Substance use declined, mental health worsened in teenagers during COVID-19 pandemic

While adolescents’ mental health has declined during the coronavirus disease 2019 (COVID-19) pandemic, the rate of substance use has also decreased concurrently, a recent longitudinal, population-based study in Iceland suggests.

“Our study’s findings show a conversative estimate of impaired adolescent well-being during the COVID-19 pandemic. Population-level prevention efforts, especially for girls, are warranted,” said the authors. [Lancet Psychiatry 2021;8:663-672]

“On the other hand, the decreased rate of substance use observed during the COVID-19 pandemic might indicate an unintended benefit of isolation, which might serve as a protective factor against future substance use disorders and dependence,” they continued.

“Further studies, especially those using samples stratified by gender, are needed to determine the effects of varying social restrictions and cultural factors on coping mechanisms used by adolescents during times of uncertainty,” suggested the authors.

In the study, data of 59,701 teenagers 13–18 years of age who participated in the Youth in Iceland school survey in October or February in 2016 and 2018, and in October 2020 (ie, during the COVID-19 pandemic) were extracted. The survey administration period was longer in 2020 to include all schools as some had to undergo quarantine during the timeframe.

An increase in depressive symptoms (as assessed by the Symptom Checklist-90) and worsened mental well-being (as assessed by Short Warwick Edinburgh Mental Wellbeing Scale) were observed across all age groups during the COVID-19 pandemic compared with peers of the same age prior to the pandemic (depressive symptoms: β, 0.57; 95 percent confidence interval [CI], 0.53 to 0.60) (mental wellbeing: β, -0.46; 95 percent CI, -0.49 to -0.42)

Subgroup analysis showed significantly worse depressive symptoms and mental well-being in girls compared with boys (depressive symptoms: β, 4.16; 95 percent CI, 4.05 to 4.28) (mental wellbeing: β, -1.13; 95 percent CI, -1.23 to -1.03)

Of note, the COVID-19 pandemic was associated with a significant reduction in cigarette smoking (odds ratio [OR], 2.61; 95 percent CI, 2.59 to 2.66), e-cigarette use (OR, 2.61; 95 percent CI, 2.59 to 2.64), and alcohol intoxication (OR, 2.59; 95 percent CI, 2.56 to 2.64) among adolescents 15–18 years of age, with comparable results between boys and girls.