Page 21 - July Aug 2022 Newsletter Final_Neat

Child &

Adolescent Psychiatry:

An Editorial

Richa Bhatia, MD, DFAPA

Poor mental health among children and adolescents is a significant public health concern.
In December 2021, the US Surgeon General issued an advisory on the urgent need to ad-
dress the youth mental health crisis (hhs.gov). Rates of mental health problems among
children and adolescents were rising even prior to the pandemic. Between 2009 to 2019, ‘persistent feelings of sad-
ness or hopelessness’ in the past year among high school students, rose from 26% to 36%, i.e., to 1 in 3 high school
students (Bitsko et al, CDC, 2022). Bitsko and colleagues noted that in 2019, 18.8% of high school students had seri-
ously considered attempting suicide. These statistics are alarming. Mental health among children and adolescents is
closely linked with physical health, health risk behaviors, social connectedness, education, and employment (Bitsko
et al, CDC, 2022).
The COVID-19 pandemic further exacerbated mental health problems among children and adolescents, through
school closures, decreased social connectivity, losses and illness in families, greater likelihood of exposure to child
abuse and domestic violence, greater parental stress, increase in rates of parental substance use and mental health
conditions, increased screen time, financial difficulties among families, changes in insurance and other factors result-
ing in decreased access to care, and challenges around adaptation to homeschooling (Jones et al, 2022). Significant
research from around the world suggests that prevalence rates of depression and anxiety among children and ado-
lescents increased further during the pandemic (Racine et al, 2021).
In addition to the COVID-19 pandemic, other major world events, such as war, migration, climate change (largescale
fires in California and other parts of the world), surge in gun violence (including school shootings), are additional
factors which may be adversely impacting the mental health of children and adolescents.
Children and adolescents constitute about 1/3rd of the world population. Given childhood and adolescence are cru-
cial periods for brain development, children and adolescents are especially vulnerable to the development of psychi-
atric disorders. In fact, ½ of all lifetime cases of mental illness are thought to have emerged prior to age 14 (Kessler et
al, 2007). This is true not only for ADHD and Autism Spectrum Disorder, but also, often true for depressive disor-
ders, anxiety disorders, and substance use disorders which may originate in childhood or adolescence. Untreated
psychiatric conditions in childhood and adolescence tend to affect self-esteem and learning. Additionally, earlier on-
set of psychiatric disorders is linked with a more protracted course, greater severity, and greater impairments in
functioning. Moreover, childhood psychiatric disorders may be linked to a disrupted transition to adulthood, by way
of adverse effects on schooling, employment, and social functioning. Therefore, early identification and timely inter-
vention is key.

Given that mental health of children and adolescents may be affected by a multitude of factors, such as school and
home environments, peer relationships, family mental health, bullying, abuse or trauma, media exposure, gender,
sexual orientation, prenatal stress, epigenetics, racial/ethnic discrimination, poverty and other social determinants of
health, it is important to understand and address the biological, psychological, social, cultural, and contextual factors
contributing to poor mental health among children and adolescents.
Of particular importance is the need for efforts to address and prevent trauma and early life adversity. According to
2011-2017 data, 62.3% of California adults have experienced at least one ACE, and 16.3% have experienced four or
more ACEs (osg.ca.gov). Childhood trauma and early adversity have adverse effects on brain architecture and on the
trajectory of brain development, increasing vulnerability for future development of psychiatric disorders (Li et al,
2022). Childhood abuse and trauma may also adversely affect immune, neuroendocrine, cardiovascular, and meta-
bolic systems. Neuroimaging research suggests that physical abuse is linked with changes in the prefrontal cortex,
while emotional abuse has been found to be linked with changes in the orbitofrontal cortex and postcentral gyrus, in
addition to adverse effects on other brain regions (Li et al, 2022). Deprivation in childhood Continued on page 22

NORTHERN CALIFORNIA PSYCHIATRIC SOCIETY Page 21 July/August 2022