How has Covid-19 affected child and adolescent mental health?

Trigger warning: eating disorders, body dysmorphia

A study into the consequences of the Covid-19 pandemic and subsequent lockdowns on child mental health conducted by Imperial College London has released concerning preliminary results, which highlight a significant increase in mental distress amongst younger generations. 

The government-backed study found that the proportion of teenagers who are clinically depressed more than doubled from 14% to 35% during the first nine months of the pandemic, and noted profound disruption to sleeping patterns as one of the major behavioural changes. The study reported that a quarter of children and young people suffered from disrupted sleep. It also found one in ten often or always felt lonely.

Statistics recorded by the NHS for eating disorder referrals in England revealed a doubling in the number of urgent referrals

372,438 under-18s saw referrals for help with their mental health between April and December 2020. This is the most ever recorded by the Royal College of Psychiatrists, and 28% more than the 292,212 referred in the same period in 2019. 

Adrian James, the college’s president, added: “The extent of the mental health crisis is terrifying, but it will likely get a lot worse before it gets better. Services are at a very real risk of being overrun by the sheer volume of people needing help.”

It is not only anxiety and depression that children are struggling with either – though public mental health discussions are often reduced to these two issues. Eating disorders have also been on the rise among school children.  Statistics recorded by the NHS for eating disorder referrals in England revealed a doubling in the number of urgent referrals made between July and December of 2020 in comparison to the same time the year before.

Karen Street, Officer for Mental Health at the Royal College of Paediatrics and Child Health, told the Observer: “We’re seeing an increased presentation to acute hospitals of children in crisis. What we found in the first lockdown is that things seem to go quite quiet on all fronts right at the beginning, but later, there was a really steady and big surge of people presenting with eating disorders.” 

Food insecurity, changes to routine, pressure to exercise, and depression have been linked to this rise. The Imperial College study also noted an “80% increase in smartphone and social media use”, which could be linked to issues relating to self-image and body dysmorphia. 

Half of adult mental illnesses manifest by age 14

– Professor Mireille Toledano, Imperial College scientist

Professor Mireille Toledano, the Imperial College scientist leading the study, stressed: “Early life through to adolescence is really a critical period for lifelong health – half of adult mental illnesses manifest by age 14 – and by 24, that figure is already at 75%.”

This is a stark warning for the future, as many mental health professionals fear the situation is set to worsen.  The Institute for Fiscal Studies warned in February that “the long term costs of the pandemic will fall disproportionately on today’s children.”

Nadine Dorries, Minister for Mental Health, commented: “These initial findings illuminate how incredibly difficult this pandemic has been for many, especially children and young people, and I remain absolutely committed to supporting the mental wellbeing of everyone.” She announced that the government would be allocating “an extra £23 billion a year to mental health services, this will help an additional 345,000 children and young people access NHS funded services or school and college based support by 2023/244.” 

There is concern, however, that the government is focused on a solely reactionary response, treating mental illness once an individual has already broken down or sought help. Mark Fisher of The Guardian argued before this current crisis that not enough is being done to “address the social causation of mental illness” or act on avoidable risk.

As a result, some have criticised Ms Dorries’ voting record – she has consistently voted against raising welfare benefits at least in line with prices, voted to end financial support for some 16-19-year olds in training and further education, and in April of this year, she voted against introducing a temporary period for reduced rates on residential property. However, others are supportive of the Conservatives’ plan for supporting the public’s mental health, which includes an investment of £3.3m for the expansion of 23 local community projects to help prevent mental illness in children and young people.

Across the board, studies indicate that the children of parents who are suffering financially or otherwise are most vulnerable to mental distress. Children living in households falling behind on rent, mortgage, or bill payments were more than twice as likely to experience problems with their mental health than their more financially secure peers. 

One in ten children and young people reported that during the pandemic, their family did not have enough to eat, or had increased reliance on food banks compared with before the pandemic.

School and university closures have also highlighted the disproportionate effects of lockdown on learning

Additionally, “children with a parent in psychological distress were more likely to have a probable mental health problem”, according to a research paper that analysed data from the UK Household Longitudinal Study (UKHLS) panel. 

The research paper reported: “This is particularly concerning because parents, compared with working-age adults without young children, have experienced larger than average increases in psychological distress during the pandemic. This suggests that support for parents at this time matters for child mental health.”

When parents are impaired, children lose access to vital support systems which are crucial during periods of instability and isolation. Additionally, children have been cut off from support available from teachers and pastoral teams due to school closures. 

School and university closures have also highlighted the disproportionate effects of lockdown on learning – 12% of children had no reliable internet access at home, 19.1% had no quiet space to work, and 26.9% did not have a desk at which they could study. These unstable working environments have added to the academic stress and burnout of young people. Many have expressed frustration at the unpredictable closure of schools early in the pandemic, and are feeling demotivated in their studies. 

Yet researchers also argue that we mustn’t regard this crisis as existing solely in connection to the pandemic. Although the past year may have pushed individuals to new extremes that led them to seek help, a series of warnings were issued even before the pandemic hit. 

There were previous indications that funding for children’s mental health was failing to match the increased need – children’s and young people’s mental health services accounted for only 1% of the NHS budget back in 2019.

Bernadka Dubicka, Chair of the Child and Adolescent Faculty at the Royal College of Psychiatrists, said the Covid-19 pandemic had highlighted and intensified an existing problem in child mental health. She went on to say: “We’ve got a crisis on top of a crisis. We had a pre-existing crisis in child and adolescent mental health before the pandemic. The indications are things just got much more difficult for many children and families, and also for the staff trying to provide services.”

Research recommends urgent attention be paid to their soaring mental health difficulties

A World Health Organisation (WHO) paper published in 2013 had previously highlighted the need for a proactive – as opposed to reactionary – approach to public mental health pointing to “a number of key actions, not limited to treatment requiring state intervention to promote mental health”. These included providing “better (and more) health and social care services for currently underserved populations with unmet needs”.

The Imperial College London report and others like it illustrate that children and young people have been caught at the intersection of innumerable competing issues during the pandemic, which have combined to precipitate an urgent mental health crisis. They have been isolated from their peers, are struggling with academic stress and uncertainty over their exams, and are exposed to the growing psychological distress of their parents, which is disproportionately experienced across different socio-economic circumstances. 

Although children are at the lowest risk of dying from Covid-19, the research recommends urgent attention be paid to their soaring mental health difficulties, catalysed by the pandemic, but also symptomatic of ongoing issues in the area of state-funded medical and financial support.