Mental health of adolescents in the U.S. is of significant concern. A national survey of youth ages 8–15 years old found that 13% of youth experienced a mental health disorder, including anxiety disorders and depression . Frequently, mental health disorders persist into adulthood if left untreated, therefore, early detection is critical . Mental health symptoms may be increasing; numerous studies have reported an increased need for mental health services for youth, including a 50% increase in inpatient mental health admissions between 2006 and 2011 [1, 28, 36]. Demographic factors, such as gender, socioeconomic status (SES), and race/ethnicity are associated with depression and anxiety symptoms. In adolescence, girls tend to have higher rates of depression than boys . Lower SES is related to higher rates of anxiety and depression symptoms in children and adolescents .
The coronavirus disease 2019 (COVID-19) pandemic may have further impacted mental health of youth. In spring of 2020, isolation guidelines were imposed in the U.S. to mitigate the spread of the emerging COVID-19, including closure of non-essential businesses, closure of schools and universities, and limitations on private and public gatherings . These restrictions impacted typical activities of adolescents, including how they attended school and work, participation in and access to sports and other extracurricular activities, and interactions with peers. While these isolation policies were imposed to combat the spread of the virus, they may have caused unintended impacts on mental health.
Emerging evidence from international studies suggest depression and anxiety symptoms in adolescents during the early COVID-19 pandemic were high. Additionally, research investigating specific risk factors for adolescents during the pandemic suggest that race/ethnicity and gender identity may impact risk for mental health problems [13, 19, 32]. In a sample of adolescents and young adults (age 14–35 years) in China, 40% reported psychological distress (anxiety and depression symptoms) and 14% reported PTSD symptoms via online survey two weeks after the World Health Organization declared COVID-19 a public health emergency . In another online survey, 45% of a college student sample in China reported psychological distress, defined as a score above 19 on the Kessler Psychological Distress Scale which measures anxiety and depression symptoms, during the initial COVID-19 outbreak (January 2020) . Several online surveys of children and adolescents in China examined factors associated with anxiety and depression during the pandemic. Female gender, adolescent age (compared to child age), residing in an urban area, emotion-focused coping, and low social support correlated with higher anxiety symptoms [6, 30]. Low social support and smartphone and internet addiction were associated with higher depression symptoms [6, 30]. In contrast, an online survey of children and adolescents (grades 1–12) conducted in March of 2020 found that parent-child discussions about COVID-19 correlated with higher life satisfaction and lower depression and anxiety symptoms .
In a sample of 16–25 year old individuals living in Germany and using a digital mental health application, 38% met criteria for psychological distress (anxiety and depression symptoms) on the Kessler Psychological Distress Scale during May 2020 . McElroy et al. 20 created a Pandemic Anxiety Scale (PAS) to capture anxiety unique to the pandemic, utilized in a sample of UK children and adolescents (age 4–16 years). In this sample, lower household income, female gender, and having a chronic physical health problem were associated with higher pandemic anxiety as measured by the PAS. In a sample of Canadian adolescents who completed an online survey in April of 2020, adolescents reported high concern of the pandemic and high pandemic-related stress. Additionally, higher hours spent connecting with friends virtually correlated with higher depressive symptoms, while physical activity correlated with lower depression. Further, female gender was a predictor of depressive symptoms .
Two longitudinal studies examined anxiety and depression in adolescents prior to and during the COVID-19 pandemic. Magson et al. conducted a study which surveyed 248 adolescents living in an urban area of Australia at two timepoints: 12 months prior to the pandemic (T1), and two months following initial pandemic lockdown (T2). Adolescents reported higher depressive symptoms and anxiety at T2 compared to T1, as measured on the Short Mood and Feelings Questionnaire- Child Version and Generalized Anxiety subscale of the Spence Children’s Anxiety Scale, respectively. Female gender, worries about COVID-19, and difficulties with online learning predicted increases in anxiety and depressive symptoms from T1 to T2 . In a sample of 322 U.S adolescents surveyed January of 2020 (prior to the pandemic in the U.S.) and at 3 timepoints after the implementation of COVID-19 isolation orders (mid-April 2020, early May 2020, and late May 2020), internalizing problems decreased from prior to the pandemic to the first follow-up, particularly for youth who reported high levels of internalizing problems prior to the pandemic . No studies, to our knowledge, have examined anxiety and depression in adolescents during the COVID-19 pandemic longitudinally across a longer time period.
A significant limitation to existing studies conducted during the pandemic is that many adolescent studies also included either young adults up to age 35 years or younger children [18, 32, 34]. Adolescents may have different experiences than young adults, and research on exclusively adolescent samples is necessary to understand their unique pandemic experiences. Many published studies are based in China and Europe, however, there may be cultural differences in both mental health and pandemic-related anxieties, therefore, U.S.-based studies are important to inform clinicians in the U.S. Further, at the time of the implementation of our study, research focused primarily on the initial wave of the pandemic and did not investigate mental health over time. This is critical given the ongoing status of the COVID-19 pandemic and continued after effects; mental health status may shift over the course of the pandemic and aftermath.
The goal of the present study was to describe anxiety and depression symptoms in U.S. high school students during the early COVID-19 pandemic and evaluate potential demographic predictors (race, ethnicity, gender, and community distress score (a surrogate measure of SES)). Further, we aimed to investigate longitudinal changes in mental health between the beginning of the pandemic and a 6-month follow-up. We hypothesized that racially and ethnically minoritized individuals, those living in areas with higher community distress, and females would have elevated symptoms of anxiety and depression compared to other groups. Given prior research showing that, if left untreated, anxiety and depression worsen over time, we also hypothesized that over the course of 6 months of the pandemic depression and anxiety symptoms would increase, and that disparities by gender, race, and community distress may be exacerbated [9, 16, 22].