essay on role of youth during covid 19 pandemic

• Open access
• Published: 22 October 2024

Supporting young people through the COVID-19 pandemic and beyond: a multi-site qualitative longitudinal study

• Madelyn Whyte 1 ,
• Emily Nichol 2 ,
• Lisa D. Hawke 2 , 3 ,
• Kelli Wuerth 1 ,
• Meaghen Quinlan-Davidson 2 ,
• Aileen O’Reilly 4 , 5 ,
• Joseph Duffy 4 ,
• Steve Mathias 1 , 6 , 8 , 9 ,
• JL Henderson 2 , 3 &
• Skye Pamela Barbic 1 , 6 , 7 , 8 , 9 , 10  

BMC Health Services Research volume  24 , Article number:  1266 ( 2024 ) Cite this article

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Throughout the COVID-19 pandemic, youth have experienced substantial stress due to abrupt changes in education, finances, and social life, compounding pre-existing stressors. With youth (ages 15–26) often at critical points in development, they are vulnerable to long-term mental health challenges brought on by pandemic trauma.

To identify youth experiences throughout the pandemic and examine changes over time, we conducted semi-structured interviews among n  = 141 youth in two Canadian provinces (Ontario and British Columbia) and across the country of Ireland at three time points over the course of more than one year (August 2020-October 2021). We conducted a qualitative longitudinal analysis using an inductive content approach.

Categories identified were (1) coping with hardship; (2) opportunities for growth; (3) adapting to new ways of accessing services; (4) mixed views on the pandemic: attitudes, behaviour, and perception of policy response; (5) navigating COVID-19 information; (6) transitioning to life after the pandemic; and (7) youth-led recommendations for government and service response. The findings also reveal trends in health and wellness in accordance with prolonged periods of lockdown, changes in weather, and return to normalcy after the availability of COVID-19 vaccines. Key recommendations from youth include incorporating youth voice into decision making, communicating public health information effectively to youth, enhancing service delivery post-pandemic, and planning for future pandemics.

Conclusions

These results provide insights into the extensive longitudinal impacts of the COVID-19 pandemic on young people across three geographical locations. Actively involving youth in decision making roles for future pandemics or public health emergencies is critical.

Peer Review reports

Researchers have long studied the relationship between risk and resilience to determine ways to promote positive health outcomes in trauma-exposed youth [ 1 ]. Literature exploring the impacts of terrorism and natural disasters has uncovered ripple effects for those exposed to traumatic events in history. Studies on youth mental health symptomology following the 9/11 terrorist attacks revealed links between direct exposure and heightened rates of post-traumatic stress disorder [ 2 , 3 , 4 ]. Similarly, data on youth affected by Hurricane Katrina found higher rates of depression and anxiety in the years following the disaster, with secondary stressors of loss of home and financial strain compounding mental turmoil [ 5 , 6 ].

As with discrete traumatic events, the COVID-19 pandemic presented unique challenges for youth (defined here as ages 15–26 years) [ 7 ]. Youth reported disruptions in accessing social and recreational services and services for their mental and physical health [ 8 ]. For example, while mental health and substance use services quickly pivoted to virtual service delivery modalities, many end users reported not receiving needed services [ 8 , 9 ]. Acute effects of the COVID-19 pandemic on youth include high rates of stress [ 10 , 11 , 12 ] and interpersonal challenges [ 13 ], gendered differences in mental health status [ 12 , 14 , 15 , 16 , 17 ], and mixed effects on substance use [ 18 , 19 , 20 ]. Youth also experienced hardships with schooling and academic performance [ 21 , 22 , 23 , 24 ], with the transition to virtual learning posing challenges for many young people who had difficulties adjusting to a self-directed learning style and lack of supports [ 24 ]. Furthermore, the pandemic-related restrictions resulted in increased unemployment rates for youth ages 15–24 in all countries including Canada and Ireland, leading to financial strain and concerns about the future [ 8 , 25 ]. Exposure to heightened stress through sudden risk of infection, school closures, financial strain, isolation, and an increasingly polarized political climate in the early stages of the pandemic created a tumultuous environment with the potential to affect lifetime developmental trajectories [ 10 , 11 , 26 ].

Quantitative longitudinal studies of youth mental health and wellbeing during the COVID-19 pandemic have suggested ongoing negative impacts of the pandemic as a whole and across many mental health and wellbeing variables [ 16 , 17 , 20 , 27 , 28 , 29 ]. Stress, anxiety, and depression increased among youth during the pandemic, while general wellness and positive health behaviors such as physical activity declined [ 27 , 28 ]. However, there is a lack of qualitative, longitudinal literature examining youth experiences during and perceptions of the COVID-19 pandemic and response. An in-depth exploration of youth experiences during the pandemic is required to gain insight into their mental health experiences, perspectives on public health measures, hopes and aspirations for the future, and recommendations for the post-pandemic recovery and future outbreaks, pandemics, and public health crises.

To gain insights into the ongoing experiences of youth during the pandemic internationally and understand how to best meet their needs going forward, we conducted a longitudinal qualitative study during the pandemic. Our objectives were to (1) explore youth experiences during COVID-19 at three time points and in three regions (two provinces in Canada: British Columbia and Ontario, and the country of Ireland) to determine ongoing impacts of the pandemic on mental health and wellbeing, and (2) offer youth-oriented recommendations for government and service response.

This qualitative study aims to explore youth perceptions of the COVID-19 pandemic across three regions: British Columbia, Ontario, and Ireland and three time points. Employing a phenomenological approach, we sought to capture the lived experiences of young people and understand the meanings they ascribe to these experiences during this unprecedented time.

Study sample

We recruited participants for this multi-phase longitudinal study from three geographic locations: Ireland and two Canadian provinces [British Columbia (BC) and Ontario (ON)]. Recruitment procedures varied slightly by site as described below. The selection of the three geographical locations was predicated on three key criteria: (1) each location implemented a comparable model of care tailored to youth; (2) established research infrastructure existed to facilitate a rapid response to the pandemic-related needs of youth; and (3) the sites shared analogous policies pertinent to pandemic management. We selected participants using purposive sampling to ensure representation across different demographics, including age, gender, and cultural backgrounds. Ethical approval for this study was provided by Jigsaw’s Research Ethics Committee (JREC/2020/004), the Centre for Addiction and Mental Health Research Ethics Board (046-2020), and the University of British Columbia Behavioural Ethics Research Board (H20-01537).

In Ireland, a mental health seeking sample was recruited from Jigsaw services. Jigsaw – the National Centre for Youth Mental Health is an early intervention integrated mental health service in Ireland that aims to support youth aged 12 to 25 with their mental health and wellbeing [ 30 ]. Clinicians invited youth ages 16–25 (with consent from parents/guardians, if under 18) who resided in Ireland and used Jigsaw’s brief intervention services to participate in the study, and, with consent, youths’ contact details were shared with a member of the research team. An invitation to take part in the study was also emailed to all youth registered for Jigsaw’s online synchronous chat support service who had provided consent to be contacted for research purposes. As per the protocol at Jigsaw, no honorarium was offered to participants recruited from the clinical sites. The rationale was that the payment could influence their help-seeking behaviours.

Ontario (ON), Canada

In ON, youth ages 14–28 who were participating in a larger longitudinal quantitative study on mental health and COVID-19 at the Centre of Mental Health and Addictions (CAMH) [ 31 ] were asked for consent to be contacted for this sub-study. CAMH is the largest mental health teaching hospital in Canada, providing a range of clinical services for all ages. The study included youth recruited from three clinical studies and one non-clinical study [ 32 , 33 , 34 ]. Among those who provided consent, emails were sent to potential participants, and purposive sampling was carried out to include a diverse sample of youth in this sub-study. Thirty participants were recruited from the clinical sample, and thirty-one participants were recruited from the non-clinical sample, with the goal of representing both cohorts and a wide range of demographic characteristics. Participants received an email message inviting them to participate. Participants were paid a $30 honorarium for each interview.

British Columbia (BC), Canada

In BC, a Foundry-led social media campaign was developed with youth and launched to recruit diverse youth ages 16–24 who resided in BC. Foundry is an integrated youth services initiative for youth ages 12–24 that provides support in person and virtually through a single access point for multiple service streams, including mental health [ 35 ]. Among those who indicated interest in the study, purposive sampling was carried out, and a diverse sample of youth from across the province was invited to the consent phase of the study. Two groups were recruited: A clinical group ( n  = 30) who had accessed Foundry services in the past 12 months, and a non-clinical group ( n  = 30) who had not accessed Foundry services. As with ON, participants in BC were paid a $30 honorarium for each interview.

Consent and interview procedures

Data collection procedures at each site varied slightly. All procedures were conducted in English. Youth provided verbal or written informed assent/consent to their data being collected and stored for research purposes. In cases where youth could not legally consent due to jurisdictional laws, consent was received from their parent/guardian. Participants were informed that all questions were optional, and that they could end the interview at any time. Participants were followed up with via email. The interview schedule is reported in Table  1 . Our research team comprises individuals both within and outside the gender binary.

In ON, demographic data (e.g., age, gender identity, race/ethnicity, employment status) and psychosocial data were collected from the initial quantitative survey [ 31 ]. Interviews were conducted by phone or through a secure video conferencing system, WebEx (Cisco Systems, San Jose, California), hosted on a secure institutional server. Interviews were digitally recorded and transcribed verbatim by either a research staff member or a professional transcription agency. Participants were assigned unique participant IDs, and identifying information was removed during transcription. In Ireland and BC, demographic surveys were completed electronically at the start of all three time points. In BC, psychosocial questions were completed as part of this survey. Semi-structured interviews were conducted through Zoom (Zoom Video Corporation, San Jose, California) by a member of the research team. In BC, this research team for interviews consisted of a research coordinator and seven youth research assistants, and in Ireland the team consisted of two youth research assistants. Youth research assistants were between the ages of 16–24 years, who received training and supervision from the study leads (SB, JH/LH, AO) to conduct interviews and support analyses. Interviews were recorded and transcribed verbatim by two youth research assistants in BC and two youth research assistants in Ireland. Unique participant IDs were given and identifying information was removed from the transcripts to maintain confidentiality. A copy of the semi-structured interview guides used across all sites is contained in Appendix A.

The engagement of youth was a core component of this study. One to two youth co-researchers were employed at each site to support all elements of the research process and were provided with training and supervision by the site lead researchers. Youth co-researchers were aged 18–24 years, had lived and living experience of mental health challenges and accessing the system, had past research experience in health services research about youth, and were hired by the local site leads. Youth co-researcher groups were consulted on various aspects of the project across the three study sites, including co-developing the recruitment materials and research and interview questions, interpreting and validating the findings, and contributing to other knowledge translation materials [ 36 , 37 ].

We employed inductive content analysis, which involved reading and re-reading the data (familiarisation); identifying broad categories; developing and refining subcategories and fine-grained codes; and collating and interpreting the data to generate succinct categories and subcategories [ 38 ]. We used NVivo 12 Software [ 39 ] to support data analysis. This process was iterative, with many drafts of refinements until an accurate depiction of the data was captured [ 38 ]. At the intra-site level, the research team met weekly to ensure a mutual understanding of code definitions and coded two transcripts together for each time point. At these meetings, study site leads (MW/SB, AO, LH) reviewed the codes and resolved conflicts if they occurred. At the inter-site level, all team members met weekly to discuss discrepancies and refine codes and the coding framework. For this paper, we present site differences over time. A future analysis is planned to explore differences in age, gender, and race/ethnicity amongst the categories and will be reported elsewhere.

Demographics

As shown in Table  2 , a total of 141 participants ages 14–26 years took part in the study at T1 (BC n  = 59, ON n  = 61, Ireland n  = 21). Retention was 87% at T2 ( n  = 123 total; BC n  = 50, ON n  = 56, Ireland n  = 17), and 78% at T3 ( n  = 110 total; BC n  = 43, ON n  = 53, Ireland n  = 14). The interview times ranged from 20 to 120 min. On average, participants from Ireland were younger, with 33.3% of youth aged 14–17, compared to BC (20.3%) and Ontario (6.6%). Participants from Ontario had more gender diversity (26.1% boys/men, 47.5% girls/women, 16.3% outside the gender binary) compared to BC (72.9% girls/women) and Ireland (85.7% girls/women).

Table  3 outlines psychosocial factors documented across time-points in BC and ON. Due to resource limitations, participants from Ireland did not complete the psychosocial surveys.

Content categories

Table 4 outlines seven primary categories and multiple subcategories uncovered during analysis. Interviews at different time points and sites were analyzed separately and trends over time and across sites were documented, capturing shifts in health and wellness, personal circumstance, and perception of policy response. These findings are discussed together when consistent across sites and time points, and differences are described when applicable. These categories and subcategories are described in the following sections and include verbatim supporting quotes

Category 1. Coping with hardship

The study revealed a range of pandemic-related hardships that contributed to significant cumulative stress over the course of the investigation. Participants articulated a multitude of challenges, including the loss of cherished experiences, strained interpersonal relationships, disruptions to education and professional development, financial setbacks, deteriorating mental health, and increased xenophobia fueled by rising political tensions. These interconnected issues are described in seven sub-categories.

Experiences of loss and missed opportunities

Youth reported experiencing loss of important childhood and adolescent milestones, describing missing out on their “prime years” (BC, T1) due to lockdowns and restrictions. Youth expressed awareness for how their generation has been impacted in unique ways due to the transitional nature of the participants’ ages, with one participant saying, “I’ve been a lot more lonely … it feels like a ton of my prime-time – my prime years are being wasted” (BC, T1). For some, these disruptions felt like a disadvantage in terms of emotional and professional development, with one participant saying, “It affects our generation a lot , just because … these are our prime years to meet new people and gain new experiences and stuff like that. I feel like we have … a disadvantage” (BC, T1).

Youth were also impacted by missing out on important events to celebrate achievements such as graduation, birthdays, and other moments of significance. These missed opportunities to recognize pivotal moments of accomplishment in a public forum were realized in the early days of the pandemic: “I didn’t have a graduation ceremony , so I didn’t get to celebrate or take pictures with my parents. Didn’t get to walk with my diploma or say goodbye to my friends , or do any form of partying or celebrating finishing school” (BC, T1).

No longer able to engage in typical activities as an adolescent, youth suffered erasure of formative experiences, reporting, “you’re never going to get the year back” (Ireland, T2). Lost time and missed opportunities contributed to a collective sense of grief.

Isolation, cohabitation, and interpersonal challenges

Across regions, interpersonal challenges became apparent due to lockdown and restrictions on social gatherings, where connections became strained due to diminished contact: “It is almost like a whole year of bonding is gone” (Ireland, T1). Warmer weather acted as a buffer against isolation, since participants had more freedom to engage with others safely outside. During colder months, as case numbers rose and restrictions tightened, participants expressed increased feelings of loneliness:

Different views on policy guidelines and pandemic restrictions contributed to relational disconnect. The strain on relationships was most apparent at T2 as restrictions tightened, and friends and family members had differing views on vaccinations and following guidelines:

“ I still feel kind of disconnected from a lot of my friends , just because of the pandemic , and everyone’s different ways that they feel about the restrictions. A lot of my friends are , maybe , more open , and maybe not following the rules as much as myself” (BC, T2).

Many participants expressed technology fatigue over time, where communicating in the form of texting or video chatting could not replace the in-person connection: “That’s a big part of it , not being able to just hug people” (Ireland, T2). For some, maintaining virtual relationships was a daunting task, described more like a chore than an opportunity for social interaction: “ You kind of can only keep so many relationships going virtually” (ON, T2). As one participant described the trials and tribulations of virtual communication:

“I just have a lot of troubles with calls , maybe not calls , but texting people … I just don’t think you can maintain any sort of social relationship just on social media. ” (ON, T1).

In contrast, too much time with family was also reported by some participants to fuel conflict due to a lack of personal space, with youth noting the adverse effects on their mental health as a result. “Family issues spiked up” (Ireland, T1) during lockdown, when family members were living, working, and attending school under one roof, the effects of which were felt most among youth with challenging dynamics with their parents: “My parents weren’t very supportive of me and I kind of had to stay in that house , and you know , get talked down to and belittled every single day , but also my anxiety from not going out really anywhere skyrocketed” (ON, T1). Confined by the inability to seek refuge in safe relationships, feelings of isolation were compounded for youth in challenging family dynamics.

Disruption to education and professional development

Youth described how online learning was an adjustment. Difficulties associated with abrupt changes in educational formats were most apparent at T1. Youth experienced obstacles managing a self-directed learning style, feeling distracted and less productive at home. Some students with disabilities experienced challenges navigating a new way of learning without the necessary infrastructure to provide accommodations in virtual course formats:

“A lot of institutions took the opportunity of digital and online services to mean that they no longer had to provide specific disability services , which , had they talked to students , would know that’s not acceptable nor equitable access … online does not mean accessible” (BC, T1).

Technical issues compounded by adjusting to an online format while at home posed several learning barriers:

“I find it very hard it’s like school online takes a huge toll on like me personally I find it extremely stressful to keep up with it. It’s given me a couple of like breakdowns especially in the last couple of weeks … it doesn’t feel like you’re actually in school like or in college. You’re just in a room watching things” (Ireland, T1).

For those experiencing greater mental health problems due to pandemic-related challenges, academic performance declined. Students described heightened stress, lower mood, lack of focus, an inability to complete course work, and an overall work environment not conducive to productivity. Teacher-student communication issues emerged, where students needing extra assistance were unable to receive proper support virtually. Managing questions over email was not adequate for those requiring clarity and a fluid back-and-forth dialogue on an academic issue:

“We used to speak with the teacher , we used to be in a classroom , you could talk to them. But now everything’s online , and learning online is a lot harder , ‘cause you can’t really ask questions the way you could in class sitting in front of the teacher” (ON, T1).

In applied programs and career paths requiring more technical training among college- and university-aged students, educational progress slowed. Without adequate hands-on experience, youth felt they were not receiving the same type of education they would have had if the pandemic had not happened. In some cases, youth worried how lacking such skills would affect future career prospects, feeling “ripped off in terms of professional development” (BC, T2).

“Starting a brand-new program , especially one that’s super hands-on learning , it was really difficult to find times and opportunities to practice hands-on skills that I need to develop” (BC, T2).

Employment and financial setbacks

Job loss or reduced “COVID hours” (BC, T2) led to financial stress that was particularly noted in T1. Fear surrounding being able to find a new job and afford the cost of living took a toll emotionally, adding new stress for some on relationships:

“It was the end of my school term , so I had no money left , and it was definitely pretty scary , so I don’t want to be in that situation where I was floundering , looking for money , and I ended up having to rely on my boyfriend a lot. Which , this is my ex-boyfriend , but it kind of created this weird power imbalance in our relationship , where I had to rely on him for everything” (BC, T1).

As an age group that occupies a large portion of customer service and hospitality positions, youth expressed concern about returning to a work environment with potentially increased exposure to COVID-19: “[Working in retail is] absolutely terrifying , to be exposed to that many people every day , like , you know , how many people come through to shop which is something that we’ve all been avoiding over the past couple months” (Ireland, T1). Fear of contracting COVID-19 arose, along with challenges dealing with the public with the implementation of new public health mandates requiring masks and vaccination in certain establishments:

“Since everything was opening up , the public seemed a little more lax in terms of some of the public health restrictions. So , you know getting into disagreements over , you know if they should wear a mask and stuff like that , and having to explain that the pandemic is still going on. It is a customer service job , so I’d get yelled at quite a lot this summer [2021] over that , as well as you know trying to enforce public health recommendations” (ON, T3).

Mental health challenges presented in the form of disrupted sleep schedules, increased substance use and social anxiety, and decreased motivation. Youth described how prior stressors were exacerbated by pandemic-related stress, with symptoms most prevalent during lockdown periods and winter months.

With online school and reduced work hours or job loss, maintaining a routine became difficult, which perpetuated mental health challenges: “I have trouble with maintaining a regular sleep schedule. And so that’s exacerbated by not having a schedule – like during the pandemic there’s more onus on me to schedule things and there’s less outside – outside factors for me to rely on as a schedule” (ON, T2). Youth described reliance on unhealthy coping mechanisms and increased substance use to mitigate mental health challenges: “When I feel like that [out of control] , then that’s when I start to smoke and do a lot of other things to keep myself distracted and mellow it out” (ON, T1). Unable to turn to typical coping strategies such as leaning on friends, youth struggled to find ways to support their wellbeing:

“My substance use has definitely gone up or it has become more frequent , like quite dramatically. And that’s in part because I , again , I live alone , I work from home , so there’s a lot more opportunity sort of for me to engage with substance use. (ON, T2).

Over time, youth described how isolation heightened social anxiety: “You’re always on edge , everything seems like we’re in war or something and you have to stay inside ‘cause there’s curfews and danger and everything all the time” (Ireland, T2). Living in a perpetual state of fear when interacting with others and experiencing lockdowns led to difficulties socializing: “Being cooped up inside 24/7 isn’t good for anybody … You stay inside , you’re going to develop different problems socially” (Ireland, T2). Everyday tasks such as going to the grocery store or seeing friends became associated with fear:

“I’m afraid of going into public places like Costco , or being in a bigger group of friends. If there’s ten people – even if we’re social distancing , I still feel uncomfortable if someone’s gone somewhere , and I know where they’ve gone , or I don’t know where they’ve gone even , I feel uncomfortable” (BC, T2).

Motivation to learn, work, or complete typical tasks decreased while navigating life through the mundaneness of the pandemic: “I can’t bring myself to do anything … If I tried to do school , I couldn’t do school , even one course. I can barely take care of myself throughout the day. I just don’t have any motivation to do anything” (ON, T3).

For many, winter months intensified boredom, where shorter days and colder weather negatively impacted mental health. Youth described feeling like they were living the same day on repeat:

“It definitely got worse in the winter. …I kind of started to feel like I was living the same day over and over again , especially in , like January , February , like I was living the same week because it would be like I have the exact same worries on Monday and then that’s done. And then I have the exact same worries again and again and again and again” (Ireland, T2).

In instances where youth contextualized prior difficulties with mental health problems, COVID-19 added “this extra layer of anxiety and stress that’s just been coated across everything … It feels like it’s just blanketed the whole thing , and it’s added more weight to everything” (BC, T1). Youth described feeling a “constant high state of alert and stress” (BC, T2), with little to no relief: “It’s just something that’s always there and I feel like it kind of accentuates whenever something that you do have that’s more negative on your life … It kind of compounds with anything negative in your life , and so it’s very easy to kind of wear down on you” (ON, T2).

In addition to negative mental health impacts of the pandemic, youth experienced physical health declines due to closure of gyms and recreation centres, colder weather making it difficult to exercise outdoors, and inaccessible physical health services, including doctors, physiotherapy, and other health services: “I loved going to the gym but I have not been to a gym since probably December” (ON, T2).

However, improved mental and physical wellbeing were often observed in summer months, where youth had opportunities to get outside, exercise, and safely interact with peers in a physically distanced manner: “I think summer is also a big factor , like weather. It changes everyone’s mood. So I think it’s definitely more hopeful when the summer comes. Everyone will be more happier and more hopeful” (BC, T2).

Youth living in urban vs. rural settings

COVID-19 experiences differed for youth depending on their community. Those in rural areas expressed gratitude for more open space to get outside and physically distance:

“If I was to live in town in the city , I wouldn’t be going out for a walk , because I’d be more likely to bump into people … I’d be inside more , and then I’d be driven more crazy. I really do need those walks every now and again , and just get out of the house. And I don’t know if I would be confident enough to do that in town” (Ireland, T2).

However, misinformation and people not following guidelines was a reported concern, with one youth in a rural community reporting, “I think in terms of the general attitude around COVID , it’s maybe a bit more … Uneducated , than in a city” (BC, T2). In urban spaces, greater population density led to an increase in fear and added challenges getting around the city:

“If we had enough money to afford a car , we wouldn’t have to worry about catching COVID from public transit. Wouldn’t have to get in that sardine bus. We’d be able to go and visit friends without worrying about , like , OK , I am exposing myself to , like , hundreds of people” (ON, T3).

Experiences of xenophobia

Asian-Canadians experienced a “big increase in harassment and racism” (BC, T2) noted midway through the study period. Instances of hateful rhetoric became more commonplace, and as a BC participant recalled, “I did get some of the racist comments when I was at Costco , because of being Asian. I did receive a lot of comments about it , so I think those did affect me , and I think it’s going to affect me after the pandemic , as well” (BC, T2). Because of these experiences, as well as seeing cases of racism and xenophobia on the news, some described feeling unsafe in public settings:

“I guess it’s important to stay more vigilant now. (…) [S]ometimes there’s those kind of creepy looking [people] who you don’t know if they’re going to start verbally harassing you on the subway and stuff because you’re alone and there’s not people around to kind of protect you anymore” (ON, T3).

In Ireland, one participant spoke about how xenophobia is resulting in a “ divide in society ”, citing a mentality in Irish society of “‘No Chinese , no Brazilians , no Brits’ , because like they brought the new variants” (Ireland, T2). They also spoke about their family members experiences’ “getting abused on the bus” and being told “ you brought COVID here ” (Ireland, T2).

Category 2. Opportunities for growth

This category emerged consistently among youth across all three recruitment locations. At Times 1 and 2 (T1 and T2), participants expressed a strong appreciation for the opportunity to acquire new skills and engage in a more measured approach to goal-setting and personal development. As the study progressed, youth participants articulated a growing sense of gratitude for previously taken-for-granted resources (T3), such as the re-opening of schools and recreational centers. Additionally, they acknowledged the adaptive measures their networks implemented during the pandemic, notably highlighting the efforts of teachers in developing innovative online curricula.

Learning new skills and hobbies

The pandemic presented an opportunity to develop new hobbies and skills. Honing a craft, indulging in creative endeavors, and exercising buffered against stressors in the early days of quarantine during T1 interviews:

“During the first lockdown , I actually picked up the hobby of running , because I didn’t have anything else to do. And I always wanted to try running , but I never really got the chance to” (Ireland, T1).

With newfound leisure time, youth were able to put their energy towards activities that would otherwise not be prioritized, which improved mental health:

“Especially during the early days of quarantine , that was pretty helpful , being able to create something , or lots of people got into baking. I don’t know , I think little things like that , like being able to acquire a new skill that you didn’t have before , I think that’s important for your mental health , and just feeling like you are accomplishing something , even when everything else is kind of at a standstill” (BC, T1).

Slower pace of life and commitment to personal development

Many used their newfound free time to slow down, self-reflect, and “build better habits” (ON, T3). The impacts of a slower pace of life were particularly apparent during T1 interviews, as some youth experienced reduced responsibilities because of changes in employment and education. This gave youth time to reflect: “It’s forced me to slow down , in a way , and to spend more time with myself , and learn more about myself” (BC, T1). Others were able to recover from burnout: “I was running at such a high level , and burning a lot of steam and not giving myself that time to reflect on situations and myself , and COVID kind of forced me to do that , because I had the literal time to do it” (BC, T1).

Despite hardship during the pandemic, more time alone acted as a catalyst for change: “It taught me a lot about my mental health … how to take care of myself , and how to practice self-care” (BC, T1). Several youth took initiative to understand themselves better and begin a journey of healing during this time.

In some instances, youth noted an increase in help-seeking behaviour, declaring, “If it wasn’t for the pandemic , I think I’d still probably be suffering from mental health [problems]” (Ireland, T3). These participants practiced self-care by confronting their mental health issues and reaching out for support instead of suppressing emotions.

“The thing about being stuck in your house is that you can’t escape anything. Like all of your issues , you have to deal with them right now because there’s no going anywhere… I’m at a point now where I’m being forced to make life changes and I’m being forced to actively confront my life and my issues” (Ireland, T2).

Gratitude for re-opening and life prior to the pandemic

Gratitude and appreciation toward returning to a“normal” life as restrictions lifted were noted across all time points: "I think it kind of just made me appreciate everything, kind of more. Like even whenever I was able to see my granny for the first time, I just would be something so normal to me and then it was just like this whole big thing” (Ireland, T1). For some, the pandemic served as a reminder to “[have] gratitude for what’s happening in the present cause you don’t really know what’s going to happen in the future” (ON, T3).

Positive experiences with remote education and employment

While some youth experienced a multitude of difficulties adjusting to remote education and employment, others found they were able to excel with the shift to virtual. Positive attitudes towards remote education and employment increased in T2 and T3 as rocky transitions passed. Virtual education and employment were valued for accessibility reasons for individuals who live in rural regions and/or have certain disabilities or physical or mental health conditions that limit their ability to participate in in-person activities: “I also have a chronic illness , which affects fatigue and mobility , so being able to have class online was really helpful , as well” (BC, T1).

Category 3. Adapting to new ways of accessing services

Physical health, mental health, and substance use services had to quickly shift from in-person to virtual care. During this transition period, youth experienced service disruptions, noted in T1 interviews. Barriers to accessing services improved with time as adaptations to online service delivery developed. However, concerns including prolonged wait times, not feeling prioritized in the mental health sector, and hesitancy to seek help persisted through all time points.

Difficulties seeking support in the midst of health service disruptions

For many, wait times were an obstacle prior to the COVID-19 pandemic, made worse by service closures during lockdowns. Such disruptions left youth with few resources to manage their mental health: “There was no options. There was no Skype call offered to me. There was literally nothing. I was lucky to receive a text message at one stage” (Ireland, T2).

With nowhere to turn, several youth noticed a decline in health:

“For myself , though … Maybe some worsened health , just because appointments have taken so long to get to , and I haven’t been able to see in-person doctors” (BC, T1).

Getting comfortable with virtual services

Once virtual services were implemented, some youth expressed preference for in-person support, though many acknowledged benefits of virtual appointments. One was using virtual services for general health concerns and prescription refills:

“It’s been working well , for me. Most of the time , it’s just for a prescription refill or an update on how my health has been , so it’s pretty convenient to just call and expect a phone call , like I can be at home , and I don’t have to go anywhere and wait for too long” (BC, T1).

Another benefit was that many participants felt more comfortable accessing virtual supports than in-person supports due to the online disinhibition effect:

“When I was doing it face to face I would shy away from a lot of conversations because I’d feel embarrassed or I’d get distracted. Where now on a Zoom call it just kind of feels like a normal phone call.” (Ireland, T1).

By T3, the convenience and accessibility aspects of virtual services were acknowledged as something that should be continued: “I think online services can be great , more accessibility for people in remote locations. Jobs that don’t conform to like business hours for therapists … I think it’s better than only in person , because in person is just not accessible” (BC, T3).

On the other hand, some participants had ongoing negative experiences with virtual services. The effects of their day-to-day life being virtual began to take a toll: “I’m so fatigued from all the virtual stuff that it would just drive me crazy if I tried to use virtual services for mental health” (ON, T3).

For some participants in both countries, technology problems created fractures in the flow of appointments, negatively impacting the overall quality and experience of services:

“When the network is cut off or the internet’s lagging or you’re having a hard time hearing the other person , that interrupts the intervention. That interrupts the mindfulness practice that you were just in the middle of and kind of taints the experience” (ON, T3).

Disrupted continuity impacted client satisfaction, reducing desire to access services in this way. Participants described virtual counselling as “totally disconnected” (BC, T1). Lack of a personal connection to establish a rapport contributed to hesitation attending more intimate appointments over phone or video: “I feel discouraged to go up to these online sessions. It still feels like you’re talking to the computer. It’s not the same” (Ireland, T1).

For youth living with family or roommates, they felt the lack of privacy led them to be hesitant to access virtual services and inhibited from maximizing their therapeutic experience:

“I wasn’t sure about [virtual services]… if I was able to do that in the home , because as I said before , like , everybody’s at home. It’s hard to find a space where it’s quiet and nobody can hear you. A space where you can really be vulnerable with the person that you’re talking to and trust that it’s only them that can hear the information and all that” (Ontario, T1).

With regards to synchronous chat, the depersonalization aspect of texting was a concern due to inability to convey the full range of expression during diagnostic procedures: “A lot of emotions and undertones aren’t really gotten across with text … from a diagnostic perspective , it’s probably not the best because people can really fake things via text , like , you could lie your way out of anything on text message , and nobody would know” (ON, T1). For others, synchronous chat provided an alternative option when coping with anxiety due to flexibility of communicating in times of need without a scheduled appointment and no pressure: “It’s not invasive or anything , and you can say as much as you want or stop replying when you want” (Ireland, T1).

Category 4. Mixed views on the pandemic over time: Attitudes, behaviour, and perception of policy response

This category summarizes how attitudes, behaviors, and perceptions of policy responses to the pandemic evolved over time among youth across the three recruitment locations. Initially, participants expressed mixed feelings about the pandemic, highlighting both concerns and adaptations in their daily lives. As time progressed, a shift in perceptions emerged, with some individuals recognizing the necessity of certain policies and their effectiveness, while others maintained skepticism about government responses. The way in which guidelines were poorly communicated to youth during the pandemic shaped youth in both countries in a similar way, leading to a nuanced interpretation of adhering and accepting the measures.

Adherence to guidelines

Notable observations were made regarding how youth and other generations reacted to the pandemic over time. Fear of the unknown meant a greater willingness to follow public health guidelines such as physical distancing, wearing a mask, and frequently using hand sanitizer in the early days of the pandemic:

“I think initially everyone was [taking it seriously] , young and old , were petrified , when we didn’t know. I think fear of the unknown at the start was why the first lockdown worked so well. Because everyone was really adhering , because like , no one knew how it [COVID-19] was going to affect you , you’d see the awful things on the TV and you didn’t know that sometimes you could literally have nothing [no symptoms]” (Ireland, T1).

Others expressed willingness to adhere to public health guidelines in service of collective responsibility: “I think that their role , like our role , everybody’s role is to try and stop the spread. So everybody has a responsibility to limit their contact” (Ireland, T1).

Several youth expressed discontent regarding others not taking guidelines seriously, impacting how youth perceived the longevity of the pandemic: “I also do see people around me that are not taking the pandemic very seriously … I just have frustrations with the current situation that make me not very optimistic about it” (BC, T1). Social media became a space where youth could check in on what their peers were doing, influencing feelings of hope during this time: “I see a lot of Instagram posts , social media posts where people are all together without a mask on , without anything , large group of people. That definitely brings down the hope a little bit … Situations like that can really set back the progress that’s been made” (ON, T1).

Youth perceived their peer groups as adhering to guidelines more than older generations in terms of physical distancing: “ I feel like it’s usually the middle-aged people who are more not following the policies and rules of outdoor places , or even restaurants and whatnot. I think that for the most part , youth are being pretty respectful of that” (BC, T1). Potential reasons for this difference were explored:

“I think that teenagers as a whole have actually handled it very , very well. Because we’re so young , we’re like a sponge. We soak things up. We’re still being taught things. We’re still being told how to do things , as where , somebody in their 30s are kind of set in their ways” (Ireland, T1).

Over time, youth demonstrated a declining adherence to public health guidelines, as one participant articulated: “ The fed-upness has taken over the wanting to be safe ” (Ireland, T3). Participants conveyed a sense of fatigue stemming from the frequency of lockdowns and the continually evolving nature of public health directives. Additionally, they noted a lack of targeted communication over time aimed at youth, which hampered their understanding of these changes and the shifting objectives associated with them.

“I think , in the beginning we all saw how serious it was and we all kind of knew it was our , not job , but aim , to keep other people safe , so that’s why we were sticking to all the guidelines and we were doing what we were told and things like that. But in the past three months , being stuck at home , back lockdown again , school. I’ve seen a lot of people , and it shocked me , that have just completely given up on it , and just don’t want to do it anymore … I think they’ve kind of given up hope a little bit” (Ireland, T2).

In this context, youth from all three geographical locations and across various genders articulated that the observed change in behavior should not be interpreted as a lack of concern. Rather, they attributed this shift to the cumulative effects of the pandemic on lifestyle changes and mental health. Participants noted that the escalating impact of these factors contributed to a growing sense of indifference toward compliance with established guidelines in each country. Despite the disillusionment with policy guidelines, increased anxiety about getting COVID-19 was also noted over time, across participants of all ages, genders, and geographical locations:

“I think I’m more actively worried than I was previously. Before , I just kind of took my precautions – I did my best to stay out and that kind of thing. But now , I find myself getting stressed out at the grocery store when people are too near me. And I find myself actively avoiding certain situations , even more so than I did before … So it’s just – I feel a lot more anxious , right now , when I’m out in public” (BC, T2).

Such concerns were worsened by the rise of new strains of COVID-19, reigniting fear of uncertainty of the severity of the disease and risk of a greater spread: “Everyone now is talking about the Delta variant and it’s just so mentally draining” (ON, T3). These fears led to participants experiencing a greater sense of hopelessness due to concern that the current resources to combat COVID-19 would not be effective long-term:

“Just hearing that it is more deadly and more contagious , is definitely a worry. Because I know before people were thinking , well , you know , there are the vaccines coming out , so once I get it I’ll be fine. But you know , the findings that maybe it doesn’t work completely against the variants , that kind of makes it seem like there is no solution in place” (ON, T2).

Perception of policy response

Participants had mixed reactions to government policy response in all three regions. In Canada, the Canada Emergency Response Benefit (CERB) program, which provided financial support to Canadians whose employment income was affected by COVID-19, was viewed overwhelmingly as having a positive impact by alleviating financial strain. For students in college and university, having the financial support allowed youth to focus on their education and limit additional stressors:

“I think the government definitely did help , especially with CERB cheques and things like that … having the government step in and financially assist me during this time was hugely beneficial , and allowing me to continue with my education , and not be stressed about money” (BC, T1).

On the other hand, some participants in Ireland felt the COVID-19 Pandemic Unemployment Payments (PUP) were a source of stress, with some young person worrying “that they’re going to make everyone pay back for COVID pay in tax” (Ireland T3). Others felt frustrated by “COVID pay” (Ireland T3), causing tensions between those who received it and those who did not: “My friend signed on to the COVID pandemic payment … I stopped talking to her for about four days , I was like … ‘I have to do 20 hours in three days. I am exhausted and you’re rubbing it in my face’” (Ireland, T2).

While youth expressed contentment with restrictions implemented to keep people safe, a number of concerns were also raised. Over time, dissatisfaction centred around issues of changing guidelines and continuous lockdowns put in place by each region’s government: “I think the way they’re going about it , as in a little-by-little , and then they open it a little bit and then they go back again , think that’s doing a lot of damage to people’s mental health” (ON, T2).

Absent youth voice in policymaking

A growing concern raised across sites and timeframes was a consistent lack of youth voice. Youth did not see themselves reflected in policy or feel they had an impact to steer outcomes, though they noted the importance of their voice for realising change for the youth population. In terms of policy decisions, youth expressed discontent with “no youth at that table” (BC, T1) and felt “brushed to the side” (Ireland, T3), describing, “I feel like we have no say and we’re just following what other people are telling us to do” (ON, T2). Lack of attention to youth issues contributed to a sense of invisibility: “It’s like we don’t exist” (Ireland, T2).

Despite desire to be involved in government and decision-making processes, youth noted minimal opportunity to engage: “To a person who is young , them being able to put their voices out , that ability is very much hampered down , just because of these systemic barriers that are happening , and forces that work against young people” (BC, T1). The absence of youth participation was most apparent concerning decisions around education. Many felt dissatisfied with schools closing and re-opening:

“Being a student is unique , because I feel like most students were placed in a position where they didn’t really have a lot of power and we felt really passive in how we were receiving information and how decisions were being made in terms of our education ” (ON, T3).

As the last group to get the vaccine, youth raised concerns about returning to school: “My university has mentioned that we would be opening up in September [2021] despite the fact basically no one would be up for vaccination until October at the earliest. I feel like that’s something someone could have pointed out” (ON, T2). Lack of choice regarding decisions to continue school virtually or in-person created strife among university-aged students: “Going back to campus full time without any online options , I don’t think that a young person would necessarily make that decision” (BC, T3). Frustration continued to grow over time as the perception of neglect persisted: “There’s been such a lack of concern for university age people , you know? That I think people are getting a bit disgruntled” (Ireland, T3).

Youth recognized the value in having their opinion shared despite being young: “Just because you’re 20 doesn’t mean your experience is worth less” (BC, T3). Desire for involvement stemmed from an understanding of being future decision makers: “We’ll be the next people in-charge of things. Every generation can build on the last generation … I think that’s what makes young people in the world so important , because we can all learn from people’s past mistakes and build on that and stuff” (Ireland, T2). With this mindset, youth described the importance of engaging in activism and online petitions and voting when of age in order to effect change.

Unfair judgement of youth role in the pandemic

A recurring sentiment among participants was the perception that youth were being disproportionately blamed for the spread of infection in the media. Youth described feeling “unfairly targeted” (BC, T1) upon experiencing criticism for breaking rules and not taking the pandemic seriously:

“We’ve all been labelled like this , you know , ‘it’s the young spreading the virus’ , ‘it’s the young that don’t care’ , but it’s not like that , that’s not true , like I’m taking all this very serious. It’s affected my life in ways that I could never have even imagined” (Ireland, T1).

In light of these accusations, youth countered such blame by pointing out how they are vulnerable to infection as the last age group to be eligible for the vaccine, as well as a demographic notably on the front lines of customer service and hospitality jobs, placing them at increased risk compared to those with the option to work from home:

“… [Young people] are sort of being blamed for a lot of the spread , but also , that age category is probably a lot of the people who’re working minimum-wage , front-line jobs , being forced to be out in places , taking public transit , living with roommates … And we’re going to be the last to be vaccinated which is , again , frustrating” (ON, T2).

Vaccination in the face of hesitation

Overall, youth expressed willingness to get a COVID-19 vaccine. For those with concerns, hesitancy was raised surrounding uncertainty about the speed at which the vaccines were developed and rolled out in addition to not knowing the long-term impacts. Such concerns were most commonly raised at T1, prior to vaccines becoming available: “I’m not anti-vaccine , but I feel like they are rushed … You never know what the side effects are in a year or ten years from that vaccine , right? That’s something that I worry about” (BC, T1). Some youth felt like the misinformation online contributed to their uncertainty about the vaccine:

“I have mixed feelings about [the vaccine] … I feel like I feed in to Facebook been like , oh , it will make you have a brain damage … don’t take it , [you’ll] never have children and stuff like that. But I feel like if it was that bad , they wouldn’t be giving it to people. So , I just look at actual scientific side of it rather than feed into random people on Facebook” (Ireland, T2).

To address these concerns, youth described needing more information, presented in a way that explains how the vaccine works:

“I want to know information and I want to learn about it. I wouldn’t let anyone put any vaccine into me without knowing about it. So , I think what has really worried me is that the information and the responses have been so , so vague to a point where it seems really shady” (ON, T2).

Despite hesitation, youth discussed several motivating factors that led them to get a COVID-19 vaccine, primarily for functional reasons and as a means to return to normalcy by T2 and T3. Youth noted how a vaccine would provide a sense of safety: “I am at ease that something is protecting me” (ON, T3). More than just in a practical sense, vaccines gave participants a renewed sense of optimism:

“What is exciting about the vaccine is the potential to dream about the future again in a meaningful capacity. In a way , COVID took away the ability to conceive of any future because the future became indistinct , right. But having the vaccine allows you to go back to imagining a future that is with other people which is important” (ON, T2).

Category 5. Navigating COVID-19 information

In this category, participants reported the complexity involved with navigating COVID-19 information and the associated confusion with content posted on social networks, news articles, and within their own personal networks. Youth across all three countries relied on social media and online platforms for updates, which sometimes led to misinformation and uncertainty, and an overall feeling that the content was not developed for youth by youth. To counter this, many actively sought reliable information from trusted sources, such as health organizations and educational institutions. Peer discussions, primarily online through platforms such as TikTok, also played a crucial role in shaping their understanding, as youth shared insights and strategies to cope with the evolving situation. Youth emphasized the need to develop their own approach to critically engage with information, despite the challenges posed by the rapidly changing landscape of the pandemic.

Confusion around pandemic information presented by the government

Youth found pandemic information confusing and containing too much jargon: “It was not easy to understand. Just a lot of big words and government words” (BC, T1). As a result of inaccessible language, youth were deterred from seeking out information: “I don’t listen to it anymore because it’s too confusing , it’s too much information being thrown out in 5-minute speeches” (Ireland, T1). Over time, as guidelines changed, participants felt it was hard to follow and keep up to date with current guidelines: “I think maybe the government could’ve done a bit better of mitigating some of that ambiguity and uncertainty , and helping people cope with the ever-changing guidelines and protocols” (BC, T1). The need for youth-friendly information was addressed:

“I feel like they should have like some younger people on the government’s team just to like explain what some things mean to the younger generations … me and some of my friends have read some stuff from the government website , and we’re just like , ‘what does even half of this mean?’” (ON, T1).

Accessing COVID-19 information through multiple forms of media

The primary sources where youth accessed pandemic information were the government and news media’s social media, webpages, and daily addresses. Having options tailored to the needs of the individual was beneficial:

“I really like the Prime Minister’s address …because I have dyslexia , I don’t really like reading , I don’t like going through long articles. I need to just hear it … So , I just appreciated someone putting everything into a concise press conference so I don’t have to go hunting for all the articles , hunting for the information and everything” (ON, T1).

Social media was commonly discussed, as participants described using various platforms such as verified news outlets and government run Instagram, TikTok, Twitter, Reddit, and YouTube to access information from people or organizations whom they trust:

“I think the government actually did a decent job of putting things on Instagram. I wasn’t really active on any other platform , but just seeing like , you know , the infographics about , here’s what you’re allowed to do” (BC, T3).

Youth were astutely aware of the need to find reliable sources and wade through misinformation, citing the spread of false information as a barrier to staying informed:

“It’s very hard to avoid any kind of misinformation or just complete lies about it. That’s kind of a difficult thing , and I’d say that’s where a lot of difficulty in miscommunication comes from is just because people’s primary new source is the internet , which is not always very reliable” (Ireland, T3).

Category 6. Transitioning to life after the pandemic

This category summarized how youth across the two countries experienced the complex transition back to a “new normal”. This transition reflected fear, resilience and adaptability, as young people worked to rebuild their lives in a changed world. This is described in more detail in three sub-categories described in detail below.

Cautious readjustment to a new normal

Young people anticipated challenges with re-adjusting to life after the pandemic with years of diminished social interaction and physical distancing, particularly felt in the midst of lockdowns: “Everyone’s afraid of each other” (Ireland, T2). Participants described a persistent cautious outlook when attending public events or gatherings, with one participant saying, “I think immediately after the pandemic , there’s going to be a lot of people who are a little skittish about re-integration into crowds and restaurants” (ON, T2). Such challenges with reintegration were recognized “as almost a trauma response , where if someone gets too close to you , you feel unsafe” (BC, T1).

Some participants grew comfortable with spending time alone, with long-lasting impacts on their desire for socialization: “I’ve gotten used to my own company and I’m starting to enjoy just being with myself but that’s also a negative” (Ireland, T2). Participants recognized the importance of social interaction, though felt as though transitioning from spending time alone to engaging with others in person might be challenging: “I feel like it’s going to be hard to go back to real life , because I’m so used to not leaving my house , now , and I’m kind of like a bear in hibernation , now. I don’t know if that’s going to be an easy transition” (BC, T1). Balancing the needs for social interaction with the comfort of spending time alone was thought to be a difficult balance to navigate, with concerns for long-term mental health impacts. Participants recognized these challenges as collective trauma: “Some people will be traumatized by it and may never heal from it” (ON, T2). Without adequate supports in place, youth feared for their ability to heal moving forward.

Concerns for the future

When considering their futures in a post-pandemic world, participants expressed concern for the state of the economy as well as their own job prospects: “I think economically Ireland will have a long time recovering and especially for when I’m older and I’m buying a house. I feel like the prices will still be really high” (Ireland, T1). In light of these concerns, several youth noted that they re-evaluated their plans and goals for the future to adjust to a new world and changes to their own self, considering, “What is post-COVID for me now , because I am in a much different place than I thought I would be” (ON, T3). In light of these fears, youth described the need for support, though had concerns that their needs would not be met, particularly for those without a strong social support network:

“I do think [young people] face unique circumstances and I think because of a lot of income inequality , like the general expectations for new graduates , I think young people have a lot of challenges that have been exacerbated by the pandemic , and I feel like if there aren’t the correct social safety nets in place. It can leave a lot of young people behind … You know , not everyone has a family that they can rely upon during these sorts of times , and I think we just have to make sure that we’re looking out for everyone” (BC, T1).

Optimism about positive social changes

Despite hardships endured during the pandemic, youth were able to identify unseen benefits and potentially positive long-term changes in terms of the workplace, education, hygienic practices, and social justice. Youth hoped to see flexibility regarding work-from-home policies, “where workplaces are more lenient , [and] people understand things like childcare” (BC, T1), with improved accommodations for employee needs: “I think more people are going to be opting to work from home if they’re allowed to because commuting to work doesn’t really do much for them” (ON, T2).

Youth were optimistic about improved health beyond the pandemic. Continued hygienic practices to prevent spread of illness beyond COVID-19 were discussed in a positive light: “Sanitizing , washing our hands , wearing masks when we’re sick , taking time off to stay at home when we’re sick , I feel like those are going to have long-term affects within the workplace , and within school” (BC, T2). While exacerbated mental health challenges were noted as a continued uphill battle to address, the pandemic sparked more conversation around mental health, trauma, and help-seeking that resulted in de-stigmatization, which was thought to be a step in the right direction:

“I hope in the recovery of Ireland and the economy of Ireland and stuff , they don’t forget about mental health because it was such an important thing during COVID and I hope that’s , that slowly doesn’t fade away” (Ireland , T1).

Because of the political discourse throughout the pandemic with attention to social justice issues, youth were optimistic that some of the structural inequities brought to light would be addressed in society: “I think that will be the big frontier , because I think the pandemic , for all the bad , does provide an opportunity to rectify some of the inequalities we’ve seen exposed through it” (BC, T1). Inherently tied to these changes was a developed sense of compassion and empathy among youth and others, and the belief that change is possible:

“I’m hoping this period helps develop empathy and kindness in people … I’m hoping that this is an opportunity for people to kind of reflect on the skills that they offer in that sense and hopefully grow in that sense , and using those newfound skills and newfound parts of themselves to engage with their communities and to take care of their communities , whether that’s physically or by leading it on a kind of social change front or whatever that may look like” (ON, T1).

In this sense, youth expressed actionable strategies to use their voice through social media and partaking in social justice movements to pressure policymakers: “ We deserve health and equity , and we have the resources and the capability to have those things , we just need to make it happen” (ON, T3). Participants found hope in this belief, with the change starting within themselves: “I know me , for one , I’ve come out of it a better person” (Ireland, T2).

Category 7. Youth-led recommendations for government and service response

Four subcategories about key recommendations for government and service response were generated from the data over time, which related to strategies for amplifying youth voice, communicating public health information effectively to youth and combatting misinformation, optimizing services post-pandemic, and planning for future pandemics.

Youth voice needed in decision-making

Participants raised the importance of incorporating youth voices in policy decisions, particularly when directly impacted by the outcome. Youth articulated the need for their voices to shine through research so that policymakers understand their needs, with attention to questions such as, “How are you living your life? What are your priorities? What are your concerns?” (ON, T3). School was recognized as the best way to reach a broad spectrum of youth: “I feel like the only way you could really collect information from a bunch of young people is through school” (ON, T3).

In addition to research, youth expressed desire for more opportunities for leadership to develop skills in advocacy and bridge the gap between youth and those in charge. Participants noted that adults in positions of power have an important role in creating such opportunities, where leaders “who have paved the way for other youth to use their voice [are] really important” (BC, T1). Opportunities at school for youth to address issues were discussed: “I feel like there could be maybe like a group of students and young people who can kind of just voice the opinions of everyone on their behalf and stuff and maybe just offer up suggestions” (Ireland, T1). On a broader level, the establishment of a youth advocate role within government was suggested as a means to effectively communicate the specific needs of young people, rather than relying on assumptions made by adults who may not fully understand their perspectives (Ireland, T1, BC T3).

The importance of diversity in youth experiences was recognized, with understanding that historically, persistently, or systemically marginalized youth with important stories to share may be ostracized from participation in research and decision-making:

“I feel like there are definitely people who should be involved but the people who should be involved are not usually the people who can be involved. Like if you are poor and in an immigrant household you are probably at home taking care of you siblings and have no time to sit on committee meetings” (ON, T2).

Communicating public health information effectively to youth and combatting misinformation

Youth discussed the need to continue to “use social media in a way that you promote responsible information or reliable information” (ON, T3) because “that’s where a lot of young people spend a lot of their time” (BC, T3). Concise, digestible content in the form of infographics was said to be an effective way to disseminate information, promote services, and encourage service uptake: “None of the BS , you know … cut all the medical jargon out … explain it simply” (Ireland, T1).

With regard to sharing COVID-19 information, youth thought it “would be helpful if there was more clarity as to why each restriction was put in place” (Ireland, T1) to combat frustrations with fluctuating and sometimes contradictory restrictions and to improve adherence to guidelines.

“I think it would be helpful if there was more kind of like clarity as to why each restriction is put in place, because people would be like ‘Hang on. So we can’t do this, but people can like, come into the country and leave the country.’ And like ‘We can do this at school, but we can’t do this in shops’. And they’ll be like, why is that? And they kind of get frustrated and be like, I’m not listening to them anymore. So I think it would be helpful if there is more thorough explanations as to why, like maybe you can do this, but not that, and stuff. " [el].

Aiming information at parents is another way to spark dialogue between parents and their children about mental health: “I think by targeting adults , that would help the situation for younger people to feel more comfortable talking about their issues” (BC, T3).

Aside from social media, school was reiterated as a means to convey information to youth, teach emotional literacy, and provide resources: “I think getting information to students through institutions; I think it’s a very smart move. Like keeping up with your school’s newsletter” (ON, T3).

Creating visibility surrounding resources and mental health can promote help-seeking, as recognized by a university student in BC: “I feel like sometimes it’s like you have to go out and seek it , but it’d be nice if universities sent out emails midway through the semester , just to tell people about that” (BC, T2).

A key issue raised by participants regarding accessibility of virtual information was the prevalence of misinformation and knowing how to identify reliable sources. As a generation who grew up with social media, the need for strategies to address these issues was apparent. Youth expressed desire to learn about internet literacy and critical thinking skills in the classroom:

“I think internet literacy , where if people grow up and they learn , OK , not everything on the internet is true … If that thought process was taught in school , then it wouldn’t really be as big a problem as it is today” (ON, T2).

Similarly, accountability within the platforms themselves and in government was suggested as a welcomed solution:

“I think holding the people accountable that spread misinformation will help and there being less bots or problematic ideas going … tech companies holding people accountable , or governments holding people accountable” (ON, T3).

Post-pandemic services: enhancing service delivery to improve outcomes

An issue brought to light during the pandemic was the lack of affordable and accessible mental health services, worsened by intensifying mental health problems experienced during this time. For youth, the pandemic presented an opportunity to address some of the issues faced within the system that impact youth specifically. Despite a desire to seek help, lack of affordable and timely services created a major barrier to care:

“A lot of people want mental health services and either they can’t afford it or they’re on like a six-month , one-year waiting list” (ON, T3).

To address this issue, youth recommended expanding social safety nets to cater to the needs of this population:

“Starting with the expansion of disability benefits , making it so that people who are on disability are not living in poverty , that would be a good start , because we are going to have a fall out in terms of the people who have been affected by COVID” (ON, T3).

In the aftermath of COVID-19, there was an expressed desire for priority to be given to mental health services to counterbalance the mental health challenges that were worsened by increased stress and decreased access to services:

“The government’s definitely going to have to implement some sort of strategy , like for aftercare , I feel. I just feel like it’s going to be a domino effect and it’s going to go on for years to come … You just don’t know what kind of effect that would have on somebody” (Ireland, T2).

Post-pandemic services should also continue to offer virtual care according to participants. While many youth declared a preference for in-person services, there was recognition of the value in having options:

“[Services should] still be definitely available online , especially because some people , you know , maybe aren’t comfortable [with] the face-to-face environment yet , or maybe are immunocompromised or just physically can’t get there” (BC, T3).

Planning for future pandemics

In a future pandemic, youth emphasized that personalizing messaging to all demographics is important. In the youth context, this can be seen as communicating information regarding an infectious disease in a way that is easy to understand, digestible, and does not instill fear and prioritizes facts:

“I really like simplicity , like getting to the point. Easy facts. Anything factual information that has key points and bolded and have diagrams , pictures , or even , like , an example , analogies , et cetera , would be really important to understand” (BC, T1).

Ensuring resources and funding are available would help youth feel supported in times of crisis. Not all youth have strong familial relationships to provide safety and protection, requiring implementation of safety nets:

“Far too often , the young-person demographic , so like not a minor , but not a middle-aged person , is often ignored in planning stages. It’s assumed that we can operate as those people have , but I think we have a much less robust support system , and even just crisis funds and things like that. I think that needs to be accounted for” (ON, T2).

In light of these recommendations, it is evident that the COVID-19 pandemic constitutes not merely an acute public health crisis but a historical event with enduring implications for youth health and wellness for many years to come. The pandemic has revealed significant gaps in service delivery for this population, highlighting the necessity for a comprehensive approach to address their ongoing needs, ideally with diverse youth at the centre of all decision making, knowledge sharing, and future planning.

This study examined youth experiences during COVID-19 over an extended period, providing valuable, youth-generated recommendations for government and service responses to pandemics and other public health emergencies. Our longitudinal qualitative analysis revealed critical trends that demonstrate the multifaceted impact of COVID-19 on participants at various stages of the pandemic, with consistent findings across regions, including BC and Ontario in Canada, as well as Ireland. These insights underscore the necessity of incorporating youth perspectives into future public health strategies. Youth described their experiences of coping with the many hardships of the pandemic and adapting to new ways of accessing services, but they also identified areas for personal growth through the hardship. Challenges with transitioning to a post-pandemic life were similar across both countries. Youth leveraged their experiences to provide recommendations for responses by governments and service-providing organizations for future pandemics and public health emergencies.

Findings were consistent at each time point, despite some small differences in the cohorts. This may be due to the similar COVID-19 responses in these regions, including lockdown measures, vaccination rollout, testing, and contact tracing [ 40 ]. Their adaptive responses all included a series of lockdowns comprising of stay-at-home orders, school and non-essential business closures, a vaccination strategy that prioritized vulnerable populations and essential workers, mandatory use of face coverings, and providing income support to affected workers [ 40 ]. Furthermore, ON, BC, and Ireland have integrated youth services that provided virtual mental health services to youth throughout the pandemic [ 30 , 35 , 41 ]. While Ireland had more confirmed COVID-19 cases per capita than ON and BC, this did not seem to influence the impacts on youth [ 42 ]. The sample of youth from Ireland were younger on average, and more focus on school and family was found in the data. These findings align with observations in similar populations in other high-income countries [ 40 ]. Nevertheless, it is crucial to acknowledge that further research on the impacts of the COVID-19 pandemic on youth in areas with lower income, a varied COVID-19 response, and/or without integrated youth services would be beneficial to assess the applicability of these findings across wider regions.

The challenges encountered in response to the COVID-19 pandemic are multifaceted and align with emerging literature. For instance, the loss of significant life experiences has been identified as a critical factor impacting young people in profound ways during the pandemic [ 43 , 44 ]. Additionally, educational challenges arose, particularly in the form of difficulties adjusting to online learning environments [ 24 , 45 , 46 , 47 ]. Job loss and financial instability contributed to cumulative stress over time, driven by sudden economic disruptions and uncertainty about the future [ 48 , 49 ]. Essential workers faced heightened risks upon returning to work, grappling with the dual pressures of potential COVID-19 exposure and the new responsibilities associated with enforcing public health guidelines [ 50 ]. Furthermore, there was a notable increase in incidents of racism and xenophobia, compounding the adversities faced by many individuals. Anti-Asian attitudes in the age of COVID-19 have been documented in the American context [ 51 , 52 , 53 ], noting higher rates of harassment and health disparities throughout the pandemic due to harmful rhetoric regarding COVID-19 origins. Difficult-to-follow public health information was an additional challenge, as was initial vaccine hesitancy [ 54 , 55 , 56 , 57 , 58 ] (Everest L, Henderson J, Prebeg M, Relihan J, Ma C, Hawke LD: Relationship between mental health on COVID-19 vaccine hesitancy in youth: a mixed methods longitudinal cohort study, Under review), although attitudes shifted toward favouring vaccines with time. With the myriad of challenges came a decline in mental health and mixed effects on substance use behaviors, particularly noted in T1 and T2, as is documented in the literature cross-sectionally and longitudinally [ 16 , 17 , 18 , 19 , 20 , 29 , 59 , 60 , 61 ].

With the complex changes in contexts, environments, and lifestyle, youth also experienced disruptions in health service accessibility, including mental health service access. These disruptions may have further constituted a barrier to health and wellness [ 31 , 62 ], although acceptance of virtual services seemed to increase with time. Isolation, financial strain, and setbacks in educational and professional development in the context of reduced service accessibility may be contextual factors that led to the short-term impacts on mental health; this trajectory could also extend into long-term impacts on mental health and substance use, which is an important area for ongoing research as the pandemic resolves [ 63 ].

Despite the hardships experienced, youth also identified several strengths and opportunities for growth during the COVID-19 pandemic. Youth in both countries described picking up new skills and hobbies such as cooking, exercise, and creative endeavors, which helped with overall wellness. In some cases, mental health improved due to reduced demands on time and increased time to self-reflect, slow down, and recover from burnout. In this sense, the pandemic was a catalyst for change where help-seeking and engagement in services were realized for the first time. Access to green spaces was a positive factor; indeed, this has been shown to reduce symptoms of depression, anxiety, and stress [ 64 , 65 , 66 ]. A small body of research discusses the positive developmental opportunities, strengths, and effective coping strategies leveraged by youth during the changes in the pandemic [ 8 , 67 ]. Another body of research outlines post-traumatic growth in various populations during this time [ 67 , 68 ]. Together, these findings can serve to identify strengths, protective factors, and resiliencies that can be harnessed to support mental health and wellbeing during challenging periods in history, from a pragmatic and strengths-based lens. Indeed, youth remained optimistic about the potential for the pandemic to act as a catalyst for positive social change.

Youth expressed concerns regarding the insufficient attention given to their needs, the unique adversities they faced, and their lack of engagement and leadership in formulating solutions during the pandemic response. Consistent with existing literature [ 69 , 70 ], it is imperative to prioritize youth involvement in research and policymaking by centering their issues and recognizing them as equal stakeholders and rights holders. The Children and Youth in Challenging Contexts (CYCC) Network report (2013) outlines best practices for engaging youth to combat social exclusion and mitigate power imbalances, emphasizing the necessity of collaboration [ 71 ]. Organizations, educational institutions, and governmental bodies at all levels should enhance their capacity to create platforms that enable youth to voice their concerns on pertinent issues and ensure that their perspectives are actively considered. Establishing student and youth advocacy groups, along with dedicated government liaison positions, can facilitate the bridging of gaps and foster increased political participation among young people.

Based on the current findings and the emerging literature, examples of solutions that youth might propose to better address future pandemics and public health emergencies include the use of verified, fact-checked social media posts to clearly communicate public health information in a consistent manner [ 72 , 73 ], together with strategies to eliminate help-seeking barriers and support system navigation [ 74 , 75 ]. Incorporating age-appropriate internet literacy into school curricula to help cultivate critical thinking skills and discern factual information from unreliable sources was also discussed. Free or affordable mental health services are needed, as well as attention to accessibility needs. Attention should be given to enhancing access for those with minimal technological literacy skills [ 76 ]. Financial supports and means to safely socialize, exercise, and alleviate symptoms of mental illness are additional youth priorities. In a similar vein, resources should be distributed to address safety concerns for those in unsafe households, who may be at risk of emotional or physical abuse during periods of lockdown. Additional novel goals and solutions may be proposed through ongoing and appropriate youth engagement in policy, service, and research design.

Strengths and limitations

This study provided longitudinal insights that capture a substantial period of change during the evolving COVID-19 pandemic. Spanning multiple jurisdictions with large samples, the study identified similar cross-cutting experiences reported by a wide variety of youth. With youth engagement throughout, the research questions and approaches were informed by youth voices. However, limitations of this study include response bias, varied sampling strategies and timelines across study sites, complicating comparisons between sites, as well as attrition. While flexibility in sampling strategies is a strength of qualitative longitudinal research design for reasons including enhancing generalizability of findings, comparability can also be a limitation. The variability in recruitment approaches across different sites may have hindered the ability to discern consistent patterns and trends over time. Future research is needed to distinguish patterns amongst different groups (e.g., gender, age, race/ethnicity). Given the longitudinal nature of this study, participant numbers declined over time. As the findings suggest, “COVID fatigue” may have contributed to study drop-out. Those who chose to remain in the study may differ from those who did not complete all three timelines. The use of virtual means to recruit and conduct the interviews expanded the geographical reach of the study, but limited it to youth with online access.

This is the first known international longitudinal qualitative study to describe youth experiences during the COVID-19 pandemic across two Canadian jurisdictions and Ireland, with implications for policy and practice. Despite the many challenges encountered over the course of the pandemic, youth reported aspects of growth. For this population, pre-existing stressors were compounded by pandemic-related challenges and reduced access to care, signifying the importance of prioritizing youth mental health moving forward. Areas of need highlighted throughout the pandemic have implications for future policy decisions, with an opportunity to enhance health and social service delivery. Investment in resources rooted in youth-identified needs and priorities is vital to mitigate the long-term challenges associated with pandemic trauma among youth.

Data availability

Due to multiple sites participating, the data sets generated during the current study are not publicly available but are available from the corresponding author under reasonable request.

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Acknowledgements

We are grateful to have conducted our research on the ancestral lands of many different Indigenous Nations and Peoples across what we now call British Columbia and Ontario. We would like to thank the youth participants, advisors, and research staff, who contributed valuable insights and shared their experiences throughout the duration of this project. We would also like to acknowledge with gratitude the research teams at Jigsaw, the Centre for Addictions and Mental Health, Foundry, and the University of British Columbia.

This study was funded by the Canadian Institutes of Health Research Operating Grant #172661: COVID-19 Rapid Research FO - Social Policy and Public Health Responses.

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Emily Nichol, Lisa D. Hawke, Meaghen Quinlan-Davidson & JL Henderson

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Lisa D. Hawke & JL Henderson

Jigsaw – The National Centre for Youth Mental Health, 16 Westland Square, Pearse Street, Dublin, D02 K535, Ireland

Aileen O’Reilly & Joseph Duffy

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Steve Mathias & Skye Pamela Barbic

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Skye Pamela Barbic

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Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada

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SB, JH, and AO conceptualized the study. JH and SB obtained funding for the study. SB, MW, LH, AO, JD, and LH supported project data collection and activities. EN, MW, LH, and SB drafted the manuscript and JH, SM, MQ, KW, JD, AO reviewed the manuscript.

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Whyte, M., Nichol, E., Hawke, L.D. et al. Supporting young people through the COVID-19 pandemic and beyond: a multi-site qualitative longitudinal study. BMC Health Serv Res 24 , 1266 (2024). https://doi.org/10.1186/s12913-024-11752-z

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Children and youth mental health: not all equal in the face of the COVID-19 pandemic

Delphine collin-vézina, barbara fallon, johanna caldwell.

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Issue date 2022.

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This article reviews the empirical evidence gathered in the past 2 years on the impact of the COVID-19 pandemic on mental health for children and youth. Grounded in a social justice framework, this review highlights that all are not equal in the face of the pandemic, and that children, youth and families living in precarious contexts have been impacted most. Practice and policy measures moving forward must take this reality into account to help all children and youth thrive and recover from this unprecedented worldwide crisis.

Keywords: COVID-19 pandemic, Children and youth, Mental health, Well-being, Marginalized groups

The pandemic has had a detrimental impact on children's and youth's mental health.

Social isolation from peers and significant adults are key factors that have negatively impacted young people's mental health status.

Research also indicates social disparities have expanded since COVID, and many families have accumulated multiple stressors that are impacting their well-being and functioning.

Children and youth with pre-existing mental health disorders, living in financially precarious situations, from racialized groups, and/or involved with child protection services experienced lower levels of resilience when faced with the COVID-19 pandemic.

Practice and policy measures moving forward must take this reality into account to minimize long-term mental health consequences for young people.

Refers to any individual from 13 to 18 years of age

Refers to any individual from 0 to 12 years of age

The COVID-19 pandemic, also known as the coronavirus pandemic, is an ongoing global pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

A state of well-being in which individuals can realize their own potential, cope with normal stressors, study and work productively and contribute to their community

Refers to individuals from 0 to 18 years of age

Introduction

First identified in Wuhan (China) in late 2019, the COVID-19 virus created an unprecedented worldwide crisis. On March 11, 2020, the World Health Organization (WHO) declared COVID-19 a worldwide pandemic, forcing many countries to impose important public health measures to contain the spread of the virus, including forced quarantine, travel restrictions, shutdown of services, and school closures. As of January 9, 2022, over 304 million confirmed cases and over 5.4 million deaths had been reported ( World Health Organisation, 2022 , World Health Organisation, 2022 ). Although less likely to experience severe health consequences when exposed to the COVID-19 virus, children and youth clearly saw their lives overturned across the globe. It is established that pandemics are linked with increased mental health issues among children and adolescents, which include stress, worry, helplessness, academic concerns, and behavioral problems such as substance abuse and suicide ( Meherali et al., 2021 ). This article reviews the empirical evidence gathered almost 2 years into the COVID-19 pandemic on the impact on mental health for children and youth. Grounded in a social justice framework, this review will highlight that all were not equal in the face of the pandemic and that practice and policy measures moving forward must take this reality into account.

Mental health is a state of well-being in which individuals can realize their own potential, cope with normal stressors, study and work productively and contribute to their community ( World Health Organisation, 2022 , World Health Organisation, 2022 ). Mental health is not simply the absence of mental disorders and diagnoses. It is a state that allows children and youth to reach their full potential, to achieve different milestones and to experience positive quality of life ( Centers for Disease Control and Prevention [CDC], 2021 ). Concerns about the impact of the pandemic on child and youth mental health were raised at the beginning of the pandemic, pointing out that the pandemic itself, as well as associated public health measures implemented to contain it, could be potentially traumatic for children, youth, and families ( Collin-Vézina et al., 2020 ). As highlighted by Perry (2020) , the COVID-19 pandemic corresponds to all criteria of a stressful event: it is unpredictable, extreme, prolonged, and based on an unknown and unfamiliar danger, which makes the experience likely to activate a physiological danger response and produce intense stress.

In the current pandemic context, it thus stands to wonder how children and youth adapted to the situation. This article highlights empirical evidence linking the pandemic to children and youth's mental health challenges by focusing on: (1) worldwide general populations of children and adolescents and (2) vulnerable populations that are more likely to have experienced negative consequences in the midst of the pandemic, notably children living in poverty or involved with child protection services, who are more likely to also be racialized and to be experiencing socioeconomic challenges compared to general populations.

Impact of the pandemic in general child and adolescent populations

The impact of the COVID-19 pandemic on child and youth mental health have been the subject of numerous studies around the world, starting as early as spring 2020. A few rapid and systematic reviews were conducted and summarize the lessons learned on outcomes of the pandemic in general populations.

de Miranda and colleagues' paper ( 2020 ) focused on 51 studies, 15 of which included original data, to answer the question: What are the mental health effects of the pandemic on children and adolescents? Most studies they reviewed screened for anxiety and depression symptoms as benchmarks for mental health. Psychometric tools varied across studies making comparisons somewhat difficult, though the presence of clinical levels of anxiety and depression were found to be high across studies ranging from 12.9% to 46.7% for anxiety and from 11.8% to 47.8% for depression. Most studies were cross-sectional and did not measure pre-pandemic levels of depression and anxiety, therefore not allowing examination of the causal role of the pandemic in the symptoms documented. Papers included in their review showed that older adolescents exhibited more depressive symptoms than children. Findings were mixed regarding anxiety symptoms: some studies documented no significant difference between ages, while others reported higher anxiety with increased age. All studies but one that considered gender in their analysis showed that adolescent girls were more likely to present anxiety and depressive symptoms than male adolescents and younger children. Recent studies not considered in the above review—as they were published in early 2022—confirm that psychological distress during COVID-19 is greater for females (compared to males) and for adolescents (compared to children) (for example, Hébert et al., 2022 ), suggesting that differential responses should be implemented to address mental health consequences in different populations.

A subsequent systematic review from Fong and Iarocci (2020) looked at child and family outcomes following the first wave of COVID-19 that included 17 original studies, 8 of which captured child outcomes more specifically. These child outcomes ranged from anxiety and depression, as well as post-traumatic-stress disorders, fear and worry, and obsessive-compulsive disorders. These 8 studies' locations were varied, representing many countries and social realities: India, Turkey, China, USA, Australia, and the Netherlands. Rates of anxiety (including post-traumatic stress disorders) and depressive symptoms varied substantially depending on whether parents were reporting those symptoms (for example, 10% for clinical anxiety based on parental reports) or if children were self-reporting their symptoms (for example 22% for depression and 19% for anxiety). As in Marques de Miranda and colleagues' paper, studies were for the most part cross-sectional and thus not able to address whether the pandemic was responsible for causing the symptoms under study.

In November 2021, Public Health Ontario (2021) released a rapid review updating the information presented in earlier reviews. The literature search identified eight studies that focused on adolescents and 13 studies that included parents of preschool and school-aged children in the general population. Most studies were again cross-sectional in nature, based on online surveys, and conducted in the first wave of the pandemic (from March to May 2020). Their review provided more in-depth insights on differential responses to the COVID-19 pandemic for children and youth. In addition, the authors screened for studies that investigated pandemic outcomes in general and specific populations (e.g., children with severe obesity, children with physical disabilities). They found the impact to be different for young children and adolescents. Parents of young children reported more behavioral difficulties, hyperactivity, and conduct problems. For example, the prevalence of conduct problems was perceived by parents to have increased by 35%–40%. Adolescents reported increased anxiety and depressive symptoms, and 32% mentioned that public health measures implemented during the pandemic made their mental health worse. Studies that investigated suicide, suicidal ideation, and self-harm reported mixed findings in relation to the impact of the pandemic: some showed increased levels of those mental health issues in 2020 compared to 2019, while others showed no difference when comparing those periods. The impact of the pandemic on adolescent substance use before and during the pandemic was also investigated. Although the proportion of adolescents who used alcohol or cannabis did not increase, those who reported use before the pandemic increased their consumption following the outbreak. Further, males were more likely to be using substances alone as compared to females, and higher depression symptoms were linked to higher prevalence of abusing substances alone.

In addition to investigating the prevalence rates of mental health challenges in children and youth populations, these reviews looked at factors that could amplify or mitigate the negative impact of the pandemic, notably social isolation and loneliness, school closure, and parental stress and other parental outcomes.

The role of social isolation and loneliness

Most children and youth had to physically isolate from their peer and support groups at different moments since the pandemic was declared in March 2020. As highlighted by Shen (2020) , confinement and social isolation measures imposed upon communities worldwide prevented young people from fulfilling the important development milestone of relying on peer interaction for socialization and identity formation. It is well established that social isolation and loneliness are predictors of depression, anxiety, and suicidal thoughts and actions (see Loades et al., 2020 's research review spanning from 1946 to March 2020) and, as a result, researchers have investigated whether this relationship remained true in the context of COVID-19 pandemic. As an example, Cost et al. (2022) examined the impact of COVID-19 emergency measures on mental health for children and adolescents with and without pre-existing psychiatric diagnoses. They found that deterioration in mental health status after the COVID-19 pandemic for both groups was linked to increased stress from social isolation. Children and youth experienced an unprecedented time during which they had to adhere to strict confinement rules implemented at different levels and times across the globe.

Panchal et al. (2021) conducted a comprehensive systematic review focusing exclusively on the impact of the COVID-19 pandemic lockdown on child and adolescent mental health. They identified 61 studies representing nearly 55,000 children and adolescents worldwide. The exposure to COVID-19 lockdown was operationalized in each study (measures in place, length of lockdown). Anxiety, depression, and irritability symptoms were commonly reported by parents or by teenagers themselves. Their results showed that adolescent females presented with more severe symptoms in comparison to boys and to younger children. They found, however, that for a significant proportion of families, the lockdown measures were associated with improved family relationships and mental health conditions, specifically in families reporting positive parent-child communication, further demonstrating that the impact of COVID-19 lockdown measures has been diverse depending on existing protective family factors. Yet, COVID-lockdown was associated with higher psychological distress in populations who had pre-existing mental health challenges. They noted that individuals with previous eating disorders have been among the most significantly affected young people, with 41% of those under clinical care experiencing a reactivation of eating disorder symptoms due, potentially, to lack of weight monitoring by professionals during confinement. They also found that while some young people remained socially connected, for instance through social media, a heavier use of those outlets was a risk rather than a protective factor in predicting psychological distress during the COVID-19 pandemic. Consequently, being “physically isolated but socially connected” did not seem to be a protective factor for most young people, as pointed out by Ellis et al. (2020) .

The role of school closure

Closely related to social isolation and confinement measures, school closures have been identified as a potential detrimental factor to children's learning and mental health. Less than one-third of low-income countries introduced a national distance learning program by April 2020, meaning that many children had no learning opportunities for at least some part of the 1st year into the pandemic ( United Nations, 2022 ). Even in Western countries, models of educational delivery varied greatly across jurisdictions and provinces (i.e., fully remote, fully in-person, and blended models combining both), resulting in differential schooling experiences across student groups ( Gallagher-Mackay et al., 2021 ).

The Fraser Mustard Policy Bench conducted a literature review on the impact of pandemic-related school closures on children and youth ( Sansone et al., 2021 ). Most of the literature located for this review was from the US and Europe, with limited evidence from other countries. The studies reviewed that were conducted early in the pandemic predicted substantial learning losses for children, which would increase achievement gaps in the short term and have potential long-term consequences on educational attainment, employment outcomes, and well-being. Emerging evidence from studies that have measured the initial impact of school closures on academic performance show that, as predicted, the pandemic has contributed to learning losses that are greater than what would have occurred during a regular school year and have exacerbated educational inequalities ( Dorn et al., 2020 ). The available evidence is consistent that learning losses are greater among economically disadvantaged students, who typically begin their education with achievement gaps.

More specific to child and youth mental health, Viner et al. (2021) released a systematic review specific to the impact of school closures. A total of 27 studies were located to document impacts on emotional and behavioral outcomes. However, most studies did not include pre-pandemic data which left the question of the predictive effect of school closure on mental health uncertain. Recently, a few projects have provided more conclusive evidence of the impacts of school closure and social isolation on children and youth. Despite their inability to assess the specific impact of school closure against the influence of other lock-down measures that occurred simultaneously (e.g., social isolation), their longitudinal design made conclusions more robust. For example, Larsen et al. (2021) analyzed data from the Norwegian Family Dynamics Study to investigate the impact of school closure and social isolation on children's emotional, somatic/cognitive and worry reactions. They compared data collected in April and May 2020 (when most schooling happened remotely in Norway) to information already gathered between 2017 and 2019 in a sample of 374 children. They found that children on average coped better emotionally in 2020 in comparison to previous years, but did more poorly in terms of sleep and concentration.

The role of parental stress and other parental outcomes

Worldwide, the vast majority of children generally live with their parents or other significant adults providing care for them. This is also the case for adolescents and young adults in many industrialized countries. For example, European youth leave their parents or guardians' homes at age 26.4 years old on average ( Statista, 2021 ). It is thus no surprise that parental stress and other parent-related factors, which young people could have been exposed to in their homes during COVID-19, are considered fundamental factors to predict heightened mental health problems in children and youth. Considering only the most recent review published ( Public Health Ontario, 2021 ), 10 studies identified collected primary data to investigate the role of parental outcomes in children's and adolescents' mental health status, including parental stress, parenting practices, parent-child relationship, parent mental health, parental resilience, and family functioning. They concluded that parental factors such as stress, resilience, and anxiety were significantly associated with their child's mental health outcomes in both negative and positive directions.

On the negative side, some studies revealed that parents struggled to manage their children's behavior and symptoms of anxiety and depression during the pandemic. A few of those studies also demonstrated that cumulative stressors related to COVID-19, including losing employment and income, being unable to provide for family needs, and uncertainties regarding childcare, were significantly associated with perceived stress. High level of stress was unfortunately associated with harsh parenting and poorer quality parent-child relationships, which may have led to increases in family violence and maltreatment. Additionally, studies that focused on parents whose children had a disability showed that the pandemic has put an outstanding pressure on those families, and that parents struggled to cope and needed substantive support to maintain their positive parenting practices.

On the positive side, some of these studies show that parents who perceived parental support and control over the pandemic reported less stress, which in turn influenced more positive parenting practices. In line with the broader scholarship on factors influencing parenting (e.g., Park and Lau, 2015 ), Fong and Iarocci (2020) concluded their review stating that age of parents (older) and socio-economic factors (higher SES) appeared to mitigate negative outcomes, making these families more resilient in the face of the pandemic. To contrast this, as is highlighted in the next section on vulnerable populations, many families struggling with poverty-related stressors did not have as many protective factors to provide a buffer from adversity caused by the pandemic. This, in turn, may unfortunately have increased their parental stress and weakened their parenting practices, which negatively impacted their children's and adolescents' mental health.

Impact of the pandemic on vulnerable child and adolescent populations

Social justice paradigms posit that unequal and unfair distribution of power, resources, and obligations within societies make vulnerable groups of children and youth more likely to experience mental health problems. We will focus on three groups of children and youth for whom high rates of mental health issues have been documented prior to and during the pandemic: children and youth living in poverty, in maltreating/abusive homes, and in out-of-home care settings.

The COVID-19 pandemic and child poverty

UNICEF released a statement in December 2021 to raise awareness of the increase in child poverty due to COVID-19 pandemic. They stated that 100 million more children could be living in poverty by the end of 2021 compared to the pre-COVID situation, which would bring the estimated number of children and youth living in monetary poor households to almost 640 million worldwide ( UNICEF, 2021a , b ). It is projected that recovery from the pandemic will be experienced unevenly across groups with different SES statuses, and that this trend might be particularly pronounced in low-income countries. In that line, OXFAM International (2021) has coined COVID-19 “the virus of inequality” based on evidence that while the richest individuals have already recovered from financial losses created by the first wave of the pandemic, it will take more than a decade for the poorest people to recover from the economic impacts.

Living in poverty is a clear risk for experiencing more severe health consequences due to COVID-19, primarily due to lack of access to vaccines and healthcare ( Tai et al., 2020 ). Using a very robust meta-analysis strategy that included 68 studies representing 4.3 million patients, Maguesh et al. (2021) confirmed that socioeconomic determinants were strongly associated with COVID-19 health outcomes, and more notably in racial and ethnic minority groups. Indeed, poverty is noted by the CDC (2020) as a longstanding social determinant of health that makes some ethnic and racial groups more at risk to experience deleterious impacts of the COVID-19 pandemic. In the US, for example, the highest national poverty rates are for American Indians and Alaska Natives, and Black or African Americans ( US Census Bureau, 2013 ). Similar trends of higher poverty among Indigenous and racialized groups have been documented in other countries, including Canada and Australia ( Canadian Poverty Institute, n.d. ; Markham and Biddle, 2016 ). Poverty and race/ethnicity are thus social realities that are intrinsically intertwined, and the impact of COVID-19 on children's and youth's mental health must be looked at through those lenses.

Singh et al. (2020) published a narrative review on mental health outcomes for children and adolescents impacted by the COVID-19 pandemic. Their thematic analysis yielded different themes, one of which was the impact of lockdown on underprivileged children. That theme highlighted multiple ways by which the mental health of children and adolescents living in poverty was at risk due to the COVID-19 pandemic, including increases in child labor and child homelessness. These issues are compounded by the lack of access to education and school services that were replaced by distance learning and online courses not necessarily available to underprivileged young people, particularly those living in rural areas. These challenges, coupled with limited access to community resources, are likely to have created greater vulnerability and exposure to unfavorable economic, social and environmental circumstances. This echoes Ali and colleagues' pre-pandemic findings ( 2019 ) that corroborated that youth who are from low-income households and/or from racial/ethnic minority groups are more likely to receive mental health services exclusively from school settings. Other evidence prior to the pandemic suggests that school-based mental health programs are not only effective in providing early assessments and services to at-risk children, but also have indirect benefits on schooling and learning experiences, such as reduced absenteeism and improved academic performance ( Yau et al., 2015 ). School closures may indeed disproportionately limit access to mental health and educational support services for disadvantaged students, thus making subsets of young people more likely to experience learning and mental health challenges resulting from the COVID-19 pandemic.

It is thus no surprise that UNICEF released a statement urging governments to avoid implementing measures that directly impact children and youth, notably school closures. They stated that prolonged, nationwide school closures have compromised decades of progress in education and that a shadow pandemic of mental health issues has taken hold in parallel to the physical health threats of COVID-19 ( UNICEF, 2021a , b ).

COVID-19 and child protection services/out-of-home settings

It is well documented that children and youth living in poverty and from racialized backgrounds are more likely to be investigated and placed in out of home care by child protection services (see for example: Rothwell and de Boer, 2014 ; Maguire-Jack et al., 2018 ). Ongoing challenges experienced by families living in precarious situations, coupled with the rise of financial insecurity and elevated parental stress due to the COVID-19 pandemic, have been noted early into the pandemic as risk factors that could lead to increased child maltreatment ( Caldwell et al., 2020 ), notably around issues of chronic neglect which may be mitigated by families' financial resources and access to support systems ( Feely et al., 2020 ). Research investigating the impact of previous major natural disasters and pandemics has undoubtedly shown an increase in child maltreatment and family violence due to increased parental stress, sudden shifts in routines, school closures, and drastic decreases in available community resources (see Campbell, 2020 for a review). With child maltreatment considered one of the most important risk factors for children's mental health ( Teicher et al., 2021 ), the likely increase in family violence is paramount to understanding children's and youth's adaptation to the current pandemic.

However, child protection administrative data on child protection reports amid the first wave of COVID-19 pandemic, compared with pre-pandemic rates, showed that child protection reports did not increase in spring 2020, but rather declined in comparison to previous years. According to Jonson-Reid et al. (2020) , a decline of 11%–70% in child maltreatment prevalence was noted across US states. At the international level, although the impact of COVID-19 on rates of child maltreatment varied across countries, many of those noted decreases in child maltreatment prevalence were reported in both low-income and high-income countries ( Katz et al., 2021a , b ). A decline in rates of child maltreatment would in other circumstances would been welcomed with enthusiasm and hope that fewer children and youth were actually less subjected to abuse and neglect, yet skepticism was expressed by researchers and front-line workers alike. They proposed that these trends reflected decreased monitoring of youth by mandated reporters, including teachers, school personnel, front-line workers, and other service providers ( Royer et al., 2020 ; Jonson-Reid et al., 2020 ). Indeed, in general, child maltreatment data suffers from an important limitation, which is to include only cases that are brought to the attention of the authorities and are documented in information systems. Given that school personnel are among the most frequent sources of reports of suspected maltreatment to child protection authorities, school closures were identified as a significant factor involved in the decline of reports noted in child protection services during the first wave of the COVID-19 pandemic ( Fallon et al., 2020 ).

Children and youth who were subjected to family violence before the pandemic may have also faced supplementary challenges. First, previous traumas endured by children and youth served by child protection services may have induced a lower tolerance for additional stressors thus making them more prone to subsequent mental health problems compared to non-abused individuals ( Hammen et al., 2000 ). Although trauma-informed treatments could continue through tele-mental health routes during the pandemic, these services were not fully adapted or not available at all to meet the needs of all children and youth ( Racine et al., 2020 ).

Second, violence dynamics—which for some families may have been well contained and monitored by social services prior to the pandemic—may have worsened as a result of the current crisis. The shift to non-contact child protection services in some jurisdictions is likely to have limited the capacity of front-line workers to assess risk fully and thoroughly for child abuse and neglect. For example, Tener et al. (2020) interviewed child protection workers from the US and Israel regarding current cases of child sexual abuse they had in their caseload. These workers identified the current confinement and lockdown measures as a deterrent to abuse disclosure, thus impacting child abuse investigation processes and plummeting child abuse reports.

Third, children and youth placed in out-of-home care settings due to child maltreatment concerns in their family of origin have experienced even more severe consequences of lock-down measures. On the one hand, as shown in Musser et al. (2021) 's US study, there was a decrease in the number of youths placed in the foster care system during the COVID-19 pandemic, with the most important reduction in April 2020 when schools were closed through the Safer-at-Home Order. As the name suggests, this policy assumed that children were safer at home (to avoid contracting the virus) when one of the biggest threats to their well-being and mental health was in that very environment. The need for safety and protection due to child abuse and neglect may have been ignored. On the other hand, foster care youth and workers in institutionalized settings (e.g., group homes, residential treatment facilities) had to carry extra burdens during the pandemic, over and beyond all challenges faced by the general population. Through surveys conducted among professionals and caregivers in foster care, Whitt-Woosley et al. (2022) identified several challenges faced in out-of-home care settings, related to children and youth mental health including disruptions in service provision and court proceedings, visitation disruptions with biological families, and loss of access to social connections. As pointed out by Lorch and Fuchs (2020) , staff and children in out-of-home care settings may have experienced feelings of insecurity for reasons listed above, as well as the lack of clarity of discharge plans and the design and delivery of programs happening on a week-to-week basis depending on the varying public health measures in place. Lastly, many young people in out-of-home care settings reached the age of majority over the course of the pandemic and were left with few resources to enter this new phase of their lives in such a turbulent era. A high prevalence of psychiatric disorders among care alumni has been established. For example, Okpych and Courtney (2018) found in a pre-pandemic study that nearly half of their sample of care alumni screened positive for a mental health or substance abuse disorder in the past year. As a result, many jurisdictions have extended support to youth aging out of care by adopting moratoriums on youth transitions out of the child protection system during the COVID-19 pandemic (for example, see the work of the National Council Youth in Care Advocates, 2022 ). Yet many youth transitioning out of care around the world are still left unsupported during this important life stage, which may impact their current and future mental health and functioning.

Caldwell et al. (2020) highlight that our attention has been devoted to short-term negative impacts on children and families served by child protection services since the beginning of the pandemic. They suggest that our efforts be redirected to consider long-term consequences of this unprecedented crisis. First, that all child protection services be deemed “essential,” to avoid reducing services or shifting to distanced and virtual operations. For example, Herrenkohl et al. (2021) point out that home visiting programs are arguably gold-standard practices that must be sustained in the midst of the pandemic to continue engaging at-risk families from the pre-birth period and prevent child abuse and neglect from happening in the first place.

Second, in the longer term, that permanent universal poverty alleviation policies be developed, offered, and sustained given the high rates of hardship among families involved with child protection services and children and families whose mental health is compromised by economic precarity. Taking a public health prevention and early intervention approach that targets poverty-related factors can improve child mental health outcomes, particularly when rooted in an accessible, relationally based, culturally responsive approach ( Herrenkohl et al., 2021 ). Equitable standards should also be adopted worldwide to support transitions to adulthood for youth in care. This can be achieved by focus on eight rights-based pillars that each can be addressed through different programs and policies: financial; educational and professional development; housing; relationships; culture & spirituality; health & wellbeing; advocacy & rights; and emerging adulthood development ( CWLC, 2021 ).

The current crisis could be an opportunity to redesign support systems related to child and youth mental health, along with child protection practices and policies, and thus build a stronger, more equitable, child protection system.

Recommendations for practices and policies

The lessons learned from the COVID-19 pandemic and the effects of the restrictions imposed to mitigate infection will likely reveal themselves in the decades to come. Manifestations of inequity are infused in the daily experiences of racial/ethnic minority children, children with pre-pandemic mental health challenges, and children who live in economically disadvantaged situations. The pandemic both exacerbated and highlighted these inequities. Policy solutions are needed to guide helping professionals as they navigate how to assist children and families with the trauma, maltreatment, and educational loss they have experienced during COVID-19.

Overall, this review suggests that there are many actions needed to address the consequences of the current pandemic on child and youth mental health in order to shift our mental health priorities from survival to supporting resilience in children and families ( Stark et al., 2020 ) including:

Train education, child services, and health care staff on COVID-19-related child and adolescent challenges, with an emphasis on specific risks faced by children and youth with pre-existing mental health challenges, and those living in poverty, from racialized groups, and involved with child protection services.

Adopt trauma-informed practices and policies to address the stress and exacerbated mental health problems induced by the current pandemic, for children, youth and their caregivers ( Collin-Vézina et al., 2020 ; Cuartas, 2020 )

Identify strategies for providing and sustaining psychosocial support to children and adolescents in schools and other community resources, and develop plans to sustain those services despite lockdown and confinement measures ( Phelps and Sperry, 2020 ).

Favor in-person mental health services and therapeutic interventions, particularly for children and youth with pre-existing psychological diagnoses to avoid the risk of exacerbating mental health problems ( Pelizza and Pupo, 2020 ).

Adapt referral pathways to encourage intersectoral collaborations as a means to minimize strain on existing resources.

Provide targeted support to care centers, families, and foster families to emotionally support children and engage in appropriate self-care, to reduce parental stress, and improve family connection—all of which are protective factors to child and youth mental health.

Provide financial and material assistance to families whose income-generating opportunities have been affected to alleviate the impact of poverty on child and youth mental health, as well as those whose pre-existing economic vulnerabilities were exacerbated during COVID-19.

Encourage child and youth engagement in initiatives to imagine our post-pandemic world, as exemplified by the UNESCO #NextNormal global action ( 2020 ).

Continue monitoring child and youth mental health challenges through robust longitudinal studies and improved measurement tools ( Ransing et al., 2020 ).

This article aimed to review empirical evidence linking the pandemic to child and youth mental health challenges, by focusing on (1) worldwide general populations and (2) vulnerable populations that are more likely to have experienced negative consequences in the midst of the pandemic, notably children with pre-existing mental health challenges, living in poverty, from racialized groups, and/or involved with child protection services/out-of home care settings. Regarding general populations, rapid and systematic reviews paint a bleak picture of COVID-19 related mental health outcomes for children and adolescents. Several studies were conducted internationally to document child and youth mental health status amid the pandemic, focusing on anxiety and depression symptoms, post-traumatic stress disorder, conduct and attention problems, substance abuse, and suicide. Virtually all studies were cross-sectional in design thus limiting the possibility of inferring causal links, though by implementing quick surveys these studies filled an important gap in knowledge. Despite this methodological limitation, studies conducted thus far suggest that an important proportion of children and youth have been struggling in the context of the pandemic, and that age and gender must be taken into consideration to appreciate the impact on young people, with female adolescents displaying the highest psychological distress. Pre-existing mental health challenges also pose a greater risk for experiencing mental health challenges amid the COVID-19 pandemic, particularly in the context of lockdown measures. Studies based on more robust methods are likely to be underway and their results forthcoming. These future studies will enrich our understanding of the impact of the pandemic on child and youth mental health in the long term. The analysis of factors that amplify or mitigate the impact of the pandemic in general populations suggests that interventions targeting parental stress and parent outcomes and those enhancing social interactions for children and youth should be preferred, as well as policies that only employ school closures as last resort public health measures to contain the spread of the virus. As we start imagining a post-pandemic world, it is paramount to implement practices and policies that will not only focus on preventing the virus from spreading, but to address the shadow epidemic of mental health difficulties experienced by those who will grow up to be the next adult generation.

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