**7. Young people and COVID-19**

Young people may have escaped the pandemic relatively unscathed in terms of serious physical health sequelae of COVID-19, given that they were substantially less likely to be afflicted by severe illness, but the same cannot assumed regarding young people's social and emotional well-being. Children are more sensitive (e.g. to news reports on TV) and may develop a view of the world that it is a terrifying place to be. They may witness their parents struggling to cope, and this could reinforce their view of the world as a frightening place. In the longer term, this can colour or cloud the lens through which they view the world. The babies born during the pandemic experienced a lack of socialisation- have they missed critical periods of social and emotional development?

It is well established that adolescence is a stage of life wherein there is a heightened need for peer interaction, and emphasis is placed on social stimuli [45]. The severity and gravity of the COVID-19 situation forced many countries to implement strict public health measures such as physical distancing, self-isolation, school closures, and suspension of most sporting and other recreational activities, resulting in unprecedented levels of social disconnection by effectively precluding young people from engaging in face-to-face contact outside the realm of their own household or social bubble. Many young people missed out on life events which typically punctuate the adolescent and young adult periods of the life span, the socalled "coming of age" events such as school-leaving examinations and graduation ceremonies. Others embarked on their third level educations in a radically-changed educational environment, where online teaching prevailed in lieu of in-person lectures, and students were required to stay at home rather than move into their campus accommodation.

It is not yet known what longer-term social and emotional effects the pandemic may herald for our young people. It may be the case that social deprivation and physical isolation from peers will have a lasting impact on the psyche of young people: research has demonstrated that peer acceptance and peer influence are of paramount importance during adolescence. Indeed, animal studies have even demonstrated that social isolation and deprivation in adolescence can give rise to unique effects on brain and behaviour, in comparison to other stages in the lifespan. In highlighting the power of social networks, Jain [46] explains that irrespective of the particular type of trauma a person experiences, early social supports for the person in the aftermath of the trauma can actually prevent the onset of PTSD. Furthermore, for those who develop PTSD, a supportive social network can be instrumental in the healing process. Jain [46] stresses that early optimisation of social support in the wake of traumatic events is now considered excellent treatment. In addition, the person's perception of the support they receive from others is thought to be of utmost importance in terms of protection against developing PTSD.

On the other hand, it may transpire that the trend towards digital platforms of interaction, such as social media, may bestow some level of protection for young people against feelings of social isolation and thereby result in a less damaging effect to their mental well-being. Jain [46] examines the impact of social media technology during times of natural disaster and asks if such technology can be harnessed to bolster the social networks of post-disaster survivors. For example, in 2010, survivors of the Haitian earthquake turned to social media to tell their stories, which in turn rallied the response of the mainstream media to the disaster. Similarly, online communities were established in the wake of hurricane Katrina, providing support for survivors and a space to help process the trauma they had experienced. Of course, there are drawbacks to social media: trolling,

misinformation and privacy concerns, to name just a few. It should also be noted that social media technology is not universally accessible: people of lower socioeconomic status are less likely to have the means to access smart phones, tablets, or similar devices. The tragedy is that it is those of lower socioeconomic means who are more likely to be adversely affected by disasters, such as this pandemic, and therefore are perhaps the most needy of support in our society.

A number of rapid cross-sectional surveys have suggested an increased prevalence of anxiety and depression amidst the pandemic, as well as lower levels of well-being. However, Kwong et al. [47] issue a word of caution regarding such rapid surveying of a population: information relating to the participants' pre-pandemic mental health and potential confounding factors, is lacking, thus preventing a comprehensive assessment of whether adverse mental health outcomes arise in those with pre-existing mental health difficulties, or whether those with no previous psychiatric history develop mental health difficulties which are attributable to the pandemic. In an effort to remedy this situation, Kwong and colleagues [47] aimed to quantify the prevalence of depression, anxiety and mental well-being prior to and during the COVID-19 pandemic. Data were compiled from the Avon Longitudinal Study of Parents and Children [ALSPAC] and Generation Scotland cohort. Results showed that the prevalence of depression during the pandemic was similar to pre-pandemic prevalence in the ALSPAC index generation (mean age of 28 years), while the rates of anxiety had increased almost twofold, i.e. 24% in comparison to the pre-pandemic level of 13%. The authors identified young people, women, people with pre-existing mental or physical health difficulties, and those experiencing socioeconomic adversity, as at-risk groups for developing depression and/or anxiety amidst the pandemic, even when controlling for pre-pandemic anxiety and depression. Similar results were found by O'Connor et al. [48], in a study of just over three thousand people, which found that while levels of depression did not change significantly, suicidal ideation increased over time, and anxiety decreased following an initial spike. Subgroup analyses demonstrated that young people (aged 18–29 years), in addition to women, people from socially disadvantaged backgrounds and people with pre-existing mental health difficulties, had worse mental health outcomes during the pandemic. The authors cited the growing rates of suicidal ideation across waves of the pandemic, particularly in young adults, as cause for concern. It is possible that anxiety arises in response to an ongoing threat and sense of uncertainty, whereas the sense of global community and the "all in this together" attitude may bestow some protection against negative self-talk, self-blame and depressive guilt.

In a 2021 survey conducted by a U.K.-based charity for youth mental health, Stem4, it was found that three in five young people reported experiencing mental health difficulties such as anxiety and low mood. The same organisation witnessed an increase of over 1000% in views of its online resources page (which offers advice on matters such as coping skills for anxiety) during the lockdown period, in comparison to pre-lockdown [49]. In a recent Irish qualitative study [50] examining presentations to the paediatric emergency department, clinicians reported that there was an increase in demand for psychological supports for young people during the pandemic. The authors found that overall, the pandemic and the resultant public health restrictions have had a negative impact on the psychosocial well-being of young people. They found that the difficulty in accessing primary care and community services exacerbated the struggle of young people in need of support. There were anecdotal reports that presentations with self-harm had increased and the reduced access to out-patient child and adolescent mental health teams was cited as a possible contributing factor in this regard. The strife of children with neurodevelopmental disabilities was also highlighted: the authors highlighted that in the

#### *Perspective Chapter: Fallout from the Pandemic – A Social and Psychological Description… DOI: http://dx.doi.org/10.5772/intechopen.101499*

absence of a structured daily routine and support services such as specialist schools, some children with autism spectrum disorder struggled significantly, culminating in some being brought to the emergency department by their parents, who were struggling to cope with the escalation in their child's challenging behaviour. There is the additional concern that the closure of schools and other community services equated to the loss of safety nets for vulnerable children, who might have otherwise been referred to appropriate support services. Once again, the long-term consequences, if any, of these pandemic-induced challenges are to be elucidated. Perhaps the best course of action at this point would be to implement adequate services for young people as we emerge from the pandemic, with a focus on those services which were insufficiently resourced during the pandemic, such as communitybased mental health services.

Finally, there is the question of intergenerational trauma. Although in its infancy, the study of epigenetics seeks to establish if children of traumatised parents have an increased risk of developing similar difficulties to their parents. It is thought that PTSD may alter gene expression in a trauma survivor, and these alterations could then be passed on to the survivor's progeny at a cellular level it being speculated that such epigenetic alterations are passed to the child by "intergenerational transmission" by way of adversely affecting the parents' sperm or egg quality, or by negatively affecting the mother while she is pregnant. Yehuda et al. [51] examined the epigenetics of PTSD by assessing the effect of trauma exposure on the salivary cortisol levels of pregnant women. They found lower cortisol levels in women who were pregnant when they evacuated the World Trade Centre during the 11th September attacks, and this result was replicated in their one-year-old children. In comparison to women who did not develop PTSD in the wake of the terrorist attack, lower cortisol levels were found in mothers who developed PTSD and their infants, with mothers in the third trimester displaying the lowest cortisol levels. It is hypothesised that traumatic stress may alter the expression of an enzyme in the placenta, which in turn, modifies cortisol into an inactive metabolite. Other research has found that pregnant women with PTSD are at increased risk for impaired uterine blood flow, low birth weight babies and prematurity. It has been argued [46] that in-utero exposure to trauma can have adverse effects on the developing foetus. When we consider some of the obstacles which pregnant women faced during this pandemic: hospital visitor restrictions, fear of contracting the illness and uncertainty about vaccination, it is not difficult to imagine how stressful pregnancy was. Only time will tell if the distress and trauma experienced by many expectant mothers during this pandemic has been passed on to their "COVID babies".

## **8. Conclusion**

With potentially swathes of people reporting subjective psychological trauma and stress as a direct consequence of the pandemic, the knock-on effects on mental health services and on primary remain to be seen. Will there be an increased demand for supports in the longer term and how will these increased needs be met? Cullen and colleagues [52] issue a word of caution when considering how we ought to address mental health in the aftermath of the pandemic: "we neglect mental health at our peril and to our long-term detriment". That said, resilience factors may offset some of the adverse effects of the pandemic and these may be determined by individual personality traits and proactive coping styles. It is also obvious that psychological stress does not invariably become disorder. The challenge is for governments to adapt the wider environment and societal structures to support

resilience and learn from less successful strategies including inadequate, mixed or inconsistent messaging to assist in preparedness for future health crises.

Finally, we should be eternally mindful of the danger of forgetting. When trauma is not discussed, not processed, and perhaps actively forgotten, healing for some is hindered and probably prevented, yet excessive reflection may also potentially be retraumatising for others. Arguably a sense of complacency and lack of preparedness for future global pandemics would constitute the worst legacy of COVID-19. There is a danger that we will banish the pandemic to the depths of our subconscious, and ignore the need to actively process what has happened to our world and its citizens over the past 2 years. We know that the last pandemic incurred such a fate, with relatively little having been written about it in one hundred years since it ended. We need to consider what steps we may take to facilitate processing the trauma, in the hope that we can eventually learn from it and move past it. As mentioned previously, it has been recommended that frontline workers be formally thanked for their work during the pandemic, that their emotional and psychological wellbeing be preserved, burnout prevented and that their learning and experience be retained to ensure future responsiveness by health systems. We would suggest that a wider societal approach to actively remember the pandemic and those who lost their lives as a result, such as national and international days of remembrance, should be actively considered, lest we forget and fail to derive meaning from what we have been through during the course of this pandemic.
