Children’s mental health has worsened and suicidal thoughts have increased during COVID pandemic and remote learning, physicians say

With children in Massachusetts continuing to learn remotely, full- or part-time, during the ongoing coronavirus pandemic, physicians have noticed concerning declines in students’ mental health.

Young people have started to require more significant care through inpatient programs or hospitalization, Worcester-area doctors say. They’ve observed increases in suicidal thoughts, eating disorders, substance use and obesity among patients this year. Those problems are exacerbated for children in urban school districts, where more students live in poverty and have higher educational needs. It further stretches the education gaps that already existed.

“My patients who have anxiety and depression that was well controlled and were doing just fine, those kids, I would say the majority have had major worsening of their symptoms and a lot of them have now been presenting with suicidal thoughts, certainly with worsening anxiety and depression, many of them needing to access emergency mental health,” said Beverly Nazarian, a UMass Memorial Health Care pediatrician in Worcester and a Worcester Public Schools physician consultant.

“Just about almost every kid I see says ‘I wish I could be in school,’” Nazarian said.

Safdar Medina, a pediatrician at the Tri-River Family Health Center in Uxbridge, has seen the same trends in his patients. Medina is also the district physician for Northborough-Southborough, which currently has a hybrid learning model.

Nazarian and Medina both feel that school is a safer place for children during the pandemic. But in a district like Worcester, the answer is not easy. Worcester schools currently remain remote as HVAC repairs, needed to improve airflow to keep kids and staff safer during the pandemic, are not yet complete.

Students who need the most in-person assistance are slated to return to classrooms on Jan. 25 while other students aren’t scheduled to be back in school until March. Worcester’s ability to get kids back into school buildings is strained by limits on the number of children that can ride a school bus during the pandemic.

While teachers have been creative in finding the best ways to instruct remotely, challenges remain for families with single parents and parents who are essential workers. In those circumstances, older children often supervise younger siblings during the school day. Or, grandparents who may not speak English are trying to help kids access online learning.

“What I’m seeing in the city is, I’m seeing families who are either having to leave their kids with less than ideal supervision or with people supervising them who cannot really help them attend to learning, so we’re going to see a disproportionate effect on these kids despite the very best intentions and creativity,” Nazarian said.

In more suburban or rural districts, there are still challenges. Medina said his patients who attend school part-time through a hybrid model report that remote days are the hardest.

“I do find that is challenging for families with less means,” Medina said. “It’s easier for families that have a suburban home for their kids to go outside and come back in during a remote learning day but it’s not if they’re not in a nice setting where they can do that.”

Medina said that from Oct. 1 through Dec. 11, he had 72 patients whose depression either worsened or had a new diagnosis of depression, and half of those patients reported suicidal ideation.

“I’ve had patients that have waited up to seven days in an emergency room for an inpatient psychiatric placement and I think our ER colleagues have really seen this as a crisis within their emergency rooms,” Medina said.

A report from the Centers for Disease Control and Prevention noted that mental health-related emergency department visits among children increased starting in April and remained high through October. Compared with 2019, the proportion of visits related to mental health for children aged 5 to 11 and 12 to 17 years old increased by about 24% and 31%, respectively.

While the increase in emergency visits for children’s mental health could be inflated because of the substantial decrease in overall emergency visits during the same time period in the pandemic, the CDC said its findings help provide initial insight into children’s mental health during the pandemic.

The Massachusetts Board of Elementary and Secondary Education on Tuesday voted to increase the amount of face time students have with teachers after hearing from a panel of doctors and child advocates about the worsening mental health of school-aged children.

Suicide is a leading cause of death among children and has been increasing in recent years. Historically, most suicide victims in Massachusetts are between the ages of 18 and 24. But state health officials report that suicidality among children in middle school is increasing.

There’s a shortage of inpatient programs for young people struggling with depression, suicidal thoughts and eating disorders, Nazarian said. Many programs have moved to telehealth, and while that works for some teenagers, it is not the best format for every patient.

“There’s always been a shortage and issues with access for inpatient, but now it’s much more critical and so they’re having to be inpatient on regular medical floors which is obviously not an ideal place for them,” Nazarian said.

Remote learning is difficult for students who have ADHD. Medina said that from Oct. 1 to Dec. 11, he saw about 50 patients whose ADHD worsened.

Online learning has also proven difficult for students who typically receive physical therapy, occupational therapy or other hands-on needs during school days.

“I give kudos to the special education teachers and the therapists who are trying to do this over video and trying to be very creative, but there are some things that you just can’t do [on video],” Nazarian said.

Medina has reported seeing a rise in teenager substance use. Sales of substances have continued through the pandemic and children are spending more time at home, leading to more access.

“Now more and more of them are trying to treat underlying mental health conditions, have that increased access and more free time,” Medina said. Some teens aren’t gathering in person but are connecting on social media and using substances together, the doctor said.

When students can gather in school with safety protocols like mask-wearing, social distancing and hand hygiene, they can learn and socialize, the physicians said. Without a safe way to socialize, young people may be more tempted to gather in unsafe ways, Medina said.

The doctors are also seeing more children who are overweight, as school was the only source of physical activity for many children.

Routines and set schedules can help students. It’s hard to limit screen time during remote learning, but putting phones and laptops away before bed can help, Medina said. Children should go to sleep and wake up at the same each day and shower and get dressed before online classes.

Though it may sound simple, Nazarian said, it is crucial.

Families and students should also utilize resources like school nurses, school physicians and school adjustment counselors as mental health needs arise.

Medina and Nazarian worry about the long-term health impacts these issues will have but hope children will be able to bounce back when school and routines become more normal.

“Kids are remarkable in how resilient they can be,” Nazarian said.

If you are struggling with suicidal thoughts and feelings, help is available.

  • Any parent struggling with the emotional hardships of raising a family is encouraged to call the Parent Stress Line at 1-800-632-8188.
  • Help is also available through the National Suicide Prevention Lifeline by calling 800-273-TALK (8255); military veterans and their loved ones should press “1” for the Veterans Crisis Line.
  • The Trevor Lifeline is available to help lesbian, gay, bisexual, and transgender youth and young adults at 866-4-U-TREVOR (488-7386).
  • Samaritans Statewide Hotline 877-870-HOPE (4673).

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