Behaviors and Experiences Survey, United States, January-June 2021. [DOI] [PMC free article] [PubMed]
Data Availability Statement
No datasets were generated or analysed during the current study.