The impact of COVID-19 on emotional, social, and behavioral health in adolescents with preexisting mental health concerns: A qualitative study

Objective: The COVID-19 pandemic has caused a decline in well-being for many adolescents. However, the impact of COVID-19 on mental health outcomes among adolescents remains understudied. The current study qualitatively examined the impact of COVID-19 restrictions on adolescents with mental health concerns prior to the pandemic. Methods: We enrolled 20 adolescents who were engaged in care through an Adolescent Health Specialty Clinic prior to COVID-19. Participants were 12- to 19 years old who experienced mental health concerns prior to COVID-19 and experienced declining mental health (e.g., new mental health diagnosis or increased severity of previous mental health diagnosis reported during clinical visit or documented in medical chart) during the pandemic. In-depth interviews were conducted, and inductive coding was applied to transcripts to identify emergent themes. Results: Five key themes were identified: manifestations of declining mental health, loss of motivation, changes to social relationships, use of social media, and coping mechanisms. Adverse mental health outcomes were provoked by experiences of loneliness and social isolation, especially due to school closures which disrupted routines, access to educational and social support, and key cultural milestones. The increased uses of social media and illicit substances were notable coping strategies. Conclusions: Findings from this study strengthen our understanding of the key factors influencing the psychosocial well-being of adolescents during the pandemic. Our results may help inform researchers, clinicians, and policymakers to develop guidelines and community-based strategies for mitigating the potentially negative effects of future pandemic-related disruptions to mental health among adolescents. (PsycInfo Database Record (c) 2023 APA, all rights reserved) Impact Statement The current study examined the impact of COVID-19 restrictions on adolescents with mental health concerns prior to the pandemic. Results emphasize the importance of obtaining first-hand perspectives from adolescents to optimize their care. Providers should prioritize mental health and substance use screening given the impact of the pandemic. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Association Between Co-Occurring Anxiety and Depression With Drug Overdose Encounters in the Emergency Department Among Adolescents and Young Adults in the Era of COVID-19.

PURPOSE: COVID-19 risk mitigation efforts could have negatively impacted anxiety, depression, and substance use among adolescents and young adults. METHODS: We analyzed 45,223 emergency department visits from April 2018 to March 2022 of patients aged 12-21 in Pinellas County, Florida. RESULTS: Frequency of overdose, anxiety, and depression significantly increased from the pre-COVID-19 to the COVID-19 period. Anxiety (adjusted odds ratio: 1.49, 95% confidence interval: 1.11, 1.98) and depression (adjusted odds ratio: 2.89, 95% confidence interval: 2.15, 3.88) were associated with significantly higher odds of overdose during COVID-19. DISCUSSION: Mental health and overdose among adolescents and young adults worsened during COVID-19, necessitating greater screening and treatment in primary care.

COVID-19 Vaccine Hesitancy and Vaccination Status in a Community-Based Cohort of People Who Inject Drugs in Baltimore, Maryland, March-June 2021.

OBJECTIVE: People who inject drugs are a population who are often unengaged with health care services. The objective of this study was to characterize COVID-19 vaccine hesitancy and uptake in a community-based sample of people who inject drugs in Baltimore, Maryland. METHODS: The ALIVE study (AIDS Linked to the IntraVenous Experience) in Baltimore is a community-based cohort study of people with a history of injection drug use. From March 2 through June 28, 2021, 346 ALIVE participants completed a survey on substance use, structural determinants of health, and COVID-19 vaccine hesitancy. The exposure of interest was COVID-19 vaccine hesitancy, and the primary outcome was vaccination status as of June 30, 2021. We extracted data on the dates of vaccination from electronic medical records linked to study participants. RESULTS: The median age of the sample was 60 years; most participants were male (66%) and non-Hispanic Black (87%). Most (55%) trusted the COVID-19 vaccine, and 68% had received ≥1 dose. After age standardization, survey participants were more likely than the Maryland general population to be unvaccinated (prevalence ratio = 1.20; 95% CI, 0.97-1.49; P = .10). Participants who somewhat trusted or did not trust the COVID-19 vaccine had 6-fold higher odds of being unvaccinated than participants who trusted the vaccine (odds ratio = 6.30; 95% CI, 3.74-10.60). CONCLUSION: Uptake of COVID-19 vaccine among people with a history of injection drug use was high. Attitudes and knowledge about vaccination were important predictors of vaccine uptake. Education and outreach efforts could be effective in reducing hesitancy and increasing vaccination in substance-using populations.