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Anderson TL, Valiauga R, Tallo C, Hong CB, Manoranjithan S, Domingo C, Paudel M, Untaroiu A, Barr S, Goldhaber K. Contributing Factors to the Rise in Adolescent Anxiety and Associated Mental Health Disorders: A Narrative Review of Current Literature. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2025; 38:e70009. [PMID: 39739929 DOI: 10.1111/jcap.70009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 12/11/2024] [Accepted: 12/13/2024] [Indexed: 01/02/2025]
Abstract
BACKGROUND The prevalence of anxiety among adolescents has seen a notable increase in recent years, becoming a significant public health concern. In fact, anxiety is substantially more prevalent in Generation Z (individuals born between 1997 and 2012) than in any of the past three generations. We aimed to examine what factors contribute to the increased prevalence in teen anxiety and identify points of intervention. METHODS This study employed a narrative review method. We performed a literature search of the PubMed, ScienceDirect, and Medline databases and identified original research and review articles discussing increased anxiety and other mental health disorders in Generation Z. RESULTS We provide a comprehensive overview of the factors contributing to the increased rates of adolescent anxiety, including academic pressures, social media influence, family dynamics, and broader societal stressors. CONCLUSIONS In this narrative review, we examine the multifaceted nature of adolescent anxiety, identifying contributing factors. Additionally, we discuss potential clinical, educational, and community-based interventions to prevent and treat adolescent anxiety. By understanding and addressing the underlying causes of anxiety, it is possible to mitigate its impact and promote healthier developmental trajectories for young individuals.
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Affiliation(s)
- Thea L Anderson
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Rasa Valiauga
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Christian Tallo
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | | | | | | | - Manasvi Paudel
- Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Ana Untaroiu
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Samantha Barr
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kate Goldhaber
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
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Li Y, Zhang Y, Zhao J, Du X, Shi C, Lai L, Liu X, Cai Z, Chen A, Ren Z. The Association Between Distress Tolerance and Depressive Symptoms in Children and Adolescents: A Three-level Meta-analysis. ADOLESCENT RESEARCH REVIEW 2024. [DOI: 10.1007/s40894-024-00252-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2024] [Accepted: 10/25/2024] [Indexed: 01/02/2025]
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Goldfus TB. The impact of social media use on depression, anxiety, and well-being for teens/young people: using hypnosis to build a strong sense of self. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2024; 66:140-156. [PMID: 37586041 DOI: 10.1080/00029157.2023.2240863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
The national conversation continues to focus on the negative impact of social media on teens/young people. The lingering effects of the pandemic revealed sharp increases in the common practice of "compare and despair" as well as higher rates of loneliness, isolation, depression, and self-harming behaviors. In May 2023, the US Surgeon General warned that social media "is the defining public issue of our time" and is driving the teen mental health crisis. These concerns for the mental health of humans across the globe are real and dramatic. Social media's impact on young people can be neutral, negative, positive or shades of each. The hypnosis community has an opportunity to be a more vital presence in helping young people navigate, manage, and reduce negative social media impact and to harness social media's very positive contributions, many of which are well documented. This article focuses on assessing social media use in teens and young adults, identifying developmental tasks being practiced on social media, and how factors such as time spent on social media and social media experiences have promoted trauma, stress, depression and anxiety. In addition, it will consider some of the ways in which the isolating effects of COVID-19 have further impacted well-being. Finally, the article will discuss how hypnotherapists can leverage social media to foster stronger ego strengthening using therapeutic interventions that employ hypnosis, hypnotherapy techniques and interventions, hypnotic scripts, and social media to lower mental health risks in teens/young adults.
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Zimmer-Gembeck MJ, Modecki K, Duffy AL, Hawes T, Farrell LJ, Waters AM, Gardner AA, Shum D, Skinner EA. A pattern-centered analysis of adolescents' concerns and hopes about future crises: Differences in ways of coping and personal adjustment. J Adolesc 2023; 95:1195-1204. [PMID: 37202899 DOI: 10.1002/jad.12194] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Many adolescents are concerned about global and future crises, such as the health of the planet or terrorism/safety. Yet, adolescents can also express hope about the future. Thus, asking adolescents about their concern and hope could yield subgroups with different ways of coping and personal adjustment. METHOD Australian adolescents (N = 863; age 10-16) completed surveys to report their concern (worry and anger) and hope about the planet, safety, jobs, income, housing, and technology, as well as their active and avoidant coping, depression, and life satisfaction. RESULTS Four distinct subgroups were identified using cluster analysis: Hopeful (low on concern and high on hope across all issues, 32%), Uninvolved (low in concern and hope; 26%), Concerned about the Planet (CP, 27%), and Concerned about Future Life (CFL, 15%). When compared (adjusting for age, sex, and COVID timing), the CP subgroup was highest in active coping (e.g., taking action) but moderate in personal adjustment. Hopeful had the most positive adjustment, whereas CFL had the poorest adjustment. Uninvolved were lowest in coping but moderate in adjustment. CONCLUSIONS Findings suggest ways of coping and adjustment may not always align, in that CP is connected with more active coping but also some cost to personal adjustment, whereas Hopeful is associated with optimal adjustment but perhaps at the cost of active coping. In addition, although CFL adolescents emerged as the at-risk group, the low levels of hope and coping in Uninvolved adolescents raise the possibility that they are at risk of future problems.
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Affiliation(s)
- Melanie J Zimmer-Gembeck
- School of Applied Psychology and Griffith Centre for Mental Health, Griffith University, Southport, Australia
| | - Kathryn Modecki
- School of Applied Psychology and Griffith Centre for Mental Health, Griffith University, Southport, Australia
| | - Amanda L Duffy
- School of Applied Psychology and Griffith Centre for Mental Health, Griffith University, Southport, Australia
| | - Tanya Hawes
- School of Applied Psychology, Griffith University, Southport, Australia
| | - Lara J Farrell
- School of Applied Psychology and Griffith Centre for Mental Health, Griffith University, Southport, Australia
| | - Allison M Waters
- School of Applied Psychology and Griffith Centre for Mental Health, Griffith University, Southport, Australia
| | - Alex A Gardner
- School of Applied Psychology, Griffith University, Southport, Australia
| | - David Shum
- Department of Rehabilitation Sciences and Mental Health Research Centre, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Ellen A Skinner
- Department of Psychology, Portland State University, Portland, Oregon, USA
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Montero-Zamora P, Vos SR, Unger JB, Zeledon I, Lee R, Soto DW, Brown EC, Duque M, Garcia MF, Scaramutti C, Ertanir B, Schwartz SJ. Perceived Negative Political Climate Among Hispanic/Latino Adolescents Before and After the 2020 U.S. Presidential Election: Associations with Internalizing Symptoms and Substance Use. INTERNATIONAL JOURNAL OF INTERCULTURAL RELATIONS : IJIR 2023; 94:101790. [PMID: 37091741 PMCID: PMC10121197 DOI: 10.1016/j.ijintrel.2023.101790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The political climate often changes following the installment of a new president. This volatility presents opportunities for examining how elections might affect vulnerable subgroups such as Hispanic/Latino (HL) adolescents. The present study explored the perception of negative political climate among HL adolescents before and after the 2020 U.S. presidential election and its association with internalizing symptoms and substance use. We conducted the study in Los Angeles and Miami between 2020-2021, with a sample of 304 HL adolescents (Females = 60.8%), aged 15.3 years on average. Participants completed measures of negative political climate (pre- post-election) and measures of depressive symptoms, anxiety, substance misuse, and substance use intentions after the election. We used paired tests and linear mixed-effects modeling to explore changes in perceived negative climate before and after the election. Structural equation modeling was used to determine predictors of negative political climate and its associations with internalizing symptoms and substance use. Results indicated that following the election negative political climate increased significantly in Miami and among Cuban-origin adolescents but not in Los Angeles or among Mexican-origin adolescents. Pre-election perceived negative political climate was significantly predicted by gender, study site, and mother's nativity. Pre-election negative political climate predicted post-election internalizing symptoms and substance use intentions indirectly through post-election negative political climate. HL youth's perceived political climate is a complex construct that might vary across different sociopolitical contexts and populational sub-groups. Exploring variations in politically-based cultural stressors and their role as mental health and substance use risk factors is crucial to addressing HL disparities. KEY WORDS: Adolescence, Hispanic/Latino, political climate, presidential election, internalizing symptoms, substance use.
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Affiliation(s)
- Pablo Montero-Zamora
- Department of Kinesiology and Health Education, The University of Texas at Austin, Bellmont Hall, 2109 San Jacinto Blvd., Austin, TX 78712, USA
| | - Saskia R. Vos
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120, NW 14 Street, Miami FL 33136 USA
| | - Jennifer B. Unger
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles CA 90033 USA
| | - Ingrid Zeledon
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles CA 90033 USA
| | - Ryan Lee
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles CA 90033 USA
| | - Daniel W. Soto
- Schaeffer Center for Health Policy & Economics, University of Southern California, 635 Downey Way, Verna & Peter Dauterive Hall, Los Angeles CA 90089 USA
| | - Eric C. Brown
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120, NW 14 Street, Miami FL 33136 USA
| | - Maria Duque
- Department of Kinesiology and Health Education, The University of Texas at Austin, Bellmont Hall, 2109 San Jacinto Blvd., Austin, TX 78712, USA
| | - Maria Fernanda Garcia
- Department of Educational and Psychological Studies, School of Education and Human Development, University of Miami, 5202 University Drive, Coral Gables FL 33124 USA
| | - Carolina Scaramutti
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120, NW 14 Street, Miami FL 33136 USA
| | - Beyhan Ertanir
- School of Education, University of Applied Sciences and Arts Northwestern Switzerland, 5210 Windisch, Switzerland
| | - Seth J. Schwartz
- Department of Kinesiology and Health Education, The University of Texas at Austin, Bellmont Hall, 2109 San Jacinto Blvd., Austin, TX 78712, USA
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Herres J, Krauthamer Ewing ES, Levy S, Creed TA, Diamond GS. Combining attachment-based family therapy and cognitive behavioral therapy to improve outcomes for adolescents with anxiety. Front Psychiatry 2023; 14:1096291. [PMID: 37168081 PMCID: PMC10165080 DOI: 10.3389/fpsyt.2023.1096291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/27/2023] [Indexed: 05/13/2023] Open
Abstract
Increases in adolescent anxiety over the past several years suggest a need for trauma-informed, culturally responsive interventions that help teens cope with environmental stressors like those associated with the COVID-19 pandemic. Although abundant evidence supports the efficacy of cognitive behavioral therapy (CBT) in treating adolescent anxiety, not all teens respond positively to CBT. CBT does not typically include strategies that address important family factors that may be impacting the teen's functioning, such as the attachment relationship. Attachment-based family therapy (ABFT) addresses the attachment relationship and other factors that contribute to the adolescent's anxiety and related distress. By enhancing positive parenting behaviors, such as acceptance and validation of the adolescent's distress and promotion of their autonomy, ABFT sessions may repair the attachment relationship and increase the family's ability and willingness to engage in CBT tasks aimed at reducing anxiety. This theoretical paper describes the ABFT model and proposes that implementing ABFT sessions prior to CBT could result in better clinical outcomes for adolescents with anxiety disorders by improving the context within which the anxiety symptoms and treatment are experienced. Given that ABFT is sensitive and responsive to family and other contextual factors, adolescents from marginalized communities and those from less individualistic cultures may find the model to be more acceptable and appropriate for addressing factors related to their anxiety. Thus, a combined ABFT+CBT model might result in better outcomes for adolescents who have not historically responded well to CBT alone.
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Affiliation(s)
- Joanna Herres
- Department of Psychology, The College of New Jersey, Ewing, NJ, United States
| | | | - Suzanne Levy
- Counseling and Family Therapy Department, Drexel University, Philadelphia, PA, United States
| | - Torrey A. Creed
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Guy S. Diamond
- Counseling and Family Therapy Department, Drexel University, Philadelphia, PA, United States
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El Frenn Y, Hallit S, Obeid S, Soufia M. Association of the time spent on social media news with depression and suicidal ideation among a sample of Lebanese adults during the COVID-19 pandemic and the Lebanese economic crisis. CURRENT PSYCHOLOGY 2022; 42:1-13. [PMID: 35582433 PMCID: PMC9099267 DOI: 10.1007/s12144-022-03148-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2022] [Indexed: 11/26/2022]
Abstract
The main objectives were to associate between social media news consumption during these unstable times and depression, as well as suicidal ideation among a sample of Lebanese adults, in addition to associate between fear of Covid-19, depression and suicidal ideation. Secondary objectives aimed to check the mediating effect of depression in the association between time spent on social media to get the news and the presence of suicidal ideation. This is a cross-sectional study executed between April and May 2021. It involved 402 Lebanese citizens aged 18 years and above, selected randomly from all Lebanese districts. Having cancer (Beta = 0.20) or lung disease (Beta = 0.27), more fear of COVID-19 (Beta = 0.16), a higher time spent on social media for news (Beta = 0.13) and a higher household crowding index (Beta = 0.29) were significantly associated with more depression, whereas having a pet in the house (Beta = -0.13) and working in the medical field (Beta = -0.17) were significantly associated with less depression. Higher depression (aOR = 1.19) was significantly associated with higher odds of having suicidal ideation, whereas more fear of COVID-19 (aOR = 0.84) and older age (aOR = 0.96) were significantly associated with less odds of having suicidal ideation. Depression did not mediate the association between time spent on social media to get the news and suicidal ideation. This study showed that more time spent on social media reading the news is associated with higher depression but not suicidal ideation. Fear of Covid-19 is associated with more depression, but less suicidal ideation. Further studies are needed to identify the causality between social media news consumption, depression and suicidal ideation. Moreover, awareness campaigns should be organized to teach people how to consume social media news in a responsible way, without letting it affect their emotions directly, which may cause psychological disorders.
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Affiliation(s)
- Yara El Frenn
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
- Psychology Department, College of Humanities, Effat University, Jeddah, 21478 Saudi Arabia
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Sahar Obeid
- Social and Education Sciences Department, School of Arts and Sciences, Lebanese American University, Jbeil, Lebanon
| | - Michel Soufia
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
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Felix CB, Rocha VN, Castro PFVF, Mendes LDMR, Fontes HPDB. Juventude e trauma geracional: como os jovens brasileiros respondem à pandemia e à infodemia da Covid-19. LIINC EM REVISTA 2021. [DOI: 10.18617/liinc.v17i1.5708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A partir da compreensão da pandemia de Covid-19 como trauma global, investigamos como jovens das cinco regiões brasileiras lidam com a crise sanitária e suas consequências, a partir de suas interações com o noticiário. Em um ambiente marcado por perdas materiais e simbólicas, e atravessado pelo excesso de informações e desinformação, buscamos entender de que maneira nossos informantes reagem à exposição midiática ao evento traumático e que sentidos produzem para o que consideramos um trauma geracional (Edmunds, Turner, 2005). Para isto, realizamos uma revisão bibliográfica sobre mídia e trauma, letramento midiático e infodemia, e apresentamos os resultados de uma pesquisa online, conduzida nos dois últimos meses de 2020, com a participação de 855 pessoas, entre 15 e 29 anos
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Schmidt SJ, Barblan LP, Lory I, Landolt MA. Age-related effects of the COVID-19 pandemic on mental health of children and adolescents. Eur J Psychotraumatol 2021; 12:1901407. [PMID: 33968328 PMCID: PMC8075089 DOI: 10.1080/20008198.2021.1901407] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Children and adolescents are affected in various ways by the lockdown measures due to the COVID-19 pandemic. Therefore, it is crucial to better understand the effects of the COVID-19 pandemic on mental health in this age-group. Objective: The objective was to investigate and compare the effects of the COVID-19 pandemic on mental health in three age groups (1-6 years, 7-10 years, 11-19 years) and to examine the associations with psychological factors. Methods: An anonymous online survey was conducted from 9 April to 11 May 2020 during the acute phase of major lockdown measures. In this cross-sectional study, children and adolescents aged between 1 and 19 years were recruited as a population-based sample. They were eligible if they were residents in Austria, Germany, Liechtenstein or Switzerland, were parents/caregivers of a child aged between 1 and 10 years or adolescents ≥11 years, had sufficient German language skills and provided informed consent. Results: Among 5823 participants, between 2.2% and 9.9% reported emotional and behavioural problems above the clinical cut-off and between 15.3% and 43.0% reported an increase in these problems during the pandemic. Significant age-related effects were found regarding the type and frequency of problems (χ2 (4)≥50.2, P ≤ 0.001). While preschoolers (1-6 years) had the largest increase in oppositional-defiant behaviours, adolescents reported the largest increase in emotional problems. Adolescents experienced a significantly larger decrease in emotional and behavioural problems than both preschoolers and school-children. Sociodemographic variables, exposure to and appraisal of COVID-19, psychotherapy before COVID-19 and parental mental health significantly predicted change in problem-scores (F ≥ 3.69, P ≤ 0.001). Conclusion: A substantial proportion of children and adolescents experience age-related mental health problems during the COVID-19 pandemic. These problems should be monitored, and support should be offered to risk-groups to improve communication, emotion regulation and appraisal style.
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Affiliation(s)
- Stefanie J Schmidt
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Lara P Barblan
- Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Irina Lory
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Markus A Landolt
- Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland.,Department of Psychosomatics and Psychiatry, And Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland
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Fegert JM, Vitiello B, Plener PL, Clemens V. Challenges and burden of the Coronavirus 2019 (COVID-19) pandemic for child and adolescent mental health: a narrative review to highlight clinical and research needs in the acute phase and the long return to normality. Child Adolesc Psychiatry Ment Health 2020; 14:20. [PMID: 32419840 PMCID: PMC7216870 DOI: 10.1186/s13034-020-00329-3] [Citation(s) in RCA: 909] [Impact Index Per Article: 181.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 05/06/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) is profoundly affecting life around the globe. Isolation, contact restrictions and economic shutdown impose a complete change to the psychosocial environment in affected countries. These measures have the potential to threaten the mental health of children and adolescents significantly. Even though the current crisis can bring with it opportunities for personal growth and family cohesion, disadvantages may outweigh these benefits. Anxiety, lack of peer contact and reduced opportunities for stress regulation are main concerns. Another main threat is an increased risk for parental mental illness, domestic violence and child maltreatment. Especially for children and adolescents with special needs or disadvantages, such as disabilities, trauma experiences, already existing mental health problems, migrant background and low socioeconomic status, this may be a particularly challenging time. To maintain regular and emergency child and adolescent psychiatric treatment during the pandemic is a major challenge but is necessary for limiting long-term consequences for the mental health of children and adolescents. Urgent research questions comprise understanding the mental health effects of social distancing and economic pressure, identifying risk and resilience factors, and preventing long-term consequences, including-but not restricted to-child maltreatment. The efficacy of telepsychiatry is another highly relevant issue is to evaluate the efficacy of telehealth and perfect its applications to child and adolescent psychiatry. CONCLUSION There are numerous mental health threats associated with the current pandemic and subsequent restrictions. Child and adolescent psychiatrists must ensure continuity of care during all phases of the pandemic. COVID-19-associated mental health risks will disproportionately hit children and adolescents who are already disadvantaged and marginalized. Research is needed to assess the implications of policies enacted to contain the pandemic on mental health of children and adolescents, and to estimate the risk/benefit ratio of measures such as home schooling, in order to be better prepared for future developments.
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Affiliation(s)
- Jörg M. Fegert
- grid.6582.90000 0004 1936 9748Department for Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhövelstr. 5, 89073 Ulm, Germany
| | - Benedetto Vitiello
- grid.7605.40000 0001 2336 6580Division of Child Neurology and Psychiatry, Regina Margherita Pediatric Hospital, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Paul L. Plener
- grid.6582.90000 0004 1936 9748Department for Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhövelstr. 5, 89073 Ulm, Germany ,grid.22937.3d0000 0000 9259 8492Department for Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Vera Clemens
- grid.6582.90000 0004 1936 9748Department for Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhövelstr. 5, 89073 Ulm, Germany
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