Students struggle with mental health amid pandemic isolation

Since the coronavirus pandemic swept across the globe, Alma Martinez has been tossed between the extremes of tempest and doldrums. Her mother lost her job, so Martinez found work as a Starbucks barista to help pay the grocery bills for a household of six. She babysat and home-schooled her two younger siblings while struggling with her own remote Coral Gables High classes, her last year of high school.

Her mood sank during long stretches of mind-numbing monotony while cooped up at home and cut off from her friends.

For Mickella Jean-Baptiste, the sadness and separation caused by COVID-19 during her wrecked senior year stirs feelings of déjà vu from her painful freshman year at Marjory Stoneman Douglas High, when school shooter Nikolas Cruz killed 17 students and faculty and injured 17 others on Valentine’s Day, 2018, in Parkland. Jean-Baptiste ran from a bathroom and hid in a darkened classroom as gunfire exploded on the floor below and a fire alarm blared. She’s learned to practice deep breathing when loud noises trigger anxiety.

“Our school had barely recovered from post-traumatic stress disorder and boom, COVID happens,” she said. “The seniors, we’ve haven’t even seen each other — no homecoming, no Spirit Week, no Grad Bash, a prom limited to six-person pods and no dancing. We only had one normal year of high school.”

The Pabon sisters, Isabella, 17, and Sofia, 15, became anorexic after they and their grandfather, who was visiting from Colombia, contracted COVID. He died in a local hospital. They never got to say goodbye. Determined to honor him — he was an extremely fit ex-boxer and professional salsa dancer — they obsessed over their diet and workout regimen. They each lost about 30 pounds. Their mother insisted they talk to a therapist.

“We’re in recovery now, learning to understand a healthy body image,” Sofia said. “It’s been such a long, depressing year. I forgot what normal is. I’m scared to go back to school.”

The disorienting despair shrouding the world has hit young people where it hurts most, battering their mental health when sense of self is still fragile and emotions are still tender. The pandemic’s one-two combination of isolation and unpredictability is especially injurious to adolescents and teens who feed on social interaction and trusted routines for personal growth.

Students have endured lockdowns and quarantines, school closures and the frustrations of virtual learning via laptop, family strife at home, financial hardship, illness and death, loneliness, missed milestones, a barrage of bad and frightening news.

They are suffering from depression, anxiety, panic attacks, insomnia, eating too much or too little, inability to concentrate, social media saturation, screen burnout, low energy, low self-esteem, and, in dire cases, suicidal thoughts.

Increase in kids’ emergency room visits

“We are seeing substantial increases in the number of kids visiting emergency rooms for mental health treatment or receiving psychiatric services,” said Dr. Ken Duckworth, a psychiatrist and chief medical officer for the National Alliance on Mental Illness (NAMI). “Adolescents and young adults were already dealing with rising rates of anxiety and depression during the past decade. The amount of exposure to trauma is a key indicator of mental illness, and some kids have experienced multiple traumas during the extensive course of this pandemic.”

Visits to the ER for mental health problems rose 31 percent among children aged 12 to 17 and 24 percent among children aged 5 to 11 between mid March and mid October 2020 compared to the previous year, according to a Centers for Disease Control and Prevention study.

Almost half of parents of teens say they have noticed a new or worsening mental health condition for their child since the start of the pandemic, according to a C.S. Mott Children’s Hospital in Ann Arbor national poll on the emotional impact of COVID-19 restrictions. The report, released March 15, found teen girls suffering more anxiety and depression than teen boys, and parents reporting disruptions in sleep patterns, an uptick in aggressive behavior and withdrawing from family among their kids.

In a CDC survey of parents in the fall, about 25 percent said the mental health of their children, aged 5 to 12, was adversely affected by remote schooling.

A Harvard study tracking 224 Seattle children aged 7 to 15 found that symptoms of depression and anxiety affecting the group more than doubled to over 60 percent by the latter part of 2020 and early 2021 compared to pre-pandemic levels.

‘Some will not bounce back’

Young people refer to the past 13 months as a wasted or lost year. Much is made of kids’ resilience. But the long-term consequences could be damaging for the most vulnerable — kids with pre-existing mental health problems, kids with disabilities and kids from poor communities.

“Under the right circumstances, most kids will bounce back,” said Dr. Elizabeth Pulgaron, assistant professor of clinical pediatrics at the University of Miami’s Mailman Center for Child Development who counsels students at nine clinics in Miami-Dade Public Schools as part of the UM School Health Initiative.

“But the kids who were struggling before COVID, we’ve stripped so many supports out from under them that I worry about their recovery. They’ll need help and it will take time. The kids I work with have a multitude of stressors from a young age: abuse, abandonment, poverty, homelessness, immigration issues. COVID adds to the list. Some will not bounce back.”

Trauma and Adverse Childhood Experiences (ACEs) can alter brain development, say psychiatrists, pediatricians and teachers. The cumulative effects of exposure to violence, death, neglect, parental strife, substance abuse, disasters such as hurricanes, tornadoes, fires, mass shootings or the 9/11 terrorist attacks can lead to chronic emotional, cognitive and physical problems and increase the risk of heart disease, suicide and mental illness.

“Multiple traumas don’t make you tougher or more adaptable, and I think we as adults and educators need to focus on healing the wounds before they become scars,” said Dr. Christopher Gentile, a pioneer in the virtual learning field and a former psychology teacher at Miami Jackson High.

“Disadvantaged kids are worried about safety, hunger, eviction, their parents working on the front lines. These kids are exposed to murders and suicides. Kids get a rush of emotions and they’re not mature enough to sort them out. When I was a teacher, we acknowledged trauma, held listening sessions and helped them process their feelings.

“We need to do the same thing with COVID or mental illness will manifest later.”

Parents’ mental health has had a strong influence on their children’s well-being, said Dr. Alan Delamater, a clinical psychologist at UM’s Miller School of Medicine Department of Pediatrics and the Mailman Center. He studied 300 kids at a diabetes clinic who had symptoms of depression and anxiety before the pandemic.

“Kids did better if their parents were able to cope during the pandemic,” Delamater said. “Kids look to parents as role models. Are the parents holding up under the stress and providing psychological support? Was the family able to stay safe in its bubble?”

Living through her parents’ marriage falling apart

For Ariane Guenther, a 14-year-old eighth grader at Archimedean Middle Conservatory in Kendale Lakes who has been remote learning since schools closed in March 2020, home has not been a refuge but a crucible where her parents’ marriage disintegrated over the course of the pandemic. They are getting divorced.

“School was kind of an escape to a place of positive energy for me because my parents were having disagreements that got worse when we were all stuck inside the house annoying each other,” Guenther said. “My dad was getting under my skin. My mom was worried about losing her job with a cruise line.”

Guenther had mild anxiety before the pandemic that grew more acute as the months dragged on.

“I used to be extroverted but now I feel anxious when I speak to anyone, like I’m bothering them,” said Guenther, who recently began telehealth sessions with a therapist. “I have a tendency to get overwhelmed and overthink: ‘What are people saying about me? How will they remember me? Did I say the wrong thing?’ I’m learning how to stay calm.”

Janell Mullings, 16, a North Miami High sophomore, said she’s been burdened by social anxiety and periods of depression. She hasn’t received much help at home but talks to Pulgaron at school. Exercising outdoors makes her feel better, too.

“I would cry in the bathroom, cry in my room, hide somewhere to cry. I had bad nightmares and I’d stay awake to avoid them,” she said. “Adding to the tension, we had lots of arguments at home over little things, like taking out the trash. My family members were not supportive in a comforting way but in a hard, strict way.”

Separated from friends, disconnected from the communal environment of school, students became homebound shut-ins climbing the walls.

“In your adolescent and teen years, so much of who you are has to do with your social activities and interaction with your peers,” said Gentile, the former Jackson High teacher. “Nothing could be worse than being grounded. Well, for a year, they’ve been grounded.”

Maria Garcia, a Michael Krop High senior, used to be outgoing. She was voted Most Friendly last year. But during the pandemic she turned into a person she doesn’t recognize — withdrawn and taciturn.

“I’m acting super different. I’m not cheerful anymore,” Garcia said. “During the holidays I’d just cry. I’ve cried more in the past year than in my entire life. I lie in bed and think about all the things I have to do that I haven’t done and then it’s too late to do them.

“My allergies and acne got worse. I’m super pale, with huge eye bags. I look like a zombie.”

As French Club president, Garcia tried to keep activities humming, but home scavenger hunts and a Halloween costume party on Zoom just didn’t cut it. Usually a social butterfly, she lost the will to keep friends chatting on Facetime.

Kids’ maturation depends on interaction with other people. The pandemic has intersected with their budding personalities at a pivotal time, starving them of typical feedback. Finding one’s identity is like trying on clothes in front of a mirror: What fits? What’s your style?

“You need to be surrounded by different people with different mindsets so you can search for what works and figure out who am I? Why am I here? Am I real?” Guenther said, laughing at her philosophical musings.

“I turned 14 on Valentine’s Day and realized nothing has changed since my 13th birthday. The days smudge together. So much time has passed and I’ve achieved so little. Your teen years are supposed to be the ones you remember most. There’s not much to remember but boredom and misery.”

Hyper sensitive to external judgment during this stage, isolated kids could get locked into self-perceptions, determining that because their grades have declined they are not smart and will never be a good student, or because they’ve lost touch with friends they’ll never be popular or socially adept, or because they are sedentary they are not skilled enough to join the soccer team or marching band and become addicted to video games instead.

Loss of friends, social structure that’s pivotal to growth

“So much growth is linked to sharing, playing, conversing, following rules, resolving conflicts, and many kids are missing out on normal progression right now,” Delamater said. “A core element of teens’ identity and feelings of acceptance is their peer group. They’re observing different behaviors and practicing their social skills every day. Removed from that interaction, they are measuring self esteem by the number of likes on social media, which places them in a vulnerable position at a critical time.”

When softball season was canceled, Gables High student Christy Concepcion found herself scrolling through what she calls the “dopamine” of social media posts for hours. Pictures of beautiful women fed her insecurities and feelings of “guilt and disgust,” she said. Only by deciding to do fielding drills in her yard and focus on music was she able to exit the social media spiral.

Sofia Bronstein, 16, was seized by panic when she worried about her performance in Zoom classes and her falling grades. She developed a tic that causes one of her eyes to blink uncontrollably.

“All of a sudden my heart will drop to the floor and I’m freezing at 80 degrees,” she said. “I have a fear of being embarrassed by classmates, that I’m not on mute and I’ll say something stupid. I was a very social person at school and now I’m awkward. I feel ashamed that I was a better, more motivated person before.”

Bronstein said therapy is helping her curb her anxiety.

The uncertainty of a pandemic that many kids thought would be only a two-week lark has shredded the rhythm and routine of their lives. Abrupt quarantine orders, rollercoaster surges in caseloads and a constant state of crisis have kept kids off balance, unable to plot goals or count on rites of passage.

“Kids are used to getting answers from teachers and parents, so when we keep saying, ‘I don’t know’ — human beings don’t like unknowns,” Pulgaron said. “It’s easier to deal with uncertainty when we have a deadline. But we don’t know when this will end, how it will play out. That exacerbates the chaos, the lack of control. Kids thrive on structure and routine and struggle with abstract concepts.”

Mia Aguilar’s entire family got sick with COVID. It was a harrowing time as she lost 10 pounds and experienced muscle aches, hair loss, shortness of breath. She still uses an inhaler.

“I thought to myself every night: Would today be my last day or was today the last day for my parents? How about my sisters?” she said.

Uncertainty has bred disappointments.

Aniela Lopez, a sophomore at Gables High, lamented the drive-by “quarantinera” for her 15th birthday. Bronstein missed her final summer at Camp Coleman in Georgia, her shot at playing a lawyer in the county mock trial competition and her brother’s bat mitzvah, postponed for a year. No school choir or Model United Nations convention for Guenther and, worst of all, no eighth-grade trip to Athens, Greece, one of the main reasons she chose to attend Archimedean. Jean-Baptiste only got one year on the step dancing team. For the Pabon sisters, all their training for track and field season was for naught. Garcia gave up on college hopes when she couldn’t submit applications in time.

“I practiced so hard for a song-and-dance audition for an entertainment company that was canceled,” said Elijah Mocombe, an iTech senior. “Could have been my big break.”

Big losses for seniors

For high school seniors, the list of lost opportunities is demoralizing. They invested three years into becoming team captains, state champions, student government leaders, drum majors, yearbook editors, theater stars, community service project organizers. Only to have their grand finale canceled by COVID.

“It’s like the enjoyment part of school was sucked out and that made the monotone drudgery more depressing,” said Arthy Suresh, a Stoneman Douglas High senior.

A year of losses has blunted students’ self-confidence and put them in a funk, Pulgaron said.

“They’re mourning prom, graduation, the varsity team they couldn’t play on, pep rallies, parties,” she said. “Those are the things they live for.”

An emerging concern for adolescents and teens is how they will handle what mental health experts are calling “re-entry” to society and in-person school.

“For remote learners, it will be 18 months out of school before they make it back in August and that gap will be challenging for re-integrating kids,” Pulgaron said. “I anticipate wait lists in the fall for kids who need help. The beginning of the school year is already a time of jitters.”

Guenther got a taste when she recently went into school to take the state standardized writing test.

“It was strange. Quarantine affected peoples’ personalities, I think,” she said. “We wanted to reach out and hug and talk but we forgot how.”

Learning valuable coping skills

Children who have fared the best during the pandemic have learned coping skills and self-care practices, said Diana Haneski, a proponent of mindfulness training. She runs the media center at Stoneman Douglas High and was a leader in implementing a mental health support system at the school after the shooting in 2018.

She invited specialists from the Center for Mind-Body Medicine in Washington to teach students deep breathing and guided imagery exercises, how to “pay attention to right now, not your past or future.”

She encouraged teachers to create Chill Corners and Zen Dens in their classrooms. She converted part of the library into a wellness center. She trained a therapy dog, a bernedoodle named River, and brings her to school every day. She uses online tools from the LG Experience Happiness and Inner Explorer programs for students. She’s applied what she learned in 2018 throughout the pandemic year.

“After the shooting we asked, ‘How are we going to get the kids through this? How can we ever go back to school?’ We were frozen, and the kids were grieving at home,” Haneski said. “We realized that they need each other for support.

“Now they’re home again, hanging out like a sloth in bed, showing only the top of their heads or the ceiling on the computer screen. They’re stuck. We want to teach them how to take care of themselves, how to empower themselves to move forward.”

Haneski is adviser to the Mind-Body Ambassadors Club. Suresh is president. Club members have been in demand during the pandemic, providing peer counseling and conducting mindfulness training workshops at other schools and local hospitals.

“We teach that when you help others, you help yourself feel better,” said Suresh, who was admitted to the accelerated eight-year M.D. program at Case Western Reserve University. She wants to be a psychiatrist. “A lot of teens try to ignore feelings or use drugs or alcohol to numb themselves.”

Young people who have clawed out of pandemic black holes say they have sought mental health counseling, applied mindfulness strategies and pursued activities that lift their spirit. Bronstein learned to play guitar. Guenther draws in a sketchbook. Mullings deleted her social media apps for a month and went swimming.

Guymael Cesaire, 17, an iTech junior, overcame loneliness by writing poetry, strengthening bonds with his family and spending time at Power U For Social Change, a community center for youth activists in Liberty City. Mocombe is also a member.

“I plan to tell my classmates we’re going to be adults and it’s going to be hard but we’ve got to keep pushing onward,” said Mocombe, who will be delivering a graduation speech later this month.

Garcia practices gratitude. The Pabon sisters practice yoga. Jean-Baptiste practices soft belly breathing.

“I breathe when I get anxious about leaving my classmates behind to go to FIU, where they won’t understand what we went through at my school or how we react when we’re triggered by certain sounds,” she said. “Sometimes I wish I could do high school over, and sometimes I don’t.”

The Harvard researchers recommend nine simple strategies for reducing stress in children: Exercise, time outdoors or in nature, adequate sleep, following a consistent daily routine, lowering levels of passive screen time and consumption of news, practicing mindfulness and meditation and finding ways to help others.

“I didn’t see the glass as half full after the shooting, but I am seeing the silver lining of COVID,” Haneski said. “We’re talking openly about mental health and not repressing it as a stigma. Kids need help, but they can heal.”

Miami Herald Staff Writers Colleen Wright and David Goodhue contributed to this report, as did Miami Herald writer David Brothers.