Anxiety depression in children are on the rise What can we do to help them if Covid restrictions return

With the Covid Delta variant spreading across the globe, the concept of ‘pandemic fatigue’ is back in the headlines. One by one, countries are bringing back restrictions that everybody hoped were lifted forever. According to the World Health Organization, pandemic fatigue is “an expected and natural response to a prolonged public health crisis” not just related to the virus itself, but to the “invasive measures with unprecedented impacts on the daily lives of everyone.” In this context, reimposed restrictive measures would not be “unprecedented,” but would this make them less harmful? Only if we draw conclusions from our recent experience, psychologists suggest, and prepare ourselves and our loved ones for the difficulties to come.

It’s clear that children are among those more exposed to the psychological effect of Covid and all the related restrictions. “Anxiety, sleeping disorders, problems with planning things, with adapting the mind to different conditions – these are the symptoms that emerged earlier as a reaction to the shocking situation, and are still present,” Professor Rocio Lavigne Cervan from the Department of Evolutionary Psychology and Education at University of Malaga in Spain, told RT. “All these factors together are harming children’s daily routine, learning process, social and family life.”

Prof. Lavigne participated in a study aimed at analyzing how confinement impacted on Spanish children’s psychological stability. And the results were extremely worrying. Out of 1,028 participants aged from six to 18, 66.9% of children and 67.9% of adolescents showed medium to high levels of anxiety.

The problem here is not just a temporary one, experts warn. If not addressed properly, it may last for a long time – possibly even forever. Professor Francesco Benedetti, group leader of the Research Unit in Psychiatry and Clinical Psychobiology at San Raffaele Hospital in Milan, Italy, explained, “In some cases, anxious reactions are expected to vanish when life returns to its normal course. But unfortunately, the traumatic events experienced in early ages may trigger psychiatric disorders.”

In the age when many important relationships develop for the first time, being forcibly separated from their peers, facing a major social-life disruption, being forced to live in a confined environment – all these factors should be considered a major trauma.

“Given my personal history of psychiatric research, I also have to point to disregarded biological effects of home seclusion: circadian (sleep-wake cycle) rhythms disruption via reducing the exposure to synchronizers (daylight and darkness, plus physical exercise in the open air), and also exposure to increased light pollution from computer monitors and other electronic devices,” the professor added. “All together played a major role in the reported increase of insomnia and use of tranquilizers – plus, we know that disrupting internal timing has a major effect in triggering mood disorders.”

When exposed to these unprecedented conditions, children need support from adults – in the majority of cases, their parents. But the pandemic lockdowns were a shock for everyone, so not all of them could give their kids a helping hand. “A psychologist may try to give parents certain tools to improve their family relations, but if the adults themselves show symptoms of anxiety or other problems, they won’t be able to help their children,” said Prof. Lavigne. “The families where both children and parents have problems require help, because the adults’ problems will be reflected in their children. Parents with problems don’t have enough tolerance, patience, and don’t have the ability to help their children to face everyday problems.”

So, there’s a need to go to a psychologist not only when a problem has already emerged, but when it’s still possible to prevent it from happening. I think it would be healthier for everybody.

Psychology Professor from the University of Malaga, Almudena Gimenez de la Pena, says that parents’ help was especially crucial for small children. “Kids younger than 12 were affected harder, as they needed more attention,” she told RT. But surprisingly, some older kids turned the difficulties into a tool for development. “They showed very good abilities to search information online and resolve their problems on their own,” Prof. Gimenez continued. “Parents complained that their children couldn’t communicate enough with their friends. But actually, it was a problem for kids under 12, while those older switched to their gadgets for online communication. A lot of people even complained that children came too deep into the virtual world.”

The same ‘technological skills’ became very useful when learning from home turned into an everyday routine. “Children older than 14 started to solve their problems on their own. If there was something that teachers were unable to explain, they searched for answers on the internet,” Prof. Gimenez said.

According to UNICEF, schools for more than 168 million children globally have been completely closed for almost an entire year due to lockdowns. Prof. Gimenez, together with a team of international specialists, completed a study analyzing the problems of families during this tough period. Researchers surveyed people from seven European countries, and realized that the problems were relatively common for all families affected.

“The first problem was lack of information. Parents have been complaining that they didn’t know what to do and how to help their children in studying,” Prof. Gimenez told RT. “Second, some education for parents was needed as well, to show them how to use school materials, as well as new technology. And then there’s the third problem – access to gadgets. Small children don’t have their own computers. Also, not every child had the chance to freely use a computer at home, as during the lockdown parents also had to work from home.”

Also, according to the study, negative experiences were more common in families with a child with a mental health condition. “There’s a huge difference between the families that have a member with certain types of special needs, and those who don’t. Families with no members with special needs had fewer problems; generally they complained about technical stuff or lack of information. But the families who have someone with disorders or special needs were damaged a lot,” Prof. Gimenez explained. “They didn’t get the help they were used to.”

Before the pandemic children attended special lessons helping them with math, reading, or other subjects they had problems with. Almost all of this support was lost.

At the same time, Prof. Gimenez realized that children with adaptation problems felt much better during homeschooling. “They could adjust the education to their personal rhythm and they had their parents closer,” she said.

Still, as Prof. Lavigne noted, the end of the lockdown didn’t bring an end to the problems. “A lot of issues started after the lockdown – the need to isolate at home after having contacted someone Covid-positive, no chance to organize family gatherings, no possibility to meet friends as was possible before. Or, for example, in case of a sudden confinement of a town, children who play sports having to cancel their games in the places nearby. It’s all a bit chaotic. And it all causes damage even worse than the lockdown itself did.”

One of the concerning side effects of Covid-related depression was a significant rise in the prescription of medication, to both adults and young people. In Spain, almost 6% of the population were treated with anxiolytics (drugs against anxiety) or antidepressants. Italy observed a 12% rise in the purchase of anxiolytics in 2020.

According to recent research based on NHS data, the number of patients younger than 17 who were prescribed antidepressants increased by 26% between April 2015 and April 2020. The peak was observed in March 2020, when the UK went into its first lockdown. Numbers showed two further peaks of antidepressant prescriptions seen around the time of the second and third lockdowns, in December 2020 and January 2021.

“A lot of studies show that commonly prescribed psychotropic drugs can have unpredictable effects on children and adolescents, followed by paradoxical worsening of the most dangerous psychopathological symptoms,” Prof. Benedetti warned. “These drugs have been thoroughly tested for safety in adults, but their effects on the developing brain are different. Commonly prescribed antidepressants can worsen suicidal ideation and trigger self-harming and suicide attempts.”

There is no doubt that psychotropics should be prescribed to young people only upon a real need, and carefully monitored for their potential behavioral side effects.

“The possible efficacy of psychotherapeutic interventions should always be considered first, and anyway, psychotherapy should always be combined with drugs, even when they are necessary.”

Prof. Lavigne agreed, “Antidepressants are not a solution. Well, when a doctor is prescribing a medicine, that’s because it is needed. But it won’t help on its own. Only combined therapy, when the drug is taken together with psychotherapy, will have an effect.”

Even when prescribed, the medicine should be taken with caution, as Prof. Benedetti explains. He said, “Some patients develop tolerance to the effects of drugs, which lose efficacy over time leading to the need of increasing dosage to obtain the same effects. This is particularly evident for benzodiazepine tranquilizers. Population research completed soon before the Covid pandemic showed that a substantial proportion of children and adolescents continued benzodiazepine treatment for six months or longer, despite recommendations calling for short-term treatment. There is no doubt that initiating these treatments should be a decision carefully weighed against other options.”

Despite all the anxiety adults are experiencing themselves, experts warn that now is the time to help their children, before it is too late. “It’s crucial to prevent the current problems from turning into chronic ones,” Prof. Lavigne stressed.

According to Prof. Benedetti, the methods of treatment shouldn’t be too complicated. “It is needed, as soon as possible, to exploit the natural healing power of our body. Children have to use any possible occasion to stay out in the light, play and exercise their muscles, socialize with their friends,” he told RT. “Problems in the rhythms of sleep and activities can be managed with chronotherapeutic interventions – light therapy in the morning, with physical exercise; darkness and rest in the evening – and also avoiding pollution by the blue components of the light spectrum coming out from computer monitors and other electronic devices, which can disrupt sleep and circadian rhythms.”

These simple methods can be more effective than drugs in fostering a normal activity-rest rhythm, and in restoring sleeping, which has been disrupted by the lack of exposure to the normal circadian synchronizers, and by the excessive exposure to artificial light.

And, certainly, moral support may help the healing better than any drug. “Many children and adolescents now face anxious reactions when coming out from their homes: This should not immediately be diagnosed as a mental disturbance and medicated,” Prof. Benedetti insisted. “Facing anxiety, and letting it flood, together with the support of a loved one who can encourage without judging, are expected to be followed by habituation and lead to the restoring of the normal rhythms of life in the large majority of cases.”

“Family matters a lot,” Prof. Gimenez agreed. “Children can cope with restrictions if their parents are available to help. But the children from families with problems suffered a lot.”

Those who had strong family ties reinforced them even more.

“We don’t know how long the pandemic will last,” admitted Prof. Lavigne. “This feeling of uncertainty is developing anxiety in both children and their parents.”

Still, even the dark times may have a silver lining. “Spanish and Italian parents – as these countries are traditionally more family-oriented – even said they got benefits from the lockdown,” said Prof. Gimenez. “They could spend more time with their children, to play with them or to cook together.”

And now we find ourselves potentially back to square one. What if the worst forecast becomes reality, and lockdowns – together with homeschooling – return in the near future? “In case of the lockdown, we would have to structure our life to make it look as ordinary as possible,” Prof. Lavigne said. “Children will have to do physical exercises at home and follow the schedule – when to wake up, to eat, everything by plan. Now, we are all a bit more connected than before, virtual activities do work, and we have more tools to use them.

“The advantage we have now is the knowledge that online systems do work,” she concluded. “Life can go on, but in a more virtual way. Those who need therapy may get it online. A lot of centers cancelled therapy during the lockdown and had to close. But others tried to provide therapy online and proved the effectiveness.”

“We learned something from the lockdown,” Prof Gimenez agreed. “But we can’t change everything. School is not just a place for studies; it’s a place where children are socializing, doing sports, and developing their personality out of the family. It can’t be replaced by education via computer.”

Prof. Benedetti thinks that new Covid variants, of course, should be addressed with all the attention they need, but without panic, and ideally, without the need to challenge children’s psychological stability. “I sometimes read in newspapers people complaining against the ‘selfish’ or ‘irresponsible’ behavior of young people – who actually, in my view, just tried to preserve their social identity and their developing personality in these difficult times. My view is the opposite: Children and adolescents gave a great example of discipline, unselfishness, even self-denial in favor of the community of the adults, which did not always treat them well. A great example of the moral sense is deeply rooted in young people, against all odds.”

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