By Iris Smith
While there is no comprehensive surveillance system to track children’s mental health and indicators of mental health vary across federal data collection systems, the available data indicate that mental health issues among children are a serious public health concern affecting all sociodemographic groups. A review of 9 national data systems that include indicators of children’s mental health from 2013-2019 found that data on Asian, American Indian/Alaskan Native, Pacific Islanders, immigrant and refugee children was especially limited.1 The review also found an association between the lack of economic resources and disparities in mental health indicators, with children living in households with the lowest income level having the highest prevalence of mental health problems. Data from the Medical Expenditure Panel Survey, a nationally representative survey of health care utilization, insurance coverage, health status and healthcare payment source of noninstitutionalized households in the U.S., found persistent disparities in access to mental health services and expenditures for outpatient care from 2010-2017, despite policy reforms. Rates of unmet mental health needs varied by geographic region and were highest in 12 southern and midwestern states. Disparities in access between Black and White children worsened over time.2
There is increasing evidence that the COVID-19 pandemic has contributed to an increase in emotional distress, suicide, and substance abuse among all population groups. A cross sectional study of 190 million emergency department (ED) admissions found that visit rates for mental health conditions, suicide attempts, all drug and opioid overdoses, intimate partner violence, and child abuse/neglect increased during the pandemic (March-October 2020) compared to visits during the same period the previous year.3 Results of the 2021 Adolescent Experiences and Behaviors Survey (AEBS)4 administered by the Centers for Disease Control and Prevention indicated that approximately 1 in 3 high school students experienced poor mental health “most of the time” or “always” during the pandemic and during the past 30 days and that 18.9% of students had seriously considered attempting suicide and 9% had attempted suicide during the 12 months preceding the survey.5 Despite research on the prevalence of mental health issues in children, research on protective factors and resilience is limited. Natural disasters such as fires, floods, and storms can lead to lasting trauma in children and are becoming more frequent. Social supports, positive relationships, a sense of “agency” and confidence in a better future are some of the factors associated with resilience.6 The 2021 ABES (Jones et al., 2021) study found that “connectedness” to individuals at school physically or virtually appeared to lower the risk for mental health problems during the COVID-19 pandemic.5 The recent increase in mental health problems among children and adolescents illuminates the need to better understand and promote mechanisms that foster resilience in the face of traumatic environmental events such as pandemics, natural disasters, and mass shootings.
Centers for Disease Control and Prevention (2022). Mental Health Surveillance Among Children, 2013-2019. MMWR February 25, 2022, Supplement 71(2). https://www.cdc.gov/mmwr/volumes/71/su/su7102a1.htm
National Academies of Sciences, Engineering, and Medicine. 2021. Mental health and substance use disorders in the era of COVID-19: The impact of the pandemic on communities of color: Proceedings of a workshop—in brief. Washington, DC: The National Academies Press. https://www.nationalacademies.org/our-work/mental-health-and-substance-use-disorders-in-the-era-of-covid-19-exploring-the-impact-of-the-pandemic-on-communities-of-color-a-workshop
Oh DL, Jerman P, Boparai PB, Koita Kadiatou, Briner, Bucci M& Harris NB (2018). Review of Tools for Measuring Exposure to Adversity in Children and Adolescents. Journal of Pediatric Health Care, 32 (6); pg.564-583. https://www.jpedhc.org/article/S0891-5245(18)30134-2/fulltext
Peitz D, Kersjes C, Thom J, Hoelling H, Mauz E (2021). Indicators for Public Mental Health: A Scoping Review. Frontiers in Public Health (9). https://www.frontiersin.org/articles/10.3389/fpubh.2021.714497/full
Rico A, Brener ND, Thornton J, Mpofu JJ, Harris WA, Roberts AM, Chyen D, KG, Whittle L, Leon-Nguyen M, MPH1; Lim C, Saba1 A, Bryan LN, Smith-Grant J, Underwood JM (2022). Overview and Methodology of the Adolescent Behaviors and Experiences Survey – United States, January-June 2021. MMWR 71(3); US Department of Health and Human Services/Centers for Disease Control and Prevention. https://www.cdc.gov/mmwr/volumes/71/su/su7103a1.htm
1 Centers for Disease Control and Prevention (2022). Mental Health Surveillance Among Children, 2013-2019. MMWR February 25, 2022, Supplement 71(2).
2 Rodgers, CR, Flores MW, Bassey O, Augenblick JM, Le Cook B (2022). Racial/Ethnic Disparity Trends in Children’s Mental Health Care Access and Expenditures From 20210-2017: Disparities Remain Despite Sweeping Policy Reform. Journal of the American Academy of Child and Adolescent Psychiatry; 61(7), pg. 915-925.
3 Holland KM, Jones C, Vivolo-Kantor AM, Idaikkadar N, wald M, Hoots B, Yard E, D’Inverno A, Swedo E, Chen MS, Petrosky, Board A, Martinez P, Stone DM, Law R, Coletta MA, Adjenian J, Thomas C, Puddy RW, Peacock G, Dowling NF, Houry D. (2021) Trends in US Emergency Department Visits for Mental Health, Overdose, and violence Outcomes Before and During the COVID-19 Pandemic. JAMA Psychiatry 78(4); pg. 372-379.
4 ABES, is a survey of a nationally representative sample of public and private school students in grades 9-12 residing in the 50 U.S. states and the District of Columbia, administered by the Centers for Disease Control and Prevention. The survey results are based on responses from 7,705 students.
5 Jones SE, Ethier KA, Hertz M, et al. Mental Health, Suicidality, and Connectedness Among High School Students During the COVID-19 Pandemic — Adolescent Behaviors and Experiences Survey, United States, January–June 2021. MMWR Suppl 2022;71(Suppl-3):16–21. DOI: http://dx.doi.org/10.15585/mmwr.su7103a3external icon.
6 Mesman E, Vreeker A, & Hillegers M (2021). Resilience and Mental Health in Children and Adolescents: An Update of the Recent Literature and Future directions. Online access: www.co-psychiatry.com; Volume 34 (6), pg. 586-592.
