Title:  Monitoring and Treating Mental Health in Students as A Result of COVID-19 

* ignore the numbers in parenthesis, it’s how I’m keeping all my research organized before formally citing *

Introduction 

The year 2020 brought nothing but the unexpected; within three months of the New Year, the daily routines of almost every American were turned upside down.  Students –– used to a day full of in-person education and social development amongst peers –– took one of the largest shocks, as their days shifted from a socially rich environment to strict isolation.  With online-only learning persisting deep into 2021, physical health of students has remained a top priority for educators, but the true pandemic became the vast detriment of the mental health of students.  Up to 80% of students report that COVID-19 has negatively impacted their mental health and 20% describing a significant worsening of mental health issues, students everywhere are left isolated, anxious, and depressed.  Worse yet, 55% of students do not know where to look for help for mental health assistance.  The toxic stress placed on students of all ages from the COVID-19 pandemic can increase psychopathologies experienced by students, hinder development in younger students, and set youth on a path to chronic mental health disorders that will continue into adulthood.  In order to address the vast mental health crisis amongst students, all institutions of education should begin administering routine mental health surveys of students in order to identify at-risk individuals, track mental wellbeing of the student bodies, and coordinate students in need with adequate resources and counseling.    

Overview of Stress  

Stress is a natural physiological and psychological process meant for survival.  The evolutionary root of stress is easy to determine –– imagine you are walking in the woods and you come across a bear; the goal is to survive.  Then the process of response in the brain follows: first, the eyes will bring information about the visual stimuli to the thalamus (the brain’s sensory command center) which will then be transported to the amygdala for emotional processing (10).  If processed as a threat, the brain sends a distress signal to the hypothalamus, which functions as a command center, communicating with the rest of the body through the autonomic nervous system (the fight or flight response).  When activated, the autonomic nervous system creates the familiar physiological indicators of stress such as increased heart rate, sweating, release of adrenaline, heightened senses, and increased oxygen respiration (10).  The brain also releases the hormone cortisol –– known widely as the stress hormone –– which helps restore energy expelled in the stress response.  This system of communication is known as the hypothalamic-pituitary- adrenal (HPA) axis.  Once the stressor is gone/the stressful event is over, cortisol levels lower and the body returns to its normal stasis (10).  Through this process, your brain is essentially moving all physiological resources (shifting from storing to using energy) to the parts of your body needed to act in any threatening situation and eventually returning to normal (11).  

Stress also has vast impacts to the inner body that are not as widely known.  When the autonomic nervous system is activated (in stressful events), digestion is slowed, the immune system is repressed, bladder systems slow (and can even be expelled in stressful enough situations), and any biological sexual desires are repressed as well (11).  The brain takes all energy from non-necessary body systems to coordinate a response.  

The individual response to stress is also a combination of genetics and environment in order for the organism to adapt.  Genes have on and off switches to control whether they are expressed or not; when a gene is expressed in an organism (or turned on), this is called the phenotype (where as genotype is the genetic presence, whether activated or not).  The environment an organism is in controls whether a gene is on or off –– this is called epigenetics (the study of environment and gene expression).  Certain on and off tags last short periods of time, while others can last a lifetime.  These tags can even be passed intergenerationally, meaning that long-term negative effects of stress can carry on to offspring.  

Positive, Tolerable, and Toxic Stress 

If stress is a completely normal body response, how can it be a bad thing? Well, stress can be broken down into three categories: positive stress, tolerable stress, and toxic stress.  Positive and tolerable stress are more typical in the human experience (similar to the bear example); however, toxic stress can have vast negative health effects.   

• Positive stress is like the bear: a threat is seen, the fight or flight response is activated, and the body returns to stasis after the stressor is gone.  Other examples include first day jitters and (typical) performance anxiety (5).  This kind of stress typically results in better performance –– hence “positive” stress –– and is healthy and typical.   
• Tolerable stress activates the body response to a higher degree.  Examples include a bad car accident or hospitalization.  If the individual has support and the activation time is limited, the brain and body will usually recover completely (5). 
• Toxic stress occurs when an individual experiences prolonged, strong, and frequent stress that can permanently alter the body’s static state (5).  Examples include abuse, neglect, caregiver chronic mental illness/substance abuse, or burdens of economic hardship.  The effects of toxic stress are exceptionally dangerous if the stress occurs in key brain developmental periods, which include young childhood and adolescence (11). 

Toxic Stress and COVID-19 

What happens if the bear follows you home every night or stays in isolation with you?  If continuously exposed to stress (especially in childhood), the physical toll on the body and brain is immense.   In the case of toxic stress, the body never calms down; cortisol levels remain high, leaving the body in a constant inflammatory state (12).  Toxic stress can change brain architecture, size, and even gene function (through epigenetics, as explained prior).  This can lead to a complete change in the stress response, permanently altering how an individual deals with stress in the future.  When occurring in a child brain, toxic stress can result in lifelong problems in behavior regulation, learning, and mental/physical health.  Physical health problems associated with toxic stress include diabetes, heart disease, cancer, and chronic obstructive pulmonary disease (5 and 12).  Mental health problems associated include anxiety, depression, PTSD, acute stress disorder, developmental disorders, and substance abuse (5 and 12).  Even if a person eventually recovers from the stress and begins processing stress normally again, the damage might have already been done.  This means that removal from toxic stress does not undo the damage already done to the brain and body. 

Results of the COVID-19 pandemic include social isolation, job loss, financial instability, health anxiety, death of loved ones, increase in course-load, and the general upheaval of typical routines.  The pandemic and its effects have also been long-lasting.  All of these outcomes are examples of strong stressors, and due to the prolonged nature, this stress can easily become toxic.  Students, rather than worrying about exclusively their classes, now have much more on their plates; the increased stress load can strongly interfere with school performance, which has vast life consequences alone.  The mountain of stress on students in the pandemic is high, so how do we keep this stress from becoming toxic and permanent? 

Benefits of Mental Health Screenings for Students 

The largest factor in determining whether stress is tolerable or toxic is support for the struggling individual and maternal warmth/affection in young children (12).  Around 50% of lifetime mental health conditions begin by age 14, and 75% emerge by age 24 (13).  Key developmental periods (as stated) occur in young childhood and adolescence.  All the key ages for mental health awareness in children and young adults begin while most are typically enrolled as students –– this is where mental health support needs to begin.  With the almost unending stress of the COVID-19 pandemic, students in these key ages are isolated and without resources –– so intervention must transcend the online barrier.  School administered routine mental health screenings are an easy way to connect to the isolated students and keep tabs on the mental health of the student body.   

Able to be administered online, mental health screenings take form of a survey taken by students.  Questions surround possible symptoms of mental illnesses and toxic stress, allowing schools to be aware of how students are feeling, despite the lack of in person interaction.  There is, on average, about an 11-year gap between symptoms first appearing and intervention (13).  Mental screenings for students can drastically cut that time, as at-risk students can be identified and connecting with counseling resources best-suited to them, without 11-years on unnecessary suffering.  Armed with screening results, schools can connect students to counselors, integrate and make families aware of struggling students, and even offer students non-school resources to continue the personalized journey to successful mental health treatment (13).  With early intervention, the prolonged nature of COVID-19 related (and unrelated) stress can be battled.  At-risk students can receive help and learn how to better cope, making this stress tolerable and NOT toxic.  Without the toxic form of stress, students would avoid all the negative and life-long health effects of toxic stress, leading to a mentally and physically healthier student and eventual adult.  The stress-coping mechanisms (and mental health coping mechanisms) learned last a life-time, helping the student both now and for the rest of their lives. 

Drawbacks (and Why They Don’t Necessarily Matter) 

One of the largest fears of universally administered screeners is the possibility for over-diagnosis and overly-aggressive reactions to results (14).  With the increase of students responding to screeners, there will be an increase in identified struggling/at-risk students.  This increases the chance for false positives, taking attention away from the truly struggling individuals.  And, with an increase in diagnosis of students (for psychopathologies that emerge from screening results), there will be an increase in students seeking treatment –– which is typically pharmaceutical intervention.  There is a large fear that the influx of students identified by screeners could become over-medicated, which is not a good thing –– medication is used for those who genuinely need it, not students who are just super stressed. 

In order to avoid over diagnosis and over response, it is important to remember that screeners are only meant to identify at risk students, not diagnose them!  Screeners are the starting point, not the end of the process.  Mental illness is a spectrum, despite two individuals having identical diagnoses, their symptomology and personal experience will likely widely vary from one another.  The goal of screeners is to identify students, and then connect them with resources to assist their specific needs –– not just to identify students and immediately medicate them.  By using screeners as only identifiers, it enables more input from the student in their preferred treatment route (or if preferred, no treatment) and merely shows the schools who to check up on.   

Conclusion 

(I suck at writing conclusions and am not exactly sure how to wrap this all up… so this is still in the works) 

The End