**5. Mental health trends in the pandemic: exploring long term impacts on health security**

The COVID-19 pandemic has had many negative effects on the mental health of both adults and children [35, 36]. The stress associated with the fear of the unknown, along with the abrupt closure of schools in March 2020, spiraled many children into emotional upheavals they had not experienced previously. The sudden switch from "going to work" every day to "working from home" or being furloughed or laid off led to enormous financial stress for many families. Not feeling financially secure may lead to significant emotional pressure for adults, which is often projected onto children, in various and often unpredictable ways. The closure of schools and businesses resulted in a significant reduction in direct human contact. Casual daily social interactions constitute an important outlet for mental health stress for many people [37, 38].

Prior to the pandemic, approximately 1 in 10 adults reported anxiety or depressive disorder. This increased during the pandemic, with about 4 in 10 adults reporting corresponding symptoms [10]. A survey in June 2020 showed that 13% of adults admitted to increased or new substance use, attributing such response to the stress related to the COVID-19 pandemic [10]. It is well established that mental health stress in adults directly impacts toxic stress in children [39, 40]. When adults are under stress, they have less emotional "reserve" or "bandwidth" to effectively care for their children, which may, in turn, result in physical child abuse, emotional child abuse, neglect, or unhealthy interactions that although not necessarily outright abusive, may still have deleterious effects on our children [41, 42].

Irritability, inattention, and clinginess were seen among children in early pandemic studies along with sleep issues, decreased appetite, and separation anxiety [43]. Adolescents may be prone to hoarding behavior due to the panic-buying seen in the early pandemic. Obsessive–compulsive behavior may be increased because of hoarding, general feelings of fear and uncertainty, a heightened awareness of how viruses are spread, as well as the need for cleanliness to prevent viral spread [43]. Increased reliance on electronic devices for online schooling or as a means for human interaction while in the quarantine may lead to worsening social media/ electronic addiction as well as cyberbullying [43, 44].

*Toxic Stress Affecting Families and Children during the COVID-19 Pandemic: A Global Mental… DOI: http://dx.doi.org/10.5772/intechopen.104991*

The mental health needs of our society related to the COVID-19 pandemic, will continue to be apparent for years to come. Many downstream effects will be unpredictable, individualized, and likely highly variable in terms of temporal patterns. Toxic stress from the poor mental health of our adults and children will lead to deleterious emotional and health effects that are yet to be seen. Focusing on the mental health of our entire population is essential to help decrease these effects. Increased mental health support with both inpatient and outpatient resources is needed now, and will certainly be needed for the foreseeable future.
