I. INTRODUCTION

The Covid-19 pandemic, which began in late 2019, has disrupted social, educational and economical structures among other areas of life as we know it. More specifically the pandemic is having adverse psychological effects on individuals of varying ages. Some of these effects include depression, anxiety, suicide ideation and greater levels of perceived stress. The purpose of our research is to explore these psychological/ mental health impacts on adolescents. This group was chosen as these individuals are prone to be affected by psychological trauma that may leave long lasting effects. These are critical developmental years for these individuals who are now experiencing many aspects of life virtually instead of face to face. The extents of mental health effects brought on by the Covid-19 pandemic vary among adolescents; therefore these effects are highlighted and analysed in this research study.

Aim

To review the psychological effects of the Covid 19 pandemic on Adolescents.

Objectives

The objectives of this research are to:

• Identify the specific mental health effects of the pandemic on adolescents.

• Identify the coping mechanisms utilised by the affected adolescents.

• Identify the behavioural changes caused by the pandemic among adolescents.

• Investigate the severity of effects of the pandemic on adolescents with pre-diagnosed mental health disorders.

II. LITERATURE REVIEW

According to O'Sullivan et al. (2021), current research primarily and disproportionately focuses on Covid-19 and associated mental health effects on children and adolescents. They explain that although these children may not be direct victims of the virus itself, they are a vulnerable group and the effects of this pandemic may last a lifetime (UNSDG, 2020 as cited in O'Sullivan et al.,2021). The United Nations Sustainable Development Group reported that $94\mathrm{\%}$ of the schoolgoing population were affected by the Covid-19 pandemic, with $86\mathrm{\%}$ of children in primary education being completely out of school in lower developing countries. These children have not only been out of school, but they are also experiencing reduced face to face and social interactions through imposed lockdowns and stay-at-home quarantine. With all of these restrictions, little room is left for them to experience meaningful interactions except through virtual and online platforms.

In the few studies that have been conducted, generally, it was found that the pandemic has negatively impacted the mental health of adolescents. Of these effects, increased levels of fear, anxiety and depression were observed in addition to increased suicide ideation (O'Sullivan et al., 2021; Cohen et al., 2021). These were all attributed to isolation /prolonged quarantine, decreased communication with peers and poor sleep (O'Sullivan et al., 2021; Cohen et al., 2021). Limitations of such studies revealed that: most interviewees were primarily college students, associations between and among variables could not be inferred (current studies are cross-sectional) and of the limited studies available, a few were not peer-reviewed (Elharake et al., 2022). It was also noted that many studies were dependent on the parents' perception and interpretation of their children's mental well-being and psychological state (Cohen et al., 2021). Moreover, the duration of currently available studies may not have provided ample time to assess changes in behaviours and mental state as they "varied from 3 weeks to 6 months concerning the implementation of public health measures" (Cohen et al., 2021). Together, these incidents allow significant room for misrepresentation and limit the accuracy of the findings. More research needs to be done to adequately represent these adolescents so that protective measures can be put in place to get them through these unprecedented times.

III. MATERIALS AND DESIGN

a) Study Design

The research subjects of this review were adolescents, including students who were ages 10-21 during the COVID-19 pandemic. The review articles for this research were published between 2019-and 2021 and conveyed a combination of review and qualitative research. This was ideal for the present research as it allows a detailed review of the psychological effects of the COVID-19 pandemic on adolescents.

b) Eligible Studies and Study Databases

For this research, the articles chosen were articles published during the COVID-19 pandemic which were obtained utilising google scholar. The main keywords used in the search were: COVID-19, adolescents, highschoolers, mental health and psychological effects. The information in the selected articles was reviewed by each author and utilised in the research.

IV. RESULTS

Overall, it was found that the mental health of adolescents during the pandemic worsened. A study conducted only two weeks after the pandemic began noted that approximately $40.4\mathrm{\%}$ of the participants experienced psychological problems (Liang et al., 2020). In the US, emergency department visits for mental health increased by $1.7\mathrm{\%}$ with an additional increase in suicide and suicide ideation by patients (Krass et al. as cited in Listernick & Badawy, 2021). Likewise, Ravens- Sieberer (2021) revealed that "the prevalence of noticeable mental health problems was $9.9\mathrm{\%}$ before the pandemic and increased to $17.8\mathrm{\%}$ during the pandemic." This is a significant increase and a cause for concern.

Of all the symptoms of psychological stress, the main reported mental health effects found affecting adolescents during this time were anxiety and depression. Listernick & Badawy (2021) reported that the rates of paediatric anxiety before the pandemic increased by approximately $9.6\mathrm{\%}$ in China while in Germany, it increased similarly by $9\mathrm{\%}$. Studies in the United Kingdom also share similar findings and report that children have experienced a $75\mathrm{\%}$ increase in depressive symptoms during lockdown (Listernick & Badawy, 2021).

Moreover, studies from India confirm the negative psychological impacts of the Covid-19 pandemic and quarantine. The research compared the mental health states of quarantined and non-quarantined children. The results from this study showed that approximately $68\mathrm{\%}$ of quarantined children and adolescents experienced some form of psychological distress; a significant difference from the results from the non-quarantined individuals (Saurabh & Ranjan, 2020). Of these individuals, $66.1\mathrm{\%}$ experienced helplessness, $68.59\mathrm{\%}$ experienced worry and $61.98\mathrm{\%}$ experienced fear (Saurabh & Ranjan, 2020 as cited in de Figueiredo et al., 2021). An interesting observation made was that individuals (adolescents) infected with Covid -19 or individuals in contact with infected persons scored higher on depression, distress and anxiety scales (Essadek & Rabeyron, 2020). Additionally, it was found that girls scored higher on anxiety, distress and depression scales (Essadek & Rabeyron, 2020).

Furthermore, the cause of these psychological changes in these adolescents was mainly attributed to social isolation and other pandemic-related restrictions (O'Sullivan et al., 2021; Margson et al., 2021). In the United Kingdom, a survey conducted by a mental health charity noted that $83\mathrm{\%}$ of respondents felt that the pandemic made their existing mental health conditions worse. Of this, $26\mathrm{\%}$ attributed these changes to limited mental health support due to reduced face-to-face services and communication challenges through the phone or online (Lee, 2020). Many students/adolescents utilise the mental health services provided to them by their schools. With unpredictable lockdowns, quarantines and closure of schools, it has become increasingly difficult for them to get help and make use of these services. Other causes of worsening mental health include financial losses/ financial insecurity, increased social media use, domestic violence, family stress and even the mental health of their parents (Margson et al., 2021).

As a result of the pandemic, physical distancing has posed a challenge for adolescents in their regular day-to-day interactions. It disallows the natural urge for physical touch, especially in situations where it is needed for comfort. This may harm adolescents as they may "bottle up" their emotions and are consequently left to cope with the emotional distress. The WHO has realised the impact that this is having on individuals and in an attempt to minimize the deleterious effects (of social distance on the physical well-being of minors), health professionals have developed guidelines for activities that can be performed at home depending on the reality of each family (WHO, 2020).

Irrespective of this, during a stressful experience like physical distancing, it is natural to have more fights among teenage and younger siblings and families (RCN, 2020). It was noted that quarantined children may get an increased risk of psychiatric disorders, and a higher risk of developing mood disorders, psychosis, and even suicide attempts (Liu et al., 2020). Teenagers may feel isolated from their friends and face major disappointments as graduations, seasons, and sporting events, and other planned events are cancelled or postponed. They may also experience frequent irritability, changes in weight or sleeping habits, repeated thoughts about an unpleasant event, and conflicts with friends and family (HC, 2020). As compensation, they may indulge in activities allowing for substance abuse, depression, risky sexual behaviours, and they may even suffer from post-traumatic stress disorder according to the CDC (2020).

Lastly, many adolescents may cope with the loneliness felt during the pandemic by binge eating. A recent study showed that school routines are important coping mechanisms specifically for young people with mental health issues (Lee, 2020). Furthermore, supporting studies show that periods without school are associated with decreased physical activity; increased screen time, irregular sleep patterns, and less appropriate diets in children and adolescents (Wang et al., 2020).

V. CONCLUSION

The sudden occurrence of the Covid-19 pandemic has generated undeniable changes in the mental health of adolescents. These individuals are experiencing higher rates of anxiety, depression, posttraumatic stress and eating disorders, compared to the years prior to the start of the pandemic. This is in addition to the typical stressors associated with this age group. As a means to deal with this, adolescents may indulge in risky behaviours and several studies have noted behavioural changes including increased aggression. As stated before, adolescence is a formative period in an individual's life; the effects that they are facing now will possibly affect their futures. Although organisations such as the WHO are making efforts to protect and help these individuals, more needs to be done so that they do not continue to suffer the brunt of the pandemic.