COVID-19 was a novel coronavirus firstly evolved in late 2019 and rapidly spread all over the world affecting everyone in this planet. While science has highlighted the physical damages, the infectivity, and the socioeconomic burdens, the negative psychological impacts arisen directly or indirectly from COVID pandemic are usually under-reported. The social distancing and many public health measures taken at the time of crisis have inevitably aggravated the emotional challenges. Schools and workplaces were closed forcing students to study online and adults to work at home. People became disconnected and isolated losing the usual supportive networks.

Children and adolescents, being a group that is least visible and voiceless, are in particularly vulnerable during disasters and pandemics. The COVID outbreak and city lockdown have brought about short-term and long-term physical consequences as well as mental health implications for children and adolescents. During the COVID Pandemic, most of the children have been trapped at home with limited space to play or exercise resulting in dramatic increase in obesity, overweight and visual problems. Those with special care needs and behavioural problems are more susceptible to the isolation challenges because most of the supportive and training services were shutdown. Many of the resources and attentions have been shifted to fight against the COVID battles leaving the most vulnerable group aside.

Adolescence is a second window of brain development highlighting the functional maturation in executive and social networks influencing cognitions, emotions, and behaviour of the teenagers. The rapid physical growth and hormonal changes together with the challenging social interactions and peer connections make adolescents more vulnerable to mental health problems and stress reactions during this critical period of life. When uncertainty and difficult circumstances are the norms during pandemics, prolonged exposure of toxic stress and social isolation would complicate the situation further. During the lockdown, teenagers, staying away from their friends and the school support, have lost the usual protective factors. Older adolescents, in particularly, have missed out significant life events such as graduation ceremony, sport events and even public examinations which may never be a second chance to reattend.

Global studies showed that one in four adolescents were experiencing depressive symptoms during the Pandemic. Other common mental health problems arisen in the post-COVID era included anxiety, post-traumatic stress disorders, obsessive compulsive disorders, sleep disorders and distorted eating. Teenagers spent more time to stay online instead of getting in touch with the real world. Many internet-related issues such as internet addiction, substance abuse, cyber-bullying and cybercrimes became growing concerns. Teenage girls were more engaged in the social media browsing through the IG collections of slim body figures and following those unrealistic dieting recipes resulting in the sudden surge of eating disorders. All these mental health challenges would create short term crisis as well as long-term and undesirable physical and psychological impacts jeopardizing the normal growth and development of adolescents.

Adolescents living in certain circumstances are at more disadvantaged than others. For example, mental health issues are not commonly discussed in Asian families making adolescents difficult to disclose their psychological needs to families or friends. Many of the parents are even reluctant to let their adolescents seek medical attention on mental health disorders which would further delay the diagnosis and treatment. The health seeking behaviours of teenagers also give rise to another obstacle for the mental health care. A local study in Hong Kong showed that more than two third of youths preferred to seek remedies for their medical and mental health problems through the internet. Their health decisions relied mainly on number of likes and shared experiences of the users online rather than the advice from healthcare professionals.  

Even though many global studies have confirmed the negative impacts of COVID-19 pandemic on adolescent mental health, appropriate measures and attentions to safeguard the mental wellbeing of young people are still far from adequate. The unawareness of the general public, insufficient supportive services, shifting of resources and policy focuses into infectious diseases, practice of social distancing and isolation all contribute to the poor mental health outcomes of the youngsters. Moreover, infectious control measures are usually based on public health concerns rather than holistic approach focusing on individual’s basic needs and mental health challenges of adolescents. Hence, it is crucial for policymakers to bear in mind the psychological needs of adolescents in addition to the physical concerns.

As paediatricians, we should alert the public and policymakers to recognize the detrimental psychological impacts of COVID-19 on adolescents and to balance the resources and manpower to control the spread of the pandemic on one hand but also at the same time to address the specific needs of adolescents. Timely actions and long-term strategies should be ready to support the adolescents to adjust to the unusual changes during pandemic and to restore their normal life and functions as far as possible.  APPA, as a group of dedicated paediatric societies and organizations in the Asia Pacific region, should advocate the mental wellbeing of adolescents and children in the post-COVID era and encourage member societies to work hand in hand with concerted efforts to formulate appropriate preventive measures and practical advice to tackle the newly evolved psychological crisis.