TAKING A STAND AGAINST BULLYING
THE EFFECTS OF THE COVID-19 PANDEMIC ON DEPRESSION AND SUICIDE IN ADOLESCENTS
AUTHOR Heather Felton , MD
The global pandemic caused by COVID-19 has dramatically affected all of us , but depending on who we are and where we are in life , the effects have been very different . While children can get and transmit the virus , they have not until this delta variant suffered the same physical health conditions as older adults . But they are not immune to all of the consequences of COVID-19 . Most parents across the US have reported a decrease in their mental health and also the behavioral health of their children , with the replacement of in-person school and social interactions by online versions . Normal safety nets were also more difficult to access during the early months of 2020 . The social isolation , increased reliance on the Internet and decreased access to mental health services have rightfully led to concerns of increased depression and suicide in adolescents .
The US Preventive Services Task Force ( USPSTF ) recommends screening adolescents beginning at age 12 for major depressive disorder ( MDD ), and the American Academy of Pediatrics ( AAP ) recommends the use of the Patient Health Questionnaire-9 Modified for Adolescents ( PHQ-9A .) The PHQ-9A screens for MDD and less severe depression symptoms hoping that they will be picked up earlier . A recent study in Pediatrics was unique in that it began in June 2019 and ended in October 2020 . They found that levels of depression symptoms , MDD and suicide risk were similar pre- and post-pandemic . The known stressors associated with non-traditional instruction and social isolation may not have been as significant only because the pre-pandemic levels of depression symptoms and suicide risk were so high to begin with . However , there was an increase of 3.7 % to emergency rooms across the US for suicide attempts among 12-to-25-year-olds . This matched what I felt practicing pediatrics in Louisville in 2020 . Our clinic uses the PHQ-9A for all adolescents , and while it was not uncommon to have positive screens , I found myself routinely referring children to the emergency room for suicidal ideation . Pre-pandemic this would happen once a quarter , but there were a few months when it was happening once a week . Naturally , the next question is , why is this happening ?
Zoom , telehealth , virtual meetings and non-traditional instruction ( NTI ) made their way into our lives in spring 2020 . Children and adolescents spent plenty of time online and on social media before the pandemic , but in 2020 they relied on it for school and all social interaction . Studies before 2020 had documented an increase in depression when more teenagers were using social media . There was legitimate concern that this would be a significant cause of in-
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