Position Statement No. 10: Implications of the COVID-19 pandemic for the mental health and education of children and adolescent

One group that is particularly vulnerable to the impact of COVID-19 is children and adolescents. Although they are less susceptible to the severe physical manifestation of the disease caused by the SARS-CoV-2 virus, the psychological and educational effects of the pandemic can be very serious for them, sometimes lasting much longer than the pandemic itself.

1. Possible psychological consequences of the COVID-19 outbreak for children and adolescents

Research suggests that young people are being particularly affected by the stress of the COVID-19 epidemic [1,2,3,4,5]. Contributing factors include the destabilization of family life, isolation from peers, the need to change habits, and loss of a safe routine [6]. Anxiety and uncertainty are also increased, due to intense exposure to negative information about the pandemic and its consequences. All this adds to the stress normally associated with the developmental changes natural to these stages of life, in both the biological, social and psychological spheres, including qualitative changes in ways of experiencing and thinking.

Research shows that the psychological condition of young people is particularly negatively affected by enforced confinement at home, which not only relegates them to partial inactivity and isolation from their peers, but often deprives them of the privacy and intimacy that is so necessary at developmental age [2,3,7]. Adolescents, especially those on the threshold of adulthood, may also be concerned about their poorer prospects for the future: the pandemic could thwart their dreams, aspirations, and hopes for success. In addition, with many parents and caregivers facing serious difficulties, young people may become victims of verbal, psychological, and physical abuse, experienced directly or indirectly [1]. The confinement of children and adolescents in their homes causes them to spend more time online.

While the Internet does allow them to learn, play, and stay connected with their peers, unsupervised use of the Internet promotes exposure to harmful content. With many of life’s activities moving online, peer-on-peer abuse is also following suit. A UNICEF paper points out that during the COVID-19 pandemic, an increasing number of young children are using a variety of online tools, including instant messaging and games. However, they have limited experience using the Internet and may be less resilient to adverse, including hurtful, behavior by others online. Parents and caregivers should remain alert to signs that suggest their charges may be experiencing online bullying. It is also important for them to make sure that the privacy settings on applications that children use (e.g. Facebook or Instagram) are set so as to make as little sensitive personal information publicly available as possible (date of birth, phone number, address, etc.). Keeping children and young people safe online is a huge challenge for many parents, caregivers and teachers, with respect to which they should have specialist advice and support.

The various forms of stress experienced by young people during a pandemic can lead to the onset or exacerbation of a range of mental illnesses, such as depression or psychotic disorders [1,4,7,8]. In some, it can lead to behavioral disorders such as suicide and self-harm, eating disorders, sleep disorders, or violence against others [3,8,9,10]. Experiencing direct or indirect acts of psychological and physical abuse at an early age can permanently impair the development of cognitive, emotional, and social skills. It also may facilitate the future development of psychosomatic and psychiatric disorders, addictions or suicidal thoughts [1].

2. Possible implications of the COVID-19 pandemic for the education of children and adolescents

The time of the pandemic and the related periodic school closures has clearly demonstrated the importance of universal schooling, not only in providing basic knowledge to young members of society, but also as an institution that fosters their proper development [11]. The system of distance-learning causes many children to experience mounting educational problems and increasingly fall behind. Available empirical research indicates that the first wave of the epidemic in spring 2020 already worsened the educational outcomes of the year-groups affected by school closures, and augmented the inequalities among schools and among students [12]. Based on research available even before the pandemic, in turn, we can attempt to estimate what the economic magnitude of the effects of these school interruptions and educational gaps might be. Exclusion from schooling equal to losing 1/3 of a school year leads on average to a 3% loss in future individual earnings over a lifetime [13]. Given the already observed disparities in the impact of school closures on student educational outcomes, the future earnings of pandemic-affected year-groups can be expected to be not only lower, but also characterized by wider inequalities.

Due to the global nature of the school interruptions, economic losses my occur not only on the individual level, but also on the whole-economy level. In the optimistic scenario, with irregularities in the functioning of the school system lasting in total only about half of a single school year, the attendant losses in the national economy may still amount to more than 1.5% of GDP (Gross Domestic Product) over the next several decades [13]. This is due to losses in the acquisition of cognitive skills by today’s children and adolescents, which may translate into decreased human capital in adulthood, including: poorer skills at learning and cooperation, lower creativity, independence and innovation. These are abilities that are crucial for the development of a modern knowledge-based economy.

A separate issue is posed by entering the workforce during a deep recession, which, according to available research, can have a long-term negative impact on the future earnings of today’s youth. The salaries of those entering the market in unfavorable conditions are from 3% to 8% lower, on average, than for those who enter the labor market in a period of prosperity, with the difference persisting for up to ten years [14,15,16]. Entering the labor market during a recession is also associated with such disadvantages as increased mortality in middle age, lower likelihood of marriage or partnership union, lower fertility rates, and higher likelihood of relationship breakdown [17]. Findings suggest that for children and adolescents, economic turmoil – even if perceived as temporary – can have a lasting and negative impact on their lives and health.

3. What can be done?

Providing psychological and psychiatric support to children, adolescents and parents

Given the varying responses to the pandemic threat, it will be necessary to develop individualized ways of providing help and support during the pandemic situation and several years afterwards. This requires appropriate identification and monitoring of the following by parents, teachers, and psychologists:

  • factors that augment COVID-19-related stress (e.g. exposure to infection, having family members infected, losing loved ones, undergoing quarantine);
  • side-effects of pandemic stress (e.g. economic losses, family breakups, changes in life plans);
  • psychosocial impacts (e.g. depression, anxiety, insomnia, substance abuse, domestic violence), and
  • indicators of vulnerability (e.g. pre-existing physical or psychological conditions that increase sensitivity to stress).

Support for child psychiatry is required. There also needs to be close collaboration between the medical community and researchers in the behavioral and social sciences. Children, adolescents and their parents should have ongoing access to specialist care that provides both psychological support and appropriate treatment.

The Polish community of psychologists and psychotherapists has taken several initiatives in this regard. For example, the Polish Psychological Society (PTP) publishes a list of its member psychologists who offer free psychological assistance to people who need support during the pandemic. Also, the association of psychologists and psychotherapists “Psychologists for Society” offers free telephone support during the pandemic. A government website also provides information about where to get help.

Promoting knowledge of ways of coping with stress in a pandemic

A key role in alleviating anxiety is played by talking about the pandemic (special guidelines have been developed in this regard [18]) and psychoeducation (providing information on how to live in times of a pandemic, or how to cope with stress). It is also important to promote knowledge about the importance of establishing and sticking to routines, engaging in physical activity, striving to ensure positive experiences and self-esteem. This is a task for parents and schools, but also for education specialists and psychologists. Also worth noting are such initiatives as the one prepared by the Institute of Psychology at the Jagiellonian University, offering a range of information for parents and teachers on how to cope with stress and tips on when, how, and where to seek help. A  recently published book entitled Człowiek w obliczu pandemii [People Facing a Pandemic] [19], for instance, seeks to provide teachers and parents with more information about the consequences of the pandemic for psychology and the human psyche.

Safe and efficient relaunch of school education

Given the already evident negative effects of school closures, they should not be the first countermeasure implemented in response to every surge in infection rates. If they are necessary, however, there should be a firm commitment to efficiently and safely reopening schools as soon as the epidemic situation permits. The strategy for this process should be based on the three pillars called for by our Advisory Team in Position Statement No. 2 of 19 August 2020 [20] and by education-economics experts in their open letter of 30 November 2020 [21]. These three pillars are: maintaining an appropriate sanitation regime, introducing hybrid teaching (e.g., splitting school classes and school weeks into onsite vs. offsite), and taking a regional approach to the introduced operational restrictions. This strategy should be supported by the National Immunization Program and a new testing strategy in line with our Advisory Team’s Position Statement No. 6 of 17 November 2020 [22].

In the long run, it will be necessary to reform school curricula, reducing nonessential information and emphasizing knowledge-acquisition skills. Curricula should also include basic knowledge about epidemiology, hygiene, disease prevention, and vaccination. It is moreover crucial to teach critical analysis of sources so that future generations will be able to distinguish science from pseudoscience and truth from falsehood. The scope of instruction in social skills such as cooperation and mutual solidarity should also be broadened.

About the team

The Interdisciplinary COVID-19 Advisory Team to the President of the Polish Academy of Sciences was set up on 30 June 2020. The team is chaired by Prof. Jerzy Duszyński, President of PAS, with Prof. Krzysztof Pyrć (Jagiellonian University) as deputy chair and Dr. Anna Plater-Zyberk (Polish Academy of Sciences) as its secretary.

Other members of the team are:

Dr. Aneta Afelt (University of Warsaw)

Prof. Małgorzata Kossowska (Jagiellonian University)

Prof. Radosław Owczuk, MD (Medical University of Gdańsk)

Dr. Anna Ochab-Marcinek (PAS Institute of Physical Chemistry)

Dr. Wojciech Paczos (PAS Institute of Economics, Cardiff University)

Dr. Magdalena Rosińska, MD (National Institute for Public Health – National Hygiene Institute, Warsaw)

Prof. Andrzej Rychard (PAS Institute of Philosophy and Sociology)

Dr. Tomasz Smiatacz, MD (Medical University of Gdańsk)

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[2] Singh, S., Roy, D., Sinha, K., Parveen, S., Sharma, G., & Joshi, G. (2020). Impact of COVID-19 and lockdown on mental health of children and adolescents: A narrative review with recommendations. Psychiatry Research, 293(August), 113429.

[3] Liu, J.J., Bao, Y., Huang, X., Shi, J., Lu, L., 2020. Mental health considerations for children quarantined because of COVID-19. Lancet. Child Adolesc. Health 4 (5),347–349. PubMed

[4] Shanahan, L., Steinhoff, A., Bechtiger, L., Murray, A. L., Nivette, A., Hepp, U., … Eisner, M. (2020). Emotional Distress in Young Adults during the COVID-19 Pandemic: Evidence of Risk and Resilience from a Longitudinal Cohort Study. Psychological Medicine.

[5] Glowacz, F., & Schmits, E. (2020). Psychological distress during the COVID-19 lockdown: The young adults most at risk. Psychiatry Research, 293(May), 113486.

[6] Lee, C., Cadigan, J., Rhew, I. (2020). Increases in Loneliness Among Young Adults During the COVID-19 Pandemic and Association With Increases in Mental Health Problems, Journal of Adolescent Health, 67, 5, 714-717.

[7] Liang L, Ren H, Cao R et al. The effect of COVID-19 on youth mental health. Psychiatry Q. 2020; 91: 841–852

[8] Jiao WY, Wang LN, Liu J, Fang SF, Jiao FY, Pettoello-Manto- vani M, Somekh E (2020) Behavioral and Emotional Disorders in Children during the COVID-19 Epidemic. J Pediatr 221(264– 266):e261

[9] Beam, C. R., & Kim, A. J. (2020). Psychological sequelae of social isolation and loneliness might be a larger problem in young adults than older adults. Psychological Trauma: Theory, Research, Practice, and Policy, 12(S1), S58-S60.

[10] Lee J (2020) Mental health effects of school closures during COVID-19. Lancet Child Adolesc Health.

[11] Dalton, L., Rapa, E., & Stein, A. (2020) . Protecting the psychological health of children through effective communication about COVID-19. TNE LANCET, VOLUME 4, ISSUE 5, P346-347. DOI.

[12] Maldonado, J. and De Witte, K. (2020). The effect of school closures on standardised student test (20.17; KU Leuven Discussion Paper Series). KU Leuven – Faculty of Economics and Business.

[13] Hanushek, E. A. and Woessmann, L. (2020). The economic impacts of learning losses (No. 225; OECD Education Working Papers). OECD Publishing.

[14] Wee, S.L. (2013) Born Under a Bad Sign: The Cost of Entering the Job Market During a Recession, Working Paper

[15] Andrews, D., Deutscher, N., Jonathan Hambur, J., and David Hansell, D. (2020), The career effects of labour market conditions at entry, OECD Productivity Working Papers, OECD Publishing, Paris 

[16] Philip Oreopoulos, P., von Wachter, T.M. and Heisz, A. (2012), The Short- and Long-Term Career Effects of Graduating in a Recession, American Economic Journal: Applied Economics, 4 (1): 1-29, DOI: 10.1257/app.4.1.1

[17] Schwandt, H. and Till M. von Wachter, T.M. (2020), Socioeconomic Decline and Death: Midlife Impacts of Graduating in a Recession, NBER Working Paper No. 26638

[18] Dalton, L., Rapa, E., & Stein, A. (2020) . Protecting the psychological health of children through effective communication about COVID-19. TNE LANCET, VOLUME 4, ISSUE 5, P346-347. DOI.

[19] Kossowska, M., Letki, N., Zaleśkiewicz, T. and Wichary, S. (2000) Człowiek w obliczu pandemii. Psychologiczne i społeczne uwarunkowanie zachowań w warunkach kryzysu zdrowotnego [People Facing a Pandemic: The Psychological and Social Circumstances of Behavior During a Health Crisis], Wydawnictwo Smak Słowa

[20]  COVID-19 Advisory Team to the President of the Polish Academy of Sciences, Position Statement No. 2: On students returning to school in September 2020

[21] COVID-19 Advisory Team to the President of the Polish Academy of Sciences, Position Statement No. 6: On the need to change the testing strategy

[22] Zajęcia przez internet nie zastąpią nauki w szkole [Online Classes Cannot Replace Learning at School], Rzeczpospolita, 30.11.2020