It’s been several weeks Prime Minister Naftali Bennett announced the government had decided to end mandatory quarantine for children who came into contact with COVID carriers. The change was welcomed bytens of thousands of parents for whom the omicron wave caused total chaos, some leaving quarantine with their kids only to re-isolate a few hours later as a result of yet another schoolmate testing positive.
But despite the end of mandatory quarantine, Yaakov Ophir warns that the ongoing lockdowns and periods of isolation have already left their mark. Many experts in the field already speak of a “psychiatric pandemic,”, and according to Ophir, a clinical psychologist who specializes in psychopathology in the digital era, the scientific literature is showing us that the damage has already been done – particularly when speaking about children, and especially adolescents, the age group that used remote learning more than any other group. “There is an increase in suicidal ideation, and while there is no clear indication of actual suicides, there is an evident increase in suicidal ideation, intention or behavior,” states Ophir, who is a research associate at the Technion-Israel Institute of Technology..
His claims are backed by an extensive scientific review, whose results were published last summer in the journal Child and Adolescent Mental Health. The review surveyed 116 articles published in countries that included the United States, China, and Canada. The results show an increase in depression and anxiety among young people, based on data from a total of 127,923 children and adolescents.
Six of the studies included in the review focused on suicidal thoughts among children and adolescents as a result of the pandemic and its effects, with three of them reporting an increase in such tendencies, when compared with pre-pandemic levels. In an April 2020 study of Canadian adolescents, for example, 18 percent of the participants reported suicidal thoughts – an increase of 6 percent, as compared to 2017. Another study of suicidal ideation, this one among American teens reported an increase from 17 percent among participants in 2017 to 37 percent in 2021. Of course, suicidal thoughts, as serious as they may be, sometimes lead to actual deaths. Another study, one that focused on suicide rates among children and adolescents in Japan, shows an increase of 49 percent during the second wave of the pandemic.
“Kids are at serious risk at the moment, and we have gone a step too far,” warns Ophir. What’s more, he says, “studies show a significant increase in additional pathologies: behavioral issues, difficulties with regulating emotions, up to actual psychiatric disturbances like anxiety, depression, and risk of suicide. To my mind and based on what I am seeing in the clinic and elsewhere, we are really putting our kids at risk. Even if there hasn’t been, or isn’t an actual rise in cases of suicide, the suffering kids and adolescents are experiencing is dramatic.”
According to Ophir, the wave of quarantines among schoolchildren during the recent omicron wave led to a surge in cancellations at his clinic at the Megilot Regional Council treatment center. “It really saddens me. You see kids who come here with all the warning signs, their parents are being pushed by the school to send them for therapy, and they actually start and make good progress, and then they have to enter isolation and the therapy stops or is ruined,” he says.
“We know that mental health issues were rife even before the pandemic, but now it is getting worse; we see very long waiting times for mental health appointments in the public system; we are witnessing a wave of mental distress among children and adolescents. I don’t want to blame anyone, but I do wish to tell our leaders – we can’t go on like this. Kids have to get their stability and routines back and we have to deal with the damage that has already been caused.”
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‘It is an ongoing trauma’
The situation in Israel is not so different from what studies from around the world reveal. An Education Ministry-led survey conducted among school guidance counselors shows that, since the last lockdown, in the spring of 2021, there has been an increase in requests related to at-risk behavior like smoking, drug and alcohol use, and high rates of verbal and physical abuse – from 18 percent during the lockdown to 24 percent once school resumed. A Welfare and Social Affairs Ministry report details an increase of close to 5 percent in adolescent suicide attempts in 2020 compared to a year earlier.
According to Ophir, on top of the psychological damage caused in this period, the moral injustice our kids are going through is worse. “Let me say something controversial,” he says cautiously, “we know that the elderly and those with underlying conditions are at risk from the pandemic, but that it is not a disease that affects children. When we use aggressive collective measures, without distinguishing children from people at risk, we put our kids in a pressure cooker and create a really dangerous situation for them. It is time for this to stop, and we should have done so long ago.”
The consensus emerging from bulk of the research conducted so far is that children and adolescents are vulnerable to lockdowns, isolations, and their impact – particularly children with compromised immune systems or chronic illnesses, and children dealing with atypical neurological developmental issues, such as hyperactivity, attention problems, obsessive-compulsive disorders, and communication problems. These children are at higher risk of suffering from additional mental health challenges than other children who nonetheless suffer the consequences of the pandemic – less access to physical activity, entertainment and culture, and to the support networks of family and friends.
The good news, says Ophir, is that children are naturally very adaptable creatures. “At the end of the day, most kids have a natural developmental tendency toward positive mental health,” he says. “But at this stage we are looking at ongoing trauma.
“During the first, and even the second, lockdowns, we all stayed at home, had quality family time together, and many people gained a lot from this. But with ongoing trauma, people, and children especially, may develop unbeneficial survival habits.” For example, many parents have to continue working under isolation, and the child has to entertain themselves. For kids, such prolonged boredom or lack of activity are very detrimental. Things get only worse with more vulnerable parts of the population like single mothers, who sometimes due to economic reasons or work demands don’t have hours a day to spend with their children.”
Which brings us of course to the subject of [digital] screens.
Ophir: “I don’t object to screen-time. I even think there is unnecessary panic about this, but I am aware that during lockdowns and quarantines, kids can spend an entire day in front of a screen. Sometimes parents have no choice, but nonetheless – we need to acknowledge that this comes at a price. Screen time comes at the expense of healthy and constructive activities like sports or high-quality sleep. The initial price is that becoming habituated to lengthy periods in front of a screen replaces interpersonal interaction, which as I said, is the basis for good mental health. A secondary consequence is that there is higher risk of kids being exposed to problematic content, like pornography and violence.”
Between a rock and hard place
Ophir is careful not to use terms like “screen addiction,” but he is concerned that dependencies are being created that will outlast the pandemic. Afterwards, he explains, “We aren’t going to need so much screen time, but the kid will have become dependent. When we suggest playtime with friends, we may encounter responses that resemble detox symptoms. Even though I claim that the scaremongering around screens is excessive, I still think we have reached a difficult moment.”
A joint study conducted jointly by Ophir and Dr. Hananel Rosenberg from Ariel University, Dr. Yaniv Efrati from Bar-Ilan University, and the doctoral student Refael Tikochinski from the Technion, to be published soon, examines this issue. The study looked at the relationship between screen time and levels of frustration and guilt among mothers of children in grades 1 through 6.
“We studied how mothers react, beginning with the assumption that most mothers are the ones spending the most time with their children,” Ophir says. “It would be interesting to examine fathers as well, but that would add a layer of complexity to the study that was not really part of the research question. What we focused on was the coronavirus-effect: Does COVID-19 cause an increase in children’s screen time, and to a consequent increase in feelings of guilt among parents?”
Not surprisingly, the researchers found that screen time of all kinds dramatically increased during lockdowns and isolations among both age groups: screen time for entertainment purposes, including social media, increased 73 percent among the 4th-6th graders and 108 percent with the 1st-3rd graders, while screen time for educational purposes increased by 8 percent among both groups.
The study revealed an increase in frustration and feelings of guilt among mothers during these times. The frustration and guilt were affected proportionally by a number of factors, like the number of children, financial status, attitude toward screens, etc., but a major factor contributing to an increase in feelings of guilt among all the mothers was the increase in screen time for entertainment purposes only. That is to say – it is not the use of screens in general that causes feelings of guilt, but the purpose of the screen time. “In other words,” the researchers state, “mothers are more concerned with the psychological effects of extended screen time than they are with the physical health impacts.”
Why do you think mothers feel increasingly more frustration and guilt the more time their kids spend in front of a screen?
“Seeing their kids looking at screens generated feelings of guilt among parents even before COVID-19,” Ophir notes. “Part of this is the media’s fault, in all its guises, which tends to inflate and exaggerate when it comes to screens: both television and newspapers are full of alarming headlines, and all manner of prophets of doom circle around and cause anxiety. In addition, the WHO and other organizations advise parents to minimize screen time. Parents are in the line of fire: they can’t withstand the technological onslaught, and it becomes even harder once the kids get older.”
Many will know the feeling. Accustomed to working long hours and seeing screens popping up wherever they turn, Israeli parents are flooded with feelings of guilt on a regular basis. Then COVID-19 hits, throws us into the pressure cooker of lockdowns, quarantines, financial anxiety, and the tedium of being confined within four walls, and the frustration and guilt rise exponentially. It appears that the study conducted by Ophir and his colleagues told us what we already knew, even if preferred to ignore it. “Parents can’t tell their child, who is isolating with them while they have to work, that they have to sit around and do nothing all day,” he says. “What choice do they have? Technology wins in the end,” he stresses and finishes with: “What our study mainly shows is the situation of parents in the last two years – frustrated, stuck between a rock and hard place.”