How the Pandemic Impacted Adolescent Mental Health, Substance Use

Across the United States, K-12 students left school for an extended period after stay-at-home orders were issued at the onset of the pandemic.

Alongside his coinvestigators, Dr Jeff Temple, affiliated with the University of Texas Medical Branch, was already studying a sample of adolescents when COVID-19 restrictions were enacted. Amid uncertainty about how the pandemic would impact students, the team of researchers adapted their ongoing study to measure how adolescent mental health changed over time.

In this interview, Dr Temple shares his findings and emphasizes returning adolescents to their social networks as soon as possible after a school closure to curb worsening mental health.

What existing data led you to conduct this research into the impact of COVID-19 restrictions?

We were conducting a study of a healthy relationship program that we started well before the pandemic. There were 24 schools, in which 12 schools had our intervention and 12 schools were control, where they just had health class as normal. We started following these kids in 2018. Their second year of follow-up is when the world shut down due to the pandemic.

We thought, "This is going to have an effect on kids." We did not know what the effect of ripping them out of school was going to be. It was necessary, especially before we had vaccines, but we did not know how bad it was going to get.

They were taken away from their typical milestones: rites of passage, hanging out with friends, dating, experimenting, getting into trouble, making mistakes, etc. They were robbed of the opportunity to do those things that shape us and make us better adults, all the while being alienated from their social support networks and worried about this huge pandemic. It was a perfect storm that could affect kids' mental health.

We thought it was a perfect opportunity to add questions to our ongoing study, to look at things like mental health and substance use. Since we already had that data before the pandemic, we could have a real-time look at whether COVID-19 and resulting school closures had a direct effect on these kids' mental health and substance use.

Can you briefly describe your study and its findings? Did you find any of the outcomes surprising?

COVID-19-induced stress, isolation, loneliness, and economic impact all affected kids' depression, anxiety, and substance use, which included alcohol, cigarettes, vaping, hard drugs, and marijuana. We were able to account for prepandemic factors, so we can say with some level of certainty that COVID-19-related stressors were associated with worsening mental health and substance use.

A surprise was that COVID-19-induced isolation was actually inversely related to substance use. What I mean by that is the kids who were more likely to abide by stay-at-home orders were much less likely to use substances.

This is not necessarily a positive finding because the pandemic is not going to last forever, and kids are going back to school and their social networks. Access to substances is probably happening before, during, or after school, so that is a prevention target. This finding also tells us parental monitoring is important, in terms of preventing or reducing substance misuse in teens.

What are the possible real-world applications of these findings?

The biggest silver lining of the COVID-19 pandemic was learning how hugely important social interaction is. Prior to the pandemic, I used to joke about being a misanthrope, but within a couple months, I realized how much I missed people and needed that interaction. We are social beings.

The same thing applies to our kids. They need their social networks. It is part of becoming a human: developing those relationships and transitioning from a tween to a teen, from a teen to a young adult, and from a young adult to an adult.

From a real-world perspective, this tells us there are going to be additional school closures in the future, whether due to future pandemics or natural disasters like hurricanes and earthquakes. Whatever it takes, we need to try to get kids back to a routine with their networks as quickly as possible to make sure they do not miss too many milestones and interacting with folks.

Thank you. Do you intend to expand on your research going forward?

We do. We submitted a grant to the National Institute of Mental Health to continue following this sample so we can understand the long-term effects of COVID-19. We will be able to study the mental health of those who were more greatly impacted—for instance, if they had a family member who died or became sick, if they were very afraid of COVID-19, or if they experienced more of the economic downside. We will be able to see what those long-term impacts of the pandemic are, even 10 years later, with this study.

The other cool thing about this study is we had that intervention, which was a relationship violence prevention program. Participants learned healthy relationship and communication skills. Long term, we will be able to see whether kids who participated in that intervention could use those skills to mitigate the effects of the pandemic.

The idea was to prevent violence, but if the program can have a secondary benefit of reducing the impact of the pandemic, this may indicate we need these types of programs in schools nationwide. If this intervention works, that is a good sign to make programs robust and consistent, so we can make better, happy, healthier humans and inoculate them against this type of stress.

The last big question I have for you is, where do you see the future of adolescent mental health going as the pandemic wanes?

Prior to the pandemic, adolescents were in a mental health crisis. We are under-resourced and underfunded. We have a climate crisis and a political crisis. We have social media, and the data is saying to a large degree that it makes everything worse. Then we had the pandemic and everything associated with that. It is a perfect storm for a generation of adolescents to be severely affected.

For the next generation of adolescents, we need to increase the number of mental health professionals. We need to have prevention and socio-emotional learning programs at schools. We need to meet this problem head-on, because it is not going to get better until we do something about it.

I think we need investments in behavioral health care and crisis prevention, like what we have done for cancer, HIV, and COVID-19. If we can devote billions of dollars to resource our nation during a pandemic, we can strive to create healthier, happier adolescents.

About Dr Temple

Jeff R Temple, PhD, is the newly minted vice dean for research and scholarship at the University of Texas Medical Branch, School of Nursing. He is also a professor, licensed psychologist, and director of the university’s Center for Violence Prevention.