COVID-19 Is Taking A Toll On Young People’s Mental Health Too
This story is a part of Science Friday’s coverage on the novel coronavirus, the agent of the disease COVID-19. Listen to experts discuss the spread, outbreak response, and treatment.
In the U.S., we’re heading into the fourth month of the COVID-19 pandemic. Social distancing and lockdowns have taken a toll on everyone’s mental and emotional well-being—including children and teens, many of whom may be having trouble processing what’s going on.
Psychologists Archana Basu and Robin Gurwitch discuss the unique issues the pandemic brings up for children and teens. They talk about how parents and caregivers can support the mental health of the kids and teens in their lives, helping them better cope with isolation and uncertainty, as well as learning remotely during the pandemic.
Robin Gurwitch is a psychologist and professor in the Duke University Medical Center’s Center for Child & Family Health in Durham, North Carolina.
Archana Basu is a research associate in the Harvard T.H. Chan School of Public Health and a clinical psychologist at Massachusetts General Hospital in Boston, Massachusetts.
IRA FLATOW: This is Science Friday. I’m Ira Flatow. In the US, we are now heading into the fourth month of the COVID-19 pandemic with social distancing lockdowns and still many unknowns. I mean, it certainly has taken a mental and emotional toll on everyone, right? Children and teens are no exception.
So we wanted to check in with our younger listeners and their families to hear how they’ve been feeling and processing the pandemic. We asked a couple of experts to reflect on your experiences and questions and to talk about how parents and caregivers can support the mental health of kids and teens in their lives during the pandemic. So let me introduce them.
Robin Gurwitch is a psychologist and professor at the Center for Child and Family Health at Duke University Medical Center. And Archana Basu is a research associate at Harvard TH Chan School of Public Health and a clinical psychologist at Mass General. Welcome, both, to Science Friday. And Archana Basu is a research associate at Harvard TH Chan School of Public Health and a clinical psychologist at Mass General Hospital. Welcome to Science Friday.
ROBIN GURWITCH: Thanks for having us.
ARCHANA BASU: Thank you.
IRA FLATOW: Robin, let me begin with you. You’ve worked with children and families who have experienced disasters. How is the pandemic unique in terms of other types of crises?
ROBIN GURWITCH: So when we think about what’s happening with COVID-19, there are several unique features. One, we can’t see it. So I can’t go outside and say, there’s somebody with it. There’s somebody without it, right? So it’s invisible. I don’t have any knowledge with this pandemic around how bad it will get, when it went end, and everybody is directly affected.
So while Katrina cut a wide swath across the United States, there were still places in the United States that were not physically damaged. With COVID, there is nowhere in the world that I can say, oh, if I went to this little corner, it wouldn’t be there. So those uncertainties certainly do make this pandemic quite unique.
IRA FLATOW: Archana, this pandemic, as Robin has said, is an event that most people have not experienced. So how do you characterize? Is there a playbook for this? Is there a medical manual to characterize what this event is?
ARCHANA BASU: Unfortunately not. And I think the long-term uncertainty, there isn’t sort of it’s all clear now. You know, there’s not a clear horizon. And the ways in which we are coping and what we are adapting to is changing along the way. I think the other thing is some of the public health recommendations in terms of how to cope. Typically, one of the main ways in which we sort of adapt to stressful situations is by you know huddling in with our loved ones. Caregiving is very visceral. It’s hugging our family and friends and holding hands.
But the physical distancing guidelines are actually affecting our ways of coping. They’re necessary, and there are good technological solutions to staying emotionally connected, but there is a missing piece in terms of the physical connection that I think is also important to acknowledge.
IRA FLATOW: Are you seeing more patients due to COVID or different issues in patients that you were already seeing?
ROBIN GURWITCH: Well, I think, in general, what the science tells us after any large-scale event, including public health emergencies like COVID, is that the mental and emotional stressors are going to far outweigh, sometimes, the physical stressors. And so we’re dealing not only– families are not only dealing with the mental health concerns around COVID and its long lasting, but with so many deaths, you’re also coping with grief and loss that is quite different than typical grief and loss because the circumstances surrounding the death.
So those two pieces really are pushing the mental health numbers across the country, both for adults as well as children. Hotlines are reporting many more calls with COVID happening. And I think, as Archana talked about, some of our coping strategies during times of uncertainty are undermined, adding to more emotional stressors. But it’s also when this first started and everybody went to a stay at home or there was a period where most everyone was given stay at home, as things are reopening, I think we’re adding a new uncertainty to this.
OK, yesterday, I was allowed to do this. Today, I can’t, or vice versa. Even within my own community, how come my neighbor next door is not wearing a mask and I am or, vice versa, they are? And so it’s very confusing for children, as well, to be able to navigate all of this uncertainty. And I think the uncertainty, honestly, is getting higher than lower, because there are different things happening in different parts of the country now.
IRA FLATOW: I want to share some of our listeners’ comments with you and have you react to them, because we have a lot of listeners who are asking questions. And let me first go to Matthew from Maryland and Louisa from New York.
MATTHEW: Hello my name is Matthew, age 10, in Maryland. During the COVID-19 outbreaks, it has been really hard for us kids to connect with friends. And that, along with not knowing a lot about COVID, is making it very stressful for us in these times. And that is making it really hard for us to concentrate on things like school when we’re really worried about things, and that’s making it hard.
LOUISA: My name is Louisa. I live in New York, and I’m 10. I’m scared that quarantine will never end. I’m scared that everyone will be different when it’s over. I’m scared of me changing. I’m scared of becoming more introverted. I don’t want to be that person.
IRA FLATOW: Wow. So how do you react to those? Dr. Basu, Dr. Gurwitch, what would you say?
ARCHANA BASU: All of those feelings make a lot of sense. They are worried about what they’re already experiencing and worried about the uncertainty of what the future might hold, when this might end. And there’s a lot of feeling of sadness. There’s disconnect from friends. I think there’s also this idea of families sort of are struggling to both work from home and manage academic goals and schooling from home, which incidentally, I don’t consider homeschooling. I mean, this is crisis schooling.
I think that I would say, for parents, the idea, first and foremost, that they support themselves– as they are one of the most powerful buffers for their kids– is important. So self-care is not selfish. We can’t pour from an empty cup. And so having regular opportunities to refuel so that we can be emotionally available to hear these stories, to hear this experience of our kids, and then think through what are things we can do. Yes, I’m missing friends. What are ways in which we can maybe talk to friends more regularly?
I also think that as there is partial reopening, there are safe ways in which families can think about connecting more with their friends and family and neighbors while practicing physical distancing, while wearing their mask in an outdoor environment, not in large gatherings. But there may be safe ways in which families could consider that, taking into account kind of the unique needs of their own family.
So, certainly, if you have family members or kids with some pre-existing physical health conditions that concern you more, I would definitely recommend checking in with your doctor and really thinking through what measures feel comfortable for you, talking to your kids as well as families and friends about exactly how you’d like to plan that meeting. But I think that there are ways in which we can realistically plan for and realistically reassure our kids.
So not to say there’s nothing to worry about, because obviously, that’s not true, and that’s confusing. But there are realistic ways in which we can reassure kids that this will end. And we don’t know exactly when and what that will look like, but we know that this will eventually end. And in the meantime, here are some ways in which we can stay connected you know with your friends, with Grandma and Grandpa, and with the school. And I think those are some ways in which parents can sort of support themselves as well as their kids.
ROBIN GURWITCH: And I think your questions around friends, as Archana mentioned– totally agree with her– we know that connectedness is imperative piece of coping and resilience. So exploring how do we connect. But one of the little– I think was the little girl talked about, worried about what was she going to be like. And so, again, reaching out and saying, well, what would you like to do? How would you like to be different?
What are the values we want to instill in our children that they can move forward with this? How can they connect in new and exciting ways? I mean, we’ve had drive-by graduations, drive-by birthday parties, virtual events. So we’re becoming incredibly creative. And let children think through that.
I saw the other day a young child, probably about 10, started a COVID lemonade stand. She had all the ways to make sure it was safe and healthy, and she was going to donate her moneys to a food bank or something. Children have incredible ways that they may want to cope and connect with others.
There are also resources just for kids. I know, for example, Nickelodeon had a town hall where children asked questions and people answered, and that was for children from 6 to 12. So it may be something that parents want to sit down and watch that with their children and talk about the answers. So thinking about resources, but it’s not plopping the child down in front of it. It’s doing it with them so you know what information they’re hearing, and it’s information that may be able to spur and start the conversation.
There are wonderful children’s books, for example, on racism that are fantastic. So if that’s a topic that you want to discuss but you’re not sure how, it can start with as simple as reading a book together and then talking about the book and how that plays out. So there’s not a, gosh, if you do this, this will happen. That would be amazing. But each family is trying to navigate this the best way that fits their family.
IRA FLATOW: There are so many big issues happening right now. There is this pandemic. We have protests for racial justice. We have climate change issues that have not gone away. Do you have to prioritize what stressors you talk to them about?
ROBIN GURWITCH: These issues are all important. So the question is, how do we start it? So if parents haven’t done it, then I would strongly say do this. We know that parents that talk to children about difficult topics, their children actually do better than parents that try to shield them or assume they just know it already.
So sitting down with your child and saying, you know, we’ve been staying at home for a long time. We’ve started to– we wear masks or whatever their family is doing because of Coronavirus or because of COVID. Tell me what you know about it. And be able to sit and hear what they say. Correct some misperceptions, because they’re there in young children, they’re there in adolescents, that are completely not accurate that we can correct those.
We can check in how’s this making them feel and to validate those feelings. Because just like adults, our feelings are all over the place, from worried and anxious, to angry about things that I’m not doing, to happy that I can spend more time with my mom if I’m little, or nobody’s bothering me about how much time I spend on my iPad. So there’s a lot of differences.
But the bottom line is, if we can have this frank conversation about COVID, then that’s telling me that my parents or caregivers are willing to talk to me about the tough stuff. So then I can have the same conversation if we see protests in our neighborhood or we see something on TV or we even think about going to join those protests. I can have that conversation.
The structure of the conversation is going to be very similar. We are truly building a foundation that if my parents and caregivers can talk to me about racism, can talk to me about COVID, can talk to me about fill in the blank, then that’s who I go to if I’m being bullied. That’s who I go to if I’m just disappointed because a relationship went bad. That’s who I go to about worries about x, y, or z.
So really, parents have an opportunity to think through what are the values and beliefs that I want to share and hope to promote in my children and teens. And how can I let them know that I am there for them and we can have these conversations?
IRA FLATOW: I’m Ira Flatow, and this is Science Friday from WNYC Studios. So what I hear you saying is that you want your kids to know from you that their concerns are valid and they need to be kept in the loop and want to be kept in the loop about what’s going on, and that’s how you respect their opinions.
ROBIN GURWITCH: I think that’s incredibly important. And you know we may circle back to our teens a little bit more than we may circle back to our four-year-olds, but we still continue to circle back. Because I think no matter what you’re discussing, whether it’s racism, whether it is disparities, whether it is COVID, I also want to make sure that I’m telling my child about, here’s what we’re doing in our family. Here’s what we think.
Here’s what our community’s doing. Here’s what our state is doing. Here’s what our public health director is telling us about it. And I’ll keep checking in. The conversation includes what’s being done to impact the current events, but also to talk to them about what they are doing and what they want to do.
We have to recognize that young people– and I mean even little ones– have great ideas about how they might want to help. Whether it’s– my neighbor down the street is five years old. And every day when I take a walk, she has a new chalk art on the sidewalk with smiley faces or something else, because that’s what she’s decided, she wants to make people feel kind and happy. So children may do different things.
So think through what can they do. We all are handwashing and know how to do that. That’s something I can control and something children can learn to do. But are there other ways? Are there other values we want to put out there? That doesn’t mean that we, as adults, can’t ever show distress. That would be insincere and disingenuous to say that adults don’t feel stress.
The best predictor of how well children are going to do is how well their caregivers are going to do. So while I may acknowledge my distress, I need to make sure that I say, however, this is what I’m doing so I will be able to cope with it. These are the ways that I’m managing it. Let’s think what we’re going to do as a family.
So it’s not that the distress and showing that is bad. In fact, I think it’s very healthy. But it’s the coping that’s the more important step.
IRA FLATOW: After a short break, we’ll continue our conversation about supporting children during the pandemic. This is Science Friday. I’m Ira Flatow. We’re talking this hour about supporting the mental health of kids during the pandemic and hearing from our younger listeners about their experiences. My guests are Robin Gurwitch, a psychologist and professor at the Center for Child and Family Health Duke University Medical Center, and Archana Basu, research associate at the Harvard TH Chan School of Public Health and a clinical psychologist at Mass General Hospital.
There have been studies that show, in fact, that children mirror their parents stress level, do they not? I mean, this is also a stressful time for the caregivers. How do caretakers balance their own stress while they try to manage the stress of their kids?
ARCHANA BASU: Checking in with yourself to see, what is this bringing up for me? And it can be very normalizing, as Robin said earlier, for kids to know that it’s OK to worry. Worry is actually in the spectrum of normal feelings. It’s just a question of how do you keep a sort of adaptive level of worry, where you’re sort of monitoring the risks around and thinking through things, but not getting overwhelmed?
And I think being sort of deliberate in checking in with yourself as a parent and then asking kids about how they’re feeling and what’s on their mind. Because of course, what a four-year-old is worried about– say, when do I get to meet my cousins again? Will I get to go on that trip to Grandma’s house? What about summer camp? Versus an older teen, who might be worrying about, certainly, meeting up with friends or applications to college. The worries can look different based on their ages.
Parents can talk through with them about those specific worries. And I think being action oriented, thinking about what works for your family. So one of the things, as a therapist, I ask pretty consistently of parents is, you know your child well. What has worked for you and your family and your kids in the past? And kind of building maybe sort of a toolbox of options, because what worked tonight may not be the same thing tomorrow. And it’s helpful to have sort of a range of options.
I think the other thing I would just highlight is the theme of uncertainty. And how do I start a conversation to which I know I won’t have a lot of answers? And I would just say, I think we can be role models to our kids in coping with uncertainty, too. So what do we know, and what is our plan for what we know? And what are things we don’t know, and how do we cope with that?
So what are trusted sources of information through which we will continue to gather information, be it public health systems, the CDC, school authorities, and so forth? And taking it kind of week by week or sometimes day by day. This is sort of an emotional marathon, and coping with the uncertainty, I think, is a big part of it. And in our conversations with kids, I think we can model for them, importantly, how we ourselves are coping with the uncertainty.
ROBIN GURWITCH: I was going to say children often show their level of distress through their behaviors. So, again, I can’t turn to “how do my children react” in the manual. But what we do know is that oftentimes we see stress in behaviors. So young children may have more temper tantrums and meltdowns. There may be, for older kids, irritability across the board, some problems with learning new information or even remembering things I used to do.
So children truly need a little bit more patience. But guess what? Adults are also a little bit more irritable and a little less patient. So we need to take a step back and recognize that sometimes I’ve had some good days and sometimes maybe not so good. And give ourselves a little bit of a break that we’re doing the very best we can. And to recognize that children will need, more so than usual, a little bit of extra patience and attention.
And Ira, while I love listening to you, it’s also important that adults know that too much media on the topics of disaster is not a good thing. So everybody needs to make sure that they take a break. And that doesn’t mean I’m going to turn off the TV and then go online to look it up or make a phone call and talk about it with a friend and then turn on public radio. It means truly, honest to goodness taking a break.
Young children shouldn’t be watching this at all. For older children, ask them. If they don’t want to tell you what do they know, because sometimes adolescents shrug their shoulders and that’s it, so saying to them, tell me what your friends are saying about all this. And get the conversation started that way. If you watch something on TV together, turn it off and sit down and say, what did you think about those protests they were showing? Or what do you think about the numbers for COVID?
IRA FLATOW: We had another reaction from so many people who want to talk about this, and many of them talked about how social distancing has been affecting them.
CHRISTIAN: I would say the biggest way teens are being affected by this pandemic is just loneliness. A lot of teens are stuck at home. The only way they can talk to their friends is via digital, and that can kind of get lonely without seeing your friends face to face.
MADDIE: I’ve been trying to make up for the lack of social contact by FaceTiming, leaving chalk messages outside friends’ houses, and even going for walks or runs six feet apart with masks. But the masks we wear are much more than a boundary between us and the virus. They’re separating us from the very thing that makes us human– each other.
IRA FLATOW: Christian from Dallas and Maddie from Green Bay, who was quite expressive there. And you did mention some ways that people can get around this, kids can get around this and try different things and be very creative. But kids are, teenagers are, worried about this, and then finding that isolation is affecting them. Should we expect that there will be lasting consequences of what we’re going through now with all these different stressors being put upon the children?
I remember when I was a kid, we had multiple stressors. I remember being afraid of polio, of catching polio. And then we were afraid of nuclear war and all kinds of things like that. And that was many, many, many decades ago, but I still remember them as if they were yesterday.
ROBIN GURWITCH: And still now I know that I can avoid nuclear war by hiding under a desk. Someone once asked me recently did I think children would remember this and it would make a difference in their life. Everybody will remember where they were during COVID, what it was like, just like any other events that have been seminal in our history. Since we can’t change it, we need to embrace it and think about, all right, this is what’s happening. What can I do about it? How am I going to manage this?
So while we know that loneliness certainly is highly correlated with anxiety and depression, we need to think about what can we do to stay connected. And I think as your it sounded like a young adult listener said, she’s worried about the distance between them that is beyond just the mask. And I think as children move forward, to consider what do they want it to look like. How can they still have fun, even with some of the new guidance?
School may be a little bit different when I go back in the fall, but I’ll still be able to do things with my friends. So planning and thinking through those. I think that, again, how we’re coping now impacts how we’re going to cope later. How do we build those coping strategies?
And I personally hope that, at the other end, we will actually come out of this a more kind and just country. And I’ve heard kids talk about it. Better appreciation for what people are doing, whether it’s the mail carrier, health care workers, the person at the grocery store, that we treat a little bit differently, a little bit kinder. That I may think twice about the child who’s sitting– my friend at school that’s sitting alone.
One of the things that I hope for children as we come through this– for all of us– is that we take some of the kindness and clapping and supporting of people during COVID and don’t stop just because we go back to what we’re doing. But we carry that ahead forward, and we treat everybody a little bit kinder and more appropriately. And certainly, superimposing the public health issue of racism on top of the public health issue of COVID, I think we really do need to move forward. The question is, what do we want that to look like?
IRA FLATOW: I hear you. I want to bring up, also, what we hear every day on the news, is the news about deaths. 120,000 deaths, 3,000 deaths a day. How do kids deal with that? How can you make sure that they’re just not remaining fearful about their loved ones dying? And now we’re hearing news about young people dying more often than we thought they would be. Are they fearful that their parents and their friends around them may be dying?
ROBIN GURWITCH: I think that goes along with the feelings of worry and being scared and anxious. And while parents and caregivers may want to allay those by saying, don’t worry, this won’t happen to me, this virus really doesn’t care what you say. It’s going to do what it’s going to do. So we need to make sure we don’t make those blanket, we’re going to all be fine.
But rather, here’s what we’re doing to make sure that we can stay as safe and healthy as possible. This is why we’re staying at home. This is why we’re wearing masks or other things. So children hear that this is what we’re doing and to recognize that our health care professionals are doing the very best that they know how to do as well. So making sure that we discuss safety, talking about what we’re doing for safety reasons.
But with those deaths, I think we can acknowledge– even if our children don’t bring it up, if they have alluded to it– that, yup, one of the worries is about whether or not I’m still going to be here, whether or not I may die. And here’s what I’m doing to keep myself healthy.
ARCHANA BASU: One of the best ways that we can emotionally support children as they experience these losses– and it’s not just, of course, there’s grief and bereavement about losing a loved one, but also the loss of some of the rituals– not being able to participate as a community, as a family, in end-of-life rituals and lean on each other for support in the ways we do. So the range of losses is actually quite a wide range. And I think as parents and families, acknowledging that with our kids allows us to validate their feelings, help them give words to their own experiences, and to not feel alone with their worries, feelings, or questions.
One of the things sort of– this is a Mr. Roger’s code, which is the anything that is mentionable is manageable. And I think that sort of really is true, even in this situation.
IRA FLATOW: I’m Ira Flatow, and this is Science Friday from WNYC studios. As I mentioned before, this is the fourth month into the pandemic. Talk about how the conversation or issues changed when talking about supporting the mental health of children. What did we talk about at the beginning, and what are we talking about now?
ROBIN GURWITCH: I think, in the beginning, we were talking about what this is, what we know, what the plans are. Those issues are still important now, but the answers are likely changing, right? Now, we’re talking about what does it look like? Because children probably heard about phased reopenings. What does that mean?
I can shop elderly hours, and I can tell you that I’m not sure exactly what phased reopening means in every place, because it’s all different. And it seems to be very fluid. But having those conversations about this is what’s happening now. I really encourage families to check and be in touch with information that their schools are putting out so they can be informed and they can support their children in the conversation about what’s going to be happening with school next year.
That’s going to be a new conversation than it was when this first started and schools were shutting down. Topics of the conversation are likely to be somewhat similar. The answers are going to be different. And it’s continuing to have those conversations that are so important.
And to know that there are many available services. If families are worried at all am I doing OK, is my child, is my teenager doing OK, there are help lines, hotlines, and mental health resources that are out there like never before.
IRA FLATOW: That’s a good point to bring on my last question. Archana, the pandemic is certainly showing the inequities in our systems, that black and brown communities are underserved and the hardest hit. And this is certainly true for mental health access. You talk about community resilience. How do you create that?
ARCHANA BASU: We’ve talked about this throughout, which is the intersection of the COVID-19 pandemic with pre-existing disparities in health equity and health opportunities. One of the other things you’ve talked about is coping is about– you know, individuals are not trait levels, they are either resilient or not resilient. Individuals can build resilience, and part of that building resilience for kids and individuals is supporting and building resilience for the systems within which children live, grow, and develop.
So I think practices and policies that support parents and families are critical, but also the other communities within which kids live and grow– so schools, for example. In fact, studies have recently shown that there is a substantial proportion of children who only get mental health services through school-based counseling centers. So they’re not coming into hospitals or community mental health centers.
Children are grappling with the demands of educational goals and learning while still being in this coping with stress, sort of flight or fight response and coping with uncertainty. Teachers and counselors need support in terms of helping their kids balance and address some of these needs. And I’m not a policy person, but I will say we have population-based data, including from the prior 2008 recession, that shows that large economic changes and economic recession impacts mental health for adults and is also associated with increased risk of violence in the household.
So, clearly, we know that there are other policies– such as economic policies, paid leave, work from home policies– that can support parents and can support families and, therefore, impact mental health, even though they may not be mental health policies themselves.
So I guess I would say there are things that individuals and families can do to build resilience– some of the coping skills that Robin and I talked about. But there are policies and practices that support families, schools, employer-based policies, and even community-based programs and agencies, faith-based agencies– churches, for example. They are all key allies in building this support system. It’s all part of our coping system.
IRA FLATOW: Well, I want to thank both of you for a very stimulating conversation and giving us something to think about. Robin Gurwitch is a psychologist and professor at the Center for Child and Family Health Duke University Medical Center. Archana Basu is a research associate at Harvard TH Chan School of Public Health and a clinical psychologist at Mass General Hospital. And we want to thank all of the kids and parents who took time to call in and share their experiences during the pandemic. Thanks to both of you.
ROBIN GURWITCH: Thank you so much for having us.