Concerns about the mental health and wellbeing of adolescents were growing even before Covid-19 and the recession. Vulnerabilities may be heightened as a consequence of the pandemic, lockdown and widespread uncertainty about the future.
Against the backdrop of growing concerns about adolescent mental health, Covid-19 and policy responses to contain its spread are likely to create challenges for mental health and wellbeing through a number of channels. These include added stresses, magnification of existing conditions, and disruptions of contact with social ties and daily life.
Much is still unknown about how the pandemic and the recession will affect adolescent mental health, but we do have a developing evidence base that can highlight important factors for our attention, and indicate what is important for us to learn more about. In addition, mental health is a multi-faceted issue that touches a wide array of factors and outcomes. Endeavours to understand it and the role of the pandemic will require an open and multi-disciplinary approach.
What does research in economics and other disciplines tell us?
Depressive symptoms on average rise considerably during adolescence and do not level off until young adulthood (Caspi et al, 2020; Kiessling and Norris, 2020). The onset of depressive episodes during adolescence is linked to greater risks of depression later in life (Momen et al, 2020; Thapar et al, 2012).
Poor environments in early life are linked with an increased risk of mental distress later in life (Adhvaryu et al, 2019; Persson and Rossin-Slater, 2018); and increases in household income are linked with short-term reductions in psychological distress among adolescent girls (Baird et al, 2013). Evidence extensively documented outside economics shows that adverse experiences are related to the onset of depression in adolescence, especially among girls and those who experience multiple stresses (Thapar et al, 2012).
Features of the school environment appear to have a role in depressive symptoms during adolescence, but this is still an early area of research in economics. Peers are likely to play a role, but the current evidence is mixed (Eisenber et al, 2013; Fowler and Christaki, 2008; Zhang, 2018). But exposure to negative signals about one’s ability appears to be strongly linked with an increase in depressive symptoms (Kiessling and Norris, 2020). Recent evidence also links increases in mental wellbeing among special needs students with increased school funding to support these students (Freriks and Mierau, 2019).
From beyond economics, we know that adolescence is a period of continued brain development that is associated with greater activity in reward and danger sensitive regions along with hormonal changes at puberty (Thapar et al, 2012; Ahmed et al, 2015). These changes may make adolescents more vulnerable to adverse events.
In the long run, poor mental health can translate into economic consequences by lowering educational attainment and hurting people’s labour market outcomes (Biasi et al, 2019; Cornaglia et al, 2015; Currie and Stabile, 2006; Ettner et al, 1997; Fletcher, 2010; Fletcher, 2014).
The long-run economics costs arising from mental health disorders are significant. Total costs have been estimated at up to 2.5% of GDP in the United States and 3.5% in Europe (OECD, 2015).
What might be effective policy responses?
Problems with mental health during adolescence are a growing concern, and the onset of depression during this period greatly increases the risk of repeated episodes later in life. Thus, how to support positive mental health outcomes during adolescence is crucial to young people’s capabilities right as they are on the cusp of furthering their education and entering the labour market.
In general, economic research points out that mental health problems can be costly for the economy or, going the other way, that the economy can affect mental health.
Policy options include:
- Raising resources for counselling in schools after lockdown is lifted. This may be important even for those at mild risk, as a way to help to shift the focus from negative information that may be harmful to schooling effort.
- Targeting interventions designed with input from multi-disciplinary partnerships to support the most vulnerable adolescents. Based on what we know, these would be focused on those likely to have experienced multiple adverse events through the pandemic.
- Using the upheaval as an opportunity to plan changes at the school level to improve mental health awareness and support. Given the increased prevalence of depression in adolescence, a strategy designed to train teachers in awareness of warning signs and actionable steps to follow in supporting those assessed as in danger sooner is one example that may help to reduce the onset of depression.
Related question: How can we protect young people from being scarred by coronavirus?
How reliable is the evidence?
Reports from the OECD and a large number of peer-reviewed studies indicate the significant consequences of mental health distress. It lowers educational attainment and hurts individuals in the labour market, which further suggests long-term risk from any links between the pandemic and mental health.
Where the pandemic creates adverse events for vulnerable adolescents, this places them at greater risk of depression and thus greater long-term risk of poor educational and labour market outcomes. The recent and growing body of research on the increased prevalence of mental distress in adolescence and underlying risk factors for it can then help to point to where vulnerabilities may be heightened as a consequence of the pandemic.
Evidence on the rise of depressive symptoms during adolescence has been suggested for some time from small sample studies and observations from neuroscience on brain development during adolescence. More recently, these patterns have been found in large-scale surveys that track a large group of individuals over time. This work with larger surveys is still new and room remains for replication, but a consistent picture is emerging: distress in mental health on average rises considerably during adolescence.
How childhood environments and conditions may relate to mental health problems has also received attention recently. High quality studies find:
- Causal links between maternal stress during pregnancy and the child’s use of medications for ADHD (attention deficit hyperactivity disorder) and later anxiety and depression in adulthood.
- Causal evidence that exposure to poor household income during childhood results in increased mental distress in adulthood. Boosts in family income during adolescence in a developing country have been linked with short-term boosts in mental health among girls.
- Exposure to adverse events, especially among girls and those likely to experience multiple stresses, is descriptively linked with a greater risk of depression.
Overall, the development of this evidence base is work in progress, but it is of high quality and suggests significant links between adverse childhood conditions and mental health outcomes in adolescence and adulthood.
School environments too may have a role. Peers are an obvious potential source of positive or negative influence on mental health. But the current evidence in economics is mixed for the effects from peer mental health, while in psychology it is more consistent for peer victimisation.
Research in progress suggests that adolescents’ rank within their school cohort is related to symptoms of depression and is driven by those who experience worse than expected rankings. This is consistent with a hypothesis of greater attention to negative feedback about ability than to positive signals that can be drawn from research on ‘attentional biases’ towards negative over positive information.
Finally, questions around how resources, class sizes, teacher quality and other features of school life affect mental health are open areas for further study, and we will benefit from employing experimental designs to uncover actual causal channels.
Overall, the evidence base currently suggests that features of the school environment can play a significant role in the development of mental health but still much more work is needed to enable policy that can mitigate harmful and boost helpful effects.
Related question: How will lockdown and the recession affect children’s health?
Related question: How can we make up the learning losses from lockdown?
What research is underway?
Impact of pandemic response upon public mental health and disparities: Alex Morton, Alex, Julie Cameron, Lee Knifton, Otto Lenhart, Ioanna Nixon, Neil Quinn and Susan Solomon are collecting survey data in Scotland with the purpose of understanding the consequences of pandemic-related lockdown measures for mental health and wellbeing along with what interventions can prevent negative consequences and for what groups.
Global study on health and wellbeing during the coronavirus pandemic: Ilka Gleibs, Neela Muehlemann and YingFei Héliot are looking across countries at how policy interventions and measures aimed to fight the pandemic have translated into impacts on individual health and wellbeing and how people respond.
Peers and mental health: Lukas Kiessling and Jonathan Norris are exploring how information shocks about ability can generate depressive states in an economic model and then drawing on quasi-experimental variation in the shape of cohort ability distributions to test how one’s ability rank in their cohort affects depressive symptoms.
What we need to know and where to look
Risk factors for depression in an already vulnerable population are important to identify for understanding how adverse events such as the pandemic and policy responses to it may affect depression in this population.
To put this information to work effectively at a policy level, we need to know how risk factors for depression in adolescence interact with variety of factors such as homes, schools, neighbourhoods and generally the environments where adolescents spend much of their time.
There are multiple areas that the current evidence base can highlight where more evidence is needed. These can partly be summarised by the following:
Identifying those most at-risk and effective interventions
- Exposure, directly or indirectly, to the effects of coronavirus is likely to create significant stress, which can be a factor in the onset of depression. This is especially concerning for adolescents, given their increased vulnerability to adverse events and doubly so for those already likely to have experienced adverse events. Thus, what are the effective treatments that can be administered during the pandemic and how can we identify and reach the vulnerable?
- Those already depressed, or at-risk of it, may be more likely to be attuned to negative outcomes over positive outcomes. This may risk greater depression and educational outcomes post-pandemic. Thus, how can we better target this mechanism in the schools?
Understanding the consequences of the pandemic and effective policy responses
- The recession will add further stress through loss of jobs and security in the household. How will this impact filter down to the children and adolescence in the home? Post-pandemic, what steps can be taken to reduce the harm?
- How has disruption in daily life through lockdowns affected adolescents’ mental health? Predictions are not entirely clear as features of the school environment, from which they are absent, may help or hinder mental health. How will this disruption affect them and can schooling be better designed to reduce factors that harm adolescent mental health?
Where can I find out more?
The COVID-19 pandemic has increased and broadened inequality in psychological distress in the UK: Writing at VoxEU, Apostolos Davillas and Andrew Jones find that during the pandemic mental health distress has risen across groups but that it has particularly affected young people.
COVID-19: Narrative economics, public policy and mental health: Writing at VoxEU, Annie Tubadji, Don Webber and Frederic Boy analyse big data on anxiety levels around lockdowns in the UK and Italy. Their results suggest that cross-country policy differences can have spillovers such that inconsistencies may raise anxiety and particular times of the day, such as pre-bedtime, may be important to consider for policies aimed at lowering anxiety.
Mental health deserves priority over railways: Richard Layard argues that the highest value for money in government spending comes from treating mental illness (in the Financial Times).
Who are UK experts on this issue?
- Richard Layard, Centre for Economic Performance at the London School of Economics
- Martin Knapp, Care Policy and Evaluation Centre at the London School of Economics
- Francesca Cornaglia, Queen Mary University of London
- Marc Suhrcke, University of York