Author of the article: Blair McBride
Worsening mental health indicators in Alberta children and youth are spurring some doctors to declare a crisis in the fourth wave of the pandemic.
Diagnoses and severity of depression, anxiety and eating disorders have increased by at least 20 percent in the last four months, say doctors, some of whom worry the worst is yet to come.
Although COVID-19 restrictions are looser now than one year ago, mental health issues are being driven by a combination of return-to-school stress, less socializing, excessive screen time and general worry over the pandemic.
More fearful
Dr. Caroline Buzanko, who works with youth aged five to 22 at her Koru Family Psychology clinic in Calgary, said 80 per cent of her clients are currently reporting anxiety, up from 40 per cent in April.
“Depressive symptoms are secondary after anxiety, more in older kids,” she said. “There’s been a 20 per cent increase since the summer.”
In her interactions with patients, she finds youth are more fearful in many situations. She described a recent experience where a patient went to Disney World for her 18th birthday.
“She was mortified that someone would get sick before they went. (Youth) are on edge all the time worrying about what will happen,” she said.
In Calgary, psychiatrist Dr. Chris Wilkes has found a 200 per cent increase in emergency room visits for youth under 18 for anxiety, depression and eating disorders in the last eight months.
“We’ll probably see a worsening or high level of (demand for) mental health services for some time to come,” Wilkes said. “We have a crisis in terms of a demand on our services that is outstripping our resources.”
Dr. Rena LaFrance, a psychiatrist at Misericordia Community Hospital in Edmonton, said the severity of mental health issues she is seeing in patients aged four to 18 has doubled or tripled in the last few months.
The most common issues she’s seeing are anxiety, depression, obsessive-compulsive disorder, acute stress, ADHD and bereavement among children who lost family members to COVID-19.
“That doesn’t get better when kids go online and back (to in-person learning),” she said.
LaFrance attributes the problem to children absorbing the fourth wave anxieties of their parents, more deaths in the news, and uncertainty about kids getting COVID.
For children under 11, who can’t yet be vaccinated, LaFrance said the uncertainty of not feeling fully protected is also contributing to anxiety.
“There’s been fear about bringing it home to their parents and grandparents,” she said.
“They might not be thrilled at getting an actual needle (but) my perception is they are thrilled about protecting their friends and family and themselves.”
Normalcy still a ways off
For Calgary pediatrician Dr. April Elliott, the remaining restrictions in place show youth that normalcy is still a ways off, because kids are missing out on regular social interactions due to masking and distancing.
“Right now they’re being told they can’t do so many things,” she said. “And they’ve also been in an era when screen use is necessary. And it’s hard to withdraw from (screens) when they’re socially necessary.”
On a national level, youth mental health was under-addressed by governments even before the pandemic, according to researchers in the recent FACETS journal article “The impact of COVID-19 on the mental health of Canadian children and youth.”
The authors urged that a school-based national strategy on mental health be developed, as COVID “put a spotlight” on the problem.
They called for new federal funding to be allocated to schools over the next two years to deal with the “growing mental health crisis” among youth. They also want investment in a population-based follow-up of the 2019 Canadian Health Survey on Children and Youth so accurate information can be obtained about how the pandemic has affected young people.
In Edmonton, local family physician Dr. Doug Klein concurs with the need for more collaboration in schools, as he believes most youth who need help aren’t seeking it, fuelling a crisis that could get worse before it gets better.
“The health-care system and education system and the community need to work together. Children are in our schools for several hours everyday. We need to focus on making sure they’re gaining those life skills that will be protective (of mental health),” he said.
To help youth manage their mental health, Klein suggested that more needs to be done to encourage them to be active, as restrictions have led to an increase of inactivity, and getting more exercise can alleviate anxiety and depression. And LaFrance said giving kids the opportunity to talk about their COVID fears, while also working to maintain a regular home routine, can help them feel more stable amid the pandemic.
How does the prolonged COVID-19 pandemic affect mental health?
Social isolation exacerbated in the long term by the pandemic
Family and friends who have become social recluses, or co-workers who feel depressed and are unable to come to work...most of us probably know someone in one of these situations. The prolonged stress of the COVID-19 pandemic has had several effects on mental health because people are continuously being stressed by changes in their environments, such as restrictions on activities, school closures, and remote work, or no work. Some people have become depressed due to anxiety about infection and many have experienced exhaustion. Others are isolated from society and have gradually become dependent on the Internet to relieve their loneliness. Worse yet, suicides in Japan have increased since before the pandemic, and this increase is related to mental health problems. Thus, the effect of the pandemic on mental health is a complex combination of problems that change over time. However, most research to date has focused on individual symptoms at single points in time, and there is no comprehensive understanding of the pandemic’s impact on mental health. To develop such understanding, we conducted a series of surveys and examinations about various mental states.
The team examined the impact of the COVID-19 pandemic on psychiatric symptoms by using questionnaires that fortuitously were distributed over the Internet in December 2019, just before the pandemic, and then again in August 2020, December 2020, and April 2021, during the pandemic. Using data-driven statistical methods, changes in psychiatric symptoms during the pandemic were categorized into the following four components: 1) "general psychiatric burden," which is the interplay of all psychiatric symptoms; 2) "social isolation," associated with internet dependence and social anxiety; 3) "alcohol-related problems"; and 4) "depression/anxiety.” "General psychiatric burden," "social isolation," and "depression/anxiety” worsened during the pandemic. But while "general psychiatric burden'' and “depression/anxiety” peaked soon after the beginning of the pandemic, "social isolation” continued to worsen progressively through the pandemic.
Next, the team sought to identify factors that most aggravated the risks within each component. All components were more likely to worsen in women than in men. This highlights an urgent need to reduce the physical and mental burden that falls on women during the pandemic. The "general psychiatric burden" and “depression/anxiety” that peaked in the early stages of the pandemic, were greatly affected by the decrease in income during the pandemic. On the other hand, "social isolation,” which has continued to deteriorate gradually, was less likely to do so among those who changed the amount that they communicated with others and those who were self-employed. The importance of job type in "social isolation” suggests the influence of the work environment, human relations, types of work, and the ways that people connect with their colleagues.
How can society address these mental problems? Whereas economic policies were important in the early stage of the pandemic, policies, programs, and public education to maintain connections between people and throughout society may be more important from this point forward. It will certainly be necessary to continue to monitor the impact of the COVID-19 pandemic on public mental health.
“As the COVID-19 pandemic prolonged, social anxiety and internet addiction issues emerged,” notes Dr. Shuken Boku, a co-author on the paper and Associate Professor at Kumamoto University in Japan. “Social anxiety and internet addiction cause social isolation, and social isolation contributes to social anxiety and Internet addiction. This vicious cycle needs to be addressed as soon as possible before the problem becomes more serious. It is important to maintain social connections by increasing opportunities to see each other and have face-to-face contact, even online. This is especially true for those who are isolated from the society during the COVID-19 pandemic.”
JOURNAL
Translational Psychiatry
METHOD OF RESEARCH
Data/statistical analysis
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Multiple time measurements of multidimensional psychiatric states from immediately before the COVID-19 pandemic to one year later: a longitudinal online survey of the Japanese population
ARTICLE PUBLICATION DATE
10-Nov-2021
COI STATEMENT
N.K, T.H., and M.H. are employees of KDDI Research Inc. Y.M. is an employee of KDDI Corporation. N.K., Y.M., T.H., and M.H. were involved in the study design, data acquisition, statistical analysis, and interpretation of the results. For the remaining authors none were declared conflicts of interest.
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