The coronavirus disease 2019 (COVID-19) pandemic—and the social distancing measures
that many countries have implemented—have caused disruptions to daily routines. As
of April 8, 2020, schools have been suspended nationwide in 188 countries, according
to UNESCO. Over 90% of enrolled learners (1·5 million young people) worldwide are
now out of education. The UNESCO Director-General Audrey Azoulay warned that “the
global scale and speed of the current educational disruption is unparalleled”.
For children and adolescents with mental health needs, such closures mean a lack of
access to the resources they usually have through schools. In a survey by the mental
health charity YoungMinds, which included 2111 participants up to age 25 years with
a mental illness history in the UK, 83% said the pandemic had made their conditions
worse. 26% said they were unable to access mental health support; peer support groups
and face-to-face services have been cancelled, and support by phone or online can
be challenging for some young people.
School routines are important coping mechanisms for young people with mental health
issues. When schools are closed, they lose an anchor in life and their symptoms could
relapse. “Going to school had been a struggle for [some children with depression]
prior to the pandemic, but at least they had school routines to stick with”, said
Zanonia Chiu, a registered clinical psychologist working with children and adolescents
in Hong Kong, where schools have been closed since Feb 3. “Now that schools are closed,
some lock themselves up inside their rooms for weeks, refusing to take showers, eat,
or leave their beds.” For some children with depression, there will be considerable
difficulties adjusting back to normal life when school resumes.
Children with special education needs, such as those with autism spectrum disorder,
are also at risk. They can become frustrated and short-tempered when their daily routines
are disrupted, said psychiatrist Chi-Hung Au (University of Hong Kong, Hong Kong,
China). He advised parents to create a schedule for their children to reduce anxiety
induced by uncertainty. With speech therapy sessions and social skills groups suspended,
he cautions that stopping therapy can stall progress, and children with special needs
might miss their chance to develop essential skills. He points out that creative ways,
such as online speech and social skills training, are needed to make up for the loss.
Many countries are postponing or cancelling university entrance exams. In Hong Kong,
the authorities made a last-minute decision on March 21 to push back the Diploma of
Secondary Education (DSE) exams, which were scheduled to start on March 27, by a month
to April 24. According to a poll by the student counselling group Hok Yau Club in
March, 2020, over 20% of the 757 candidates surveyed said their stress levels were
at a maximum 10 out of 10, even before the postponement was announced. 17-year-old
DSE candidate Yoyo Fung has been experiencing loss of appetite and sleep problems,
and said she found the uncertainties of whether the exams could be delayed further
stressful. “I have a huge wave of fear that I might contract the virus and thus cannot
make it to the exams. Staying healthy has become another stressor”, she said.
Meanwhile, college and university students are stressed about dormitory evacuation
and cancellation of anticipated events such as exchange studies and graduation ceremonies.
Some lost their part-time jobs as local businesses closed. Students in their final
years are anxious about the job market they are going to enter soon. “College students
[…] are more vulnerable than we think, especially with the current academic and financial
burden”, said Chiu.
Social distancing measures can result in social isolation in an abusive home, with
abuse likely exacerbated during this time of economic uncertainty and stress. Jianli
County in Hubei province, China, has seen reports of domestic violence to the police
more than triple during the lockdown in February, from 47 last year to 162 this year.
Increased rates of child abuse, neglect, and exploitation have also been reported
during previous public health emergencies, such as the Ebola outbreak in west Africa
from 2014 to 2016.
However, not much is known about the long-term mental health effects of large-scale
disease outbreaks on children and adolescents. While there is some research on the
psychological impact of severe acute respiratory syndrome (SARS) on patients and health-care
workers, not much is known about the effects on ordinary citizens. Evidence is especially
scarce in children and adolescents. “This is an important gap for research”, Au said.
COVID-19 is much more widespread than SARS and other epidemics on a global scale.
As the pandemic continues, it is important to support children and adolescents facing
bereavement and issues related to parental unemployment or loss of household income.
There is also a need to monitor young people's mental health status over the long
term, and to study how prolonged school closures, strict social distancing measures,
and the pandemic itself affect the wellbeing of children and adolescents.
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2020
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