US Surgeon General Vivek H. Murthy issued a public health advisory on Tuesday, December 6, 2021 in order to provide recommendations for how to address the mental health challenges confronting children, adolescents, and young adults, which have been exacerbated by the COVID pandemic. The advisory, issued by the Office of the Surgeon General, speaks about actions that various groups, such as, family members, community organizations, technology companies, and young people themselves can do to ease the burden of this mental health crisis. What steps health care professionals and health professionals can take is also addressed.

Even before the COVID-19 pandemic, mental health challenges were the leading cause of disability and poor life outcomes in young people, with up to 1 in 5 children ages 3 to 17 in the US with a reported mental, emotional, developmental, or behavioral disorder.1 In addition, in 2016, of the 7.7 million children with treatable mental health disorder, about half did not receive adequate treatment.2

In recent years, certain mental health symptoms, such as depression and suicidal ideation, have substantially increased. From 2009 to 2019, the proportion of high school students reporting persistent feelings of sadness or hopelessness increased by 40%; the share seriously considering attempting suicide increased by 36%; and the share creating a suicide plan increased by 44%.3


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Between 2011 and 2015, youth psychiatric visits to emergency departments for depression, anxiety, and behavioral challenges increased by 28%.20 Between 2007 and 2018, suicide rates among youth ages 10-24 in the US increased by 57%.4 Early estimates from the National Center for Health Statistics suggest there were tragically more than 6,600 deaths by suicide among the 10-24 age group in 2020.5

The prevalence of mental health issues is strikingly visible in subpopulations. For instance, girls are much more likely to be diagnosed with anxiety, depression, or an eating disorder, while boys are more likely to die by suicide or be diagnosed with a behavior disorder, such as attention deficit hyperactivity disorder (ADHD).6,7,8 In recent years, suicide rates among Black children (below age 13) have been increasing rapidly, with Black children nearly twice as likely to die by suicide than White children.9 Moreover, socioeconomically disadvantaged children and adolescents — for instance, those growing up in poverty — are 2 to 3 times more likely to develop mental health conditions than peers with higher socioeconomic status.10

During the pandemic, young people also experienced other challenges that may have affected their mental and emotional wellbeing: the national reckoning over the deaths of Black Americans at the hands of police officers, including the murder of George Floyd; COVID-related violence against Asian Americans; gun violence; an increasingly polarized political dialogue; growing concerns about climate change; and emotionally-charged misinformation.11,12,13,14,15

Although the pandemic’s long-term impact on children and young people is not fully understood, there are reasons to be optimistic. According to more than 50 years of research, increases in distress symptoms are common during disasters, but most people cope well and do not go on to develop mental health disorders.16 Several measures of distress that increased early in the pandemic appear to have returned to pre-pandemic levels by mid-2020.17,18

Some other measures of wellbeing, such as rates of life satisfaction and loneliness, remained largely unchanged throughout the first year of the pandemic.17, 19 And while data on youth suicide rates are limited, early evidence does not show significant increases.20,21

In all of this, there are reasons for positivity as some young people managed to thrive during the pandemic: They got more sleep, spent more quality time with family, experienced less academic stress and bullying, had more flexible schedules, and improved their coping skills.22,23,24,25 Many young people are resilient, able to bounce back from difficult experiences such as stress, adversity, and trauma.26

Actions proposed that health professionals and health care organizations can do include:

·       Recognize that the best treatment is prevention of mental health challenges. Implement trauma-informed care (TIC) principles and other prevention strategies to improve care for all youth, especially those with a history of adversity.27

·       Routinely screen children for mental health challenges and risk factors, including adverse childhood experiences (ACEs).28

·       Identify and address the mental health needs of parents, caregivers, and other family members.29

·       Combine the efforts of clinical staff with those of trusted community partners and child-serving systems (eg, child welfare, juvenile justice).

·       Build multidisciplinary teams to implement services that are tailored to the needs of children and their families.

This public health advisory also lists resources for health care organizations and health professionals.

References

Protecting Youth Mental Health: The U.S. Surgeon General’s Advisory. Office of the Surgeon General. Published online December 6, 2021.

1.  Perou R, Bitsko RH, Blumberg SJ, et al. (2013). Mental health surveillance among children — United States, 2005-2011. MMWR. Morbidity and Mortality Weekly Report Supplements. 62(2), 1–35.

2.  Whitney DG, Peterson M. US national and state-level prevalence of mental health disorders and disparities of mental health care use in children. JAMA Pediatri. 173(4), 389-391. doi:10.1001/jamapediatrics.2018.5399

3.  Youth Risk Behavior Surveillance Data Summary & Trends Report: 2009-2019. Centers for Disease Control and Prevention. Page last reviewed: February 8, 2021

4.  Curtin, SC. State suicide rates among adolescents and young adults aged 10–24: United States, 2000–2018. National Vital Statistics Reports, vol 69 no 11. Hyattsville, MD: National Center for Health Statistics.

5.  Curtin SC, Hedegaard H, Ahmad FB. Provisional numbers and rates of suicide by month and demographic characteristics: United States, 2020. April 9, 2021. Vital Statistics Rapid Release; no 16. Hyattsville, MD: National Center for Health Statistics.

6.  McLean CP Asnaani A, Litz BT, Hofmann SG. Gender differences in anxiety disorders: prevalence, course of illness, comorbidity and burden of illness. J Psychiatr Res. 45(8), 1027–1035. doi:10.1016/j.jpsychires.2011.03.006

7.  Salk RH, Hyde JS, Abramson LY. Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms. Psychol Bull. 143(8), 783–822. https://doi.org/10.1037/bul0000102

8.  Hedegaard H, Curtin SC, Warner M. Increase in suicide mortality in the United States, 1999–2018. NCHS Data Brief, (362), 1-8. Hyattsville, MD: National Center for Health Statistics.

9.  Bridge JA, Horowitz LM, Fontanella CA, et al. Age-Related Racial Disparity in Suicide Rates Among US Youths From 2001 Through 2015. JAMA Pediatr, 172(7):697–699. doi:10.1001/jamapediatrics.2018.0399

10.  Reiss F. Socioeconomic inequalities and mental health problems in children and adolescents: a systematic review. Soc Sci Med. 90, 24–31. doi:10.1016/j.socscimed.2013.04.026

11.  Ssentongo P, Fronterre C, Ssentongo AE. Gun violence incidence during the COVID-19 pandemic is higher than before the pandemic in the United States. Sci Rep. 11(1), 20654. doi:10.1038/s41598-021-98813-z

12.  Confronting Health Misinformation: The U.S. Surgeon General’s Advisory on Building a Healthy Information Environment. Office of the Surgeon General (OSG). 2021. US Department of Health and Human Services.

13.  Managing the COVID-19 infodemic: Promoting healthy behaviours and mitigating the harm from misinformation and disinformation. WHO, UN, UNICEF, UNDP, UNESCO, UNAIDS, ITU, UN Global Pulse, & IFRC. September 23, 2020.

14.  Johnston WM, Davey GC. The psychological impact of negative TV news bulletins: the catastrophizing of personal worries. Br J Psychol. 88 (Pt 1), 85-91. doi:10.1111/j.2044-8295.1997.tb02622.x

15.  Duan L, Shao X, Wang Huang, Y, Miao J, Yang Zhu, G. An investigation of mental health status of children and adolescents in China during the outbreak of COVID-19. J Affect Disord. 275, 112–118. doi:10.1016/j.jad.2020.06.029

16.  Goldmann E, Galea, S. Mental health consequences of disasters. Annual Review of Public Health. 35, 169–183. doi:10.1146/annurevpublhealth-032013-182435

17.  Aknin LB, De Neve JE, Dunn EW. Mental health during the first year of the COVID-19 pandemic: A review and recommendations for moving forward. Website: PsyArXiv Preprints. February 19, 2021. doi:10.31234/osf.io/zw93g

18.  Brülhart, M, Klotzbücher V, Lalive R, Reich, SK. Mental health concerns during the COVID-19 pandemic as revealed by helpline calls. Nature, 10.1038/s41586-021- 04099-6. doi:10.1038/ s41586-021-04099-6

19.  Luchetti M, Lee JH, Aschwanden D. The trajectory of loneliness in response to COVID-19. Am Psychol. 75(7), 897–908. doi:10.1037/amp0000690

20.  Appleby L, Richards N, Ibrahim S, Turnbull P, Rodway C, Kapur N. Suicide in England in the COVID-19 pandemic: Early observational data from real time surveillance. The Lancet Regional Health. Europe, 4, 100110. doi:10.1016/j.lanepe.2021.100110 57

21.  Ahmad FB, Cisewski JA. Quarterly provisional estimates for selected indicators of mortality, 2019-Quarter 1, 2021. National Center for Health Statistics. National Vital Statistics System, Vital Statistics Rapid Release Program. Page last reviewed: October 6, 2021

22.  Sharma M, Idele P, Manzini A, et al. Life in Lockdown: Child and adolescent mental health and well-being in the time of COVID-19, UNICEF Office of Research – Innocenti, Florence; pages 43-46

23.  Roy A, Breaux R, Sciberras E, et al. A Preliminary Examination of Key Strategies, Challenges, and Benefits of Remote Learning Expressed by Parents During the COVID-19 Pandemic. Website: PsyARXiv Preprints. doi:10.31234/osf.io/5ca4v

24.  Wright Jr KP, Linton SK, Withrow D. Sleep in university students prior to and during COVID-19 Stay-at-Home orders. Curr. 30(14), R797–R798. doi:10.1016/j.cub.2020.06.022

25.  Vaillancourt T, Brittain H, Krygsman A, et al. School bullying before and during COVID-19: Results from a population-based randomized design. Aggress Behav. 47, 557– 569.doi:10.1002/ab.21986

26.  Osgood K, Sheldon-Dean H, Kimball H. 2021 Children’s Mental Health Report: What we know about the COVID-19 pandemic’s impact on children’s mental health –– and what we don’t know. Child Mind Institute.

27.  Bhushan D, Kotz K, McCall J, et al. Office of the California Surgeon General. (2020). Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health. Office of the California Surgeon General. doi:10.48019/PEAM8812

28.  Watson P. How to screen for ACEs in an efficient, sensitive, and effective manner. Paediatr Child Health. 24(1), 37–38. doi:10.1093/pch/pxy146

29.  Interim Guidance on Supporting the Emotional and Behavioral Health Needs of Children, Adolescents, and Families During the COVID-19 Pandemic. American Academy of Pediatrics. July 28, 2021. 

This article originally appeared on Psychiatry Advisor