Even before the COVID-19 pandemic began, concerning mental health trends and major treatment gaps were noted among adolescents in the United States. According to data from the National Survey on Drug Use and Health, an estimated 13.3% of US adolescents aged 12-17 experienced at least 1 episode of major depressive disorder in 2017, yet 60.1% of these individuals did not receive treatment for their illness.1
In addition, survey results from the Centers for Disease Control and Prevention demonstrated increasing rates of US high school students experiencing persistent sadness or hopelessness (from approximately 26% in 2009 to 37% in 2019), serious contemplation of suicide (from 14% to 19%), suicide planning (from 11% to 16%), and suicide attempts (from 6% to 9%). The highest risk levels were observed for White, female, and sexual minority students compared with non-White, male, and heterosexual students.2
Early findings indicate that these issues are being further exacerbated by the current crisis, with an especially high risk of worsening mental health among individuals with pre-existing psychological problems. These results have shown increased symptoms of depression, anxiety, and post-traumatic stress disorder among youth of various age groups.3,5 “The number, severity and duration of these symptoms are influenced by age, history of trauma, psychological status before the event, hours spent watching media coverage of the event, having a family member who died and the presence or absence of social and economic supports,” wrote Hertz and Barrios in a paper published in February 2021 in Injury Prevention.2
They noted that school closures may reduce access to mental health screening and care for vulnerable students, considering the large number of adolescents — nearly 3.5 million in 2018 — receiving such services in educational settings.2 These settings represent the only source of mental health services for many adolescents, particularly those from low‐income households and racial and ethnic minority groups. The authors thus emphasized the heightened importance of collaboration between schools and community health professionals to address the growing mental health needs of students.
Adolescents and other youth are also affected by the impact of the pandemic on their caregivers, including unemployment, financial and emotional stress, and fear of infection, highlighting the need for adults to receive adequate care and support as well.6,7 Some youth have been forced to spend more time in abusive or otherwise dysfunctional homes due to quarantine requirements.
“Assessing the relative safety of a child at home is one of the major challenges posed to mental health professionals during a pandemic,” according to a November 2020 paper co-authored by Cécile Rousseau, MD, researcher, psychiatrist, and professor in the division of social and transcultural psychiatry at McGill University in Montreal, Canada.6 “Fueled by parental stress and in the absence of the benevolent gaze of the school or daycare, the risk of maltreatment is increasing as the rate of cases reported to youth protection is decreasing.”
Providers at hospitals across the US are reporting alarming increases in rates of attempted and completed suicides among youth — especially teenagers. One school district in Las Vegas has lost 19 children to suicide since the pandemic began. Regarding the increasing number of pediatric patients presenting to hospitals nationwide with suicidal ideation, clinicians have described them as having “worse mental states” compared to similar patients typically seen before the pandemic.8
Such trends underscore the vital importance of youth outreach and creative intervention and support during these times. Mental health providers “must continue to advocate to ensure that families and children get the mental health support that they need to support resilience, to decrease family conflict and child maltreatment, and to decrease risk-taking, unsafe, and dangerous behaviors,” as stated in the November 2020 article.6
We recently interviewed Dr Rousseau to further discuss these issues and potential solutions.
What are believed to be the reasons for the generally low rates of mental health treatment among adolescents even pre-pandemic?
I believe there are 2 main reasons: First, MH services are overall difficult to access and often not very user-friendly for youth. Although some emerging models are addressing this, they are not generalized. Second, there is a widespread tendency to confound psychological distress and its expression — through sadness, anxiety, and anger — and mental disorder.
The first is associated with life being hurtful, which is very common, while the second is associated with more individual vulnerabilities. Of course, the 2 phenomena overlap, but in past times, distress was not medicalized or an object of treatment. Rather, it was addressed through interpersonal networks, spirituality, and so on. In the past decades there has been a shift in paradigm.
How has the pandemic affected and exacerbated mental health issues in this population?
The pandemic has generated first an acute stress response — which is normal, with fear and panic reactions, among others. To a certain extent, this has supported adherence to public health measures. As time passes, this becomes a chronic stress reaction with predominant avoidance symptoms such as denial and minimization of the pandemic risk. Frustration and anger regarding constraints have also increased, leading to scapegoating through conspiracy theories, and to legitimation of violence.
These are widespread reactions, which are not within the disorder range. For many people with vulnerabilities, however, the pandemic has exacerbated their symptoms, except for some cases of phobia — particularly school phobia — or cyberdependence, as these individuals may enjoy the confinement.
What are the relevant recommendations for clinicians about how to address these issues in practice and advocate for their adolescent patients?
Clinically, outreach to our patients to maintain continuity of care is crucial. In cases of frequent family conflict, virtual care should be used cautiously as it may not provide the needed confidentiality and safety and may aggravate the family conflict in some cases.
For new cases, management should include decreasing the impact of the collateral consequences of the pandemic — most commonly from social isolation and lack of stimulation — on adolescents’ development.
What are some of the broader, longer-term solutions that are also warranted?
Schools and colleges should be at the forefront of prevention. In Canada, pediatricians have advocated for the return of youth to school and the preservation of their social network (not partying, of course!). Youth need their peers to pursue their individuation-separation task, and this has been made impossible during confinement. We need to find a balance between the security of the elderly and the fulfillment of adolescent developmental needs.
- Major depression. National Institute of Mental Health. Updated February 2019. Accessed online February 7, 2021. https://www.nimh.nih.gov/health/statistics/major-depression.shtml
- Hertz MF, Barrios LC. Adolescent mental health, COVID-19, and the value of school-community partnerships. Inj Prev. 2021;27(1):85-86. doi:10.1136/injuryprev-2020-044050
- Rogers AA, Ha T, Ockey S. Adolescents’ perceived socio-emotional impact of COVID-19 and implications for mental health: results from a U.S.-based mixed-methods study. J Adolesc Health. 2021;68(1):43-52. doi:10.1016/j.jadohealth.2020.09.039
- Liang L, Ren H, Cao R, et al. The effect of COVID-19 on youth mental health. Psychiatr Q. 2020;91(3):841-852. doi:10.1007/s11126-020-09744-3
- Ma Z, Zhao J, Li Y, et al. Mental health problems and correlates among 746 217 college students during the coronavirus disease 2019 outbreak in China. Epidemiol Psychiatr Sci. 2020;29:e181. doi:10.1017/S2045796020000931
- Rousseau C, Miconi D. Protecting youth mental health during the COVID-19 pandemic: a challenging engagement and learning process. J Am Acad Child Adolesc Psychiatry. 2020;59(11):1203-1207. doi:10.1016/j.jaac.2020.08.007
- Chatterjee R. Make space, listen, offer hope: How to help a suicidal teen or child. NPR. Published online February 2, 2021. Accessed online February 7, 2021. https://www.npr.org/sections/health-shots/2021/02/02/962185779/make-space-listen-offer-hope-how-to-help-a-child-at-risk-of-suicide
- Chatterjee R. Child psychiatrists warn that the pandemic may be driving up kids’ suicide risk. NPR. Published online February 2, 2021. Accessed online February 7, 2021. https://www.npr.org/sections/health-shots/2021/02/02/962060105/child-psychiatrists-warn-that-the-pandemic-may-be-driving-up-kids-suicide-risk
This article originally appeared on Psychiatry Advisor
This Man Is Honoring COVID Victims By Telling Their Stories, One Obituary At A Time
Alex Goldstein started the Twitter account @FacesofCOVID in March of 2020 to help him make sense of grief.
The account has been his way to honor some of the nearly 600,000 people who have died in the U.S.
Even back in March 2020, Goldstein knew something was wrong. The communications specialist’s home city of Boston was hit early and harshly from virus. As the death toll climbed and businesses shut down, he started to feel overwhelmed. How could a virus kill so many and yet he knew so few of its victims? Who were the people who had passed away from COVID, and what were their stories?
RONNIE “BRO” BALDWIN, 63, of Chicago, died of COVID on June 12, 2020.
He was a bus operator and a carpenter by trade who ran his own maintenance business and trained many within the community to do handyman jobs. “He is terribly missed.” pic.twitter.com/uhpVhS74tL
— FacesOfCOVID (@FacesOfCOVID) June 12, 2021
He created FacesofCOVID to learn those answers. He has posted over 5,000 virtual obituaries from newspapers and families of those who have died.
“I think that the story at the beginning of the pandemic was largely a data story. We were getting thrown all these numbers thrown at us — hospitalizations and cases and deaths,” Goldstein tells Morning Edition. “I found it really hard to process and I felt like, we were missing the human element of that story.”
One of the things that made this pandemic especially difficult was the lack of mourning rituals. Families saw their loved ones one last time from iPads in isolation wards. Many funeral homes did not let more than 10 mourners at a time attend a service due to regulations. In a time of immense grief, people couldn’t mourn in familiar ways.
MASSACHUSETTS — DAVID & MURIEL COHEN, of Longmeadow died on the same day, hours apart, in the same room.
David was a WW2 veteran & a liberator of the Ohrdruf concentration camp who taught children about the horrors of the holocaust.
— FacesOfCOVID (@FacesOfCOVID) November 2, 2020
“It’s a place where they can share their loved one’s story and see people from all over the country and all over the world saying, ‘Your loved one meant something, and even if I didn’t know them, we are all less because they’re not here anymore, and we all share in your sadness,’ ” Goldstein says.
As long as COVID-19 continues to exist and take lives, Goldstein plans on running the account indefinitely.
“I don’t want us to immediately lose sight just because things are reopening,” he says. “There’s a lot of pain out there, and if FacesofCOVID can help people slow down a little bit on their impulse to change the channel, I think that can be a good thing.”
Tori Dominguez is an intern at Morning Edition.
Novavax Says Its COVID Vaccine Is Extremely Effective
The first results from a large efficacy study of a new kind of COVID-19 vaccine are now out, and they are good. Very good.
According to Novavax, the vaccine’s manufacturer, it had a 100% efficacy against the original strain of the coronavirus and 93% efficacy against more worrisome variants that have subsequently appeared.
In addition to efficacy, the PREVENT-19 (the PRE-fusion protein subunit Vaccine Efficacy Novavax Trial COVID-19) trial showed the Novavax vaccine was safe for users. Like other COVID-19 vaccines, it caused headaches, chills and muscle aches after injection, but few of these side effects were considered serious or severe.
The study involved 29,960 volunteers in the United States and Mexico. In the study, two-thirds of the volunteers received two shots of the vaccine and one-third received two shots of a placebo.
A total of 77 cases of COVID-19 occurred during the study: 63 in the placebo group and 14 in the vaccine group. According to the Novavax statement describing the results, none of the cases of COVID-19 in the vaccine group were related to the original strain of the virus, hence the 100% efficacy against the original strain.
The breakthrough cases were all caused by the newer, more worrisome variants, and all of the breakthroughs in the vaccine group were mild. By contrast, 10 in the placebo group were considered moderate and four severe. Novavax’s statement did not specify which variants in particular were prevented.
The company says it intends to file for authorization from regulators in the U.S., Europe and the United Kingdom later this summer. Novavax says it will be able to deliver 100 million doses per month by the end of September and 150 million doses per month by the end of the year.
The Novavax vaccine is what’s known as a protein subunit vaccine. All COVID-19 vaccines are based on something called the coronavirus spike protein. That’s the protein that prompts the immune system to make antibodies to the virus.
The vaccines made by Moderna and Pfizer-BioNTech deliver the genetic instructions for the spike protein in the form of messenger-RNA, and the cells of the person receiving the vaccine make the spike protein. The Johnson & Johnson vaccine delivers those instructions using a viral vector, again relying on the vaccine recipient’s cells to make the protein.
Novavax, on the other hand, makes the protein in cell cultures grown in giant bioreactors in manufacturing facilities and delivers the fully formed vaccine along with a substance for priming the immune system in its vaccine.
The Novavax vaccine was one of the vaccines chosen for development as part of Operation Warp Speed. The U.S. government is providing $1.75 billion to the company to support the vaccine’s development.
It’s not clear at this point whether the Food and Drug Administration is prepared to continue to grant emergency use authorizations for COVID-19 vaccines. The FDA may require Novavax to go through the standard licensure process, which can take considerably longer than an EUA.
Specific antibodies may be effective against multiple coronavirus types
Patients who have been exposed to a coronavirus may produce a versatile, cross-reactive coronavirus antibody; this may be useful for the eventual development of a broad-acting vaccine.
There are seven human coronavirus types, of which, four cause the common cold, named OC43, HKU1, 229E, and NL63. Most people become infected with at least one of these four coronaviruses at some point in their lives. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is another member of the coronavirus family that causes COVID-19. Infection with the cold-causing coronaviruses may lead to immune memory. This could potentially impact on the immune response to COVID-19.
Research published in Nature Communications compared blood samples of patients collected before the pandemic with those who tested positive for COVID-19. By doing this, the researchers were able to find antibody types that cross reacted with other coronaviruses and SARS-CoV-2.
Cross-reactive coronavirus antibody produced during SARS-CoV-2 infection
It was discovered that a cross-reactive coronavirus antibody is triggered as a direct result of a COVID-19 infection. Dr Raiees Andrabi, a senior author of the paper, stated, “We were able to determine that this type of cross-reactive antibody is likely produced by a memory B cell that’s initially exposed to a coronavirus that causes the common cold, and is then recalled during a COVID-19 infection.”
Memory B cells are long-lived, as they can circulate throughout the body for decades in order to recognise and fight pathogens that they have previously encountered. Memory B cells offer protection against reinfection by rapidly producing specific antibodies. Although the study found evidence of pre-existing cross-reactive memory B cells that were triggered during SARS-CoV-2 infection, there was only weak evidence of pre-existing SARS-CoV-2 cross-reactive serum antibodies in pre-pandemic patient samples. However, the researchers were able to identify one cross-reactive neutralizing antibody specific to the S2 subunit of the spike (S) protein.
How does this antibody work?
The researchers used electron microscopy to visualise how the cross-reactive antibody had the ability to neutralize a range of coronaviruses, including SARS-CoV-2. They found that the antibody typically bound to the S protein of the virus. This area did not seem to vary in different coronavirus strains.
Ge Song, the first author of the paper, stated, “The study highlights how important it is to fully understand the nature of pre-existing immunity, especially in regard to coronaviruses. Earlier exposure to a coronavirus, even a virus that causes mild colds, impacts the nature and level of antibodies produced when more serious coronavirus threats emerge.”
Significance of the study
Since immunological memory forms the basis of vaccination, the findings of this study could potentially lead to the creation of a vaccine or antibody treatment that works against most or all coronaviruses. Pre-existing immunity to endemic coronaviruses should be further investigated to evaluate antibody responses to SARS-CoV-2.
Co-author Dr Dennis Burton explained, “Another deadly coronavirus will likely emerge again in the future – and when it does, we want to be better prepared. Our identification of a cross-reactive antibody against SARS-CoV-2 and the more common coronaviruses is a promising development on the way to a broad-acting vaccine or therapy.”
Song, G., et al. (2021). Cross-reactive serum and memory B-cell responses to spike protein in SARS-CoV-2 and endemic coronavirus infection. Nature Communications, 12(1), 1-10. Retrieved from: https://www.nature.com/articles/s41467-021-23074-3
Versatile coronavirus antibody may be starting point for broader-acting vaccines (2021). EurekAlert! Retrieved from: https://www.eurekalert.org/pub_releases/2021-05/sri-vca052721.php
Quast, I. and Tarlinton, D. (2021). B cell memory: understanding COVID-19. Immunity, 54(2), 205-210. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7826135/
Image by mattthewafflecat from Pixabay
June 18 Web Event: Asian Immigrant Experiences with Racism, Immigration-related Fears, and the COVID-19 Pandemic
While the country has collectively experienced health and economic difficulties with the COVID-19 pandemic, certain groups have experienced a disproportionate impact. The Asian American community has had to cope with the burden of pandemic-related racism and, as one of the fastest growing immigrant communities in the nation, immigration-related fears due to policy and regulatory action of recent years. Yet, there is often limited data and focus on the experiences of the expanding Asian immigrant community. KFF is hosting a June 18 public web event to highlight and discuss the complex set of challenges facing Asian immigrants and strategies to address them.
The one-hour interactive web event begins at 12 p.m. ET on Friday, June 18, featuring remarks from U.S. Congresswoman Judy Chu, who has been a leading voice on many of the issues to be discussed and chairs the Congressional Asian Pacific American Caucus. Findings from a new KFF survey of Asian American patients from four community health centers will be released at the event with a panel discussion and audience questions to follow.
Welcome and Keynote Remarks
- KFF Executive Vice President for Health Policy Larry Levitt (moderator)
- U.S. Congresswoman and Chair of Congressional Asian Pacific American Caucus The Honorable Judy Chu
- Chief Program Director of Blue Shield of California Foundation Carolyn Wang Kong
Presentation of Survey Findings
- KFF Vice President and Director of the Racial Equity and Health Policy Program Samantha Artiga
- Director of Policy and Advocacy at the Association of Asian Pacific Community Health Organizations (AAPCHO) Adam Carbullido
- Vice President of Strategic Initiatives at International Community Health Services Sunshine Monastrial
- Chief Deputy of Administration at Asian Health Services Thu Quach
The one-hour event will conclude with a question-and-answer session.
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