US Surgeon General Vivek H. Murthy issued a public health advisory on Tuesday, December 6, 2021 in order to provide recommendations for how to address the mental health challenges confronting children, adolescents, and young adults, which have been exacerbated by the COVID pandemic. The advisory, issued by the Office of the Surgeon General, speaks about actions that various groups, such as, family members, community organizations, technology companies, and young people themselves can do to ease the burden of this mental health crisis. What steps health care professionals and health professionals can take is also addressed.
Even before the COVID-19 pandemic, mental health challenges were the leading cause of disability and poor life outcomes in young people, with up to 1 in 5 children ages 3 to 17 in the US with a reported mental, emotional, developmental, or behavioral disorder.1 In addition, in 2016, of the 7.7 million children with treatable mental health disorder, about half did not receive adequate treatment.2
In recent years, certain mental health symptoms, such as depression and suicidal ideation, have substantially increased. From 2009 to 2019, the proportion of high school students reporting persistent feelings of sadness or hopelessness increased by 40%; the share seriously considering attempting suicide increased by 36%; and the share creating a suicide plan increased by 44%.3
Between 2011 and 2015, youth psychiatric visits to emergency departments for depression, anxiety, and behavioral challenges increased by 28%.20 Between 2007 and 2018, suicide rates among youth ages 10-24 in the US increased by 57%.4 Early estimates from the National Center for Health Statistics suggest there were tragically more than 6600 deaths by suicide among the 10-24 age group in 2020.5
The prevalence of mental health issues is strikingly visible in subpopulations. For instance, girls are much more likely to be diagnosed with anxiety, depression, or an eating disorder, while boys are more likely to die by suicide or be diagnosed with a behavior disorder, such as attention deficit hyperactivity disorder (ADHD).6,7,8 In recent years, suicide rates among Black children (below age 13) have been increasing rapidly, with Black children nearly twice as likely to die by suicide than White children.9 Moreover, socioeconomically disadvantaged children and adolescents — for instance, those growing up in poverty — are 2 to 3 times more likely to develop mental health conditions than peers with higher socioeconomic status.10
During the pandemic, young people also experienced other challenges that may have affected their mental and emotional wellbeing: the national reckoning over the deaths of Black Americans at the hands of police officers, including the murder of George Floyd; COVID-related violence against Asian Americans; gun violence; an increasingly polarized political dialogue; growing concerns about climate change; and emotionally-charged misinformation.11,12,13,14,15
Although the pandemic’s long-term impact on children and young people is not fully understood, there are reasons to be optimistic. According to more than 50 years of research, increases in distress symptoms are common during disasters, but most people cope well and do not go on to develop mental health disorders.16 Several measures of distress that increased early in the pandemic appear to have returned to pre-pandemic levels by mid-2020.17,18
Some other measures of wellbeing, such as rates of life satisfaction and loneliness, remained largely unchanged throughout the first year of the pandemic.17, 19 And while data on youth suicide rates are limited, early evidence does not show significant increases.20,21
In all of this, there are reasons for positivity as some young people managed to thrive during the pandemic: They got more sleep, spent more quality time with family, experienced less academic stress and bullying, had more flexible schedules, and improved their coping skills.22,23,24,25 Many young people are resilient, able to bounce back from difficult experiences such as stress, adversity, and trauma.26
Actions proposed that health professionals and health care organizations can do include:
· Recognize that the best treatment is prevention of mental health challenges. Implement trauma-informed care (TIC) principles and other prevention strategies to improve care for all youth, especially those with a history of adversity.27
· Routinely screen children for mental health challenges and risk factors, including adverse childhood experiences (ACEs).28
· Identify and address the mental health needs of parents, caregivers, and other family members.29
· Combine the efforts of clinical staff with those of trusted community partners and child-serving systems (eg, child welfare, juvenile justice).
· Build multidisciplinary teams to implement services that are tailored to the needs of children and their families.
This public health advisory also lists resources for health care organizations and health professionals.
Protecting Youth Mental Health: The U.S. Surgeon General’s Advisory. Office of the Surgeon General. Published online December 6, 2021.
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19. Luchetti M, Lee JH, Aschwanden D. The trajectory of loneliness in response to COVID-19. Am Psychol. 75(7), 897–908. doi:10.1037/amp0000690
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21. Ahmad FB, Cisewski JA. Quarterly provisional estimates for selected indicators of mortality, 2019-Quarter 1, 2021. National Center for Health Statistics. National Vital Statistics System, Vital Statistics Rapid Release Program. Page last reviewed: October 6, 2021
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29. Interim guidance on supporting the emotional and behavioral health needs of children, adolescents, and families during the COVID-19 pandemic. American Academy of Pediatrics. July 28, 2021.