Chicago pediatricians: The social isolation of remote learning is dangerous to youth

We have observed an insidious rise in depression, anxiety and suicidal ideation among adolescents.

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“Without the buffers provided by schools to identify students who are struggling,” write five Chicago pediatricians, “our nation’s youth are presenting later, sicker and in crisis.”

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As hospital resident pediatricians in Chicago, we have witnessed firsthand the monumental effects of the COVID-19 pandemic on childhood mental health. Evidence from the first year of the pandemic in the United States suggests that the social isolation created by school closures has exacerbated an ongoing childhood mental health crisis.

We are concerned that if this isolation continues, the emotional toll will be much higher and continue to prove deadly for some children.

As pediatricians, we are on the front lines of health care. We are granted a window into the lives of our patients, many of whom are Chicago Public Schools students. Over the last year, we have witnessed patients becoming increasingly withdrawn and depressed, and we have seen them hospitalized at alarming rates for mental health crises.

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With a nationwide shortage of beds at facilities designed to support children with mental health concerns, many kids essentially are trapped in the hospital awaiting transfer for weeks at a time. In our primary care offices, we have observed an insidious rise in depression, anxiety and suicidality among adolescents.

The 14-year-old who has become more withdrawn, whose parents found a draft suicide note just in time. The 12-year-old who took 20 tablets of Tylenol. The 11-year-old who began cutting.

Their stories vary, but most share a few common elements: falling behind in school, loneliness and isolation.

Our observations in Chicago are not unique. Research nationwide has found an alarming trend with respect to the toll of social isolation on youth worldwide. Using Centers for Disease Control data, researchers have compared the proportion of pediatric mental health-related emergency room visits prior to and during the pandemic. Mental health-related visits among children aged 5–11 and 12–17 years increased approximately 24% and 31%, respectively, last year.

Without the buffers provided by schools to identify students who are struggling, our nation’s youth are presenting later, sicker and in crisis.

Given this data, it is important that school districts thoughtfully evaluate the toll of isolation on the mental health of their students. Las Vegas public schools recently reopened after noting a doubling in youth suicide compared with the prior academic year, with 18 suicides this half-year compared with 9 the year prior. The New York Times reports that those lost to suicide have been as young as 9 years old.

We recently requested data for Chicago’s youth from the City of Chicago to conduct a similar analysis. Based on our experience caring for Chicago’s adolescents, we are worried that we will find similar trends of increased suicide attempts and successful completions in our kids during the pandemic.

The most robust data on youth mental health in the pandemic has come from China. A cohort study of 1,300 youth conducted at Anhui Medical University found much higher rates of depressive behaviors in youth after the lockdown. Prevalence of depressive symptoms, non-suicidal self-injury, suicidal ideation and suicide plans all increased over the course of the pandemic — with suicide attempts more than doubling.

Teachers, counselors and school support staff are our respected partners in caring for children. They are the first to notice when a child may need additional emotional support, has a learning disorder, may be a victim of child abuse or has food insecurity. As pediatric visits have declined over the pandemic, many children are not being seen by either pediatricians or teachers in person, leaving them vulnerable to their mental health concerns going unnoticed.

The overwhelming data from school re-openings in Europe, Asia and the United States show minimal COVID-19 transmission in schools. In addition, when infections do occur at schools, studies show low rates of secondary transmission (spread outside of a classroom) and no increase in ICU admissions for teachers.

In contrast, data on the dangers of prolonged social isolation is abundantly clear. Any increased infection risk for teachers, staff and families must be balanced against the very real danger that delaying in-person learning poses to mental health and overall well-being, knowing that suicide is the second leading cause of death in adolescents.

Parents, teachers, pediatricians, schools, hospitals —– we are all looking out for the safety of children. We hear and respect teachers’ concerns about safety. Safe reopening of schools involves universal masking, social distancing, cohorting of students, outbreak planning and adequate financial support for schools to invest in infection control measures.

Moreover, teachers and staff should be able to obtain COVID-19 vaccines efficiently.

As pediatricians, it is our duty to advocate for the safety of children. We are now far enough into the pandemic that we should let the data drive our actions. Prolonged social isolation from school closures is unsafe for a portion of Chicago’s youth as it is associated with increased risk of depression, suicidal ideation, and mental health harm.

These facts need to be a part of the discussion when considering whether to reopen schools.

Erin Klein, Hasanga Samaraweera, Michael Bertenthal, Kristie Sparks and Grace St. Cyr are resident pediatricians at three Chicago hospitals. The views they express are their own, not necessarily those of their hospitals.

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