It has been nearly two years since the coronavirus disease was declared a pandemic. Social distancing measures have led to school closures in many countries around the world, and repeated follow-up measures have led to a large degree of inconsistency in the delivery of education for many children.
In the Americas alone, schools remained closed for more than 41 weeks. One year into the pandemic, nearly 50% of students worldwide were still facing partial or complete closures of school. Although many students were able to navigate these circumstances with and even saw an improvement in their mental health status, a significant number were unable to do so.
The mental health effects of the pandemic and subsequent disease mitigation effects are well documented in adult populations. However, relatively fewer studies are available that assess the mental health impact of the pandemic in pediatric populations.
Youth spend a significant portion of their time in school, and alongside educational benefits, students also receive the opportunity for social interaction. For youth with pre-existing mental health problems, schools and the routines that come with it are protective and serve as coping mechanisms. This is not something that is well replicated in the virtual education environment, leading youth to miss out on important and enriching social experiences. Although the closure of schools has served well in protecting children from COVID-19 infection, the effects on mental health require further consideration.
The pandemic and related shutdowns present as multiple risk factors for children, placing them at a cumulative risk for mental illness. Pandemic-induced domestic problems for parents, parental job loss, food insecurity, and lack of interpersonal communication are just a few examples of factors that may contribute to allostatic load in youth. Allostatic load, or the cumulative effects of chronic stress, is a known risk factor for poor physical and mental health outcomes later in life, meaning that some of the effects of the pandemic may remain hidden for some time.
Some youth may also experience sleeper effects from the pandemic, where the effects of the pandemic are not seen immediately. Instead, they manifest following some level of appropriate neurobiological development or changes in social environment. Youth who were facing adversity prior to the pandemic may be sensitized to instances of future stressors, like the pandemic. This places youth from lower socioeconomic families, youth with pre-existing health problems, disadvantaged youth, or youth who faced early life trauma at higher risk.
Similarly, youth who faced little adversity prior to the pandemic may also experience sensitizing effects. For this subgroup of individuals, the pandemic may lower their threshold for stress and therefore cause psychopathology later in life. Youth may also be mechanistically exposed to distal stressors through proximal familial responses, where the parent-child relationship may see changes due to stressors affecting the parent.
These effects are of high concern given the repeated exposures to extended isolation measures and stressful events due to disease mitigation efforts. Youth may experience the effects of the pandemic at different timepoints depending on their developmental stage or changes in social environment. Furthermore, alterations in stress responsivity may modify how youth respond to challenges in the future. This includes their ability to reintegrate into the in-person learning environment, their ability to cope with any future instances of confinement at home, and any other stressors they may face.
As such, youth require continued support throughout the reintegration process, and youth that may be at additional risk of adverse effects during and after the pandemic require additional monitoring. Policies should appropriately consider the possible effects on mental health outcomes.
To date, nearly all of the studies looking at mental health effects of the pandemic in youth have been cross-sectional. Longitudinal modeling of the pandemic’s effect on youth is necessary to inform future decisions surrounding mental health supports, and also to determine the acute and sustained effects of the pandemic and its associated lockdowns.
With the increasing economic and social burden of mental health disorders, this should not be overlooked during changes to the education structure.
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Cite this: Hartej Gill. School’s Out: Mental Health and Virtual Learning - Medscape - Feb 08, 2022.