Generation climate crisis, COVID-19, and Russia-Ukraine-War: global crises and mental health in adolescents

[Mental health of children and adolescents in times of global crises: findings from the longitudinal COPSY study from 2020 to 2024]

BACKGROUND

The mental health of children and adolescents is increasingly affected by global crises, but so far there are only limited longitudinal studies on this topic. This longitudinal, population-based study aimed to explore changes in mental health during global crises.

METHODS

The study analyzed data from 2865 families with children and adolescents aged 7 to 22 years who participated in at least one wave of the COPSY (COvid-19 and PSYchological health) study from May 2020 (T1) to October 2024 (T7). On average, the families took part in 56.7% of the survey waves. Descriptive statistics and multivariate regression analyses were used to examine changes in mental health as well as the effects of crisis-related worries and digital media use.

RESULTS

The mental health of children and adolescents was significantly impaired at the beginning of the pandemic, improved again in the following years, but remained at an impaired level in fall 2024 compared to pre-pandemic levels. At the same time, concerns about wars, economic crises, and the climate crisis have increased significantly. Risk factors such as low parental education and parental mental health problems were associated with poorer mental health, while personal, familial, and social resources had a protective effect. A high level of media consumption was documented, which was associated with stressful experiences.

CONCLUSION

Global crises pose significant challenges to the mental health of children and adolescents. Resource-oriented prevention and intervention efforts are urgently needed to support young people in coping with these challenges.

Transitions in mental health care utilisation at GHU Paris between 2019 and 2024: A post-pandemic perspective

OBJECTIVE

This study aimed to analyse the long-term evolution of mental health services use following the COVID-19 pandemic.

DESIGN

This was a retrospective study, conducted from 2019 to 2024, using the Groupe Hospitalier Universitaire Paris Psychiatry and Neurosciences (GHU Paris) databases.

METHODS

We considered the number of patients consulting at GHU Paris clinics, number of patients presenting at the emergency department (ED), and number of hospital admissions per week, by sex and age group. We performed a piecewise linear regression, using a threshold approach to identify time patterns between 2019 and 2024: pre-pandemic period (T1), short-term (T2) and long-term post-pandemic period (T3). Temporal changes in mental healthcare service use were then analysed.

RESULTS

No significant overall changes were observed in the number of outpatients after the COVID-19 pandemic, except for a slight increase among patients aged 15-24 years. The number of hospital admissions remained lower in 2024 compared with 2019, with a decreasing trend in T3 for all subgroups. In contrast, the number of ED visits increased over time, with higher use of emergency services by women and young people in 2024 compared with 2019. The overall long-term trend (T3) continued to show an increasing pattern. Additionally, a reduction in schizophrenia presentations was observed, while there was an overall increase in patients with substance use or neurotic disorders.

CONCLUSIONS

Our results described transitions in mental health service use at GHU Paris between 2019 and 2024, highlighting reduced hospital admissions, increased psychiatric emergencies, and changes in the reasons for seeking care.

Supporting youths in global crises: an analysis of risk and resources factors for multiple health complaints in children and adolescents during the COVID-19 pandemic

Introduction

The number of global crises increased in recent years, significantly affecting the health and well-being of children and adolescents worldwide. Awareness of these global crises and their impact on health and well-being has risen since the COVID-19 pandemic. Research indicates that some children and adolescents are more vulnerable to the challenges resulting from these crises than others. This study examines the risk and resources factors for multiple health complaints (MHC) in children and adolescents in Germany during the COVID-19 pandemic.

Methods

We analyzed data from the German population-based longitudinal COPSY (COvid-19 and PSYchological Health) study. A total of 1,673 children and adolescents aged 11 years and older and their parents participated in at least one of the five survey waves between 2020 and 2022. We assessed MHC using the international Health Behavior in School-aged Children Symptom Checklist (HBSC-SCL), which includes four somatic complaints (e.g., headache, abdominal pain) and four psychological complaints (e.g., feeling low, sleeping difficulties). We conducted a mixed model panel regression analysis to examine longitudinal changes in MHC and identified sociodemographic, psychosocial, and pandemic-related risk factors and resources.

Results

Our results revealed increased MHC throughout the COVID-19 pandemic. Girls, single-parent children and adolescents, as well as children and adolescents of mentally ill or highly burdened parents, were at particular risk. A higher subjective perceived burden of the pandemic and COVID-19-related worries were significantly associated with a higher level of MHC. Personal resources, a positive family climate, and more perceived social support were significantly associated with a lower level of MHC.

Discussion

This paper highlights the vulnerability of children and adolescents in a global crisis, such as the COVID-19 pandemic. The results provide a scientific foundation for targeted health promotion and intervention strategies to protect and maintain the health and well-being of young people in future crises.

Development and Validation of the War Worry Scale (WWS) in a Sample of Italian Young Adults: An Instrument to Assess Worry About War in Non-War-Torn Environments

The expansion of wars around the world fosters a macrosocial stress with multilevel effects that also affect the mental health of populations not directly involved, in particular of evolutionary targets in delicate transition. The present study describes the process of development, validation, and evaluation of the psychometric properties of the War Worry Scale (WWS), an instrument that explores the psychological impact of war in contexts not directly involved and, in particular, in the target population of young Italian adults. The process of construct definition and item generation of the WWS is presented here and then verified in Study I, which, using a sample of 250 young adults (40.4% male and 59.6% female), describes the exploration of the factor structure of the instrument through exploratory factor analysis (EFA) and presents preliminary psychometric properties. An independent sample of 500 young adults (39.4% male; 60.6% female) was recruited for Study II, which describes the results of confirmatory factor analysis (CFA) supporting the second-order structure with two first-order dimensions, Worry about the Present (WWP) and Worry about the Future (WWF), composed of 10 items (5 per dimension). The internal consistency of the WWS, convergent, discriminant, and concurrent validity with other validated measures, and measurement invariance between males and females are further described. Finally, significant differences in the levels of Worry about War are found in relation to several sociodemographic variables, i.e., gender, occupational status, relationship status, and political orientation. Overall, the results of Studies I and II confirm the validity, robustness, and reliability of the War Worry Scale.

Understanding coping with the climate crisis: an experimental study with young people on agency and mental health

Background: While the impact of climate change on mental health, especially in young people, has been acknowledged, underlying mechanisms of this relation remain elusive. Based on research on active coping, we explored effects of agency on anxiety and coping in an experimental design. We further examined the relation between mental health (i.e., psychopathology, depressiveness, trait anxiety), trait factors (i.e., climate distress, intolerance of uncertainty, trait coping), state anxiety and coping with climate distress.Methods: 244 participants (15-25 years) watched a climate anxiety inducing video, followed by an agency manipulation (high agency vs. low agency vs. control). Trait mental health, intolerance of uncertainty, and climate distress and coping were examined as predictors of state anxiety and coping.Results: State anxiety decreased in the high agency and control conditions, but not in the low agency condition. High agency led to increased meaning-focused coping and low agency to decreased meaning- and problem-focused coping. Trait mental health, problem-focused, and meaning-focused coping strategies each predicted their respective state counterparts. Emotion-focused coping was further predicted by all trait measures.Conclusion: The findings suggest a risk of low agency communication due to the lack of arousal decrease and lack of using functional coping in young people.

Infant Crying, Sleeping, and Feeding Problems in Times of Societal Crises: The Mediating Role of Parenting Stress on Parenting Behavior in Fathers and Mothers

BACKGROUND/OBJECTIVES

Infant regulatory problems (RPs), i.e., crying, sleeping, and feeding problems, are associated with unfavorable outcomes in later childhood. RPs increased during the pandemic; however, their occurrence in the face of today's societal challenges remains unclear. RPs are strongly linked to parenting stress and less positive parenting behaviors, but their interplay is less investigated.

METHODS

In this cross-sectional, questionnaire-based study (ntotal = 7039), we compared the incidences of crying, sleeping, and feeding problems in infants (0-2 years) in pandemic (npandemic = 1391) versus post-pandemic (npost-pandemic = 5648) samples in Germany. We also investigated the relationship between post-pandemic infant RPs and parenting behaviors with parenting stress as a potential mediator for fathers and mothers.

RESULTS

Crying/whining/sleeping problems (34.8%) and excessive crying (6.3%) were significantly more prevalent in the post-pandemic sample. In both mothers and fathers, infant RPs were significantly associated with less positive parenting behaviors. Parenting stress partially mediated this relationship.

CONCLUSIONS

RPs in the post-pandemic era are even more prevalent than during the pandemic, highlighting the imperative for health care professionals to focus on infant mental health. Parenting stress emerges as an entry point for addressing the cycle of infant RPs and maladaptive behaviors in both fathers and mothers.

Editorial: Adolescent mental health in a rapidly changing world

There is substantial evidence that adolescent mental health has deteriorated considerably since the early 2010s across many countries, and much more strongly among girls than boys. This is probably due to a combination of societal changes that strongly influenced the lives of adolescents. The societal changes include the rise of social media and of academic pressure, the COVID-19 pandemic and increasing worries about the future. Moreover, the decreasing trend in adolescent mental health might have resulted into more mental health awareness and a tendency to overinterpret negative psychological experiences as signs of mental health problems. Several suggestions for future research are provided to increase our understanding of the origins of the recent trends in adolescent mental health.

War, emotions, mental health, and artificial intelligence

During the war time dysregulation of negative emotions such as fear, anger, hatred, frustration, sadness, humiliation, and hopelessness can overrule normal societal values, culture, and endanger global peace and security, and mental health in affected societies. Therefore, it is understandable that the range and power of negative emotions may play important roles in consideration of human behavior in any armed conflict. The estimation and assessment of dominant negative emotions during war time are crucial but are challenged by the complexity of emotions' neuro-psycho-physiology. Currently available natural language processing (NLP) tools have comprehensive computational methods to analyze and understand the emotional content of related textual data in war-inflicted societies. Innovative AI-driven technologies incorporating machine learning, neuro-linguistic programming, cloud infrastructure, and novel digital therapeutic tools and applications present an immense potential to enhance mental health care worldwide. This advancement could make mental health services more cost-effective and readily accessible. Due to the inadequate number of psychiatrists and limited psychiatric resources in coping with mental health consequences of war and traumas, new digital therapeutic wearable devices supported by AI tools and means might be promising approach in psychiatry of future. Transformation of negative dominant emotional maps might be undertaken by the simultaneous combination of online cognitive behavioral therapy (CBT) on individual level, as well as usage of emotionally based strategic communications (EBSC) on a public level. The proposed positive emotional transformation by means of CBT and EBSC may provide important leverage in efforts to protect mental health of civil population in war-inflicted societies. AI-based tools that can be applied in design of EBSC stimuli, like Open AI Chat GPT or Google Gemini may have great potential to significantly enhance emotionally based strategic communications by more comprehensive understanding of semantic and linguistic analysis of available text datasets of war-traumatized society. Human in the loop enhanced by Chat GPT and Gemini can aid in design and development of emotionally annotated messages that resonate among targeted population, amplifying the impact of strategic communications in shaping human dominant emotional maps into a more positive by CBT and EBCS.

Emotional responses and psychological health among young people amid climate change, Fukushima's radioactive water release, and wars in Ukraine and the Middle East, and the mediating roles of media exposure and nature connectedness: a cross-national analysis

BACKGROUND

New global crises are emerging, while existing global crises remain unabated. Coping with climate change, the radioactive water released into the Pacific Ocean subsequent to the Fukushima nuclear accident in Japan, and the wars in Ukraine and the Middle East (hereafter referred to as the wars) as individual crises can negatively affect the psychological health of young people, but little is known about the compounded impact of multiple crises. We aimed to examine: (1) the emotional responses of young people towards each individual crisis, (2) how aggregate levels of emotional engagement in global crises might pose different potential trajectories in psychological health, and (3) the protective or exacerbating role of media exposure and nature connectedness as mediators on psychological health outcomes of young people.

METHODS

We conducted a cross-national online survey among young people (aged 18-29 years) from China, Portugal, South Africa, the USA, and the UK. We adopted stratified purposive sampling and distributed the survey using online platforms (www.wenjuan.com and www.prolific.com). Individuals were eligible for inclusion in our analysis if they were literate in Chinese or English and had no mental disorders diagnosed within the past 12 months. Participants were asked questions on their demographic characteristics and time spent on social media, including proportion of time exposed to media pertaining to global crises of interest, and they completed surveys based on validated scales that measure depression, anxiety, stress, and wellbeing, as well as emotional responses to each global crisis and nature relatedness. We assessed the survey results using descriptive statistics, ANOVA tests, cluster analysis for individual emotional responses, and structural equation modelling for the aggregate measure of emotional engagement towards individual global crises.

FINDINGS

Between Oct 20 and Nov 3, 2023, 2579 individuals participated in the survey, of whom 400 participants from each country (200 male and 200 female participants) were included in our analysis (mean age 24·36 years [SD 2·86]). The mean emotional engagement varied between the global crises of interest (on a scale from 0 to 68, where 0 indicates no emotional response and 68 indicates strong emotional responses across 17 different emotions; wars: 32·42 [SD 14·57]; climate change: 28·79 [14·17]; radioactive water: 21·26 [16·08]), and emotional engagement also varied by country; for instance, for respondents from China, mean emotional engagement in radioactive water was relatively high (39·15 [10·72]) compared with the other countries, and for respondents from the USA, engagement with the wars was relatively low (29·45 [15·78]). We found significant variations in the level of emotional engagement between different crises, with distinct emotional profiles observed among individual countries. To assess the role of media exposure and nature connectedness on psychological outcomes, using structural equation modelling, we constructed a multi-country model comprising Portugal, South Africa, the USA, and the UK, and a standalone model for China. These models elucidated associations between emotional engagement and psychological distress and wellbeing, explaining substantial portions of the variance in both. Notably, while greater emotional engagement in the ecological crises (ie, climate change and radioactive water) generally predicted worse psychological health outcomes, we found the direction of effect for war crises to have positive outcomes for mental health in the standalone China model. Additionally, we found that media exposure mediated the negative effect of wars on psychological distress in the multi-country model, and positive psychological wellbeing in the standalone China model. Moreover, nature connectedness emerged as a potent mediator, effectively mitigating the adverse mental health effects of emotional engagement with some crises, such as radioactive water and climate change.

INTERPRETATION

Our findings offer valuable insights into the nuanced dynamics of emotional engagement in global crises and its implications for mental health outcomes among young people across diverse global contexts. Further research is needed to understand the contribution of ongoing and new global crises towards a compounded negative future outlook on young people's mental health to identify effective communication and intervention strategies that can mitigate the effect of this global challenge.

FUNDING

Research Grants Council of Hong Kong, China.