PROOF POINTS: Depression and anxiety rise among Chinese teens during coronavirus pandemic

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Psychological disorders often show up during the teenage years.  Between 10 and 20 percent of adolescents experience mental health problems, according to the World Health Organization. 

What happens when you add a stressful health pandemic to the developing teenage brain? A recent study of the psychological consequences of Covid-19 on teenagers in China suggests that both depression and anxiety could be soaring, particularly among girls, high-school seniors and low-income students.  

There have been plenty of anecdotal reports of emotional distress in the United States since the virus erupted here in Feburary 2020. Mental health professionals and educators have been sounding alarms about it. But this Chinese study gives us a sense of how big the problem could be and points to which teens are most vulnerable.

In the study, Chinese researchers administered an online survey in March 2020 to more than 8,000 middle and high-school students, ages 12 to 18, from more than 20 provinces in China. The surveys included widely used questionnaires that are used around the world to diagnose depression (PHQ-9) and anxiety (GAD-7). 

When the results came in, the researchers found that 44 percent of the Chinese students were suffering from mild to severe depression and 37 percent had symptoms of anxiety. More than 30 percent of the students had symptoms of both depression and anxiety simultaneously. It’s hard to say exactly what the normal rate of anxiety and depression would otherwise be. Previous studies in China have found an average depression rate of 15 percent among a wider age range of children, kindergarten through 12th grade. 

Qiyang Zhang, a graduate student at Johns Hopkins University who wrote about the Chinese study in a newsletter on education research, characterized the rates as “alarmingly high.” The study was originally published online in the peer-reviewed journal of European Child & Adolescent Psychiatry in May 2020. 

The researchers found that some Chinese teens were more vulnerable than others. Female students were more likely to experience symptoms than males. Students in older grades tended to have higher rates than students in younger grades with high school seniors, already coping with the stress of exams and university admissions, suffering most often. 

Geography mattered too. Students living in Hubei, the province where Wuhan is located and where the virus originated in December 2019, had higher rates of anxiety and depression than students living in other regions. But regardless of the province, rural students had higher rates than urban students.  In China, rural villages tend to be far poorer than cities and the researchers interpreted the higher rates of emotional disorders as a sign that poverty increases the stress. Some earlier studies, the researchers pointed out, had also found that emotional disorders were nearly twice as high among the poor than among the wealthy in other countries. 

It’s not clear why the pandemic triggers depression and anxiety. It might be worry about getting infected by the virus and dying but it could also be the social isolation, the excessive screen time or concerns about lost family income. 

Some might question how accurately students can judge their mental state but western researchers have repeatedly confirmed that self-assessments using these depression and anxiety tests are reliable. The Chinese researchers were concerned that they had to rely on volunteers and worried that they were undercounting more severe cases because teens with severe depression and anxiety might have been unwilling or unable to fill out the surveys. Only 3 percent of the respondents had severe cases of either depression or anxiety. 

Most of the Chinese cases were mild ones. A cluster of common symptoms — such as little interest or pleasure in doing things, feeling tired or having little energy, poor appetite or overeating — can trigger a diagnosis of mild depression. Common symptoms of anxiety were  feeling nervous, anxious or on edge, worrying too much about different things, and becoming easily annoyed or irritable. 

The study also offered some clues on how to help teens. Students who reported that they were familiar with ways to prevent Covid and took precautions such as washing hands and wearing masks were less likely to fall into a depression or develop anxieties. I’d like to emphasize this, the act of washing hands not only helps avoid the virus, but it may also help reduce emotional distress.

Students who felt optimistic about overcoming the virus also fared better. Learning about the number of people who have recovered and the scientific progress of medicines and vaccines might be helpful, the researchers suggested. However, media coverage about increasing cases and deaths can also aggravate feelings of despair and worry. 

The big implication of this study is that mental distress among adolescents is soaring in the age of Covid. The Chinese researchers recommend identifying high-risk groups — such as low-income female high school seniors — and intervening early. 

I wondered if many symptoms quickly lift once teens resume social contact. This survey took place the week of March 8, 2020, after the virus’s February peak in Wuhan. The lockdown there ended in early April. 

The worry is that a short-term distress can lead to a lifetime of illness. “When the pandemic abates,” wrote Zhang, “emotional disorders do not just conveniently disappear.”

This story about mental health of students was written by Jill Barshay and produced by The Hechinger Report, a nonprofit, independent news organization focused on inequality and innovation in education. Sign up for the Hechinger newsletter.