Young People's Mental Health Changes, Risk, and Resilience During the COVID-19 Pandemic

Abstract

Importance: As young people's mental health difficulties increase, understanding risk and resilience factors under challenging circumstances becomes critical.

Objective: To explore the outcomes of the COVID-19 pandemic on secondary school students' mental health difficulties, as well as the associations with individual, family, friendship, and school characteristics.

Design, setting, and participants: For this cohort study, follow-up data from the My Resilience in Adolescence (MYRIAD) cluster randomized clinical trial were collected across 2 representative UK cohorts. Mainstream UK secondary schools with a strategy and structure to deliver social-emotional learning, with an appointed head teacher, and that were not rated "inadequate" in their latest official inspection were recruited. A total of 5663 schools were approached, 532 showed interest, and 84 consented. Cohort 1 included 12 schools and 864 students, and cohort 2 included 72 schools and 6386 students. COVID-19 was declared a pandemic after cohort 1 had completed all assessments (September 2018 to January 2020), but cohort 2 had not (September 2019 to June 2021).

Exposures: Cohort 2 was exposed to the COVID-19 pandemic, including 3 national lockdowns. Associations of individual, family, friendship, and school characteristics with students' mental health were explored.

Main outcomes and measures: Changes in students' risk for depression (Center for Epidemiological Studies-Depression scale); social, emotional, and behavioral difficulties (Strengths and Difficulties Questionnaire); and mental well-being (Warwick-Edinburgh Mental Well-Being Scale).

Results: Of the 7250 participants included, the mean (SD) age was 13.7 (0.6) years, 3947 (55.4%) identified as female, and 5378 (73.1%) self-reported their race as White. Twelve schools and 769 of the 864 students (89.0%) in cohort 1 and 54 schools and 2958 of the 6386 students (46.3%) in cohort 2 provided data and were analyzed. Mental health difficulties increased in both cohorts but to a greater extent among students exposed to the pandemic, including for risk of depression (adjusted mean difference [AMD], 1.91; 95% CI, 1.07-2.76); social, emotional, and behavioral difficulties (AMD, 0.76; 95% CI, 0.33-1.18); and mental well-being (AMD, -2.08; 95% CI, -2.80 to -1.36). Positive school climate, high home connectedness, and having a friend during lockdown were protective factors during the pandemic. Female gender and initial low risk for mental health difficulties were associated with greater mental health deteriorations. Partial school attendance during lockdown was associated with better adjustment than no attendance when returning to school.

Conclusions and relevance: This cohort study of secondary school students demonstrated that to promote mental health and adjustment, policy interventions should foster home connectedness, peer friendship, and school climate; avoid full school closures; and consider individual differences.

Figure 1.. Study Design, Measures, and Data Collection

Student and school characteristics (characteristics of the school community, operational features of the school, and broader context), home environment, and friendships may influence students’ mental health, mental well-being, and adjustment to lockdown and return to school directly or indirectly through different mechanisms. SEL indicates social-emotional learning; SEND, special educational needs or disabilities. ^aThe other racial and ethnic groups category includes Arab, Asian, Black/African/Caribbean, mixed/multiple ethnic groups, and other ethnic groups. This category was grouped together owing to small sample sizes. ^bThe time point 3 (T3) to time point 4 (T4) window for cohort 1 was a mean (SD) of 364.6 (50.9) days and for cohort 2 was 523.9 (47.4) days. The UK government announced on March 23, 2020, that residents must stay at home and some businesses had to close. This lockdown was gradually eased until July 4, 2020, when most businesses were allowed to open. From late July 2020 onward, a series of limited and local restrictions were put in place. From November 5, 2020, the UK went into a second, 4-week lockdown, which differed from the first in that schools and universities remained open, and from December 2020 onward returned to a system of local restrictions. From December 26, 2020, the UK went into a third lockdown with a gradual end: in March 2021, schools reopened; in April 2021, individuals in groups of up to 6 were allowed to meet again outdoors, and outdoor pubs, restaurants, and nonessential shops reopened in the UK; in mid-May 2021, outdoor social contact became unregulated again, individuals in groups of up to 6 were allowed to meet indoors, and restaurants and hotels could reopen. See eFigure 1 in Supplement 1 for a more detailed description of the pandemic timeline and lockdown restrictions at the T4 measurement wave for cohort 2.

Figure 2.. Outcomes by Cohort and Time Point

A and B, Risk for depression was assessed using the Center for Epidemiological Studies for Depression scale (CES-D; range, 0-60; cutoff for caseness [dotted line], >27 points). C and D, Social, emotional, and behavioral difficulties were assessed using the Strengths and Difficulties Questionnaire (SDQ; range, 0-40; cutoff for high social, emotional, and behavioral difficulties [dotted line], >17 points). E and F, Mental well-being was assessed using the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS; range, 14-70; cutoff for possible mental health difficulties [dotted line], <45 points).^,,, Time point 3 (T3) for cohort 1 was from September 21, 2018, to February 14, 2019, and for cohort 2 was September 4, 2019, to January 17, 2020. Time point 4 (T4) for cohort 1 was from September 10, 2019, to January 15, 2020, and for cohort 2 was February 23, 2021, to June 21, 2021.