COVID-19 Distress Impacts Adolescents’ Depressive Symptoms, NSSI, and Suicide Risk in the Rural, Northeast US

ABSTRACT

Objective

Widespread concern exists about the impacts of COVID-19 and related public health safety measures (e.g., school closures) on adolescent mental health. Emerging research documents correlates and trajectories of adolescent distress, but further work is needed to identify additional vulnerability factors that explain increased psychopathology during the pandemic. The current study examined whether COVID-19-related loneliness and health anxiety (assessed in March 2020) predicted increased depressive symptoms, frequency of non-suicidal self-injury (NSSI), and suicide risk from pre-pandemic (late January/early February 2020) to June 2020.

Method

Participants were 362 middle and high school adolescents in rural Maine (M age = 15.01 years; 63.4% female; 76.4% White). Data were collected during a time in which state-level COVID-19 restrictions were high and case counts were relatively low. Self-reports assessed psychopathology symptoms, and ecological momentary assessment (EMA) was used to capture COVID-19-related distress during the initial days of school closures.

Results

Loneliness predicted higher depressive symptoms for all adolescents, higher NSSI frequency for adolescents with low pre-pandemic frequency (but less frequent NSSI for adolescents with high pre-pandemic frequency), and higher suicide risk for adolescents with higher pre-pandemic risk. Health anxiety predicted higher NSSI frequency for adolescents with high pre-pandemic frequency, and secondary analyses suggested that this pattern may depend on adolescents’ gender identity.

Conclusions

Results underscore the impact of COVID-19 on adolescent mental health, with benefits for some but largely negative impacts for most. Implications for caretakers, educators, and clinicians invested in adolescent mental health are discussed.

Supplementary material

Supplemental material for this article can be accessed online at https://doi.org/10.1080/15374416.2022.2042697.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Ethics

The study was reviewed by the University of Maine’s Institutional Review Board (approval #2017-05-18)

Notes

¹ In the larger study, adolescents were assessed at 3-month intervals prior to the pandemic. The late January/early February assessment of NSSI frequency was used as Time 1, as it was most proximal to the onset of the pandemic.

² COVID-19 restrictions precluded loaning smartphones to youth without personal devices (n = 56) as planned. These youth were prompted to complete surveys online 3x/day using a school-issued laptop. Online survey items were identical to those in the app. Representative analyses indicated no significant differences for any variable as a function of EMA method, and analyses conducted with and without youth who used the online survey revealed identical results. All cases were thus retained for analyses.

³ The small number of youth identifying as gender minority/non-binary (n = 13) precluded planned statistical comparisons with female- and male-identifying youth. Descriptive data for these youth are presented in Table 1, Table 2.

Table 1. Descriptive statistics and correlations.

Table 2. Mean-level group differences by gender identity, grade group, and sexual orientation.

⁴ The adult cut score of 16 has been used with adolescents (Roberts et al., 1990), yet this can result in identifying half of adolescents as having elevated symptoms (Rushton et al., 2002). Higher adolescent cut scores (e.g., 24) have been recommended (Roberts et al., 1991), and observed means (Table 1) provide support for this recommendation.

Additional information

Funding

Data collection and writing were supported by NIMH grant R15 MH116341 awarded to Rebecca Schwartz-Mette. The writing of this article was further supported by a postdoctoral fellowship provided by the Eunice Kennedy Shriver National Institute of Child Health and Development (T32-HD07376) through the Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, to Natasha Duell and an American Foundation for Suicide Prevention grant (PDF-0-095-19) awarded to Hannah Lawrence.