The COVID-19 pandemic brought significant disruptions to the daily lives of children and families worldwide, leading to a range of mental health challenges among the youth. However, a recent study from the Environmental influences on Child Health Outcomes (ECHO) Program at the National Institutes of Health offers a more complex perspective, indicating that not all children experienced negative mental health effects during this time. In fact, some groups of children and adolescents saw improvements in their mental health.
The research, led by Dr. Courtney K. Blackwell of Northwestern University’s Feinberg School of Medicine and Dr. Kaja LeWinn of the University of California, San Francisco, suggests that while the pandemic’s overall impact on child mental health was minimal, with slight decreases in anxiety, depression, and externalizing behaviors, the average outcomes do not fully capture the varied experiences of different groups.
Published in JAMA Network Open, the study highlights that children with pre-existing mental health challenges, such as Attention Deficit Hyperactivity Disorder (ADHD) and externalizing behaviors like aggression and rule-breaking, showed notable improvements during the pandemic. This unexpected outcome suggests that the break from school-related stressors may have been beneficial for these children.
“Our research demonstrates that the pandemic’s effects on children were not uniform,” said Dr. Blackwell. “The variations in mental health outcomes were closely linked to individual characteristics, meaning that broad averages might obscure important differences.”
Key Findings
The study, which included 1,229 youth aged 6 to 17 years from nine ECHO Cohort study sites across the U.S., revealed that sociodemographic factors such as income, race, age, and gender played roles in shaping the mental health outcomes during the pandemic:
Black children exhibited small decreases in internal distress, depression, and ADHD symptoms compared to their white peers.
Children from lower-income families(below 130% of the Federal Poverty Level) experienced declines in depression and ADHD symptoms, while those from higher-income families (350% of the Federal Poverty Line and above) showed slight increases in internalizing symptoms.
Girls showed a slight uptick in externalizing behaviors, such as acting out, in contrast to boys.
Older children(aged 12 and above) reported an increase in internal distress and depressive symptoms, whereas younger children’s internalizing symptoms remained stable.
Dr. LeWinn pointed out the unexpected improvements among children who were initially considered at greater risk due to significant pre-pandemic behavioral issues. “It may be that the reduction in school-related pressures provided these children with a respite that positively impacted their mental health,” she said.
Study Methodology and Future Directions
The ECHO study stands out by focusing on a diverse U.S. youth population, differing from previous research that often centered on non-U.S. samples or adolescents alone. Participants were socioeconomically diverse, with a significant representation of racial and ethnic minorities, and researchers used the Child Behavior Checklist, a parent-reported measure of youth behavior and mental health, to assess changes from before the pandemic (January 1, 2015, to March 12, 2020) through the pandemic (March 13, 2020, to August 31, 2022).
Dr. Blackwell emphasized the importance of identifying individual characteristics associated with either improvements or declines in mental health to better tailor interventions to those most at risk. She also highlighted the potential to discover resiliency factors that could help protect youth mental health during crises.
Looking forward, Dr. LeWinn suggested that future studies could explore the impact of school closures on mental health, particularly among marginalized or vulnerable youth. She acknowledged that any observed mental health improvements must be weighed against the significant negative impacts of the pandemic on educational outcomes. “However,” she noted, “by examining long-term data that includes school disruptions, we can gain valuable insights into the role schools play in children’s mental health.”
This nuanced understanding of youth mental health during the pandemic underscores the need for targeted interventions and continued research to support the well-being of children and adolescents, especially during times of societal upheaval.