The coronavirus pandemic has been spreading around the world over the last six months. More than 10 million people have been infected worldwide and 423,000 of them have died due to the disease. The rapidly increasing number of infections and deaths around the world have made COVID-19 one of the greatest health challenges since World War II.

Due to the escalating numbers of infected people, many governments took preventive measures to stop the spread of the disease. Highly affected countries, like Italy and China, committed to complete lockdowns for some regions, sometimes even the whole country. Nations with relatively fewer cases exacted milder measures.

These measures have had a significant impact on the economy, society, households but especially on fragile and vulnerable groups. The elderly, disabled, migrants, refugees, homeless, women, children, girls and adolescents, especially those living in humanitarian settings, were disproportionately affected.

Among these vulnerable groups that require special attention are adolescents aged 10 to 19. Being in a transition period from childhood to adulthood presents unique challenges, needs and vulnerabilities that merit a distinct type of care, especially considering the effects of complete or partial lockdown and confinement. Such needs include access to education, a healthy and sufficient diet, a safe environment, participation in social systems, accessibility to health services and health education. Taken together, these are crucial aspects affecting the mental status of adolescents.

Data on mental health

Recent data suggests mental health is responsible for 16% of the global burden of disease and disability among adolescents and approximately 10% to 20% of all young people experience mental health problems.

While mental health conditions have been the number one cause of disabilities among children and youth, during the COVID-19 pandemic more young people suffered from severe mental trauma from the direct and indirect effects of coronavirus and the corresponding measures needed, such as school closures and life disruptions.

One of the main reasons for the elevated severity of mental health conditions among young people is heavier exposure to underlying conditions, such as a family history of depression, having a chronic medical condition, physical and sexual abuse, trauma and severe stress, learning difficulties, social anxiety, school problems and substance misuse. More recent studies analyzed the mental health of adolescents during isolation with a risk-factor approach.

As of April 8, 2020, schools were suspended in 188 countries, according to UNESCO. Over 90% of enrolled students, about 1.5 billion young people, worldwide are now completely or partially disconnected from education. UNESCO Director-General Audrey Azoulay warned that "the global scale and speed of the current educational disruption is unparalleled."

The severity is intensified on adolescents with mental health conditions compared to their peers, especially when considering the effects of inaccessibility to resources, services and social support that schools and the educational system offer. Additionally, school routines are important coping mechanisms against certain mental health problems for adolescents.

Isolation and confinement at home have been an increasing obligation for every citizen including adolescents. When considering this age group and how staying at home for extended periods dramatically changes their normal daily and social routines, their risk of different types of addictions – including misuse of the internet, online gaming, social media, recreational drugs and alcohol – increases depression, anxiety and stress, according to a 2018 study among secondary school students. Such risk factors severely intensify mental health conditions.

This makes it critical to carefully analyze the effects of COVID-19 and its related precautionary measures, confinement, isolation, closures of schools, etc. on the mental health of adolescents, especially those with previous problems. Accordingly, medical attention and care should be provided.

Violence during outbreak

Recent studies and policy papers also suggest that economic and social stress have drastically deepened during COVID-19, resulting in an exponential increase in gender-based violence due to restricted movement and social isolation rules. Many women and girls are forced to stay home with their abusers and the services that regularly provided safety and protection may not be accessible or functioning during lockdowns.

Examples of risky situations would include the confinement of women and girls with abusive family members within the same house, where violent partners may use COVID-19 restrictions to further exercise power and control, or the inability of females to leave abusive situations or receive timely help and protection.

Moreover, some reports indicate an increased number of domestic violence helpline, police and shelter calls during the COVID-19 pandemic, suggesting that adolescent girls are under extreme risk of abuse and violence while lacking accessibility to necessary services.

Overall, the mental health of adolescents is severely affected by the COVID-19 pandemic, both directly and indirectly. Underlying risk factors for mental health conditions have intensified during lockdowns and services provided to young people have been closed in some countries while being completely inaccessible in others.

COVID-19 is a dramatic learning experience and an eye-opener for the world. The life we used to know has changed for everyone. The global community, governments, schools, nongovernmental organizations (NGOs), youth clubs and other stakeholders need to come together and seriously reconsider our collective approach toward adolescents and their mental health, especially during emergencies. New creative solutions are needed to address these problems, including:

• A special review of international health regulations related to adolescents and youth at global, regional and country levels;

• The role of the private sector and its potential partnership with governments to come up with innovative and complementarity approaches to public sector services when needed;

• Digital and immersive media such as augmented reality, virtual reality, etc. as potential interventions during social and educational disruptions;

• The careful analysis of the public health care system by academics and health care professionals who can advise about creative, high-quality, timely, preventive and crisis-responsive psychological services and mental health support programs for adolescents and youth, especially during emergencies.

*Public health expert and board member of Partnership for Maternal, Newborn and Child Health (PMNCH)