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Disclosures: Hawkley, Lee, Lipson and Parikh report no relevant financial disclosures.
April 08, 2020
6 min read

COVID-19’s mental health effects by age group: Children, college students, working-age adults and older adults

Disclosures: Hawkley, Lee, Lipson and Parikh report no relevant financial disclosures.
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The ongoing COVID-19 pandemic has resulted in many quarantine and social isolation measures designed to keep individuals physically distanced from others for the foreseeable future. Although these initiatives are necessary to prevent the spread of the novel coronavirus, they may be causing widespread mental health effects, including depression and loneliness, among younger and older individuals alike, according to experts.

Healio Psychiatry spoke with mental health professionals regarding the specific pandemic-related mental health challenges of four different age groups — children, college students, working-age adults and older adults.

Children need a sense of structure during quarantine

Jena Lee

Children will be challenged primarily by a lack of structure associated with the closing of schools, according to Jena Lee, MD, medical director of pediatric consultation/liaison and emergency psychiatry at David Geffen School of Medicine at University of California, Los Angeles.

“Daily structure is important to everyone, but particularly to children in their psychological and emotional development,” Lee told Healio Psychiatry. “The consistency of schedules, predictable rules and consequences, and set expectations teach children how to behave, develop self-discipline and impulse control and, importantly, a sense of safety and control. Clinically, we often see an exacerbation of behavioral problems in our pediatric patients when their routine or structure is disturbed.”

The extent of this challenge depends on the family’s ability to provide support and structure at home, which further depends on the family’s unique dynamics, resources and stressors, Lee noted.

Clinicians can serve a vital role in helping parents and caregivers form structure for children.

“Children learn from watching adults, and since they will often be at home together now, they will observe not only what the adults in the home say, but also how they implement structure, ensure consistency and deal with their own emotions,” Lee said. “Teaching parents the importance of daily structure and consistency in their responses to their children’s behaviors is a priority.”

Parents are likely experiencing significant stress during this time, so clinicians have a “double mission” of ensuring parents manage their own anxiety and stress while also modeling for their children.

For children with a history of mental illness, the lack of structure and increased stress in the family can exacerbate psychiatric symptoms, such as depression and anxiety, Lee said. These symptoms may manifest clinically as somatic complaints, difficulty sleeping or eating, or behavioral regression, depending on the developmental stage of the child.

College students face increased rates of anxiety

Sarah K. Lipson

According to Sarah K. Lipson, PhD, assistant professor in the department of health law, policy and management at Boston University School of Public Health, research over the past decade has shown a steady increase in the prevalence of depression, anxiety and suicidality among college students across the United States.

“We know that some of the most important predictors of mental health and some of the biggest factors that have been targeted in terms of prevention have been trying to foster a sense of belonging and connection for students, particularly for first-year students when they arrive on campus,” Lipson told Healio Psychiatry.

Campus closings and the overall response to the coronavirus have “fundamentally shifted” how college students may think about their sense of belonging. In addition to depression and loneliness, college students will also likely face increased rates of anxiety, fueled by the uncertainties surrounding the virus, Lipson said.

“For students who are struggling with anxiety, which has surpassed depression as the most common mental health concern on college campuses, the uncertainty regarding the coronavirus is something we really need to be worried about, since it has the potential to amplify already high rates of anxiety,” Lipson said.

In addition to the health care workers who are treating the physical symptoms of the virus, Lipson noted that mental health professionals are also doing vital work, including for college students.

“Before we can get to solutions, it’s important to think about ways to be positive and to pause and recognize that this is a really, really difficult time,” Lipson said. “If a student has struggled with anxiety, for example, there are reasons we can pinpoint as to why this might be acutely challenging for them right now.”

College leaders also play a role in mitigating mental health effects among students, and initiatives such as a pass-fail system can help achieve this end, according to Lipson.

Clinicians should form their own schedule, then help working-age patients build one

Sagar V. Parikh

With the closing of many businesses and places of employment, a significant proportion of working-age adults have lost their jobs. This can be a blow to individuals’ sense of fundamental purpose in life, according to Sagar V. Parikh, MD, FRCPC, professor of psychiatry at the University of Michigan and associate director of the University of Michigan Depression Center.

“It eats at our sense of competency if we're not at work and makes us worry whether we’ll be able to pay for essentials, such as rent and food,” Parikh told Healio Psychiatry. “It's a very profound, existential threat. For those deemed essential service workers who are still going to work, there’s added stress regarding whether they will get the virus.”

Perhaps the most difficult mental health concern for this segment of the population, according to Parikh, is increased anxiety associated with having to suddenly provide additional care for family members, such as school-age children or elderly parents, combined with potential work-related responsibilities.

Social isolation from work colleagues is another potential challenge.

“With this virus shutting down the workplace, people have lost not only social interactions with best friends who don't happen to live in their home, but also interactions with the wide variety of supportive, friendly, casual relationships at work and in public that make for a rich social texture,” Parikh said. “I think loneliness, despair and a sense of drifting are going to be prominent.”

For clinicians to be able to help this patient population, they must first quell their own anxiety, according to Parikh. Further, they can ask themselves questions such as, “How am I looking after myself? How am I protecting myself against the virus while also protecting myself against burnout?”

It’s also important for clinicians to maintain a routine by starting their workday at a dedicated time, wearing clothing similar to what they might wear to the office and having a specific time and place for conducting telemedicine sessions from home. Moreover, they should also remain aware of the key facts regarding COVID-19 so they can incorporate these into their sessions, even if it's a mental health session, Parikh said.

Once clinicians have built a routine for themselves, they can then instruct patients on how to do this in their own lives.

“We all benefit from having a schedule for activities, eating, exercise and sleep,” Parikh said. “Building these components into a fundamental schedule is important.”

Older adults need connection all the time, not just during a pandemic

Louise C. Hawkley

With social isolation measures in place in much of the world, loneliness has become a familiar facet of everyday life. Research has shown that loneliness increases risk for depression and anxiety and heightens feelings of stress — factors that contribute to worsening physical health and poor health behaviors, including substance abuse, poor nutrition and more sedentariness, as well as poor sleep quality, according to Louise C. Hawkley, PhD, of the National Opinion Research Center at the University of Chicago.

Hawkley noted that several studies have suggested loneliness may be less of a problem for older adults than it is for younger adults.

“There’s an important distinction here between loneliness — the feeling of isolation that can set in even when someone has frequent social contact — and what researchers call objective isolation,” Hawkley told Healio Psychiatry. “Right now, we’re experiencing a pandemic of mandated isolation. The fact that many older adults are already isolated by virtue of widowhood, living alone and having mobility or transportation challenges that preclude social activities in the community means they are being forced to give up what little interaction they may have had to begin with.”

According to Hawkley, the pandemic might teach societies an important lesson — isolated older adults face challenges every day, not just during times of crisis.

“It doesn’t take a pandemic for some older adults to feel what many younger adults are only now appreciating viscerally and emotionally,” Hawkley said. “We need to care for our communities by caring for the social health of all individuals, across the life course.”

Clinicians should regularly gauge the mental health of older adult patients if they aren’t doing so already, Hawkley said. Many of these patients may not readily admit to feeling lonely or stressed, and some may believe these feelings are beyond the scope of their clinician’s role.

“Clinicians who discern that their patients are in distress mentally or emotionally will want to have at their disposal contact information for counselors, social workers and others to whom they can refer the patient,” Hawkley said. “I suspect there will be a growing need for professional help for people struggling with the emotional toll the pandemic is taking. However, in some instances, for some people, a solution could be as simple as linking them with others through virtual means, internet or phone-based, and offering suggestions on what they can do to help others.” – by Joe Gramigna

Disclosures: Hawkley, Lee, Lipson and Parikh report no relevant financial disclosures.