Teens in crisis: How the pandemic has pummelled adolescent mental health

The winter lockdown delayed the end of a wellbeing programme for adolescents and children, pioneered by Stellenbosch University psychology lecturer Bronwyne Coetzee, at a school near the campus.

“But they came back after the eight-week break for the final session still doing the breathing exercises and the ‘Stop’ and ‘Go’ thoughts that we had practised,” she says, happy that her pupils have adopted these habits to protect their mental health.

Not since the school uprisings of 1976 and boycotts into the ’80s have SA’s high school pupils been as vulnerable as they are right now. Reflecting on the “lost generation of the pandemic”, Wits University psychology professor Malose Langa says: “The pandemic is having a huge impact on adolescents, who are often forgotten. We may not see the trauma yet, but it is dire.

“Young people define who they are through social relationships and then, suddenly, Covid happens, and they have to isolate.” This is a concern common among therapists who work with teens. Covid-19 restrictions have throttled a vital stage of adolescence — becoming independent and defining one’s identity through social interactions — which is needed to develop social cognition.

Wits professor and a Wellcome Trust Fellow at the Centre of Excellence in Human Development Tamsen Rochat says: “One of the biggest influences on healthy development of the teen brain are social exposures.

Those social exposures are equally, if not more, important than educational ones when it comes to teens learning about their own and others’ emotions and being able to see others’ perspectives.” The pandemic fallout is immense for teens. Some have adapted to successive waves of infections and lockdowns with harmful behaviours, like an overdependence on screens — though some have thrived away from the distractions and competition of a classroom.

The broad picture, however, is bleak. Mark de la Rey, a clinical psychologist at the Akeso Kenilworth Adolescents/ Young Adults mental health clinic in Cape Town, says: “We have observed that young people are starting to develop panic attacks, with no immediate stressor jumping out as the cause. “Unfortunately, we have seen a spike in self-harm as a form of coping, not just cutting, but punching walls, substance use [including an explosion in use of the sedative Xanax] and suicidal gestures.”

Adolescents from across Cape Town — the suburbs, Cape Flats and Khayelitsha — with hospital plans are admitted to this in-patient clinic and have similar mental health challenges overall — but, says De la Rey, “some of them are also struggling with the loss of a family member, jobs that were lost and shortages of food”.

We have observed that young people are starting to develop panic attacks, with no immediate stressor jumping out as the cause

—  Mark de la Rey, a clinical psychologist

The pandemic has trigged a “massive spike” in anxiety and depression among adolescents, which seems to be getting worse as the pandemic goes on, he says. This is on top of a steady increase in anxiety disorders over the past five years.

Six months into Covid-19, University of Cape Town (UCT) researchers found that 72% of 11,700 participants in a study showed signs of depression. “This is high and worrisome when compared to mental health results among youth gathered outside of the Covid-19 context,” says the study, led by Gibson Mudiriza and Ariane de Lannoy from the UCT school of economics. Clinical psychologist Cathy Fisher, who is based at a psychiatric day hospital, the Day Clinic in Johannesburg, describes what this looks like among the adolescents coming to its in-patient programme.

“They are presenting with panic attacks, eating disorders, anxiety and depression, and the sense of isolation and loss is big: not being able to see friends and classmates at school, do sport or extramurals,” says Fisher, an expert in adolescent care. “The onset of their symptoms has coincided with or been accelerated by the tight lockdown and pandemic, or this has exacerbated them,” she says.

A 2020 survey by the South African Depression and Anxiety Group (Sadag) found that two-thirds of more than 1,000 respondents across ages felt “stressed or very stressed” by the lockdown.

Sadag helplines were receiving more calls from people “feeling anxious, lonely, worried and depressed”. The stop-start nature of the lockdowns and their extensions, putting teens into and out of isolation, is particularly difficult for them. The pandemic feels even longer to teens than to Covid-fatigued adults, psychologists note.

“They are wondering: is this ever going to change?” De la Rey says, noting how much longer 18 months is in a teen’s life than in that of a 50-plus adult. Teachers have told him that some students returning to school after the initial lockdown were different, shifting from outgoing behaviour to becoming more guarded and distant from classmates.

“There are also unseen losses,” he says, highlighting the missing of milestones among students in grade 12, who have been building up to their final year. Younger adolescents are not exempt from the disruptions either, as Wits postdoctoral researcher Rachana Desai has discovered in the Beacon project. This involves research with 11- to 13-year-olds paired with one biological parent in Soweto.

A focus group interview with adolescents aged 11 and 13, and another with their parents, was conducted prior to the Covid-19 lockdown in 2019. During the lockdown, 200 adolescents and their parents completed a survey on their internet use. “Being able to access the internet has been a lifeline for them during Covid-19,” says Desai of the preliminary results. Adolescents commonly accessed smartphones and went online using prepaid data from their families.

“Prior to the pandemic, they relied most on WhatsApp to connect with friends, and still do,” she says. “Luckily some of them managed to maintain friendships via the internet and even to make new friends online. “Being able to establish and maintain friendships is a buffer against mental health challenges. A large number felt overwhelmed about Covid-19.” Online schooling was offered to about 60% of them, but only a quarter were able to use the internet to attend or watch recordings of school lessons or readings during lockdown.

“Some of the harmful patterns prior to the lockdown — like being exposed to sexual and harmful content and hurtful treatment online — remained consistent. They also reported being victims of cyberbullying,” says Desai. Overall, these findings are in line with international studies, such as the “Global Kids Online” report of 2018. SA had the highest rate — out of the nine countries where interviews were conducted among 9- to 17-year-olds — of being exposed to harmful sexual content.

The jump in suicide rates per month among adolescents in Japan during the second wave of Covid-19 (July-October 2020)

 - Source: Nature Human Behaviour, January 2021, 'Increase in suicide following an initial decline during the Covid-19 pandemic in Japan'

—  +49%

One 13-year-old told her in an interview: “Mem, there is this child, she was doing grade 8. She had many boyfriends … so this guy made a sex tape with her and it went viral, she was pregnant by then when people started finding out about that tape, and so she ended her life.”

Adults often feel ill-equipped to manage these risks and many parents reported feeling inadequate during the pandemic in meeting their children’s needs. Coetzee’s team conducted interviews with about 25 participants in their “Four Steps to Your Future” programme, including students, parents, teachers and mental health counsellors. “They have had a rough ride,” she says of the pupils, who have lost education and also meals through their school’s closures.

“Initially there was some excitement [at the first lockdown] because it coincided with the school holiday but over time this turned to frustration, and fears about illness and death.” Many adults get stressed about interrupted learning but academic achievement should not be the sole focus in trying to make up pandemic deficits, says Rochat.

“Online schools are burgeoning which tick the academic boxes, but they cannot provide what adolescents need from human interaction.“It doesn’t matter how much knowledge you are learning, it is critical to develop social and decision-making skills to be a success in life.”

The losses to teens developing into young adults during the pandemic are immeasurable. A recent report by the Children’s Institute flags quarantine and social isolation, the loss of loved ones, the “catastrophic” disruption of schooling, poverty, hunger and food insecurity among the stresses on children since Covid-19. Unisa psychology of education head professor Ramodungoane Tabane says: “Adolescents have been very hard hit … They are left to care for younger siblings [after parents pass on].

“The manner that Covid-19 spreads contributes to a heightened level of anxieties. The weekly funerals and recurring loss of significant others can lead to symptoms of depression as they contend with the death of family members, teachers and in some cases friends. Thus, they may become withdrawn, lose interest in previously pleasurable activities, have trouble concentrating, sleeping and have suicidal thoughts.

“The suddenness of Covid-19 deaths and their aftermath amplify the grief.” Says De la Rey: “For a lot of them, there is immediate loss. [The teen] will say: ‘I saw him on Friday go into hospital and on Monday he was gone.” The mourning process can be disrupted by the financial difficulties resulting from parents’ deaths, he adds. Shattered by trauma and isolation, adolescents find disappearing online even more attractive.

Langa, who does pro bono work at the Centre for the Study of Violence and Reconciliation and has his own practice, says: “This is their only escape, being glued to their phone, and it is a way to be with their peers. They live on social media.” The gains of being able to connect online — and nobody was better prepared for this than Generation Z — invariably come with risks, making this a double-edged sword for younger generations. Digital expert Dean McCoubrey, who founded MySocialLife to promote digital wellbeing, says mental health was “the no 1 module” chosen among 265 students they surveyed in November.

“They are constantly tuned into the buzzing online and not just social media,” he says.

“The point is that we are ‘consuming’, somewhat invisibly, and some of it is too much for our system to handle, like junk food.” Exercise has been known to significantly impact mental health outcomes, he says.

Face-to-face contact where teens learn to be flexible, read emotions, solve problems, make mistakes and test their boundaries with real-time consequences is critical to them and online connections are no substitute for this, says Rochat.

Adults should try to understand the biological developmental process of adolescents, who have been criticised as irresponsible and reckless in the time of Covid, she says. “In this phase of puberty, they are driven by changes in the body and the brain to take risks, try out new things and, very importantly, to be with their friends.

“The most significant thing is to try to maintain empathy for them and maintain good communication between parents and children.”

HOW PARENTS CAN HELP

• Know what your kids are using online (even if they are teens). Just check in and find out about their online life. And then look on Google and check out the app.  “Parent review + TikTok”,  for example. You don’t know what you’re dealing with if you don’t know what they’re consuming.
• Watch for significant changes in behaviour —  especially around the pressure of school (exams), news spikes (social unrest, for example) and also social group outbreaks. All of these they again consume. We need to know and be aware of the impact of that consumption. We need to watch.  Kids look confident and competent online, gaming and on social media, but there’s a lot more going on than we understand.
• Create real time to connect. It sounds obvious but the challenge is that we are rushed, sometimes overwhelmed and the adults are exercising poor self-control and self-regulation themselves. So how can kids who are experiencing difficulty reach out if 1) we can’t see;  2) we don’t know what that looks like in their world;  and 3) we aren’t providing alternatives to good health —  exercise, nature, connection and communication, laughter.

- Dean McCoubrey

• McCoubrey is the founder of MySocialLife, a digital wellbeing programme for schools