A daily routine, adequate sleep and limited screen time were associated with better mental health of young people during the early months of the COVID-19 pandemic, according to a new study by researchers at Harvard University and the University of Washington.
The study, published Aug. 11 in the journal PLOS ONE, surveyed more than 200 Seattle-area children and teens before the onset of the pandemic, during the initial lockdown phase in spring 2020, and six months later, when schools in the area were still operating remotely.
The spread of COVID-19, economic hardships and social isolation, especially during the first several months of the pandemic, fomented stress, anxiety and depression among children and teens alike, the study found. Now, even as school is expected to resume in person this fall, the study's findings highlight the stressors of pandemic life, within or outside of a remote learning environment. Top stressors for kids were exposure to seemingly frightening media coverage of the coronavirus; the extensive, and passive, use of screens - whether on phones, TVs or computers; and disrupted routines and sleep patterns.
Mitigating those stressors, researchers found, generally involved targeted strategies: establishing structured routines for daily life, including sleep; limiting news consumption and passive screen time; and simply getting out in nature.
"The biggest thing that we hope parents take from the study is that while youth mental health has been negatively impacted by the pandemic, there are some simple steps that families can take that may have a positive impact," said first author Maya Rosen, a research associate at Harvard who previously was a postdoctoral researcher at the UW.
The study involved two groups of Seattle-area children ages 7 to 10 and teens ages 13 to 15, who were already participating in research on youth mental health and behavior prior to the pandemic. That ongoing research, for which UW co-author Liliana Lengua started following families when the children were 3 years old, provided the team with a baseline with which to evaluate the effects of different phases of the pandemic. About half of participants were female, and about one-third were youth of color.
For this study, both young people and their parents were surveyed through web-based questionnaires, responding to questions that researchers developed specifically for the pandemic - a unique event that carried its own stressors. For example, researchers asked about issues related to the young person's physical environment, burdens on family health and finances, and social and academic stresses. The answers also helped researchers learn whether and how young people were internalizing stress - developing anxiety or depression - or externalizing it, which would manifest in changes in behavior.
The COVID-19 pandemic presented some unique experiences for youth and their families, said Lengua, a UW professor of psychology and director of the Center for Child and Family Well-Being.
"Research from past disasters, such as Hurricane Katrina, and also from studying stressful things that happen for families, such as divorce, have highlighted the factors that contribute to youth mental health in these contexts," she said. For example, unstable housing and economic situations, stressful life events, increases in family conflict or in parental mental health problems, contribute to children's responses to major stress. Those were also true during the pandemic.
"But the pandemic included unique experiences, as well," said Lengua. "Stay-home orders resulted in families having a lot of time at home without opportunities for youth to connect with peers and other adults for social support. While families reported appreciating the additional time together, for youth, this also meant feeling isolated and lonely. Having healthy daily routines and adequate sleep were particularly important in this context."
Among the findings:
- The pandemic aggravated feelings of anxiety and depression in young people who had already experienced either or both
- Young people who had elevated stress levels during stay-at-home orders were also more likely to continue to experience stress six months later
- Teens were more likely to internalize their stresses than younger children
- "Passive" screen time, which researchers defined as scrolling or watching videos or shows, compared with the potentially more interactive screen use during remote instruction or chatting with friends, was associated with higher stress
Researchers also surveyed participants about inexpensive and easy methods of alleviating anxiety. Not all of the potential stress buffers, such as physical activity and volunteering in the community, showed demonstrable effects, but others, such as sleep, structured routines and time in nature, were related to better mental health.
Exposure to news of the pandemic affected young people differently. Researchers noted, however, the importance of having honest, age-appropriate conversations with children and teens about crisis events such as the pandemic, answering their questions, and limiting exposure to sensationalized coverage.
"There was striking individual variation in how children and teens responded to the pandemic. We wanted to get under the hood of this variation to try to understand the vulnerabilities and resilience of different children. We also wanted to provide helpful tips to parents and teens," said co-author Andrew Meltzoff, a professor of psychology and co-director of the Institute for Learning & Brain Sciences (I-LABS) at the UW.
"There may be other pandemics in the future, and we think that some of the discoveries we made this time around can help parents and teens," Meltzoff said. "There is no book about 'how to cope with a worldwide pandemic,' but science can provide helpful information that people can use now, even while we continue to gather more data."
The study was funded by the Bezos Family Foundation, the National Institute of Child Health and Human Development and the National Institute of Mental Health.
Senior author on the study was Katie McLaughlin of Harvard and formerly of the UW. Additional co-authors were Makeda Mayes of I-LABS and Alexandra Rodman, Steven Kasparek and Malila Freeman of Harvard.
