Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2026 Jan;96(1):e70093.
doi: 10.1111/josh.70093.

Learning Modalities During COVID-19 and Adolescent Mental Health in North Carolina

Justin Cole Gilbert  1 , Martie P Thompson  1 , Sophia Ryan  1 , Manan Roy  1
Affiliations

Learning Modalities During COVID-19 and Adolescent Mental Health in North Carolina

Justin Cole Gilbert et al. J Sch Health. 2026 Jan.

Abstract

Background: The mental health of youth represents a critical public health issue and has worsened over the course of the pandemic, partially attributed to social isolation and school closures.

Methods: This analysis leveraged data on school learning modality (COVID-19 School Data Hub), emergency department (ED) visits (North Carolina SHEPS data), and school-district characteristics (National Center for Education Statistics) to investigate how school learning modality predicts mental health-related ED visitation in the state of North Carolina. Generalized linear mixed models were employed to quantify how the odds of mental health ED visitation varied with school learning modality. Models adjust for school-level covariates (e.g., broadband, student:teacher ratio) and patient-level characteristics (age, sex). Patient and school data are nested within counties, which were included as a random effect to address potential clustering within the data.

Results: In-person (odds ratios [OR]: 0.92, 95% CI: 0.85-0.99) and hybrid (odds ratios: 0.95, 95% CI: 0.93-0.98) modalities were associated with lower ORs for ED visits due to mental health compared to a virtual learning modality.

Implications for school health policy, practice, and equity: School districts should consider increasing the provision of mental health services for students during circumstances in which a virtual learning modality is utilized and consider adopting hybrid learning rather than virtual learning when feasible.

Conclusions: School administrators should seek to balance students' mental health and learning needs in times of crisis.

Keywords: COVID‐19; learning modality; mental health; remote schooling; school‐age; virtual learning; youth.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Learning modality over time.
FIGURE 2
FIGURE 2
Panel map of (a) percent of 2020–2021 school year spent in a virtual learning modality, (b) percent of emergency department visits related to mental health during the 2020–2021 (c) and rurality by county in North Carolina.
See this image and copyright information in PMC

References

    1. Sugg M. M., Ryan S. C., Ulrich S. E., Runkle J. D., and Thompson M. P., “Structural Influences on Psychiatric Emergency Department Visits Among Racial and Ethnic Minority Youth in North Carolina: A Neighborhood‐Level Analysis,” Health & Place 90 (2024): 103379, 10.1016/j.healthplace.2024.103379. - DOI - PMC - PubMed
    1. Centers for Disease Control and Prevention , “Web‐Based Injury Statistics Query and Reporting System (WISQARS) [Online],” 2022, www.cdc.gov/ncipc/wisqars.
    1. Yard E., Radhakrishnan L., Ballesteros M. F., et al., “Emergency Department Visits for Suspected Suicide Attempts Among Persons Aged 12–25 Years Before and During the COVID‐19 Pandemic—United States, January 2019–May 2021,” MMWR. Morbidity and Mortality Weekly Report 70 (2021): 888–894, 10.15585/mmwr.mm7024e1. - DOI - PMC - PubMed
    1. Hawes M. T., Szenczy A. K., Klein D. N., Hajcak G., and Nelson B. D., “Increases in Depression and Anxiety Symptoms in Adolescents and Young Adults During the COVID‐19 Pandemic,” Psychological Medicine 52, no. 14 (2022): 3222–3230, 10.1017/S0033291720005358. - DOI - PMC - PubMed
    1. Martino J., Pegg J., and Frates E. P., “The Connection Prescription: Using the Power of Social Interactions and the Deep Desire for Connectedness to Empower Health and Wellness,” American Journal of Lifestyle Medicine 11, no. 6 (2015): 466–475, 10.1177/1559827615608788. - DOI - PMC - PubMed

LinkOut - more resources