Children’s Mental Health During COVID-19

Children thrive when they have stability, routine, and community. With COVID-19 creating a new normal and uncertainty for the future, it is an anxious time for everyone, particularly children, youth, and young adults. Before the pandemic, 1 in every 5 youth in the general population had a diagnosable mental health concern, including mood, anxiety, and behavioral disorders. Now, children and adolescents may face additional mental health stressors as families across the country cope with how to stay healthy, adjust to school closings and reopenings, and manage financial uncertainty in the weeks and months to come. We reached out to Westat’s behavioral health and health policy experts Abram Rosenblatt, Ph.D., Preethy George, Ph.D., and Chandria Jones, Ph.D., for insight on how this health crisis is affecting the mental health of children and youth.

Development Issues

Children experience health issues differently from adults. Most notably, childhood, adolescence, and young adulthood are characterized by rapid development, growth, and change. Children’s verbal and communication skills develop as they grow older, as does their capacity to make informed decisions. Executive functioning capacity is still evolving, so youth and teens exhibit more risk-taking behaviors. During the age of COVID-19, where we are concerned over even basic tasks like the safety of grocery shopping, there is increased concern over the “safe” behavior of youth.

Another issue is that before the pandemic, children were generally more likely to receive regular health care than adults. “Children tend to be seen by a doctor more often than adults,” explains Dr. Rosenblatt, a Westat Vice President. “In addition to routine care and vaccinations in their early years, they visit a pediatrician for their more common ailments like colds, earaches, strep throat, and the like.” As a result, pediatricians are in a frontline position to observe emotional issues and do screenings for mental health. “This is where symptoms of depression get caught,” notes Dr. George, a Senior Study Director. “Children may be experiencing physical issues that are psychosomatic in nature. Children pick up on the anxiety around them, which can translate into physical health issues,” she continues.

Finally, so much of children’s development is connected to peers and supports in the community, like schools and churches, adds Dr. George. In the time of closing of public places and sheltering in place, access to friends and even extended family may not be an option, and leads to increased anxiety.

Underserved Communities

Inequities in our social systems—health care, education, housing—have long been in place. The pandemic has put a laser focus on these issues as people from racial and ethnic minority groups are being more adversely impacted by COVID-19. According to the Centers for Disease Control and Prevention, hospitalization rates are highest among non-Hispanic American Indian or Alaska Native and non-Hispanic black persons, followed by Hispanic or Latino persons. Underserved communities have a history of distrust toward the medical community, and this is compounded by structural policies of racism in social systems.

“Even at baseline, people from these racial minority groups start at a lower level of health care and mental health care,” notes Dr. Jones, a Senior Study Director. While other communities can turn to telehealth options, access is a significant issue here. Internet access may be limited or nonexistent, and families may not have the technology that is needed.

In addition to the anxiety of dealing with COVID-19, recent issues of racial violence have garnered national and international media exposure. “This is a large confluence of trauma that can lead to significant anxiety and depression,” adds Dr. Jones. “One of COVID-19’s legacies may be how it shed light on how bad the health care situation is among communities of color.”

Strategies for Addressing Mental Health Challenges

Despite these significant challenges, our Westat experts point out that we have tools in place to handle the mental health issues that are exacerbated by the pandemic. “Over the past decades, there has been tremendous progress in handling mental health in children, adolescents, and young adults,” notes Dr. Rosenblatt. “We have seen improvement in care with the implementation of coordinated care across systems. These systems collaborate, working together in intervention and prevention.” This collaborative approach brings together experts with a variety of clinical experience—physical and mental health—to help children and adolescents as well as their families to weather the storm of trauma.

Addressing racial equity when providing service and evaluating service provision benefits youth in communities of color. Our experts note that using the systems of care approach has helped people in these communities. “Systems of care address issues of cultural diversity, and have focused intently on how to go about providing services that are youth-guided,” adds Dr. Jones.

COVID-19 has created a significant surge in telehealth use by providing remote health care services. Children and adolescents are much more comfortable with technology and communicating via screens. “Texting, chatting, and videos—children are used to communicating with these methods,” notes Dr. Rosenblatt. “COVID’s forced change to using telehealth has the potential to improve access for all communities as long as the infrastructure is there,” adds Dr. Jones.

Maintaining the gains that have been made in addressing the mental health needs of children, youth, and adolescents will be a continuing challenge exacerbated by the restrictions of COVID-19 life. Our awareness of the pitfalls and potential to capitalize on new findings can help us safeguard our health and that of our children.

We have seen improvement in care with the implementation of coordinated care across systems. These systems collaborate, working together in intervention and prevention.


- Abram Rosenblatt, Ph.D., Vice President, Behavioral Health & Health Policy

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