Abstract
The COVID-19 pandemic and containment efforts seem to be particularly challenging for adolescents. This study assessed mental health in 14- to 20-year-old high school students 1.5 years after the beginning of the COVID-19 pandemic in Austria. A cross-sectional survey was carried out from 14th September 2021 to 14thNovember 2021. Well-being (WHO-5), depressive symptoms (PHQ-9), anxiety symptoms (GAD-7) and sleep quality (ISI) were assessed. A total of 1505 adolescents participated (77.9% girls). The cut-off for clinically relevant depressive symptoms (i.e., PHQ-9 score, ≥11) was exceeded by 61.9% girls and 38.1% boys and 49.3% girls and 28.8% boys had clinically relevant anxiety symptoms (i.e., GAD-7 score, ≥11). Clinically relevant moderate insomnia (i.e., ISI score, ≥15) was reported by 27.5% girls and 16.7% boys. The prevalence of suicidal ideation (item 9 of the PHQ-9) within the last 2 weeks was 46.8% in girls and 32.0% in boys. These data collected in autumn 2021 (at the start of the second semester of reopened schools; t2) were compared to data collected in February 2021 (one semester after almost exclusively remote schooling; t1). A matched pairs analysis according to age, gender, region, school type and migration background resulted in a total sample size of N = 2514 adolescents (70.1% females). Results showed small reduction in mental health (i.e., well-being, depressive symptoms, insomnia, suicidal ideation) in girls at t2 compared to t1, and an increase in suicidal thoughts in boys (all p -values <0.05). Results suggest that mental health burden in adolescents remained high 1.5 years after the start of the COVID-19 pandemic and highlight the need to implement timely psychological support.
Introduction
It is becoming apparent that the COVID-19 pandemic is long-term in nature, proving a sustained challenge to mental health. Young people have been particularly affected psychologically (Gilsbach et al., 2021; Pieh et al., 2020; Ravens-Sieberer et al., 2021). Given that many mental disorders begin in childhood or adolescence and this age group is more susceptible to long-term consequences of mental health (Kessler et al., 2007), it is essential to continue to assess their mental health during this prolonged global crisis.
We previously assessed the mental health of adolescents in Austria in February 2021, after one semester of remote schooling and during a time where several national lockdown measures were in place (Pieh, Plener, et al., 2021). These findings indicated that mental well-being and life satisfaction were significantly impaired one year after the beginning of the COVID-19 pandemic in Austria compared to pre-pandemic data (Pieh, Plener, et al., 2021; Teutsch, et al., 2018). Another survey was conducted in June/July 2021, when there were no lockdown restrictions and schools had been re-opened for one semester. Although mental health symptoms remained poor in comparison to the available pre-pandemic data, a small improvement was observed in June/July compared to February (Humer et al., 2021). In line with this, Riiser at al. ( 2021) found that well-being depended on the magnitude of restrictions and children reported the challenges of distance learning and school as an important place for socialising as well as learning (see also O’Sullivan et al. (2021). Similarly, qualitative work from the survey in February 2021 in Austria showed that the greatest current concerns for most adolescents were school-related issues. This led to some cautious optimism that school openings and easing of other restrictions may have led to an improvement in the psychological well-being of high school students. However, it is important to monitor the robustness of these improvements as the long-term nature of the pandemic becomes more apparent.
The aim of the current study was to assess the mental health status of Austrian adolescents in autumn 2021, 1.5 years after the beginning of the COVID-19 pandemic. During this time in Austria the schools were fully open and there was no lockdown, however the rates of infection were starting to rise again. A further aim was to compare the mental health measures with a matched sub-sample from the survey conducted in February 2021 to assess the progression of mental health symptoms over the course of the pandemic.
Methods
A cross-sectional online survey was conducted via REDCap (Harris et al., 2019) from 14th September 2021 to 14th November 2021. The survey was conducted at the beginning of the second semester of reopened schools. At the time of the survey in Austria schools were fully open and there was no lockdown in place. Protective measures in classes included regular COVID-19 tests and wearing face masks outside the classroom. General COVID-19 measures in Austria during the time of the survey relied mainly on the “3G rule”, referring the need for presenting proof of vaccination, recovery from COVID-19 or a negative test to visit restaurants, hotels, hairdressers, sports centres, take part in events etc.
To assess the progression of mental health symptoms over the course of the pandemic, the sample collected from September to November 2021 (t2) was matched via propensity score matching with a sub-sample from the survey conducted in February 2021 (t1). Details from this survey have been published elsewhere (Pieh, Plener, et al., 2021). In brief, high school mainly took place in remote schooling from October 2020 until the 8th February 2021 and a national lockdown was in place. After this some aspects of the lockdown were lifted and schools re-opened but in a shift system, with students sometimes attending in presence and sometimes from home.
Approval for this study was obtained from the ethics committee and the data protection officer of the Danube University Krems (EK GZ 41/2018–2021). All participants gave electronic informed consent and confirmed that they were at least 14 years old.