The Impact of SARS-CoV-2 Infection on Youth Mental Health: A Narrative Review

Abstract

Background: COVID-19 pandemic has affected the physical health, psychological wellbeing, and mental health of the whole population. Young people are among those most at risk of developing mental health symptoms or disorders related to the pandemic.

Purpose: the present narrative review is aimed at providing an updated overview of the current literature concerning the psychological impact of the SARS-CoV-2 infection but also of the COVID-19 outbreak, environmental restriction, and social distancing on mental health outcomes among the youth population aged between 15 and 25 years.

Methods: in December 2021, an electronic search on this topic was performed on PubMed. Relevant publications from January 2020 until December 2021 were included.

Findings: 53 cross-sectional studies, 26 longitudinal studies, 4 ecological studies, 1 qualitative study, and 1 systematic review were included. We found many methodological limitations in the studies included, especially poor choice of study samples and short follow-ups. Little literature was in support of a strong relationship between SARS-CoV-2 infection and consequences on youth mental health. On the contrary, many studies showed how extraordinary measures to limit the spread of the virus have impacted young people in terms of onset of new mental disorders and symptoms, suicidality, and access to emergency psychiatric services. Depressive and anxiety symptoms and disorders show the greatest increase in incidence, especially in girls and young women.

Conclusions: it seems important to pay attention to the mental health of young people in relation to the consequences of the COVID-19 pandemic. However, studies with more robust methodologies and longer follow-ups are needed to establish precise indications for targeted interventions in this context.

Keywords: COVID-19 pandemic; SARS-CoV-2; anxiety; depression; mental health; social media; suicidal thoughts; syndemic; telemedicine; youth.

Figure 1

Possible mechanisms of direct and indirect SARS-CoV-2 infection damage to the brain. (A) Direct damage: SARS-CoV-2 infects the olfactory nerve and then the olfactory bulb. Via retrograde neuronal transmission, it reaches other CNS regions [44,45,46] (upper part of panel (A)). It infects endothelial cells of the brain vascular system and activate neutrophils, macrophages, thrombin production, and complement pathways, promoting micro-thrombi deposition [48] (lower part of panel (A). (B) Indirect damage: SARS-CoV-2 spreads to the whole organism and causes a massive activation of the immune system. This results in a cytokines storm and in a marked systemic inflammatory response [53,54]. An overactive immune response can cause lungs damage and the need for intensive care. Aggressive life-saving treatments in intensive-care units may contribute to the brain damage [11] (upper part of panel (B)). Cytokines induces expression of cyclooxygenase 2 (COX-2). The activity of COX-2 increases blood-brain barrier permeability. This facilitates the entry of cytokines within the CNS, which causes the activation of astrocytes and microglia [55,56,57]. These activated cells produce mediators of neuro-inflammation (e.g., glutamate, complement proteins, and interleukins), that induce structural changes, in particular, the pruning of the synapses [57,58] (lower part of panel (B). Both direct and indirect brain damages can converge in a neuronal loss that might represent the biological underpinning of the neuro-psychiatric symptoms described in SARS-CoV-2 infection [11,52] (not shown). SARS: severe acute respiratory syndrome; CoV: coronavirus; IL: interleukin; and TNF: tumor necrosis factor. Created with BioRender.com.