A longitudinal study of mental health in at-risk adolescents before and during the COVID-19 pandemic

Abstract

Although cross-sectional studies have shown that the COVID-19 pandemic has negatively affected the mental health of adolescents, the effect of the pandemic on adolescents with pre-pandemic symptoms is unclear. We, therefore, tested the hypothesis that adolescents had increased emotional and behavioral problems during the lockdowns imposed during the pandemic.This study included three measurements in a prospective cohort of 1022 adolescents who were oversampled based on their high risk of developing psychopathology. Before the pandemic, we assessed depressive, anxiety, stress, oppositional defiant problems, psychotic experiences and suicidality, using the Youth Self-Report; 445 and 333 of these 1,022 adolescents subsequently completed the online questionnaire in the first lockdown (in April 2020) and in the second lockdown (in January 2021), respectively. Multilevel random intercept regression models were used to determine the change in psychiatric symptoms, including an interaction term to assess whether these changes differed based on the severity of symptoms prior to the pandemic. Throughout the pandemic, the majority of the participating adolescents reported having emotional and behavioral symptoms that were within the normal range. Moreover, the mean symptom scores for all six outcomes decreased significantly among adolescents with high clinical severity prior to the pandemic.In contrast to our original hypothesis, the effects of the COVID-19 pandemic may not necessarily be detrimental, at least among a specific subgroup of adolescents with pre-existing mental health problems. Moreover, our finding that most adolescents in this at-risk sample did not report experiencing clinically relevant symptoms during the pandemic reflects their resilience during the pandemic.

Keywords: Adolescent; COVID-19; Epidemiology; Mental health; Population-based studies.

Fig. 1

Percentage of adolescents whose emotional and behavioral symptom severity increased, decreased, or was unchanged from normal, borderline, or clinical severity between baseline and C1 and between C1 and C2. Note that the majority of adolescents were in the normal range throughout the study; to improve readability, the percentages in the normal range were scaled down by a factor of 10

Fig. 2

Summary of the estimated scores for anxiety problems, depressive problems, oppositional defiant problems, stress problems, psychotic experiences, and suicidality reported at baseline, C1, and C2, stratified by emotional and behavioral problem scores measured before the COVID-19 pandemic. *p < 0.05 and **p < 0.001 (post hoc univariate test)