The impact of the pandemic on mental well-being across the world and across all age groups has been stark, though the resiliency of most persons is also of note. Clearly the disruptive impacts of the pandemic have been powerful, most particularly for those more vulnerable to becoming infected and those (e.g., elderly, co-morbidly ill, the poor, those impacted economically, etc.).
Although not the norm, many individuals and families without pre-existing conditions, psychosocial vulnerabilities, and with the good fortune to have been able to avoid contagion, have in some cases done well and in certain respects have been able to do well emotionally during the lockdown and upheaval of the past year.
This week’s newsletter discusses two disparate groups of the population that have had different overall responses to the pandemic, with recognition that the group data does not apply to all individuals in the groups — some in the negatively impacted group have done well, and some in the favorably impacted group have struggled and suffered mightily.
Adults with Alcohol Use Disorder:
In adult populations, various studies have found increased rates of depressive and anxiety symptoms (Zeytinoglu et al., 2021; Pere-Cano et al., 2020) since the start of the pandemic. There have further been findings of disproportionate negative impacts on adults with substance use disorders.
More recently, one study has delved into increased rates of alcohol (Kilgore et al., 2021). In particular, the authors found that for adults who experienced “lock-down”, the rates of problematic alcohol use, or likely dependence increased with each month. During the period from April to September 2020, adults experiencing lockdown showed increased rates of problematic and harmful alcohol use (as rated by the AUDIT questionnaire) from 21.0% in April to 40.7%. Notably, those adults in the study who were not under significant restrictions did not show an increased rate.
This drives home the complex balance and, at times the countervailing pressures, between the societally critical public health ordinances and their impacts on physical well-being and mental well-being of various groupings of patients. While more research is needed, it is clear that while primary care and mental health settings must find strategies to support our vulnerable communities with both outreach services and supports. In retrospect, it is further suggested that population-focused strategies to screen for substance use difficulties might help those experiencing higher behavioral health risk because of public health restrictions.
Adolescents:
Acknowledging again that individual responses may vary from large group collective data, it is remarkable to report that early findings from various population surveys note that adolescents as a group have fared much better during the pandemic than other age groups. Data reported on by Professor Jean Twenge, Ph.D., of SDSU’S Department of Psychology, at the recent Critical Issues in Child & Adolescent Mental Health conference drawn from US Census Bureau Survey studies show the previously noted increased in behavioral health concerns for adults during the pandemic, with a 30% increase in recognized mental health conditions for the general population and a 40% increase for parents with minor children in the home. Anxiety screening with the GAD2 showed 30-35% increases in levels of anxiety during the pandemic and surveys for both depression and anxiety clearly demonstrated that depressive and anxiety symptomatology tracked closely with Covid surges over the past year.
However, for teens (as a whole), the data was markedly different with a reversal of trends dating from around 2012–the time that cell phones became accessible and ‘indispensable’ for most American teens– showing increases in depression, self-injury incidents resulting in ER visit, and significant sleep deprivation in the absence of a pandemic and its social and environmental sequela. Mood disorders in teens during the past decade have been at peak levels in the range of 18-20% prevalence, but these rates did not increase over the past year as many would have predicted.
The comparison for sleep deprivation in teens from 2018 (50% reported as sleep deprived) versus 2020 (@ 15%) is particularly notable. Not surprisingly, family time was increased for 70% of those surveyed—most parents (even if stressed themselves) appear to be OK to be around for most adolescents. The absence of in-person social interactions was apparently compensated for by sustained (and increased) vise chat time, access to positive video shows, video gaming and social media interactions.
Even in the context of the loss of in-person school instruction and activities, the data showed little evidence of population data to suggest increased negative mental health responses in teens—sadly, it would appear that most teens find school, whether in person or remote, is not a favored activity and in both circumstances it is associated with significant stress.
Why the favorable data? What protective factors were in play for adolescents? Time away from school pressures (it is not really a fun place for most kids), a slower pace of life with opportunity to follow their natural diurnal rhythms (up late but sleeping later and longer), and not, for most, being challenged economically as the case for their parents and many striving to be independent 20-30 yo, all are thought to have served teens well, in spite of the obvious challenges of the year.
Takes homes from the data include:
1) Better sleep is associated with happier and healthier adolescents
2) Later school start times make sense
3) iPhones don’t belong in bedrooms after ~ 10:00 or earlier as “vamping” into the wee hours is not good.
4) TV time in the evening is better than an iPhone diet.
5) Interpersonal time with parents, siblings and others really is healthy.
6) Efforts to improve the quality of the school experiences of youth in junior and senior high schools ought to be a priority and a focus on providing both improved education and ongoing social-emotional support should be pursued.
7) While the aggregate data is positive, youth with pre-existing behavioral health, psychosocial stressors and other vulnerabilities need special consideration and services.
CDC Coping with Stress Resources:
https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html
San Diego County Treatment Guide: https://www.sandiegocounty.gov/content/sdc/hhsa/programs/bhs/alcohol_drug_services/dmc_ods_consumer.html
Killgore WDS, Cloonan SA, Taylor EC, Lucas DA, Dailey NS. Alcohol dependence during COVID-19 lockdowns. Psychiatry Res. 2021 Feb;296:113676. doi: 10.1016/j.psychres.2020.113676. Epub 2020 Dec 25. PMID: 33385782.
Ornell, F., Moura, H. F., Scherer, J. N., Pechansky, F., Kessler, F., & von Diemen, L. (2020). The COVID-19 pandemic and its impact on substance use: Implications for prevention and treatment. Psychiatry research, 289, 113096. https://doi.org/10.1016/j.psychres.2020.113096
Pérez-Cano HJ, Moreno-Murguía MB, Morales-López O, Crow-Buchanan O, English JA, Lozano-Alcázar J, Somilleda-Ventura SA. Anxiety, depression, and stress in response to the coronavirus disease-19 pandemic. Cir Cir. 2020;88(5):562-568. English. doi: 10.24875/CIRU.20000561. PMID: 33064695.
Zeytinoglu, S., Morales, S., Lorenzo, N. E., Chronis-Tuscano, A., Degnan, K. A., Almas, A. N., Henderson, H., Pine, D. S., Fox, N. A. (2021) A Developmental Pathway from Early Behavioral Inhibition to Young Adults’ Anxiety During the COVID-19 Pandemic. Journal of the American Academy of Child and Adolescent Psychiatry. doi: 10.1016/j.jaac.2021.01.021
Twenge, J; The mental health of youth and their parents during the pandemic; presentation at 6th Annual CICAMH conference, 3/19/21; San Diego