Mental health and suicide among adolescents in the United States in the wake of the COVID-19 pandemic: a narrative review

Background and Objective: Declining mental health (MH) and increased suicidal behaviors among adolescents in recent years is a public health crisis that has been highlighted during the coronavirus disease 2019 (COVID-19) pandemic. Restrictions imposed by the pandemic including school closures, social isolation, increased social media (SM) use, paused extracurricular activities, and family hardships have resulted in the overall decline in the MH of adolescents, a particularly vulnerable population. This narrative review aims to summarize research investigating the effects of the pandemic on adolescent MH and suicide including shifts in demographic trends and proposed explanations for the researchers' findings. The narrative review also aims to describe the role of a pediatrician in identifying youth at risk and how to navigate the management of adolescents experiencing these crises. Methods: A literature search was conducted using PubMed and the American Academy of Pediatrics (AAP) journal. Inclusion criteria were language in English, studies conducted in the United States, studies of adolescents. Only studies conducted after March 2020 were considered. A manual search of reference lists was completed. Key Content and Findings: There were many demonstrations of declining MH among adolescents during the pandemic, particularly in depression and eating disorders. There was also an increase in suicidal behaviors since the pandemic began amongst adolescents. There are also populations that have been disproportionately affected including non-Hispanic Black, Asian/Pacific Islanders and American Indian and Alaskan native racial groups, individuals living in both urban and rural areas, and those with preexisting MH diagnoses. Conclusions: The COVID-19 pandemic had profound effects on society in the United States, and there is evidence that adolescents experienced higher rates of MH diagnoses and suicidal behaviors when the pandemic began. Many of the trends identified during the pandemic have persisted despite returning to normality. This narrative review also acknowledges that suicidality and MH is a complex, multifactorial topic and that these findings are likely not entirely explained by the pandemic alone.