COVID-19 and adolescent mental health in India.

Lockdowns in India were stringently imposed from March 24, and have been eased gradually since September, but schools remain closed and online classes have replaced classroom teaching. This situation provided children and adolescents with the perfect conditions for solitude and increased internet use. Parents are concerned about the effect of school closure, social distancing, and increased internet use on their children's mental health.2, 3 Increased opportunity for internet use makes it more difficult for parents to control this access, and frequent and unsupervised internet use is associated with self-harm and suicidal behaviour in adolescents with psychological risk factors.

Coronavirus disease 2019 (COVID-19) might not be as lethal in children and adolescents as it is in adults, but it does cause a lot of psychological distress in this age group. Adolescents are experiencing acute and chronic stress because of parental anxiety, disruption of daily routines, increased family violence, and home confinement with little or no access to peers, teachers, or physical activity.

School closure and home confinement can also have a beneficial effect on adolescent mental health, by allowing for a more cohesive family lifestyle. However, in a socioeconomically disadvantaged country, the school environment might be more enriching than the home—nutritionally, emotionally, and developmentally. School closure has seriously disrupted adolescent lives in India, with many young people entering the workplace as a result, possibly never to return to education again.

During the pandemic, adolescents at high risk of psychological problems might fall through the safety net provided by a protective family life, peer support, and psychological support from teachers. It is time to address adolescent mental health in India systematically, to monitor the incidence of various psychiatric disorders (eg, depression, anxiety, and self-harm behaviours), and to identify factors for both risk and resilience.

To help identify adolescents at risk of mental disorders, frontline health workers in COVID-19 community screening teams could be encouraged to detect recent changes in behaviour, substance use, and excessive isolation among children and adolescents. Teachers and parents can be trained to identify signs and symptoms that suggest poor mental health, such as sleep disturbances, excessive anger, and difficulty concentrating. Any mental health needs can then be addressed by mental health professionals, using telemental health interventions that target adolescents, which have shown promising results. Also, task sharing and task shifting strategies could be used to develop networks of clinical care across existing health systems to provide mental health care for adolescents.