In recent years, due to global crises - pandemics, ongoing wars, climate changes, and other shifts - there has been an increase in the number of young people in both Latvia and around the world experiencing mental health issues, including anxiety and depression. A research team from Riga Stradiņš University (RSU) and Riga Technical University (RTU) is working together in a national research program project to better understand the mental health of young people during the post-pandemic period. The team is developing a new computerized method with the aim of assessing the mental health indicators of Latvian teenagers and young people (aged 13 to 19).
SUMMARY
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There has been an increase in the number of children and adolescents seeking help related to anxiety, depression, and other mental health issues.
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The causes of the health deterioration are the consequences of the COVID-19 pandemic - lack of physical activity, isolation, and later difficulties in socializing.
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It has been found that society is less afraid to admit mental health difficulties.
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The goals of the project are to determine the mental health status of Latvian youth and to develop an instrument that will allow for the evaluation of adolescents' and young people's mental health.
Media and scientific literature have written extensively about the post-COVID effects on children and teenagers. "Each of us was affected by the pandemic to some extent," says Dr. Ilona Krone, the lead researcher of the project.
COVID-19 has significantly impacted young people's mental health worldwide, with studies showing increased levels of depression, anxiety, and psychological distress among children and adolescents. Factors contributing to this decline include social isolation, disruption of routines, increased screen time, and reduced physical activity.
Existing data and studies on emotional well-being show a significant rise in the number of children and adolescents seeking help for anxiety, depression, and other mental health problems.
The situation in Latvia is illustrated by the growing demand for community-based mental health services for adolescents facing various mental health difficulties at the Children and Adolescents Resource Center (BPRC). BPRC has 14 centers in nine Latvian cities, and the demand for help has been increasing every year. In 2022, BPRC assisted 8,500 young people, while in 2023, this number reached 12,000. Currently, the demand curve has not decreased, and last year, a total of 13,917 adolescents aged 10 to 17 received services at BPRC.
Liene Dambiņa, the chairperson of the board of the Children's Hospital Foundation and BPRC, acknowledges that "the demand is still very high, despite the fact that we increased our capacity immediately after the pandemic and opened several regional branches. Currently, about 500 young people are waiting in line, which means that in some centers, there is a several-month wait for enrollment in one of our programs. However, we try to ensure that the first consultation with a specialist is provided within a few weeks so that we can assess the seriousness of the adolescent’s difficulties and, if necessary, provide immediate assistance, for example, if there is a high risk of suicide."
Similarly, at the Children’s Clinical University Hospital’s (BKUS) Child and Adolescent Mental Health Center, the number of adolescents and young people seeking help for various mental health and behavioral issues has increased. Pediatric psychiatrist, medical doctor, and researcher Ņikita Bezborodovs notes, "Globally, the absolute increase in the prevalence of mental disorders is small, but analyzing BKUS data, we see that the patient profile in the children's psychiatry department has changed. Before the pandemic, we hospitalized young children in our department (about half of the patients were young children, the other half were adolescents), but since 2020, we no longer admit young children, as all the beds are taken by adolescents, who usually arrive in urgent cases. Most often, they come with serious mood disorders or after attempts at self-harm."
Why the deterioration?
Studies show that various challenges during the pandemic added additional stress to adolescents’ and young people’s mental health. Social isolation, in particular, negatively impacted their sense of belonging, various skills, and their self-esteem. There was much uncertainty and confusion about the future. Adolescents had to experience all of this alongside the sensitivity and biological changes typical for their age. It was, in a way, normal to feel anxiety or depression in the abnormal pandemic situation. Losses were experienced, both direct and indirect. Some lost loved ones to COVID, while others experienced temporary or prolonged changes due to illness. Studies confirm the direct impact of COVID on adolescents' nervous systems and both their physical and mental health. There were also emotional losses, such as unrealized opportunities.
"Additionally, there was physical inactivity and closer confinement with the family system. This could have had both positive and negative effects, such as parental stress and potential additional conflicts within the family system. Overall, stress increased during the pandemic," explains senior researcher Ilona Krone.
Returning to school and daily life required children and adolescents to adapt again, which also led to some anxiety.
Although isolation ended, some young people continue to lead a more isolated lifestyle and socialize less. "It has been studied that the pandemic restrictions strengthened the "friendship with technology". Of course, we all experienced the COVID period differently, but for some, new habits developed, including more frequent use of technology. Indeed, studies confirm that the COVID-19 pandemic significantly increased the use of technology by adolescents and young people, both for educational and social purposes. It has been concluded that excessive screen time negatively affected well-being, physical activity, and sleep patterns.
For young people who have difficulty socializing, digital communication is somewhat more convenient. However, stress and social anxiety increase when in-person meetings are required. The pandemic period was a 'legitimate way' to avoid challenges and distress in a social setting. Some young people continue this withdrawal and isolation," concludes senior researcher Ilona Krone.
Researcher and pediatric psychiatrist Ņikita Bezborodovs adds that of course, it’s not just the pandemic that has affected young people's mental health: "There are plenty of other processes that are significant - proximity to war, social instability, climate crisis. The pandemic is not the only factor - it most likely accelerated some already starting changes. We see this also in the BPRC situation. Even after opening regional centers, the demand for services has not decreased after the pandemic, and the demand from adolescents, young people, and their families continues to grow."
Less fear to admit mental health difficulties
A new positive trend has been observed: there has been a decrease in the negative stigma associated with admitting mental health difficulties. This means that those adolescents who may have kept their struggles quiet before are now more likely to seek help.
Liene Dambiņa, the chairperson of BPRC, has observed: "For adolescents, this stigma had already been reduced before COVID - they came to us as soon as such an opportunity existed in the country. BPRC was the first institution to provide this type of service directly, without the need for a referral from a family doctor or another specialist. This made the process easier, as the adolescent could speak directly with a specialist who would provide support, rather than going through several specialists beforehand. The pandemic period and the increased public awareness have contributed to these positive trends - the reduction of stigma among adolescents’ parents. This stigma is still decreasing, and parents have become more open. Our service includes support groups for parents, and they are very well attended. Parent involvement significantly improves the recovery of adolescents and young people - there is more than a 70% improvement for those children and young people whose parents have participated in the service."
What value will the research bring?
Project leader, Associate Professor, and Medical Doctor Ainārs Stepens informs that the national goal of the research project is to determine the mental health status of Latvian youth. The task is to test both the mental health difficulties of adolescents and young people and the general population aged 13 to 19 to provide an assessment of the overall mental health profile of Latvian adolescents and young people. But how can this be measured? Until now, there has been no suitable tool, a psychometric instrument, to measure various parameters, which would also be suitable for the Latvian cultural environment. Therefore, the second goal of the study is to develop an instrument that would allow the assessment of adolescents’ and young people's mental health.
Moreover, the instrument must be suitable for adolescents and young people.
The psychometric part of the instrument has already defined statements according to certain criteria, following the guidelines for test and instrument development. The test will include a section about personality and another about psychological difficulty symptoms.
The scientific-practical part of the instrument is highly valued by the involvement of Riga Technical University, which helps implement the test in a digital format - a more understandable form for young people today. This is not simply transferring data into a digital form; it will use innovative solutions. The new computerized assessment system will also measure such psychophysiological parameters as the decision-making speed, pressure with which the respondent presses the answer button, and others, which are considered an innovation in psychological testing not only in Latvia but also globally. To use the test in Latvia, it will be standardized, and schools will collaborate, including approximately 1,000 adolescents and young people who have not previously been diagnosed with mental health difficulties.
Lead researcher Dr. Ingars Steiks from RTU reveals that ideas continue to emerge during the project's implementation, and initial ideas are being continuously improved: "We are adding more parameters, ideas, and data that we can track. By collecting data, we look for correlations according to the developed algorithms. We also involve students - they assist in developing technical solutions."
The entire team agrees that seeing the overall psycho-emotional health situation of adolescents and young people will help find the best ways to offer support and recommendations.
Without understanding adolescents' and young people's difficulties, their severity, and symptom combinations, it is harder to offer appropriate psychological support interventions.
The change in the recipient profile of services is reflected in BPRC’s experience - previously, 70% of service users were girls and 30% boys (this aligns with global statistics), but in 2023, this trend shifted, and the number of boys has increased. Liene Dambiņa explains this by saying: "I don’t think this is related to the spread of difficulties in the population, but rather to the design and accessibility of our service - it is becoming more understandable and acceptable to boys (the previously mentioned dialectical behavioral therapy is more needed by boys). And that’s very good! At the same time, we gain an opportunity to better understand boys' difficulties. Even before, BPRC collected information about our service users - young people and their families - to draw conclusions: what are the risk factors, what is the family situation, which groups tend to stop receiving services, and so on. The research carried out by the RSU and the RTU will help us understand what is happening in the general population, allowing us to offer support to adolescents/young people and their families and school environments earlier to improve the situation."
The computerized assessment system will also provide a contribution to professionals in their daily work, allowing them to assess the mental health of adolescents and young people in a timely, modern, and standardized way using a tool that follows best practices for testing in Latvia.
Development of a New Computerized Assessment Method for Measuring and Monitoring Mental Health Outcomes in Adolescents in the Post-COVID Pandemic Context
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