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A Twindemic: Adverse Childhood Experiences Jump During the COVID-19 Pandemic

May 9, 2023

Editor’s Note: Eli Cahan is a resident physician in pediatrics at University of California, San Francisco and an investigative journalist whose work focuses on the intersection of health equity and social justice. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics

As time has worn on since March 2020, researchers and the lay public alike have learned more and more about the emotional consequences of the COVID-19 pandemic. A report by the Kaiser Family Foundation found that 30-40% of adults reported symptoms of anxiety and depression by early 2021; simultaneously, the number of both suicides and overdose deaths skyrocketed.

Youth were not spared. CDC data found that pediatric emergency visits for mental illness increased substantially in 2020. A separate study showed that suicide attempts by children older than 10 years increased 30% relative to pre-pandemic rates, with younger children (aged 10-15 years) and females showing the largest upticks.

Taken together, such patterns led the American Academy of Pediatrics, along with the Children’s Hospital Association, to declare a National Emergency in Child and Adolescent Mental Health. “Children and families across our country have experienced enormous adversity and disruption,” the two organizations wrote in a joint statement. “We are caring for young people with soaring rates of depression, anxiety, trauma, loneliness, and suicidality that will have lasting impacts on them, their families, and their communities.”

Moreover, the joint declaration made clear that at the heart of these trends were root causes that included trauma and racism. “The pandemic has struck at the safety and stability of families,” the authors wrote, adding that the observed jumps in mental illness were “inextricably tied to the stress brought on by COVID-19 and the ongoing struggle for racial justice.”

However, so far, that “stress” has been difficult to quantify and characterize. A study, entitled, “Adverse Childhood Experiences Among US Adolescents Over the Course of the COVID-19 Pandemic,” which is being early released this week in Pediatrics, attempts to address that research gap by looking at how the COVID-19 pandemic has magnified the impact of another pre-existing epidemic: the epidemic of adverse childhood experiences (ACEs) (10.1542/peds.2022-060799). ACEs have previously been associated with mental illness, substance use, and suicide in youth.

In the study, Hertz and colleagues at the CDC assessed adolescents aged 13-18 years at 2 different timepoints in the COVID-19 pandemic: once in fall 2020, and again in spring 2021. They found in those 6 months or so that:

  • 1 out of every 6 children experienced an additional ACE
  • 1 out of 20 experienced 2 additional ACEs
  • 1 out of 50 experienced 3 or more new ACEs

Additionally, those already susceptible faced the highest risk: children with a high ACE burden in fall 2020 were almost three-times more likely to experience new ACEs by spring 2021, relative to those who were less impacted initially.

Hertz and colleagues also note that the nature of the ACEs experienced shifted as the COVID-19 pandemic worn on: abuse, neglect, or violence victimization, and witnessing household violence became more common—as did experiences of discrimination.

While the authors do not speculate in depth on the implications of their findings, they do suggest that the increasing burden of ACEs may well hold consequences for adolescent and adult health moving forward. “ACEs create toxic stress, which can, over the course of a young person’s growth, alter the physical structure of the brain,” they write.

Accordingly, they call upon readers to implement a broad set of initiatives to attempt to mitigate the observed patterns. Such initiatives include those that stretch beyond the traditional health system leveraging “community-based, multi-sectoral strategies”—as well as those that take more socially contextualized approaches, like targeting “restorative justice.”

Practitioners interested in understanding the lived experiences of youth during the COVID-19 pandemic—and promoting health and welfare accordingly—would be well served to read this piece closely.

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