COVID-19 pandemic-related anxiety in teenagers

Sir,

The COVID-19 outbreak since December 2019 and its subsequent transformation into a pandemic had affected persons from every age group, and children and adolescents are not immune to it.[1] Although the mortality rate and severity of COVID-19 are relatively low in young people, all the infection control measures and preventive strategies are equally important to this special population of “teenagers” like all other age groups. Moreover, teenagers and children are considered to be hidden carriers of COVID-19 in recent Chinese studies conducted on COVID-19 close contacts.[2] Therefore, more precautions have to be taken by this special population.

As the COVID-19 infection speeded to spread to >200 countries in <3 months of its outbreak, the World Health Organization (WHO) and the National authorities across the world had taken several multiple steps for containment of the spread of infection. Some of these strategies include the closure of schools, colleges and other educational institutions, shopping malls, promotion of hand hygiene, and social distancing. Some of the countries, including India, have adapted “lockdown” across the country to contain the spread of infection. While these measures are of the utmost necessity to tackle the spread of infection, these measures have created a sense of “panic” in the general public.[3,4] Further, several messages/videos are being circulated in the social media platforms regarding several modes of transmission of COVID-19 infection. Further, the news agencies/newspapers/some real-time COVID-19 tracker websites repeatedly provide real-time updates about the number of cases infected and died due to COVID-19.[5]

Teenagers and children are special groups of the population who have different “psyche.” More specifically, the adolescents/teenagers tend to experience emotions more intensely. Having teenagers confined to their homes with 24/7 parental attention/supervision can create a great degree of irritation as they are not used to such situations. Moreover, teenagers find it quite difficult to practice social distancing. Children and adolescents are finding it quite difficult to make sense of what's happening in the world, and they have their inherent suggestibility to follow the rumors/myths being forwarded in social media platforms related to COVID-19 transmission/ precautions measures.[6] All these can also lead to excessive worrying, fear, and anxiety about contracting the infection and can create a sense of panic among teenagers. In this regard, various health organizations/institutes have laid down tips/advice to manage stress and anxiety in children and adolescents.[6,7,8] In this report, we present an 18-year-old girl who presented with severe symptoms of anxiety- related to COVID-19 infection and highlight the issues related to teenagers in COVID-19 Pandemic.

An 18-year-old-female, from the urban background with no past or family history of mental illness presented to emergency services with symptoms of anxiety for 1 week. Exploration of history revealed that after the Nationwide “lockdown” was declared since March 24, 2020, she was confined to her home, would mostly be hooked up to the news channels about COVID-19 updates throughout the day. She would be following up various news channels and videos in the social media platforms about how the lives of people have been affected in different Western countries and in China, how the infected persons were dying and family members were unable to help their infected relatives/near ones, how the health-care workers were getting affected, etc. Over the period of 4–5 days of this routine, she started remaining worried that everyone on the Earth is going to get infected and die. These worries were associated with autonomic symptoms of anxiety such as palpitations, feeling restlessness, and dryness of the mouth. After 4–5 days, started to avoid the news and social media, but if she would accidentally hear anything about COVID-19 infection, her anxiety would increase further, which was now associated with intense palpitations, breathlessness, sweating, tremors, tingling sensations in the body, nausea, and feeling of impending doom. These episodes would be followed by intense crying spells. The frequency of these episodes would be 3–4 times/day, and she had to be calmed down by family members. Resultantly, she was not able to sleep, her appetite decreased, and she would mostly remain worried about her own health and that of family members. She was brought to our emergency, after one such episode. She was diagnosed with anxiety disorder (not otherwise specified) and managed with tablet clonazepam 0.5 mg and with supportive psychotherapy sessions. She was psychoeducated regarding anxiety leading to the autonomic symptoms and was taught relaxation exercises. She was followed up on telephonically and with these interventions, she showed improvement in her symptoms over the next few days.

This case description of the 18-year-old adolescent female highlights the impact of the COVID-19 crisis over this special group of population. It further explains how the excessive use of social media and telecommunication materials can affect the mental well-being of teenagers and can lead to excessive worry and subsequent severe anxiety symptoms. Various websites/health institutes/child and adolescent psychiatric societies/UNICEF and the WHO in their websites have focused on several techniques/tips to be taken care of while dealing with teenagers during this COVID-19 pandemic.[9,10] Some of which are making them aware of the current situation about COVID-19, giving proper information about how to protect themselves, promoting hand hygiene and social distancing, preparing a daily routine of their activities, limiting exposure to social media and news channels, and validating their disappointment about missing their schools/colleges/sports/ birthday parties, etc., encouraging healthy habits, promoting remote/online schooling/classes.[11,12] More specifically, the Centre for Disease Control and Prevention had advised the parents and caregivers should be available to listen to the concerns of their teenagers and children and reassure them, avoiding language that might blame others and lead to stigma, paying attention to what the children and teenagers see or hear on television/radio or online, and providing minimal but accurate and genuine information.[12] Further, it has been seen that anxious parents are more likely to make their children and teenagers more anxious. Therefore, parents and caregivers should try to manage their own anxiety related to COVID-19 and encourage distraction to tackle with their kids anxiety. More specific awareness programs focusing on this subgroup of the population are essential to decrease the prevailing anxiety among teenagers and children.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.