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levels by mid-2020.53, 54 Some other measures of wellbeing, such as rates of life satisfaction and loneliness, remained largely unchanged throughout the first year of the pandemic.53, 55 And while data on youth suicide rates are limited, early evidence does not show significant increases.56, 57 In addition, some young people thrived during the pandemic: They got more sleep, spent more quality time with family, experienced less academic stress and bullying, had more flexible schedules, and improved their coping skills.44, 58, 59, 60 Many young people are resilient, able to bounce back from difficult experiences such as stress, adversity, and trauma.61 Protecting Youth Mental Health: The U.S. Surgeon General’s Advisory 10 That said, the pandemic is ongoing, with nearly 1,000 Americans dying per day as of early December 2021.62 And many millions of children and youth have faced and continue to face major challenges. Importantly, the pandemic’s negative impacts, such as illness and death in families and disruptions in school and social life, disproportionately impacted those who were vulnerable to begin with and widened disparities.63 For additional details, see Boxes 1 and 2. Box 1 discusses risk factors contributing to children’s mental health symptoms during the pandemic. Box 2 discusses demographic groups at greater risk of developing mental health problems during the pandemic. BOX 1 Having mental health challenges before the pandemic61, 64 Living in an urban area or an area with more severe COVID-19 outbreaks65 Having parents or caregivers who were frontline workers66 Having parents or caregivers at elevated risk of burnout (for example, due to parenting demands)67, 68 Being worried about COVID-1964 Experiencing disruptions in routine, such as not seeing friends or going to school in person69, 70, 71 Experiencing more adverse childhood experiences (ACEs) such as abuse, neglect, community violence, and discrimination72, 73, 74 Experiencing more financial instability, food shortages, or housing instability75, 76 Experiencing trauma, such as losing a family member or caregiver to COVID-1977 Risk factors contributing to Youth mental health symptoms During the pandemic Note: Not a comprehensive list of risk factors Protecting Youth Mental Health: The U.S. Surgeon General’s Advisory 11 Youth with intellectual and developmental disabilities (IDDs), who found it especially difficult to manage disruptions to school and services such as special education, counseling, occupational, and speech therapies78, 79, 80, 81, 82 Racial and ethnic minority youth,83 including: American Indian and Alaska Native youth, many of whom faced challenges staying connected with friends and attending school due to limited internet access84 Black youth, who were more likely than other youth to lose a parent or caregiver to COVID-1942 Latino youth, who reported high rates of loneliness and poor or decreased mental health during the pandemic85, 86 Asian American, Native Hawaiian, and Pacific Islander youth, who reported increased stress due to COVID-19-related hate and harassment87, 88 LGBTQ+ youth, who lost access to school-based services and were sometimes confined to homes where they were not supported or accepted89, 90 Low-income youth, who faced economic, educational, and social disruptions (for example, losing access to free school lunches)91 Youth in rural areas, who faced additional challenges in participating in school or accessing mental health services (for example, due to limited internet connectivity)92 Youth in immigrant households, who faced language and technology barriers to accessing health care services and education93 Special youth populations, including youth involved with the juvenile justice, or child welfare systems, as well as runaway youth and youth experiencing homelessness61, 94, 95, 96 Additional considerations: Youth with multiple risk factors. Many young people are part of more than one at-risk group, which can put at them at even higher risk of mental health challenges. For example, children with IDDs who lost a parent to COVID-19, or Black children from low-income families, may require additional support to address multiple risk factors.97 Discrimination in the health care system. Some groups of youth and their families, such as people of color, immigrants, LGBTQ+ people, and people with disabilities, may be more hesitant to engage with the health care system (including mental health services) due to current and past experiences with discrimination.97, 98, 99 Risks of COVID-19 to children with mental health conditions. Children with mood disorders, such as depression and bipolar disorder, as well as schizophrenia spectrum disorders, are at elevated risk of severe COVID-19 illness.100, 101, 102 Groups at higher risk of mental health challenges during the pandemic Note: Not a comprehensive list of groups or risk factors BOX 2 Protecting Youth Mental Health: The U.S. Surgeon General’s Advisory 12 The good news is that, throughout the pandemic, many people have recognized the unprecedented need to support youth mental health and wellbeing and have taken action to do so. Many young people found ways to cope with disruption and stay connected.103 Families helped children adjust to remote learning.104 Educators and school staff
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