Miranda Hester

Mental health experts and clinicians anticipated an increase in self-harm and overdoses among children and adolescents as a result of the stresses associated with the COVID-19 pandemic. Now, a new study shows the opposite may be true.

, professor at the University of Toronto, and colleagues compared the risk of self-harm or overdose among teenagers and young adults living in the Ontario province in Canada during the pandemic with the 2 years preceding the pandemic via a population-based cohort study of teenagers and young adults who were born in Ontario between 1990 and 2006. Ray et al compared data for these youth between April 1, 2020 to June 30, 2021, to March 1, 2018 to February 28, 2020, looking at emergency department encounters and hospitalizations for either self-harm or drug overdose. Secondary measures included self-harm, overdose, or all-cause mortality.

A total of 1,690,733 teenagers and young adults were included in the cohort. A little less than half of the cohort were female (48.7%); the median age was 17.7 years at the start of follow-up. With 4,110,903 person-years of follow-up, investigators found that 6224 participants had experienced a primary outcome of self-harm or overdose during the pandemic (39.7 per 10,000 person-years) vs 12,970 (51.0 per 10,000 person-years) prepandemic, with a hazard ratio (HR) of 0.78 (95% CI, 0.75-0.80). Furthermore, the investigators found that the risk of self-harm, overdose, or death was lower during the pandemic than in the preceding period (HR, 0.78; 95% CI, 0.76-0.81). This was not true of all-cause of mortality (HR, 0.95; 95% CI, 0.86-1.05).

Ray et al noted a limitation of the study was that less life-threatening cases may have been missed as a result of the design. Similarly, suicides that occurred outside of the hospital setting were also not captured.

“The robust nature of the current findings suggests that, at least up to the middle of 2021, the COVID-19 pandemic has not led to an excess of intentional injury among adolescents and young adults,” Ray et al concluded. “It should be determined if this phenomenon continued within subsequent waves of the pandemic, or if unrealized self-harm or overdose events have occurred outside of a hospital setting.”

1. Ray J, Austin P, Aflaki K, Guttmann A, Park A.

 Comparison of self-harm or overdose among adolescents and young adults before vs during the COVID-19 pandemic in Ontario

Articles

New research finds evidence that contradicts previous hypotheses.

Did Rates of Self-Harm and Overdose in Youth Actually Decrease During the Pandemic?

Adolescence is a time of mental and physical fluctuation as well as a preparation for adulthood. The rapid changes that occur during this period may impact mental health, which could continue following the transition into being an adult. An investigation in 

 looks into whether social support during the teenaged years could lead to fewer mental health issues once an individual is an adult.

The investigation was a population-based cohort and used participants from the Quebec Longitudinal Study of Child Development. The participants in the cohort were given either yearly or biennial assessments beginning at age 5 months until age 20 years. They were asked to self-report their perceived social support when they were aged 19 years using the 10-item Social Provision Scale. Then, when each participant was aged 20 years, an assessment of mental health issues such as depressive symptoms and suicide ideation was administered.

A total of 1174 adolescents were included in the study, breaking down into 574 female participants and 600 male participants. The researchers found that young adults who reported higher levels of perceived social support when they were aged 19 years subsequently reported having fewer mental health problems a year later. This remained true even following adjustment for a number of mental health problems, such as depressive symptoms and suicide attempts, in adolescence at aged 15 and 17 years as well as family characteristics such as socioeconomic status. Additionally, higher perceived social support was linked with fewer symptoms of depression (β = −0.23; 95% CI, −0.26 to −0.18; P = <.001 and odds ratio [OR], 0.53; 95% CI, 0.42-0.66 for severe depression) and anxiety (β = −0.10; 95% CI, −0.15 to −0.04; P < .001 and OR, 0.78; 95% CI, 0.62-0.98 for severe anxiety). It was also tied to lower risks for outcomes related to suicide (for suicidal ideation: OR, 0.59 [95% CI, 0.50-0.70] and for suicide attempts: OR, 0.60 [95% CI, 0.46-0.79]).

The investigators concluded that perceived social support appears to help prevent the increase of mental health problems, at least over the course of a year. Providing social support during this transition period could help promote better health in the population.

1. Scardera S, Perret L, Ouellet-Morin I. Association of social support during adolescence with depression, anxiety, and suicidal ideation in young adults. 

Support in the tender younger years may lead to fewer mental health issues in the future, according to research. 

Social Support in Teen Years Could Improve Later Mental Health

As the world has changed and the space a child can breathe and spread out in has grown smaller, environmental exposures to artificial light at night, noise, secondhand smoke, near-roadway air pollution, and other adverse health effects have only increased. A report in 

 looks at whether these exposures are linked to childhood psychosocial stress.

The report’s investigators ran a cohort study that included participants from the Southern California Children’s Health Study. The participants resided in 8 densely populated urban communities and responded to highly detailed questionnaires. Artificial light at night exposure was determined via utilized satellite images. Green space also used satellite technology. Noise levels were estimated using the US Traffic Noise Model. Near-roadway air pollution was established through a dispersion model. Stress was determined at ages 13 to 14 years and 15 to 16 years through the 4-item Perceived Stress Scale, with higher scores on the scale indicate a higher level of stress.

A total of 2290 children were recruited for the study. The researchers found that girls had higher perceived stress than their male counterparts with an average score of 5.7, whereas boys had an average of 4.9. As girls aged, their average stress score rose to 6.0, but boys’ score reduced to 4.7 as they aged. Multivariate mixed-effects models that examined multiple exposures found that exposure to secondhand smoke in the home was linked with a 0.85 increase in the score. When looking at factors in the physical environment, the researchers found that an interquartile range (IQR) increase in artificial light at night was tied to a 0.57 unit increase in the score together with a 0.16 score increase per IQR increase of near-roadway air pollution and a −0.24 score decrease per IQR increase of the enhanced vegetation index.

Interestingly, income appeared to modify the artificial light at night effect size estimate. The children who lived in households earning less than $48,000 per year were found to have significantly greater stress per IQR increase in artificial light at night. Additionally, sleep duration seemed to mediate, at least in part, the ties between stress and artificial light at night, as well as enhanced vegetation index.

The researchers concluded that exposure to a number of environmental exposures such as nighttime artificial light, secondhand smoke, and air pollution were linked to increased perceived stress in young adolescents. Availability of green space did helps ameliorate those associations.

1. Franklin M, Yin X, McConnell R, Fruin S. Association of the built environment with childhood psychosocial stress. 

How does a child’s physical living space impact their neurodevelopment? Can it cause them increased stress? 

Miranda Hester

Articles

Did Rates of Self-Harm and Overdose in Youth Actually Decrease During the Pandemic?

Social Support in Teen Years Could Improve Later Mental Health

Toll of Environmental Exposures on Teen Psychosocial Stress