Young People's Mental Health Changes, Risk, and Resilience During the COVID-19 Pandemic

TY - JOUR

T1 - Young People's Mental Health Changes, Risk, and Resilience During the COVID-19 Pandemic

AU - Montero-Marin, Jesus

AU - Hinze, Verena

AU - Mansfield, Karen

AU - Slaghekke, Yasmijn

AU - Blakermore, Sarah-Jayne

AU - Byford, Sarah

AU - Dalgleish, Tim

AU - Greenberg, Mark T.

AU - Viner, Russell M.

AU - Ukoumunne, Obioha C.

AU - Ford, Tamsin

AU - Kuyken, Willem

N1 - Funding Information: Funding/Support: This research was funded in whole, or in part, by grants from the Wellcome Trust (WT104908/Z/14/Z and WT107496/Z/15/Z) and supported by the National Institute for Health and Care Research (NIHR) Clinical Research Network. All research at the Department of Psychiatry in the School of Clinical Medicine at the University of Cambridge is supported by the NIHR Cambridge Biomedical Research Centre (BRC-1215-20014) and NIHR Applied Research Centre. Dr Montero-Marin was funded by the Wellcome Trust during the project duration, has a Miguel Servet research contract from the Instituto de Salud Carlos III (CP21/00080), and is supported by the Consortium for Biomedical Research of Epidemiology and Public Health (CIBERESP CB22/02/00052). Dr Ukoumunne was supported by the NIHR Applied Research Collaboration South West Peninsula. Funding Information: Conflict of Interest Disclosures: Dr Hinze reported grants from Stiftung Oskar-Helene-Heim as part of a postdoctoral fellowship. Prof Ford reported contracted research consultancy with Place2Be outside the submitted work. No other disclosures were reported. Publisher Copyright: © 2023 American Medical Association. All rights reserved.

PY - 2023/9/21

Y1 - 2023/9/21

N2 - Importance: As young people's mental health difficulties increase, understanding risk and resilience factors under challenging circumstances becomes critical. Objective: To explore the outcomes of the COVID-19 pandemic on secondary school students' mental health difficulties, as well as the associations with individual, family, friendship, and school characteristics. Design, Setting, and Participants: For this cohort study, follow-up data from the My Resilience in Adolescence (MYRIAD) cluster randomized clinical trial were collected across 2 representative UK cohorts. Mainstream UK secondary schools with a strategy and structure to deliver social-emotional learning, with an appointed head teacher, and that were not rated "inadequate" in their latest official inspection were recruited. A total of 5663 schools were approached, 532 showed interest, and 84 consented. Cohort 1 included 12 schools and 864 students, and cohort 2 included 72 schools and 6386 students. COVID-19 was declared a pandemic after cohort 1 had completed all assessments (September 2018 to January 2020), but cohort 2 had not (September 2019 to June 2021). Exposures: Cohort 2 was exposed to the COVID-19 pandemic, including 3 national lockdowns. Associations of individual, family, friendship, and school characteristics with students' mental health were explored. Main Outcomes and Measures: Changes in students' risk for depression (Center for Epidemiological Studies-Depression scale); social, emotional, and behavioral difficulties (Strengths and Difficulties Questionnaire); and mental well-being (Warwick-Edinburgh Mental Well-Being Scale). Results: Of the 7250 participants included, the mean (SD) age was 13.7 (0.6) years, 3947 (55.4%) identified as female, and 5378 (73.1%) self-reported their race as White. Twelve schools and 769 of the 864 students (89.0%) in cohort 1 and 54 schools and 2958 of the 6386 students (46.3%) in cohort 2 provided data and were analyzed. Mental health difficulties increased in both cohorts but to a greater extent among students exposed to the pandemic, including for risk of depression (adjusted mean difference [AMD], 1.91; 95% CI, 1.07-2.76); social, emotional, and behavioral difficulties (AMD, 0.76; 95% CI, 0.33-1.18); and mental well-being (AMD, -2.08; 95% CI, -2.80 to -1.36). Positive school climate, high home connectedness, and having a friend during lockdown were protective factors during the pandemic. Female gender and initial low risk for mental health difficulties were associated with greater mental health deteriorations. Partial school attendance during lockdown was associated with better adjustment than no attendance when returning to school. Conclusions and Relevance: This cohort study of secondary school students demonstrated that to promote mental health and adjustment, policy interventions should foster home connectedness, peer friendship, and school climate; avoid full school closures; and consider individual differences..

AB - Importance: As young people's mental health difficulties increase, understanding risk and resilience factors under challenging circumstances becomes critical. Objective: To explore the outcomes of the COVID-19 pandemic on secondary school students' mental health difficulties, as well as the associations with individual, family, friendship, and school characteristics. Design, Setting, and Participants: For this cohort study, follow-up data from the My Resilience in Adolescence (MYRIAD) cluster randomized clinical trial were collected across 2 representative UK cohorts. Mainstream UK secondary schools with a strategy and structure to deliver social-emotional learning, with an appointed head teacher, and that were not rated "inadequate" in their latest official inspection were recruited. A total of 5663 schools were approached, 532 showed interest, and 84 consented. Cohort 1 included 12 schools and 864 students, and cohort 2 included 72 schools and 6386 students. COVID-19 was declared a pandemic after cohort 1 had completed all assessments (September 2018 to January 2020), but cohort 2 had not (September 2019 to June 2021). Exposures: Cohort 2 was exposed to the COVID-19 pandemic, including 3 national lockdowns. Associations of individual, family, friendship, and school characteristics with students' mental health were explored. Main Outcomes and Measures: Changes in students' risk for depression (Center for Epidemiological Studies-Depression scale); social, emotional, and behavioral difficulties (Strengths and Difficulties Questionnaire); and mental well-being (Warwick-Edinburgh Mental Well-Being Scale). Results: Of the 7250 participants included, the mean (SD) age was 13.7 (0.6) years, 3947 (55.4%) identified as female, and 5378 (73.1%) self-reported their race as White. Twelve schools and 769 of the 864 students (89.0%) in cohort 1 and 54 schools and 2958 of the 6386 students (46.3%) in cohort 2 provided data and were analyzed. Mental health difficulties increased in both cohorts but to a greater extent among students exposed to the pandemic, including for risk of depression (adjusted mean difference [AMD], 1.91; 95% CI, 1.07-2.76); social, emotional, and behavioral difficulties (AMD, 0.76; 95% CI, 0.33-1.18); and mental well-being (AMD, -2.08; 95% CI, -2.80 to -1.36). Positive school climate, high home connectedness, and having a friend during lockdown were protective factors during the pandemic. Female gender and initial low risk for mental health difficulties were associated with greater mental health deteriorations. Partial school attendance during lockdown was associated with better adjustment than no attendance when returning to school. Conclusions and Relevance: This cohort study of secondary school students demonstrated that to promote mental health and adjustment, policy interventions should foster home connectedness, peer friendship, and school climate; avoid full school closures; and consider individual differences..

UR - http://www.scopus.com/inward/record.url?scp=85171810689&partnerID=8YFLogxK

U2 - 10.1001/jamanetworkopen.2023.35016

DO - 10.1001/jamanetworkopen.2023.35016

M3 - Article

SN - 2574-3805

VL - 6

SP - E2335016

JO - JAMA Network open

JF - JAMA Network open

IS - 9

ER -