"IT WAS SUFFOCATING": A QUALITATIVE STUDY OF MENTAL HEALTH OUTCOMES AMONG ADOLESCENTS AND YOUNG ADULTS ENGAGED IN CARE DURING THE COVID-19 PANDEMIC

The COVID-19 pandemic has caused a decline in the physical, social, emotional, and mental well-being for many adolescents and young adults (AYA) in the United States. Early research suggests that AYA with existing mental health conditions may be susceptible to adverse mental health effects from pandemic-related disruptions. However, the impact of COVID-19 risk mitigation interventions (e.g., school closures and social gathering restrictions) on mental health outcomes among AYA remains poorly understood. The purpose of this analysis was to qualitatively examine the perspectives of AYA on the impact of COVID-19 disruptions in order to develop strategies for promoting and improving mental health outcomes. From April – August 2021, we enrolled 19 AYA who were engaged in care at the Johns Hopkins All Children’s Hospital Adolescent Health Specialty Clinic prior to COVID-19. Eligibility criteria included being between the ages of 12-21 and having documented worsening mental health based on medical chart review. In-depth phone interviews were conducted by clinical staff and interview transcripts were auto-generated by Microsoft Teams software. Three research team members listened to the recorded audio files and edited the transcripts for accuracy. An initial coding guide was developed by senior investigators which was piloted and refined. After finalizing the coding guide, research assistant double-coded each transcript using Atlas.ti software. Upon completing the coding, the transcripts were compared to ensure agreement. Discrepancies were resolved through discussion among all the coders until reaching consensus. We then linked and classified the codes across transcripts to identify emergent themes. All study procedures were approved by the Johns Hopkins School of Medicine Institutional Review Board. The study sample was mostly non-Hispanic White (n=13, 68%), female (n=16, 84%), with a median age of 16 (interquartile range: 15-17). Five key themes were identified. AYA consistently described negative mental health changes during the pandemic, including declining or new onset of depression, anxiety, and eating disorders. Adverse mental health outcomes among AYA were provoked by experiences of loneliness and social isolation, especially due to school closures which disrupted routines, access to educational and social support, and key cultural milestones. AYA reported negative effects to their physical health (e.g., sleep, hygiene, physical activity, and diet) caused by a loss of motivation linked to mental health decline. The increased use of illicit substances was a notable strategy for coping with worsening mental health symptoms among AYA. Given the rapid changes in COVID-19 risk mitigation policy, AYA identified consistent support from parents, teachers, and clinicians as an approach to offset the potentially harmful mental consequences of the pandemic. COVID-19 risk mitigation interventions have precipitated adverse mental health outcomes among AYA. Findings from this study deepen our understanding of the key factors influencing the psychosocial well-being of AYA during the pandemic. Our results may help inform researchers, clinicians, and policymakers to develop guidelines and community-based strategies for mitigating the potentially negative effects of pandemic-related disruptions to mental health among AYA.