Covid-19 has been hard on kids’ mental health – more support is needed urgently

8 May 2022

A rise in teenage pregnancies and gender-based violence coupled with the loss and uncertainty related to Covid-19 are all stressors fuelling the mental health burden the pandemic will leave on children, especially girls. If not adequately addressed, the mental health consequences for a generation of children and young people could far surpass the immediate health and economic impact of the pandemic, with harmful long-term social and economic consequences.

As with most children, life changed dramatically for my daughter from being in daycare one day to staying at home during South Africa’s many stages of Covid-19-related lockdown.

There were many questions.

“Why do I have to wash my hands so much?” she would ask. “So, we can be healthy and not get the bad flu,” I would answer. “When can I go back to school?” was another daily question. “When the bad flu is not making everyone sick anymore,” I would answer. But, like most children, she did not seem to understand why we were unable to go anywhere.

Children thrive when they are safe and protected, when family and community connections are stable and nurturing, and when their basic needs are met.

The Covid-19 pandemic and the unprecedented lockdown measures to contain its spread have disrupted nearly every aspect of children’s lives – their health, development, learning and behaviour, their families’ economic security, and their protection from violence and abuse.

And their mental health.

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Shouldering Covid-19’s mental health burden

An article published by the Children’s Institute in June 2020 projected an increase in anxiety, depression and post-traumatic stress as some of the mental health implications for children. It found mental health in children during Covid-19 may present as “patterns of behaviours” that suggest stressful or maladaptive coping mechanisms. These could include sleep problems, irritability, an increase in clingy behaviours and anxiety around loss or separation, or preoccupation with rituals of health and wellness.

Another aspect of the study showed most children have been exposed to loss in some form, including loss of social connections, especially with school closures, and the loss of loved ones. For many, these have included parents, grandparents or close relatives. In South Africa – where many grandparents assume the role of primary caregivers – the loss of older family members to Covid-19 has been particularly devastating. The loss or separation from a primary caregiver has a profound impact on child mental health in terms of loss of attachment figures, a safe base from which to explore the world and heightened anxiety and worry for the future.

More recent findings, published in Child and Adolescent Psychiatry and Mental Health, also laid bare the effect of Covid-19 restrictions on the mental health of particularly girls and young women. The research by the South African Medical Research Council and the University of Cape Town focused on districts with high levels of socioeconomic hardship and where HIV prevalence and teenage pregnancies were high. Lockdown had led to “increased experiences of stress and anxiety” while “poor mental health was compounded by strained family relationships, increased fear of domestic violence, household unemployment, economic stress and food insecurity”.

“In contexts where poverty and mental health stressors already interact to negatively impact the most vulnerable populations, Covid-19 is likely to have worsened these impacts,” the authors wrote. So, Covid-19 added mental health stressors to existing hardships and socioeconomic vulnerabilities. This is important to understand, “given the intersections between psychological distress and increased risk behaviours that impact sexual and reproductive health”.

Girls bear the brunt

Girls were particularly affected with, for example, the number of teenage pregnancies having increased during lockdown. In August 2021, the Gauteng health department reported that the number of children born to teen mothers in South Africa’s most populous province jumped by 60% since the start of the Covid-19 pandemic. The department’s statistics show that more than 23,000 girls younger than 18 gave birth between April 2020 and March 2021 – of whom 934 were under 14 – compared with the 14,577 girls having babies in the same period a year earlier.

Read in Daily Maverick: “Experts ring the warning bells over a mental health crisis among South Africa’s children during the pandemic”

To make matters worse, sound family planning and contraception have not been easily accessible for many South African teens and pandemic-related restrictions probably made a bad situation worse.

However, to connect the increase in teen pregnancies to the inaccessibility of condoms and contraception alone would be to assume that the 23,226 pregnancies were a product of consensual sex, when that may not always have been the case.

Violence against women and girls in the country is so pervasive that we can’t ignore its impact on teenage pregnancy. Early pregnancy and motherhood result in many girls dropping out of school, trapping many in a cycle of poverty where they are dependent on social grants, and leaving many stigmatised for being teenage mothers or forced into early marriage.

Research by the South African Medical Research Council and the University of Cape Town has found that lockdown led to 'increased experiences of stress and anxiety', while 'poor mental health was compounded by strained family relationships, increased fear of domestic violence, household unemployment, economic stress and food insecurity'.
(Photo: iStock)

It also creates a greater risk of maternal complications, resulting in low survival rates for babies, and forces many girls to prematurely take on an adult role for which they are not emotionally or physically prepared. This has devastating social and economic costs for not only teenage girls but also their families and communities. So, this pandemic risks being a time of irreversible setbacks and lost progress for girls.

High stakes

As the world enters what appears to be a deep and long-lasting recession, as jobs are lost and families lose precious sources of income, children’s sense of security, safety and normalcy has been challenged like never before.

Now, with new Covid-19 variants emerging and the virus becoming a new constant feature of life, the normalcy that once existed is becoming more distant and the long-term effects children will face will become clearer.

The stakes could not be higher.

If not adequately addressed, the mental health consequences for a generation of children and young people could far surpass the immediate health and economic impact of the Covid-19 pandemic, leaving long-term social and economic consequences in its wake.

How can we mitigate the impact?

It is clear that all of us collectively have to protect children, adolescents and caregivers from the devastating psychological impact of this pandemic.

The how, however, is less clear.

Let’s start with the more obvious. As a start, before talking to kids – especially young ones – parents need to take steps to handle their own anxiety. Taking care of yourself is important. Covid-19 has become the right time to talk about collective responsibility for our families and all of society. This is an ideal opportunity for families to develop a civic identity and parents can teach kids that part of that identity is taking care of people who are vulnerable. Each one of us is responsible for all of us, both within the family and in our communities.

We need more and immediate public and private investments in mental health and psychosocial services and programmes for children and young people, throughout their childhoods – especially in low-resource settings. For example, NGOs such as the Teddy Bear Clinic need investment so they can provide counselling services on a larger scale than what is possible now.

We must include the needs of children and young people in any discussion or implementation of Covid-19-related restrictions or containment measures. It should not be an “adult conversation”. Children and adolescents must be engaged directly to listen to their needs and tailor programmes to them. Nothing should be for them, without them.

The Covid-19 pandemic and lockdowns have triggered an increase in the number of children reaching out for mental health support. It would therefore be prudent for us to address child and adolescent mental health in South Africa as an urgent priority. The government must invest in improving the social determinants of (mental) health, work with civil society groups and the private sector to strengthen mental health and sexual and reproductive services and awareness for children and adolescents in communities, and provide the necessary training for mental healthcare workers. DM/MC

Kholofelo Mphahlele is a paralegal at SECTION27.

This article was published by Spotlight – health journalism in the public interest.

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South Africa

Shouldering Covid-19’s mental health burden

Girls bear the brunt

High stakes

How can we mitigate the impact?