A study of over 59,000 Icelandic adolescents by a team of Icelandic and North American behavioral and social scientists found that COVID-19 has had a significant, detrimental impact on adolescent mental health, especially in girls. The study is the first to investigate and document age- and gender-specific changes in adolescent mental health problems and substance use during the COVID-19 pandemic, while accounting for upward trends that were appearing before the pandemic. The findings are published in The Lancet Psychiatry.
The study found that negative mental health outcomes were disproportionately reported by girls and older adolescents (13-18-year-olds), compared to same-age peers prior to the pandemic. At the same time, it revealed a decline in cigarette smoking, e-cigarette usage and alcohol intoxication among 15-18-year-old adolescents during the pandemic.
The decrease observed in substance use during the pandemic may be an unintended benefit of the isolation that so many adolescents have endured during quarantine."
John Allegrante, collaborating senior investigator, affiliated professor of sociomedical sciences at Columbia University Mailman School of Public Health and applied behavioral scientist
Thorhildur Halldorsdottir, a clinical psychologist and assistant professor of psychology at Reykjavik University who is the study co-principal investigator, said the study represents a "landmark contribution to what we now know about just how psychologically devastating being socially isolated from peers and friends during the ongoing pandemic has been for young people."
According to the researchers, prior studies have not been designed to determine whether clinically relevant levels of depression--as opposed to self-reported depressive symptoms--and substance use have increased during the pandemic.
Inga Dora Sigfusdottir, professor of sociology at Reykjavik University, scientific director of the Icelandic Centre for Social Research and Analysis, and research professor of health education at Teachers College, said the study "differs in methodology from previous studies in that it tracked population-based prevalence of mental health outcomes and substance use over several years in order to better understand the potential effects of COVID-19 from recent upward trends in adolescent mental health problems.
Previous studies of adolescents during COVID-19 found evidence of increased mental health problems and certain types of substance use that had been rising before the pandemic. This study, however, compares current data with several pre-pandemic time points, which enabled the researchers to separate the effect of COVID-19 from other recent, downward trends in adolescent mental health.
The implication of the new study is that interventions intended to lessen the negative impact of the pandemic on adolescent mental health might help improve the mental health outlook for young people around the world who have been caught up in the pandemic, observed Allegrante, who is also senior professor of health education at Columbia Teachers College.
"Isolation during the pandemic has been universal and it is global, and it is having a clinically important, negative impact on young people who have not been in school during the pandemic. Whether an adolescent was an Icelander in Reykjavik who had been at home for most of the last year or an American in New York City, living under the same circumstances - being at home, engaged in remote learning and separated from friends--the consequences of not going to school not only set back their learning but also negatively affected their mental health. What we don't know is by how much."
The study shows that population-level prevention efforts, especially for girls, are warranted," but that "more study is needed to determine the long-term effects of quarantine and being socially isolated from one's peers, including the effects on learning and academic achievement and relationships with parents, siblings, and peers," said Allegrante.
Ingibjorg Eva Thorisdottir, chief data analyst at the Icelandic Centre for Social Research and Analysis (ICSRA) at Reykjavik University (who studied at Teachers College in 2009 as part of an exchange with Reykjavik University), was the principal investigator and lead author of the report.
Alfgeir L. Kristjansson, Senior Scientist at ICSRA and Associate Professor of Public Health at West Virginia University and a co-author of the study, said the "results underline the significance of social relationships in the health and well-being of youth and the importance of nurturing and maintaining strong social support mechanisms in their lives. The Lancet Psychiatry study report highlights these findings at population scale." Kristjansson was a postdoctoral fellow with Allegrante at Teachers College during 2010-2012.
In a commentary that accompanies the article's publication, Gertrud Sofie Hafstad and Else-Marie Augusti, both senior researchers at the Norwegian Centre for Violence and Traumatic Stress Studies in Oslo, write that the study "clearly shows that gauging the mental health status of adolescents over time is of imminent importance."
Thorisdottir, I.E., et al. (2021) Depressive symptoms, mental wellbeing, and substance use among adolescents before and during the COVID-19 pandemic in Iceland: a longitudinal, population-based study. Lancet Psychiatry. doi.org/10.1016/S2215-0366(21)00156-5.