The Academy never shies away from difficult and complex issues. In fact, we embrace them because we know our members have the skills, perspective and perseverance to tackle difficult challenges for the health and well-being of their patients.
Mental health is one of those challenges that needs our increased attention. For the past decade, rates of suicide, depression and anxiety have been on the rise for all children and adolescents, despite advances in diagnosis and treatment. The mental health system of care across our states and communities is fragile and often flat out broken. Access to timely, effective and culturally appropriate care is limited and inequitably distributed. Increasingly, we are recognizing the impacts of personally mediated and systemic racism on the mental health of all children, particularly children of color.
A survey of AAP members and staff in February 2020 identified mental health as one of the most pressing child health concerns we face. And that was before the COVID-19 pandemic. A year of social isolation, disrupted education, family stress and national unrest has taken a tremendous toll on patients and families. It also has taken a tremendous toll on pediatricians, who often bear the dual burden of addressing their patient’s mental health needs in the context of inadequate community resources, while managing their own needs or those of their family.
Too many children, families and pediatricians have been impacted by loss and grief or the fear that arises when a loved one falls ill with COVID-19. While we don’t yet have rigorous data on the impact of the pandemic on children’s mental health, we have seen enough to be concerned. And evidence continues to emerge that suggests both the prevalence and severity of mental health concerns have worsened over the past year.
I fear that as we continue to learn more, we will find that there are many more children and families who seem OK on the surface but are struggling deeply. If you or a family member is struggling, don’t hesitate to reach out to a loved one, colleague, mental health professional or the AAP for help. Sometimes as pediatricians and medical professionals, we are so busy taking care of others, we forget that it is OK if we need help, too.
What we know about the impacts of adverse childhood experiences on the developing brain suggests that for many children, the traumatic effects of the past year may be long lasting. Additionally, a review of 63 studies on the effects of social isolation and loneliness on the mental health of previously healthy children and adolescents found that events that trigger isolation and loneliness increased the risk of depression and possibly anxiety for up to nine years (Loades ME, et al. J Am Acad Child Adolesc Psychiatry. 2020;59:1218-1239). Poor mental health may well turn out to be the most prevalent “long haul” symptom of COVID-19 in children — stemming from the indirect effects of the pandemic.
However, we also know effective ways to buffer the impact of trauma and stress, and support positive social-emotional development. These include:
- timely access to evidence-based mental health treatment, including integrating mental health supports into settings such as primary care and schools;
- addressing social influences on health, such as food and housing insecurity;
- encouraging and supporting consistent and healthy adult relationships; and
- taking a two-generation approach to family support.
All of these things are within our reach, if as a nation we are willing to take big, bold steps for the sake of our children. Now is the time. Now, more than ever, they need us.
If you or someone you know needs help, call the National Suicide Prevention Lifeline at 800-273-TALK (8255) or text a crisis counselor at 741741.
