The acute and persisting impact of COVID-19 on trajectories of adolescent depression: Sex differences and social connectedness

Abstract

Background: The COVID-19 era is a time of unprecedented stress, and there is widespread concern regarding its short- and long-term mental health impact. Adolescence is a sensitive period for the emergence of latent psychopathology vulnerabilities, often activated by environmental stressors. The present study examined COVID-19's impact on adolescent depression and possible influences of different domains of social connectedness (loneliness, social media use, social video game time, degree of social activity participation).

Methods: A community sample of 175 adolescents (51% boys, mean age = 16.01 years) completed questionnaires once before and twice during the COVID-19 pandemic. Piecewise growth modeling examined the acute (7 weeks) and persistent (8 months) effects of COVID-19 on depressive symptoms, and differences across sex and social connectedness.

Results: Significant increases in depressive symptoms followed pandemic onset for boys and girls. However, this increase was earlier and more pronounced among girls than boys, whose depression only increased significantly during the persistent period and to a lesser degree. Trajectories of depression were influenced by loneliness and social connections.

Limitations: Most participants had economic stability and minimal exposure to the virus. Exacerbation of depressive symptoms may be more severe in higher risk populations.

Conclusions: Adolescent depression levels have increased during COVID-19, and are higher for girls and those who are lonely. Enhanced screening and management for adolescent depression and social connectedness could play a critical role in mitigating the negative mental health fallout of COVID-19 and future pandemics within this population.

Keywords: Adolescent; COVID-19; Depression; Mental health; Pandemic; Social.

Fig. 1

Percentage of participants who endorsed participation in various social activities 8 months into state COVID-19 related shutdown. Note. Asterisks in bar labels denote significant differences between boys and girls, *p < .05. Only respondents currently in school answered questions about school format.

Fig. 2

Boys’ and girls’ average ratings of social activity participation, loneliness and time on social video games and social media. Note. Asterisks denote significant differences across sex, ***p < .001. Social video game time and social activity participation were rated at T3; loneliness and social media time are averaged scores from T2 and T3 ratings.

Fig. 3

Estimated mean depressive symptoms in the pre-COVID, acute and persistent periods by sex. Note. Asterisks denote statistically significant changes in mean CDI score from the previous timepoint, *p < .05, **p < .01. CDI scores were modeled using a conditional growth model (random intercepts for individual) adjusted for age at shutdown, with interaction between sex*time. Time is modeled using piecewise linear regression with knot at 7 weeks after shutdown. Dashed vertical line represents the state COVID-19 related shutdown date.

Fig. 4

Estimated mean depressive symptoms in the pre-COVID, acute and persistent periods by sex, moderated by loneliness, social video game time, social media use time, and social activity participation. Note. Asterisks denote statistically significant changes in mean CDI score from the previous timepoint, *p < .05, **p < .01. CDI scores were modeled using a conditional growth model (random intercepts for individual) adjusted for age at shutdown, with 3-way interaction terms between each social connectedness variable with sex*time, e.g., loneliness*sex*time. Time was modeled using piecewise linear regression with knot at 7 weeks after shutdown. Mean CDI scores were estimated at low and high values of loneliness, social video game time, social media use time, and social activity participation, fixed at the 25th and 75th percentile values in the total sample. Loneliness: low = 4.0 vs. high = 9.5 points; social video game time: low = 0 vs. high = 5.2 h; social media use time: low = 2–3  vs. high = 4–6 h; social activity participation: low = 4 vs. high = 8 activities. Dashed vertical line represents the state COVID-19 related shutdown date.