The Mental Health Burden of COVID-19: �Strategies to Support Our Children

Laura Berness, PhD

Stepping Stones Psychological Services of Princeton, LLC

“Why won’t you let me have friends over? Everybody else is allowed.”

“I can’t do this anymore! I hate remote school.”

“I just want to have a birthday party. Why can’t things be normal?”

“Why would I leave my room? I’m fine. Just leave me alone.”

“When can we visit Grandma and Grandpa again?”

“I don’t think this is ever going to end.”

“Should I just let her have a sleepover? It would be good for her.”

“I didn’t even know he was missing so much homework. He isn’t motivated at all.”

“Why is he yelling and hitting so much? Is he just being difficult or is something wrong?”

“I know they are all on their screens way too much. But what am I supposed to do about it?”

“I need a break so badly. I am exhausted and just can’t keep doing everything.”

“I feel like a terrible parent. My own anxiety is so high and I know I’m snapping at them.”

“Why has this been so hard?”

• Family Reasons

If absence makes the heart grow fonder, what did quarantine do?

• Parents are working from home, leaving the workforce, or now unemployed
• Financial concerns
• Health and safety concerns
• Loss of childcare and other forms of support
• Strained marital relationships
• Parents are caring for kids and elderly parents
• Typical parenting strategies don’t feel applicable
• Parents are having more mental health problems

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“Why has this been so hard?”

• Educational Reasons
• Children and teens aren’t meant to learn in isolation
• School has been either hybrid or fully remote
• Parents are responsible for more of their children’s education
• Students report “zoom fatigue”
• Students with special education services have especially struggled
• Less access to school based mental health support

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“Why has this been so hard?”

• Psychological Reasons
• Pre-existing mental health conditions may be exacerbated
• Social isolation and loneliness
• Sense of hopelessness (no clear end date)
• Loss of independence
• Loss or modification of traditions/rituals
• Disrupted sleep, less exercise, poor diet
• Excessive screen usage
• Loss of a sense of time
• Layers of stress (pandemic, social injustice, divisive politics, climate change)

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Data on Pediatric Mental Health During COVID

• Significant increase in pediatric ER mental health visits (Leeb et al., 2020)
• Increased by 24% in ages 5-11
• Increased by 31% in ages 12-17

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• Increase in suicidal ideation and attempts by youth (ages 11-21) correlated with times when COVID stressors were higher (Hill et al., 2020)

Data on Pediatric Mental Health Cont.

• Parents’ surveyed reported many mental health concerns for their children (Singh et al., 2020)
• Fear and clinginess
• Isolation
• Disturbed sleep and nightmares
• Changes in appetite
• Worsening inattention
• Increased irritability
• Stress about the future (college plan upheaval, school and sports cancellations)

Data on Parents’ Mental Health During COVID

• July 2020: 27% of parents reported poorer mental health (Patrick et al, 2020)

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• December 2020: Parents reported significant anxiety and depressive symptoms:
• 40.3% of fathers and 49.3% of mothers (US Census Bureau, Household Pulse Survey, 2020)

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• How does this affect our children?

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Warning Signs for Help

• Suicidal ideation

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• Expressing helplessness & hopelessness
• “What I do doesn’t matter.” “Nothing can change this.”

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• Behavioral outbursts

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• Withdrawal from family and friends

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• Loss of interest in activities

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• Significant drop in grades

Positive Effects

• Benefits from working from home

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• Benefits from being more involved in children’s education

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• Closer family relationships

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• Children are learning more responsibility and life skills

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• Giving more thought to life goals and priorities

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• “Post Traumatic Growth”

Preparing for “Re-Entry”

• Not All COVID Experiences Were the Same

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School

Family

Friends

Sports/

Activities

Health

Preparing for “Re-Entry”

Mental Health Concerns

• Separation Anxiety
• Gradually increase separation time
• Give your child something to keep while you are gone
• Social Anxiety
• Ease back into social situations
• Role play social skills
• Take a break from screens
• School Anxiety
• Schedule meetings with counselors, teachers for support
• Build in positive reinforcement for attending

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Ways to Help Ease the Transition

• Make a plan with your child or teen

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• Be as consistent as possible

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• Recognize that flexibility may be needed

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• Ask open ended questions

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• Don’t immediately offer solutions to problems

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• Empathize and connect

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• Ask for help

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References

• Cziesler, ME, Lane RI, Petrosky E, Wiley JF, Christensen A, Naji R, Weaver MD, Robbins R, Facer-Childs ER, Barger LK, Cziesler CA, Howard ME, Rajaratnam S. Mental health, substance use, and suicidal ideation during the COVID-19 pandemic – United States, June 24-30, 2020. Morbidity and Mortality Weekly Report. 2020 August; 69(32), 1049-1057. DOI: http://dx.doi.org/10.15585/mmwr.mm6932a1 9.

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• Hill RM, Rufino K, Kurian S, Saxena J, Saxena K, Williams L. Suicide ideation and attempts in a pediatric emergency department before and during COVID-19. Pediatrics. 2020; doi: 10.1542/peds.2020-029280

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• Leeb RT, Bitsko RH, Radhakrishnan L, Martinez P, Njai R, Holland KM. Mental Health–Related Emergency Department Visits Among Children Aged <18 Years During the COVID-19 Pandemic — United States, January 1–October 17, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1675–1680. DOI: http://dx.doi.org/10.15585/mmwr.mm6945a3external icon.

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• Patrick SW, Henkhaus LE, Zickafoose JS, Lovell K, Halvorson A, Loch S, Letterie M, Davis MM. Well-being of Parents and Children During the COVID-19 Pandemic: A National Survey. Pediatrics. 2020 Oct;146(4):e2020016824. doi: 10.1542/peds.2020-016824. Epub 2020 Jul 24. PMID: 32709738.

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