Teens and a pandemic: mental health warning signs

Canceled graduation ceremonies. Drive-by birthday celebrations. High school classes conducted online. The COVID-19 pandemic has changed daily life for all of us, but for teenagers, this “new normal” poses unique challenges—and in some cases, mental health risks.

Terri A. Erbacher, PhD, a clinical associate professor at the Philadelphia College of Osteopathic Medicine, and Tyree Winters, DO, an osteopathic pediatrician in Morristown, New Jersey, explain how parents and caregivers can help young people navigate this difficult time, and how to recognize the warning signs of mental health issues in teens.

COVID-19’s impact on teens

Restrictions on school, work, extracurricular activities, and socializing are especially hard for teenagers, Dr. Erbacher says.

We are all social creatures, but teens thrive on social connection—that’s what they need the most.

And with COVID-19, that’s no longer possible in the same way, Dr. Erbacher says.

It’s also important to keep in mind that teachers, coaches, and other adults who might ordinarily notice a change in your teen’s behavior are no longer interacting with them in person, so family members may be the only ones able to spot the warning signs of mental health issues.

Red flags to watch for

Behaviors such as sleeping much more or less than usual, gaining or losing weight, having significant mood swings, or displaying out-of-character emotions such as apathy, agitation, or anger can be warning signs of mental health problems. Teens may also cope with stress by using substances such as alcohol or cannabis if they are able to find them at home, Dr. Winters notes—a red flag.

In addition to watching for in-person behavior changes, parents should also monitor teens’ social media presence, Dr. Erbacher says.

“Are teens posting dark things, saying they feel alone, hopeless, or like things will never be the same again?” she says. “Are they having positive interactions with their friends, like “I miss you!” or are their conversations indicative of mental health concerns?”

Starting the conversation

“The most important thing parents and caregivers can do is to create a safe space where teens can talk to you freely and openly about their fears and hopes,” Dr. Winters says. “Because we’re all in close proximity now, it’s a great time to develop that relationship.”

If you are concerned about your teen, Dr. Erbacher suggests starting the conversation with an observation about their behavior: “I’ve noticed you’ve really been having trouble waking up in the morning, and that’s not typical for you. Are you feeling depressed or anxious?”

If your teen is feeling down, parents should be direct about asking follow-up questions.

“You might say, ‘Some people feel hopeless right now or like they just don’t want to be here anymore. Are you feeling anything like that?’” Dr. Erbacher says. “You have to let teens know you won’t be judgmental about what they tell you, even if it’s hard for you to hear.”

While some parents and caregivers may be reluctant to ask directly about suicide, Dr. Erbacher says it’s essential to do so if you are concerned.

“The biggest and most dangerous myth I encounter is that by asking teens about thoughts of self-harm, we will give them the idea of harming themselves,” she says. “Actually, research has shown that the opposite is true—asking about these tough topics can be a lifeline that lets teens know it’s ok to come to us with these emotions.”

Getting help

The first step for concerned parents is to connect teens with mental health professionals who can assess their risk. “Families can always reach out to their primary care physician, which I implore you to do,” says Dr. Winters. “Even if you’re not able to come into the clinic, you can do a telephone visit so you can get your child, and yourself if need be, some counseling services.”

Your school district may also be able to provide assistance through a school counselor or psychologist. In the event of an emergency situation, hospital emergency departments or mental health crisis centers can provide care.

If your teen has previously been treated by a therapist or psychiatrist, it may be a good idea to schedule a check-in visit, Dr. Winters notes. “Even if you don’t see any behavior that’s blatantly concerning, your teen might be having sentinel symptoms that, if caught early, could prevent a major recurrence from happening,” he explains.