COVID-19 pandemic impact on children and adolescents' mental health: Biological, environmental, and social factors

Abstract

Since the Coronavirus disease 2019 (COVID-19) pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was announced, we had an unprecedented change in the way we organize ourselves socially and in our daily routine. Children and adolescents were also greatly impacted by the abrupt withdrawal from school, social life and outdoor activities. Some of them also experienced domestic violence growing. The stress they are subjected to directly impacts their mental health on account of increased anxiety, changes in their diets and in school dynamics, fear or even failing to scale the problem. Our aim is to bring up a discussion under different aspects and to alert public health and government agents about the need for surveillance and care of these individuals. We hope that the damage to their mental health as a result of the side effect of this pandemic can be mitigated by adequate and timely intervention.

Keywords: Adolescents; COVID-19; Children; Mental health; Social isolation; Stress.

Fig. 1

Possible impacts from COVID-19 pandemic stressors on children and adolescence's life. Under physiological conditions, activation of the HPA axis occurs through production and release of CRH through the paraventricular nuclei of the hypothalamus. CRH stimulates the secretion of ACTH by the anterior portion of the pituitary gland (adenohypophysis). Therefore, ACTH reaches the peripheral circulation and is transported to the cortex of the adrenal glands, inducing the release of glucocorticoids (e.g. cortisol) into the bloodstream. In a negative feedback mechanism, cortisol, in turn, inhibits the secretion of CRH and ACTH. However, during early stages of life, where the child or adolescent are subjected to situations of long-lasting stress, this axis can have its activity dysregulated by inflammatory mediators synthesis and release (e.g. pro-inflammatory cytokines), neurotransmitters, hormones, among other molecules which can interfere with different physiological mechanisms. It includes distinct processes since intake regulation to cognition, for example. Moreover, the homeostasis disruption caused by a dysregulation of the HPA axis in response to stress induces neuroimmunoendocrine changes, which, if persistent, can induce poor health. All probable harmful effects on an individual's health triggered by this imbalance could be related to immune, endocrine, and nervous systems overload, and even a predisposition of these individuals to develop psychiatric disorders in adulthood. In the panel on the left we have gathered some of the possible short-term effects from exposure to stressors of COVID-19 pandemic at this stage of life (e.g. distress and hopelessness, irregular food intake, abuse and trauma, interpersonal and environmental restraint, sensorial deprivation and neglect) and on the right, possible long-term consequences (e.g. underdeveloped brain circuitry, obesity, substance abuse, lack of emotional processing, psychiatric disorders, suicidal thoughts). HPA: hypothalamic-pituitary-adrenal; CRH: corticotrophin-releasing hormone; ACTH: adrenocorticotropic hormone.