Continuing Pandemic and Worsening Stress: Behavioral Health for Chicago’s Children
As we approach the end of 2021, the second calendar year that the nation and world have grappled with the COVID-19 pandemic, we wanted to check in on the status of youth mental health in Chicago to provide an update to our March 2021 Voices of Child Health in Chicago report. Even before the COVID-19 pandemic, one in five U.S. children experienced a mental health condition each year according to Sound the Alarm for Kids, a program to educate on the child and teen mental health crisis presented by the Children’s Hospital Association, American Academy of Pediatrics and American Academy of Child and Adolescent Psychiatry.
In the first half of 2021, children’s hospitals experienced a 14% increase in mental health emergencies and a 45% increase in the reported cases of self injury and suicide in children ages 5–17, compared with the same time period in 2019. Other research has indicated that more than half of parents are concerned about the mental health of their children. Additionally, parents with children at home have consistently experienced elevated rates of depressive symptoms themselves over the course of the pandemic and, among adults, there has been no evidence of improvement in the prevalence of depression and other measures of mental health, despite marked improvement in the pandemic in the U.S. since the past winter.
In this month’s Voices of Child Health in Chicago report, we provide an update on youth mental health for young children and older children. We asked 1,620 Chicago parents from all 77 community areas in the city about their children’s mental and behavioral health, feelings about this school year and family activities to promote positive coping with stress, as well as other family demographic and health questions.
- 46% of young children and 47% of older children experienced an increase in at least one mental health symptom.
- Children who had a household member who was infected with COVID-19 were more likely to experience an increase in mental health symptoms than children who did not have a household member who had COVID-19.
- Chicago families have engaged in a variety of strategies to promote positive coping with stress for their children including increased together time, connecting with friends and family virtually, and dedicated time to answering their children’s questions.
Mental Health Symptoms Among Younger Kids
In young children, we found that the mental health symptoms children were most likely to display an increase in were: tantrums (23%), clinginess (19%) and headaches (10%). This was consistent with what we saw during a previous Voices of Child Health in Chicago survey from November 2020 through February 2021.
Overall, 46% of young children had an increase in at least one mental health symptom over the last six months, indicating that the proportion of young children with increased mental health symptoms has remained the same since earlier this year.1 White children were most likely to have an increase in one or more mental health symptoms in the last six months (50%), followed by Latinx children (48%), Asian/Other-race children (42%) and Black children (38%). Young children with high household income (400%+ the federal poverty level [FPL], FPL in 2021 was $26,500 for a family of four) were most likely to experience an increase in at least one mental health symptom (51%), followed by children from households with middle income (100-399% FPL; 46%) and children with low household income (<100% FPL; 36%). The proportion of young children with increased mental symptoms was similar or boys and girls (45% and 46%, respectively).
Mental Health Symptoms Among Older Kids and Teens
Because older children’s verbal skills permit them to express more about their emotional states, we asked parents of older children (4–17 years) additional mental health questions that included emotional symptoms such as feeling sad or anxious. Among older children and adolescents, we found that the top three most prevalent mental health symptoms were having trouble concentrating (18%), feeling anxious or on edge (18%) or being sad and unhappy (16%). These data were collected before it was established that school would be in-person, so it is important to note that there was still a degree of uncertainty surrounding the learning format for Chicago youth. A 2021 study published in the Journal of Affective Disorders discussing the importance of parent-child discussions during the COVID-19 pandemic emphasized that school closures due to the COVID-19 outbreak have affected 87% of the world's students physically, socially and psychologically; however, rigorous investigation into their mental health throughout this period is still lacking.
Similar to what we saw with younger children, 47% of older kids experienced an increase in one or more mental health symptoms over the last six months compared with before. White children were most likely to experience an increase in one or more mental health symptoms (55%), followed by Latinx (52%), Asian/Other-race (40%) and Black children (37%).
Again, children with high household income were the most likely to report an increase in one or more mental health symptoms (53%), followed by children with middle or low household income (both 44%). Children who were the only child or one of two children in the household were more likely to feel anxious on edge than children from households with three or more children (23–18% vs. 7–12%).
Differences in Mental Health Symptoms in High School and Elementary Age Students
We found that high school students were more likely to experience some symptoms compared with elementary students. For instance, high school students were more likely to feel sad and unhappy than students were more likely to not listen to rules than high school students (18% vs. 10%). Just as we saw with younger children, elementary school children (21% vs. 14%). However, elementary the proportion of older children with increased mental health symptoms did not differ by child gender.
How Was Having a Household Member with COVID-19 Associated with Mental Health?
Over one in five of the families surveyed had a household member who had been infected with COVID-19 at some point (22%). We found that for both older children and younger children, having a household member who had COVID-19 was associated with a higher likelihood of experiencing an increase in at least one mental or behavioral health symptom. For younger children, 54% of children with a household COVID-19 case had an increase in one or more mental health symptoms compared with 43% of children in households without a COVID-19 case. Among older children, 61% of children with a household COVID-19 case had an increase in mental health symptoms compared with 43% of children in households without a COVID-19 case.
Older children who had a household member who had COVID-19 were more than twice as likely to feel hopeless than older children who did not have a household member who had COVID-19 (14% vs. 6%). We also found that older children who had a household member who had COVID-19 were more likely to have an increase in trouble concentrating than older children who did not have a household member who had COVID-19 (24% vs. 17%). The stress children have experienced due to the uncertainty of the COVID-19 pandemic impacts their mental health through increased anxiety, changes in their diets and in school dynamics and fear. These changes have the potential to greatly influence children’s growth and development over the life course.
Feelings About the 2021–22 School Year
Heading into the current school year, the majority of parents said their children were excited about returning to school (54%). Additionally, 40% said their children were happy; however, 30% said their children were nervous or worried. Other emotions that parents reported their children experiencing were relief (20%), fear (11%), confusion (10%) and sadness (4%).
How Chicago Families are Coping with Stress
Chicago parents also reported engaging in specific activities to help their children and families cope with the added stressors of the COVID-19 pandemic. The most common coping strategy was increased family together time (68%). Over half of parents reported connecting with friends or family virtually to cope with stress (52%) and 45% of parents said they dedicated time to answering their children’s questions and concerns. Some other tactics included extracurricular sports activities (32%), relaxation strategies (29%) and other extracurricular activities like clubs (8%).
How Can Families Help Promote Mental Health for Children?
Parents and families can use the following tips to promote positive mental and behavioral health for their children:
- Create and follow family routines to help maintain a sense of structure and predictability.
- Check in with children and teens periodically about what they are hearing about COVID-19 and answer any questions.
- Parents can monitor their own behavior and try to model calmness to provide a sense of safety and security to their children.
- When children or parents are having challenges, seek extra help and support from a therapist, counselor, social worker or the child’s school.
About the survey
This report is based on data from the Voices of Child Health in Chicago Parent Panel Survey. The survey is administered to a sample of Chicago parents by Lurie Children’s and NORC at the University of Chicago via internet and telephone. The survey is administered to the same panel of parents three times each year. The data in this report was collected from May 2021 through July 2021. The sample consisted of 1,620 Chicago parents, step-parents, or guardians who had at least one child under 18 years of age in the household (referred to as “parents” in this report). Parents were from all 77 community areas in Chicago. The survey completion rate was 50% and the cumulative survey response rate was 1.5%. All analyses were conducted with statistical weighting so that the results are representative of the parent population in the City of Chicago during the time period of data collection. For more information about the VOCHIC Parent Panel Survey, visit luriechildrens.org/ParentPanel and our page on Open Science Framework at https://osf.io/cjz82/.
Heffernan ME, Smith TL, Bendelow A, Menker C, Macy ML, CJ Cicchetti, Davis MM. Continuing Pandemic and Worsening Stress: Behavioral Health for Chicago’s Children, Voices of Child Health in Chicago Report. Vol 3, Number 10. December 2021. Available at luriechildrens.org/voices.
Who We Are
Matthew M. Davis, MD, MAPP
Marie Heffernan, PhD
Tracie Smith, MPH
Anne Bendelow, MPH
Carly Menker, BS