The Impact of COVID-19 on Emotional, Social, and Behavioral Health in Adolescents With Preexisting Mental Health Concerns: A Qualitative Study

Objective: The COVID-19 pandemic has caused a decline in well-being for many adolescents. However, the impact of COVID-19 on mental health outcomes among adolescents remains understudied. The current study qualitatively examined the impact of COVID-19 restrictions on adolescents with mental health concerns prior to the pandemic. Methods: We enrolled 20 adolescents who were engaged in care through an Adolescent Health Specialty Clinic prior to COVID-19. Participants were 12- to 19 years old who experienced mental health concerns prior to COVID-19 and experienced declining mental health (e.g., new mental health diagnosis or increased severity of previous mental health diagnosis reported during clinical visit or documented in medical chart) during the pandemic. In-depth interviews were conducted, and inductive coding was applied to transcripts to identify emergent themes. Results: Five key themes were identified: manifestations of declining mental health, loss of motivation, changes to social relationships, use of social media, and coping mechanisms. Adverse mental health outcomes were provoked by experiences of loneliness and social isolation, especially due to school closures which disrupted routines, access to educational and social support, and key cultural milestones. The increased uses of social media and illicit substances were notable coping strategies. Conclusions: Findings from this study strengthen our understanding of the key factors influencing the psychosocial well-being of adolescents during the pandemic. Our results may help inform researchers, clinicians, and policymakers to develop guidelines and community-based strategies for mitigating the potentially negative effects of future pandemic-related disruptions to mental health among adolescents.