Mental Health

COVID-19 lockdowns have significantly disrupted the daily lives of children and adolescents, with increased time at home, online learning and limited physical social interaction. This report seeks to understand the immediate effects on their mental health. Covering more than 130,000 children and adolescents across 22 countries, the evidence shows increased stress, anxiety and depressive symptoms, as well as increased and alcohol and substance use, and  externalizing behavioural problems. Children and adolescents also reported positive coping strategies, resilience, social connectedness through digital media, more family time, and relief from academic stress. Factors such as demographics, relationships and pre-existing conditions are critical. To ensure children and adolescents are supported, the report recommends building the evidence on the longer-term impact of the pandemic on child and adolescent mental health in low- and middle-income countries, including vulnerable populations.

UNICEF’s operational framework aims to help UNICEF staff and partners develop programmes across the social ecological model and the mental health continuum of prevention, promotion and treatment to improve the mental health and psychosocial wellbeing of children, adolescents and their caregivers globally. The strategies and approaches included in the framework will help in accelerating actions for children’s, adolescents’ and caregivers’ mental health and psychosocial wellbeing in national and regional development strategies. The framework can be used in development contexts, humanitarian contexts and within the humanitarian-development-peace nexus. This operational framework emphasizes engaging actors in the health, social welfare and child protection and education sectors at all levels of society to design, implement and evaluate MHPSS strategies that are locally relevant, comprehensive and sustainable. Everyone is invited to contribute to the development and improvement of UNICEF's Global Multisectoral Operational Framework for MHPSS by filling out a brief survey (no more than 30 mins) on your use of the framework.

In the last 50-60 years UNICEF, WHO & member states have worked tirelessly in reducing infant mortality rates and succeeding at it. In fact, one could go so far as to say that this is one of the major development-success stories of our time.

Globally, the increase in humanitarian crises, protracted conflicts, displacement, violence, terrorism, disease outbreaks, natural disasters and climate change is putting children and adolescents at significant risk of mental and emotional ill-health.

In some way, mental ill health has touched everyone. The statistics are alarming, and by some accounts constitute a public health emergency. Today, around 10-20 per cent of all children and adolescents suffer from some type of mental health disorder and mental health conditions account for around 16 per cent of

With suicide and self-harm now leading causes of death and injury among young people between 15 to 19 years, UNICEF and WHO are coming together for the first time at the Leading Minds for children conference to tackle the growing scale of mental health disorders among children and young people.

(29 July 2021, FLORENCE) From the outset of the COVID-19 pandemic, concerns about its impact on the mental health of children and young people were widespread. While the evidence is still emerging, there are many signs it could be severe and widespread. Faced with a potential “pandemic within a pandemic”, evidence-informed responses are urgently needed to support mental health.   A new report by UNICEF Innocenti, ‘Mind Matters: Lessons from past crises for child and adolescent mental health during COVID-19’, reviews the impact of past crises (such as natural disasters and the HIV epidemic) on youth mental health with the aim of informing responses to the current crisis. A second report – Life in Lockdown – to be released later this year (protocol available here), will synthesize the evidence on COVID-19’s impact on youth mental health.  “Too many children and young people, rich and poor alike, in all four corners of the world are experiencing mental ill health as we have never seen before. This is the silent emergency of our times. It has no borders and requires urgent attention.” – Henrietta H Fore The review finds that children and young people are at elevated risks of anxiety and depression, trauma, loneliness and isolation, suicide, and loss, which can have acute and long-lasting effects on child and adolescent mental health. Interventions to address these adverse impacts include rapid screening, parenting programmes, community and school-based programmes, and using digital tools and platforms. These interventions must be mindful of ages and stages. For example, younger children may struggle to process the temporal nature of the pandemic, whereas older children understand the implications of the pandemic more fully, which can elevate anxieties.  “Accelerator interventions” that combine interventions with other health care services and through common delivery platforms, such as schools, can address multiple aspects of children’s mental health simultaneously and reap benefits beyond the sum of those achieved through individual interventions. A review of 158 studies confirm key accelerating measures for improving mental health: interpersonal skills, emotional regulation, and direct alcohol and drug education. As is often the case, the most vulnerable children and adolescents are likely to be hardest hit by mental health impacts. There is substantive evidence that COVID-19’s biggest impact on children is on their socioeconomic environment, including access to social services, household poverty, and mobility restrictions. These children and adolescents should receive particular attention through screening and targeting of interventions. “All my plans are cancelled which means I have nothing to look ahead to and you find yourself trapped in a void of your own thoughts” – Anonymous, UK The review notes a paucity of evidence on youth mental health, particularly for younger children. While the COVID-19 crisis is generating many studies on the topic, many are methodologically weak. The crisis provides an opportunity to generate rigorous evidence on a topic that until recently had been mostly overlooked. This new evidence should showcase the voices of young people who serve as a vibrant guide to their experience, their solutions, and their priorities.  Visit our COVID-19 Rapid Research Response website. Browse hundreds of entries on COVID-19 and mental health in our Research Library and read our Research Digest on the topic. Listen to our podcast with mental health youth leaders to learn what they think is needed to better support youth mental health.  

10 October 2021 – Building on the first report in a series on child and adolescent mental health and timed with the launch of UNICEF’s State of the World’s Children 2021: On My Mind: Promoting, protecting, and caring for children’s mental health, a new report released for World Mental Health Day in 2021 looks at how the early stages of the global COVID-19 pandemic in 2020 affected the mental health of children and adolescents. A rapid evidence review was conducted to understand two key research questions: What has been the immediate impact of COVID-19 and associated containment measures on the mental health and psychosocial well-being of children and adolescents? Which risk and protective factors have affected the mental health of children and adolescents during the COVID-19 pandemic, and how have these factors varied across subgroups of children and adolescents? Building on a framework established for UNICEF Innocenti’s Worlds of Influence research report, the conceptual framework guiding the report explored the ramifications of COVID-19 on the child’s intimate world, the world around them and the outer worlds of influence while also assessing pre-existing and on-going risks. Uniquely the report also looked at positive mental health outcomes of the pandemic and found evidence on the impact of the pandemic on special populations and vulnerable groups including but not limited to migrant children, children in humanitarian settings, and children with disabilities.  "Life in Lockdown emphasizes the importance of focusing on child and adolescent mental health during the pandemic, a group that was considered to have been largely spared from the physical effects of the virus, " said Manasi Sharma, a research consultant with UNICEF Innocenti who worked on the report. "Government-imposed lockdowns, school closures, and disruption of services (including mental health care) have led to increased reports of fear and stress, anxiety, depression, anger, irritability, inattention, alcohol/substance, along with irregular physical activity and sleep patterns," she added. The report demonstrates that "although there were negative impacts, especially due to social isolation and loss of learning and networks, there were many positive outcomes and perceived opportunities, especially related to quality time with family, online learning, and time for recreation," Sharma said. "The use of digital technology during the pandemic provided social connectedness, remote learning opportunities, and a way to cope with isolation and stress. Engaging in positive coping strategies, prosocial behaviours and online learning opportunities have been key factors in building children’s resilience during this time, and these need to be highlighted and harnessed through greater investment in mental health promotion and prevention interventions."Life in Lockdown’s rapid research review included more than 130,000 children from 22 different countries. Most studies were from high- and upper-middle-income countries that were immediately affected by high infection and death rates in the early part of the pandemic, namely: China, the United States, and Italy. Key findings: Females reported greater depressive symptoms, anxiety and externalizing behaviout while males reported greater alcohol and substance abuse during COVID-19. Older children and adolescents reported higher and more severe rates of depressive symptoms. Children living in more affected areas, rural areas, or near the epi-centres of COVID-19 outbreaks were associated with higher stress and depressive symptoms including anxiety and substance abuse. Children living in poverty or in lower socio-economic status were found to be at greater risk of stress and depressive symptoms, whereas higher socio-economic status was found to be a protective factor. Children with pre-existing conditions were more significantly affected by pandemic-related changes. Children in lower socio-economic settings or humanitarian settings experienced more depression and trouble adapting to online education. Children who were exposed to pre-existing childhood abuse and neglect were at increased risk of stress. Family conflict increased the risk of mental distress among children and adolescents. Separation from families and parental depression were also risk factors for stress and adjustment during the Pandemic. Stigma based on ethnicity and all forms of racial discrimination were associated with greater anxiety among adolescents. Social isolation and loneliness during lockdowns contributed to a range of outcomes including depression, irritability, anxiety, stress, alcohol use and sedentary behaviours.  However, in some studies, children reported benefits of confinement including spending time with family, relief from academic stressors, which correlated with more life satisfaction. Experience or fear of exposure to COVID-19 predicted stress and depressive symptoms but also positive outcomes of health promotion and infection prevention, great social distancing and news monitoring. Children and adolescents who spent more time on physical activities and maintaining routines were better protected from depressive symptoms. Stress management, leisure activities and regular communication with loved ones proved to be protective coping strategies to deal with the lockdown stressors. Engaging in recreational activities, using technology to communicate with loved ones, having more time for oneself and one’s family, protected against anxiety and contributed to overall wellbeing during the pandemic.  Recommendations from the research for policy and programming: It’s never too early to start building a foundation for positive mental health in children.  Foster family-friendly policies to support parents and quality family time during pandemics. Invest in age- and gender-sensitive child and adolescent mental health care interventions and services. Promote physical activity and good nutrition for young people. Make schools a safe space for positive mental health. Focus on at-risk young populations. Address stigma and discrimination in mental health. Support digital technologies as a force for change.  Download the report to read about the recommendations to close the gaps in research on effects of COVID-19 on mental health.  

UNICEF Innocenti’s new report – Beyond Masks: Societal impacts of COVID-19 and accelerated solutions for children and adolescents – offers a comprehensive picture of the health, economic, and social impacts of the pandemic, and its implications for children and adolescents. The report examines evidence from the current crisis, examines past health crises such as HIV/AIDS, SARS and Ebola to provide insights into the current one, and proposes proven and promising solutions.

UNICEF convened its inaugural Leading Minds conference this year, taking the pressing issue of mental health of children and young people as its theme. The purpose of the annual Leading Minds conference series is to bring attention to a theme pertinent to the present and future wellbeing of the world’s children and young people by convening some of the world’s leading minds to examine available evidence and solutions and contribute to accelerating progress on solutions and breakthroughs.