COVID-19 Stress Could Increase Mental-Health Risks for Kids, Teens

By Carolyn Crist

July 03, 2020

NEW YORK (Reuters Health) - The COVID-19 pandemic will continue to affect vulnerable groups of children, especially those who are homeless, in foster care, struggle with substance-use disorders or identify as lesbian, gay, bisexual, transgender or queer (LGBTQ), according to a new paper by a social worker and a child-abuse researcher.

Stay-at-home orders, as well as family pressure and economic instability, could increase risks for anxiety, depression, suicidal thoughts and potential abuse, the two write in Pediatrics.

"My patients are resilient and strong, but I've been worrying about them. The safety nets that protect youth are gone or have changed, and those who are at risk don't have the same supports as before," said first author Dr. Rachel Silliman Cohen of Rowan University in Stratford, New Jersey.

Child protective services, mental-health professionals and teachers haven't been able to reach children and teens in the same way due to shelter-in-place restrictions, she added. Although telehealth options have helped, access is still limited.

"This is not a blip or one-time worry. This is a marathon that will affect youth for the long haul," she told Reuters Health by phone. "Academic disparities, unemployment and resource insecurity are ongoing challenges that won't disappear, even once the pandemic ends."

Dr. Silliman Cohen and her co-author Emily Adlin Bosk of Rutgers University, in New Brunswick, New Jersey, write about the challenges that children and teens are facing and the options that exist. For some adolescents, the say, home environments can be isolating and dangerous, particularly for those who may experience physical abuse, sexual abuse and neglect.

LGBTQ and gender-nonconforming youth face higher risks of physical and sexual abuse, the authors note. In addition, LGBTQ, runaway and homeless adolescents have a higher risk of depression, self-harming behaviors, suicidal ideation and suicide. The rates of attempted suicide can be two to 10 times higher than for other children.

With stay-at-home mandates, some of the supports that help youth were closed or reduced. Homeless and runaway children, for instance, are more likely to have poor physical health, substance-use disorders and sexually transmitted infections, and they may not be able to see doctors or mental-health professionals for help. They may also face a higher risk of contracting COVID-19 and may not be able to afford testing or treatment.

"Our job in society - with agencies, teachers and adults in general - is to support these kids and change our practices to help them," Dr. Silliman Cohen said. "Just because access has decreased doesn't meant that the vulnerabilities or risks have gone away."

Pediatric doctors, child-welfare agencies and advocacy groups have spoken up about the potential harms that vulnerable youth may experience during the pandemic, but more needs to be done, the authors write.

During telemedicine appointments, doctors should directly ask about abuse, household violence, mental health, food insecurity and economic issues, they suggest. Transgender youth already have limited access to medical care and medications and may need more assistance. Those with substance-use disorders may also need ongoing access to treatment, counseling and resources that help with relapse and withdrawal.

Homeless and foster care youth are also likely finding roadblocks to stable housing. Child protective services should forge partnerships with businesses or corporations to create special shelters, such as hotels or empty dorm rooms, during the pandemic, the authors write. Doctors, health departments and advocacy groups can recommend online support groups and mobile phone applications with helpful information as well.

"We know that young people have high unmet mental and healthcare needs, even before the pandemic. The inequities are magnified now," said Dr. Janna Gewirtz O'Brien of the University of Minnesota, in Minneapolis. Dr. Gewirtz O'Brien, who wasn't involved with this article, has written about mental health among homeless and runaway youth.

"Times are challenging for everyone right now, but it's also a time when pediatricians and others can be there to support these vulnerable groups and let them know we're here for them," she told Reuters Health by phone. "When families are struggling and there's more stress at home, we need to be there as a vital resource."

SOURCE: Pediatrics, online June 25, 2020.