Children who returned to in-person schooling during the coronavirus pandemic saw improvements in their mental health, according to a new study that found school reopenings were associated with significant declines in diagnoses of anxiety, depression and other conditions.
The findings, the study authors say, underscore that the social structure and support schools provide protected children’s mental well-being during the pandemic.
Researchers from the Harvard T.H. Chan School of Public Health and Elevance Health, which is a private health insurer in California, analyzed medical claims for more than 185,000 California children ages 5 to 18 between March 2020 to June 2021. Before schools reopened about 5,200 children had a mental health diagnosis and that numbers rose to 6,500 over the course of the pandemic.
But the researchers said after schools reopened, trends in mental health diagnoses, medications and spending dropped relative to trends in schools that stayed closed.
Children’s probability of being diagnosed with a mental health condition was reduced by 43 percent nine months after school reopening compared with pre-reopening levels, the study said.
They also saw that spending on mental health care, such as psychiatric drugs, ADHD drugs and other costs, decreased by 5 to 11 percent by the ninth month after a school reopened.
While other research has emerged highlighting the mental health toll that many children have faced because of social isolation, Rita Hamad, senior author on the paper and professor of social epidemiology and public policy at the Harvard T.H. Chan School of Public Health said this paper furthers the conversation into why the United States is seeing a worsening mental health crisis among children and teenagers.
She said that schools provide more than academics, they are a critical source of socialization, routine, mental health support, nursing care and for many low-income children reliable access to food.
“When kids are more depressed, more anxious, or struggling with ADHD, they are not going to be able to focus at school,” said Hamad. “Mental health and learning outcomes are closely connected.”
The sample in the study population was split relatively evenly between boys and girls, and girls appeared to benefit more from the reopenings. The group analyzed, however, was limited in the population it represented, as most of the children were from high-income Zip codes. Race and ethnic background were not accounted for in the dataset.
Hamad said the broader decline in youth mental health during the pandemic — much of it occurring while schools were closed — may also help explain why researchers have documented poor outcomes in academic performance, particularly among older girls.
In January federal data on student achievement found that children are still suffering academically according to the National Assessment of Educational Progress. It identified one of the culprits: chronic absenteeism.
Many mental health experts say the crisis among children and teens did not begin with the pandemic. Rates of anxiety, depression and suicide risk have been steadily rising for the past decade and this likely coincides with the mass adoption of smartphones and the rapid expansion of social media.
In 2021 the U.S. Surgeon General Vivek H. Murthy wrote in a 53-page advisory regarding an already fraught youth mental health crisis — he highlighted how the pandemic made it even worse.
Screen time is among the factors experts believe have contributed to those long-term trends. Researchers have linked increased screen time to disrupted sleep, social comparison, cyberbullying and reduced in-person connection, all of which are associated with poorer mental health.
So when the pandemic closed schools, it pushed more social and academic life onto screens. Many young people were already struggling, leaving them especially vulnerable to the prolonged isolation and digital immersion that would become their life for the next few years, according to Allison Kranich a professional counselor at Northwestern Medicine McHenry Hospital who was not involved in the Harvard research.
Kranich’s work is focused on teens and social media and said learning to interact with people with nonverbal cues is incredibly valuable, but highlights that during the height of the pandemic policymakers and families were making decisions with limited information.
“We were trying to mitigate risk in real time without knowing how severe the long-term consequences of covid would be,” Kranich said. “But as the pandemic wore on it became clear that the prolonged isolation required to control the infection carried mental health costs for children and teens.”
In 2020 congressional leaders designated roughly $4.25 billion for mental health and substance use disorders as part of $900 billion stimulus package.
But earlier this year Elon Musk’s DOGE cutmany programs designed to combat the ongoing youth mental health crisis, including federal funding for school-based counseling, community mental health clinics for adolescents, suicide-prevention initiatives and research tracking depression, anxiety and behavioral disorders in young people.
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