In December 2021, the United States Surgeon General issued a new advisory to highlight the youth mental health crisis exposed by the Covid-19 pandemic. They called for a prompt and coordinated response and provided several recommendations and resources for individuals, families and caregivers, community organizations, educators, health professionals, journalists and media, social media and video game companies, technology companies, researchers, and governments (U.S. Department of Health and Human Services [DHHS], Office of the U.S. Surgeon General, 2021). Citing recent research findings of an alarming 40% increase in feelings of sadness or hopelessness in adolescents since 2009, the advisory highlights groups of youth at increased risk for mental health challenges during the pandemic. These include, but are not limited to, youth with intellectual and developmental disabilities, racial and ethnic minorities, LGBTQ+ youth, low-income youth, immigrants, and other special populations such as those in the juvenile and welfare systems. Children with existing mood disorders were at a higher risk of severe Covid-related mental distress (U.S. DHHS, Office of the U.S. Surgeon General, 2021).

Recently published research reviews (Jones et al., 2021; Meade, 2021) provide compelling data from national and international studies conducted between 2019 and 2021 that support the Surgeon General's call to action. Overwhelmingly, the studies found significant correlations between increased anxiety and depression and the pandemic. Psychological disorders that increased include feelings of burdensomeness and belongingness, psychological distress, stress and trauma, drug abuse (Jones et al., 2021), as well as suicidal ideation and attempt, and mental health emergency room visits (Meade, 2021). Children ages seven or younger were found to demonstrate increases in anxiety, clinginess and fears around safety, uncooperativeness and worry, misbehavior, and boredom. School aged children were reported to have more misbehaviors, anxiety, and depression as well as difficulties with academics and social isolation (Meade, 2021). Stressors for children and adolescents during the pandemic include increased isolation and loneliness, heightened concerns over safety and well-being, racism, family and caregiver stress, increased family conflict, loss of social activities and school support systems, increased screen time and lack of physical exercise, and decreased access to mental health services (Meade, 2021).

In March 2022, the Centers for Disease Control and Prevention (CDC) issued a report of the first nationally representative survey of adolescents conducted during the Covid-19 pandemic that documented significant increases in self-report of poor mental health (>37%) and persistent feelings of sadness and hopelessness (44%). More than half reported having been emotionally abused in their homes; 11% experiencing physical abuse; and 29% that a parent or adult had become unemployed (CDC, 2022). LGBTQ+ and female youth experienced more mental health issues and abuse than their counterparts. Adolescents reported increased experiences with racism (64% and 55% of Asian and Black students, respectively). The CDC (2022) report concluded that feeling cared for, supported, and belonging at school were key protective factors for children and youth during the pandemic. However, only 47% of those high school students surveyed by the CDC experienced this phenomenon.

Long-term effects of the pandemic on youth mental health remain unknown. Pediatric nurses can play a pivotal role in the assessment and treatment of mental health disorders by recognizing that prevention is the best treatment and routine mental health screening of children, teens, and their families is a critical first step. Health care providers can also advocate for governmental support and participate in research to improve the mental health of our nation's youth.

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