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  • Teen Mental Health During COVID: What New Federal Data Reveal

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    Mar. 31—High school students experienced challenges with mental health during the COVID-19 pandemic including hopelessness, substance abuse, and suicidal thoughts or intentions. But those who felt close to people at school or who reported strong virtual connections with family and peers were less likely to report such concerns.

    Those are among the key findings of a special national survey of high school students administered by the Centers for Disease Control and Prevention in 2021. The results, released by the agency Thursday, are one of the largest sets of data about student experiences during the national health crisis.

    The survey also captured students' experiences with racism and disruptions to their home and school life, important factors for educators to address as they chart a course for recovery after the pandemic, public health officials said. That's especially true because students who reported racism at school and LGBTQ students were more likely to report poor outcomes during the pandemic than their peers, said Kathleen Ethier, director of the CDC's division of adolescent and school health.

    "Although all students were impacted by the pandemic, it did not impact all students equally," she told Education Week in an interview.

    A broad picture of high school students' lives during the pandemic

    Thirty-seven percent of the survey's 7,700 respondents said they had experienced poor mental health during the pandemic, and 31 percent said they had experienced poor mental health in the 30 days before the questionnaire, which was administered to waves of students between January and June 2021.

    Forty-four percent of students said they had experienced "persistent feelings of sadness or hopelessness" within the previous year, 20 percent had considered attempting suicide, and 9 percent of respondents said they had attempted suicide.

    Because the questionnaire, called the Adolescent Behaviors and Experiences Survey, was created specifically to be administered online to both in-person and remote students during the pandemic, researchers cautioned that it can't be directly compared to other pre-pandemic surveys of high school students, which were administered by paper and pencil to a broader set of the student population.

    But in a supplement, the report's authors cited pre-COVID student mental health concerns tracked by the agency's annual Youth Risk Behavior survey. Between 2009 and 2019, for example, the portion of respondents reporting persistent feelings of sadness or hopelessness increased from 26 percent to 37 percent.

    While it's difficult to draw firm conclusions about "causality or directionality of the findings," the authors said, the data is still valuable for school administrators and educators, who are spending an influx of federal COVID-19 aid on academic, social, and emotional recovery efforts.

    Confronting racism and building belonging

    While schools have reported difficulty with hiring counselors and tutors, the data suggest broader efforts aimed at building a sense of belonging in school may be useful ways to help students flourish.

    Twenty-eight percent of survey respondents who reported that they felt close to people at school reported poor mental health, compared to 45 percent who did not report such close relationships. Students who reported feeling connected to others virtually were also less likely to report poor mental health—36 percent of respondents compared to 42 percent of their peers.

    "We see how important schools are in mitigating the effects of the pandemic," Ethier said.

    In addition to targeted services, like counseling, schoolwide efforts that build community may be helpful in recovery from COVID-19 disruptions, she said. Research has found that mentoring, volunteering, and effective classroom management can help increase school connectedness.

    But a sense of discrimination or unfair treatment correlates with a lack of connectedness, the survey suggests, confirming previous findings by researchers who've said giving students a feeling of belonging helps them overcome academic and emotional challenges at school.

    Thirty-six percent of survey respondents reported that they had at some point been "treated badly or unfairly in school" because of their race or ethnicity, with their answers ranging on a frequency scale from having "ever" experienced such treatment to having "always" experienced it. Among racial groups, Black and Asian students were most likely to report experiences with racism at school.

    And students who reported such discrimination were more likely to report poor mental health during the pandemic than those who hadn't—38 percent compared to 24 percent. Similarly, students who reported any experience with racism at school were less likely to say they felt close to people at school and more likely to report difficulty with concentration.

    That's why schools' efforts must center on meeting the needs of all students, including those from all racial backgrounds, genders, and sexual orientations, Ethier said. That could include targeted professional development for teachers and policies that specifically address bullying of LGBTQ students.

    Young lives disrupted

    The survey also provides a large data set that captures students' life disruptions and adverse experiences in 2021, findings that could help guide immediate and long-term efforts to address the pandemic's fallout, researchers wrote.

    Among the findings:

    — Twenty-nine percent of respondents reported short-term or long-term parental job loss during the pandemic.

    — Twenty-two percent of students reported their own job loss.

    — Two percent of respondents reported some form of homelessness, including sleeping in the home of a family or friend, in the 30 days before the survey.

    — Over half of respondents, 55 percent, said their parent had sworn at them, insulted them, or put them down during the pandemic. Eleven percent reported that a parent had physically abused them at some point during the pandemic.

    — Sixty-seven percent of respondents agreed or strongly agreed that doing schoolwork "was more difficult during the COVID-19 pandemic than before the pandemic started."

    Responses showed differences among demographic groups. Asian and Latino students experienced parental job loss at a higher rate. Black students were most likely to report physical abuse by a parent. And students who identified as gay, lesbian, or bisexual were more likely than their heterosexual peers to report emotional abuse by a parent and difficulty with school work.

    Those findings may have implications for schools' ongoing equity work and for cooperative efforts with community groups to address family concerns—like hunger and homelessness—that can be barriers to success in school, researchers wrote.

    "Many student disruptions and adverse experiences in this report are interconnected with the social determinants of health," the CDC report said. "Previous research shows that disparities based on race and ethnicity and sex existed among persons who experienced economic, food and nutrition, or housing insecurity before the pandemic, and these persons had a greater likelihood of experiencing these insecurities during the pandemic."

    Student drug and alcohol use during COVID-19

    Thirty-two percent of high school students responding to the survey reported current use of a tobacco product, alcohol, or marijuana or current misuse of prescription opioids.

    Among the 43 percent who said they had ever drunk alcohol, 30 percent agreed or strongly agreed they drank more alcohol during the pandemic.

    Students who learned remotely at the time of the survey were less likely to report current use of alcohol, marijuana, and opioids than those learning in-person or in hybrid mode. That may be because they had less access to peers who helped them obtain those substances, researchers suggested.  

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  • Suicide Rate Is Spiking Upwards in Preadolescent Children

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    TUESDAY, March 15, 2022 (HealthDay News) -- In the past two decades, a growing number of preteens have taken medicines or other chemicals as a way to end their lives, new research warns.

    The mental health of children has become a big talking point in light of the pandemic, but the study data showed the problem has been percolating for years: There has been a 4.5-fold increase in suicidal ingestion cases among children between the ages of 10 and 12 since 2000.

    Study co-author Dr. David Sheridan, a pediatric emergency room doctor at Oregon Health and Science University, said mental health concerns are a growing issue in emergency department patients.

    "We've just seen rapidly escalating numbers of adolescents coming in with suicidal thoughts. And it seems like we've been seeing younger patients as well," Sheridan said.

    To verify this anecdotal information, the researchers turned to data collected in the National Poison Data System for children aged 6 to 18. The cases were coded to show whether it was a suspected suicide attempt or recreational misuse or abuse of a drug or chemical, as well as the final outcome in each case.

    During the study period, there were more than 1.2 million cases, about two-thirds in girls. Nearly 29% of the cases resulted in serious outcomes, including just over 1,000 deaths.

    While recreational ingestion stayed constant, suicidal ingestions increased dramatically. In adolescents, the increase was 2.4-fold higher, compared to a 4.5-fold increase in those aged 10 to 12.

    "It's a good thing that recreational use is not increasing, but it's just a very concerning thing that the suicidal ones are significantly increasing," Sheridan noted.

    Despite the dramatic increase, the actual number of teens with suicidal ingestion continues to be much higher than preteens, Sheridan said.

    He added that it's important for parents to know that the drugs these children are taking are sometimes those that are the most commonplace in households, including acetaminophen (Tylenol), ibuprofen (Motrin, Advil) and allergy medications like Benadryl.

    "Unfortunately, there are kids who are suicidal and they're impulsive, and so they just take whatever is at home," said Sheridan, who suggested locking up even these common medications if you have kids in this age range.

    Though the study authors noted that suicidal thinking can be fueled by many factors and is not well understood, they also said that many social media platforms were launched around 2013, which happened to dovetail with the rise in cases. Sheridan, however, urged caution about connecting the two.

    "This study was not designed to look at what is causing this rise or what the factors are," Sheridan said. "I think the goal is to highlight this is happening, to fuel more research to hopefully get to the bottom of what you're asking, which I think is a really important thing."

    The researchers would also like to see what happened with suicidal ingestion cases during the full course of the pandemic and are waiting for the data to catch up; only one pandemic year was included in the study.

    The findings were published online March 14 in JAMA Pediatrics.

    Susan Tellone, clinical director for the Society for the Prevention of Teen Suicide, said it's important to open the conversation about mental health so that people are able to talk about it as openly as they talk about their physical health. A positive side effect of the pandemic is that is happening more.

    "I'm very hopeful that we can reduce the stigma and shame attached to mental health and have it start to look like we talk about our physical health, because our brain is an organ, just like our heart, our lungs and every other part of our body," Tellone said.

    Parents can do that with their own children by asking, "Are you OK?" Tellone said.

    "And if you're not OK, what's going on in your life right now that's making you feel sad," Tellone suggested. "And to ask the question, 'Has it gotten so bad that you're actually thinking about not wanting to live?'"

    It's important to be able to have that conversation with your kids, Tellone said, and to help them when they're just starting to feel out of sorts. Three important words to keep the conversation going are, "Tell me more," she said.

    "And just listen without advice or judgment, just 'I'm here for you. Tell me more,'" Tellone said.

    During the pandemic, children have experienced isolation and uncertainty along with everyone else, and they've had an enormous amount of loss, Tellone noted. Many kids are being raised by parents who are under a lot of pressure and stress.

    "For our children, there's many factors that come into the rise in suicidal ideation, but I think the pandemic and the chronic level of uncertainty has taken its toll and it's taken its toll on families," Tellone said.

    More information

    The National Suicide Prevention Lifeline has information and a hotline at 1-800-273-8255.

    SOURCES: David Sheridan, MD, MCR, emergency department physician and associate professor, emergency medicine, Oregon Health and Science University, Portland, Ore.; Susan Tellone, RN, MSN, clinical director, Society for the Prevention of Teen Suicide, Freehold, N.J.; JAMA Pediatrics, March 14, 2022, online

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  • How the pandemic made social-emotional learning more accessible

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    Katari Coleman is senior project director for Education Development Center and co-leads the National Center on Afterschool and Summer Enrichment.

    Throughout history, tragic events have served as springboards for advancements in quality of life. For example, World War II innovations like influenza vaccines, penicillin, radars and jet engines were developed and still serve vital purposes to society. For this moment in time, the COVID-19 pandemic allowed social-emotional learning to undergo a similar development.

    Social-emotional learning, or SEL, is essential for managing emotions and problem-solving. It equips an individual with the ability to deal with difficulties that may arise throughout their life and the ability to build relationships and navigate the community they live in.

    But amid the pandemic, millions of students lost socialization and structure because of disrupted daily life, including invaluable interactions and expectations from their participation in school, afterschool and summer programming, community and religious organizations, and other extracurricular activities. These barriers illuminated an urgent and often unmet need for accessible social-emotional learning supports.

    In the two years since the pandemic began affecting American life, some states and districts began touting the value of SEL for student success, and committing to new investments and strategies for meeting the social and emotional needs of students. Below are some of the ways we’ve seen advances in SEL accessibility during this moment of crisis and transformation.

    Championing SEL for both students and adults

    To better address the SEL disruptions students and adults were experiencing, states and districts used social media platforms to make a renewed push around the importance of SEL, distributing support documents, tip sheets, briefs and other resources to make sure communities were aware of strategies to foster SEL.

    For example, California used Facebook Live and Twitter to engage education professionals, families and students in discussions about SEL and mental health supports throughout the pandemic. In particular, the California Department of Education’s Twitter campaign for the SEL WikiWisdom forum yielded over 160,000 impressions — illuminating the voices of classroom educators who may not have been heard otherwise.

    Coordinating SEL and mental health supports

    SEL and mental health are not the same, but SEL can promote positive mental health and should be implemented as part of a system of mental wellness supports and resources that include promotion, prevention, early intervention and treatment. This type of coordination is now promoted by states, local districts, and federal programs with intentionality.

    While not entirely novel, due to popular tiered SEL approaches like the Pyramid model, what is recent are the efforts taken to compile these supports to make them more accessible.

    The federal Office of Child Care Initiative to Improve Social-Emotional Wellness of Children provided a guide that outlined strategies for states, territories and tribes to consider in addressing the needs of students. These strategies ranged from systematic SEL implementation approaches to specific mental health supports.

    Using new data to inform SEL

    The collection and reflection of data that elevates the perspective of students, families and staff can lead to better understanding of these groups’ social-emotional needs and allows for the identification and focus on inequities. Not only should states systematically collect SEL data to make informed decisions, but they should also provide guidance to school districts and programs on how they can collect and use data to ensure their services are highly effective.

    Pandemic-related data uncovered life struggles for students, their families, and staff, such as housing insecurity, lack of technology and broadband access, and health concerns.

    North Carolina’s SEL and Crisis Response website is one example of a state-level resource that offered support on conducting needs assessments and mapping resources as fundamental elements of data-informed support. Basically, it provided districts and schools with assistance in collecting and generating needed data to meet the needs of their communities.

    Leveraging funds for smarter SEL supports

    Funding allows states to more accurately respond to their data and meet the actual SEL needs of their population. Though SEL has been historically supported by federal, state and local funding on some level, recent federal stimulus funding created opportunities for school districts and programs to increase professional development, resource development, and access to needed technology supports.

    The Collaborative for Academic, Social, and Emotional Learning recently shared recommendations on how states can utilize American Rescue Plan Act funding to address SEL through systematic implementation, including promotion of SEL to students, support of adult SEL competencies, and an alignment on SEL efforts across schools, families and communities.

    Through tragedy, the pandemic functioned as an incubator for developing innovative activities and resources, and resulted in unprecedented steps forward for making SEL more accessible and comprehensive.

    As we observe the social and emotional needs of our students as part of International SEL Day, it’s important we take a moment to recognize the significant investments and advances in SEL accessibility amid the crisis and take steps to ensure that the momentum endures.

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  • Odds for mental illness rise in kids after concussion

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    Kids who've suffered a concussion are at heightened risk of mental health issues in the aftermath, a large new study suggests.

    The researchers found that compared with their peers, children and teenagers with a past concussion were 39% more likely to be diagnosed with a mental health condition—including anxiety disorders, depression and behavioral disorders. They were also at greater risk of inflicting self-injuries.

    Experts stressed that most kids with concussions fully recover, and the findings are not cause for alarm.
    Instead, they said, the study underscores the importance of taking concussions seriously and paying attention to kids' mental health afterward.

    "The association between concussion and mental health outcomes is seen in some kids—not all," said lead researcher Andree-Anne Ledoux, of the Children's Hospital of Eastern Ontario Research Institute, in Ottawa, Canada.

    For families, she said, it's important to be aware that mental health problems can arise after a concussion. If they notice any "worrying indicators," Ledoux said, they can talk to their health care provider.

    Doctors, meanwhile, should screen kids for mental health issues during their concussion follow-up care, she added.

    A concussion happens when a blow or jolt to the head makes the brain move rapidly back and forth within the skull. It can cause various immediate symptoms, like headache, confusion, dizziness and a general sense of feeling unwell.

    Most kids with a concussion feel better within a couple of weeks, according to the U.S. Centers for Disease Control and Prevention. But some have prolonged "post-concussion" symptoms that may last months—including headaches, sleep problems, and difficulty with memory and concentration.

    Studies have also found that kids can suffer from mental health problems, such as depression and anxiety disorders, in the aftermath of a concussion.

    The new findings should bring further attention to those issues, said Talin Babikian, a clinical neuropsychologist at the University of California, Los Angeles.

    Babikian emphasized that when kids have a single, uncomplicated concussion, the injury is usually "time-limited."

    And when they do develop mental health symptoms afterward, she said, it is likely often related to disruptions in their lives: For some kids, having to curtail sports for a while, or be less engaged in their usual activities, can be distressing.

    In some other cases, Babikian noted, kids might have symptoms of post-traumatic stress—if, for example, they sustained the concussion in a car accident.

    She said it's important that families receive accurate information about concussion recovery. That's not only so they know what kinds of symptoms can persist or come up, but also to keep things in perspective.

    Babikian wrote an editorial accompanying the study, which was published online March 7 in JAMA Network Open.

    The findings are based on medical records from nearly 449,000 Ontario children and teens, aged 5 to 18. More than 152,000 had sustained a concussion, while the rest were treated for an orthopedic injury. None had a history of treatment for a mental health condition, or for a previous concussion within the past five years.

    Ledoux's team looked at rates of mental health diagnoses, self-injury, psychiatric hospitalization and suicide in the two groups—anywhere from one month to 10 years after the physical injury.

    The investigators found that, with the exception of suicide, kids with concussions were at relatively higher risk than their peers.

    Around 11% a year were diagnosed with a mental health condition, versus about 8% of kids with orthopedic injuries. Both self-harm and psychiatric hospitalization were much less common, affecting both groups at a rate of less than 1% per year. But again, kids with concussion were at relatively greater risk.

    It can be complicated, Ledoux noted, to distinguish post-concussion symptoms from a new-onset mental health condition. Based on the data they had, her team could not tell whether some kids with a mental health diagnosis might have had post-concussion syndrome.

    The researchers are not sure why only certain kids develop mental health symptoms after a concussion.

    "But," Babikian said, "concussion or not, there are some key ingredients that support kids' mental health."

    One, she said, is having a sense of safety and "agency," while another is a feeling of belonging and engagement with peers. It's important, Babikian said, to help kids safely get back to their normal routines after a concussion, to avoid withdrawal or "deconditioning."

    And given the importance of social engagement and exercise, no one is saying kids should be kept out of sports or physical activities in the name of concussion prevention.

    "We need to take concussions seriously," Babikian said. "But that needs to be balanced by recognizing the benefits of engagement with life."

    More information: Andrée-Anne Ledoux et al, Risk of Mental Health Problems in Children and Youths Following Concussion, JAMA Network Open (2022). DOI: 10.1001/jamanetworkopen.2022.1235

    Talin Babikian, Contextual Considerations for the Increased Risk of Mental Health Problems Following Concussion in Youth, JAMA Network Open (2022). DOI: 10.1001/jamanetworkopen.2022.1242

    The U.S. Centers for Disease Control and Prevention has more on preventing and managing concussion.

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    Citation: Odds for mental illness rise in kids after concussion (2022, March 9) retrieved 9 March 2022 from https://medicalxpress.com/news/2022-03-odds-mental-illness-kids-concussion.html

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