Pandemic restrictions aggravating known triggers for self-harm and poor mental health among children and young people

Writing in The BMJ, Professor Tamsin Ford at the University of Cambridge and colleagues say deterioration in mental health is clearest among families already struggling and call for urgent action “to ensure that this generation is not disproportionately disadvantaged by COVID-19.”

They point to evidence that the mental health of the UK’s children and young people was deteriorating before the pandemic, while health, educational, and social outcomes for children with mental health conditions were worse in the 21st century than the late 20th century. For example, between 2004 and 2017 anxiety, depression, and self-harm increased, particularly among teenage girls.

Given that self-harm is an important risk factor for suicide, it is not surprising that rates of suicide among the UK’s children and young people also increased in recent years, they write, though numbers remain low compared with other age groups - about 100 people aged under 18 died by suicide each year in England between 2014 and 2016.

Studies carried out during the pandemic suggest that although some families are coping well, others are facing financial adversity, struggling to home school, and risk experiencing vicious cycles of increasing stress and distress.

Probable mental health conditions increased from 11% in 2017 to 16% in July 2020 across all age, sex, and ethnic groups according to England’s Mental Health of Children and Young People Survey (MHCYP). In addition, a sample of 2,673 parents recruited through social media reported deteriorating mental health and increased behavioural problems among children aged 4 to 11 years between March and May 2020 (during lockdown) but reduced emotional symptoms among 11-16 year olds.

The more socioeconomically deprived respondents had consistently worse mental health in both surveys, note the authors - a stark warning given that economic recession is expected to increase the numbers of families under financial strain.

The authors acknowledge that deteriorating mental health is by no means uniform. For example, a sizeable proportion of 19,000 8-18 year olds from 237 English schools surveyed during early summer 2020 reported feeling happier, while a quarter of young people in the MHCYP survey reported that lockdown had made their life better.

And while the incidence of self-harm recorded in primary care was substantially lower than expected for 10-17 year olds in April 2020, it returned to pre-pandemic levels by September 2020, with similar patterns detected for all mental health referrals in England.

Data also show a doubling in the number of urgent referrals for eating disorders in England during 2020, despite a smaller increase in non-urgent referrals.

Professor Tamsin Ford from the Department of Psychiatry at the University of Cambridge said: “Even before the pandemic, we were seeing deteriorating mental health among children and young people, which was amplified by inadequate service provision to support their needs. The lockdown and other measures aimed at tackling the pandemic will only serve to exacerbate these problems – and even more so for some different age groups and socioeconomic circumstances.

“Young people’s lives have been turned upside down by the pandemic, as is the case for lots of people, but their education has also been disrupted and many young people now face an uncertain future. We’re calling on policymakers to recognise the importance of education to social and mental health outcomes alongside an appropriate focus on employment and economic prospects.”

Reference Ford, T. et al. Mental health of children and young people during pandemic. BMJ; 11 Mar 2020; DOI: 10.1136/bmj.n614

Adapted from a press release by The BMJ

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