Abstract

Methods

Results

Discussion

Funding Sources

Author Contributions

References

Abstract

Background

     Because COVID-19 was declared a pandemic in March 2020, nearly 93% of U.S. students engaged in some distance learning. These school disruptions may negatively influence adolescent mental health. Protective factors, like feeling connected to family or school may demonstrate a buffering effect, potentially moderating negative mental health outcomes. The purpose of the study is to test our hypothesis that mode of school instruction influences mental health and determine if school and family connectedness attenuates these relationships.

Methods

The COVID Experiences Survey was administered online or via telephone from October to November 2020 in adolescents ages 13–۱۹ using National Opinion Research Center’s AmeriSpeak Panel, a probability-based panel recruited using random address–based sampling with mail and telephone nonresponse follow-up. The final sample included 567 adolescents in grades 7–۱۲ who received virtual, in-person, or combined instruction. Unadjusted and adjusted associations among four mental health outcomes and instruction mode were measured, and associations with school and family connectedness were explored for protective effects.

Results

Students attending school virtually reported poorer mental health than students attending in-person. Adolescents receiving virtual instruction reported more mentally unhealthy days, more persistent symptoms of depression, and a greater likelihood of seriously considering attempting suicide than students in other modes of instruction. After demographic adjustments school and family connectedness each mitigated the association between virtual versus in-person instruction for all four mental health indicators.

Conclusion

As hypothesized, mode of school instruction was associated with mental health outcomes, with adolescents receiving in-person instruction reporting the lowest prevalence of negative mental health indicators. School and family connectedness may play a critical role in buffering negative mental health outcomes.

Measures

     Four indicators of mental health challenges were assessed: (1) stress levels in four areas (at school, home, work, and with friends) given response options low/moderate/high/very high; responses were coded for high or very high stress in at least one area (hereafter “high/very high stress”); (۲) mental health-related quality of life, assessed by number of the past 14 days (response options: 0, 1 or 2, 3–۶, ۷–۱۴) with mental health not good, dichotomized with a cutoff score of ≥۷ days (hereafter, ≥۷ days not good mental health); (3) seriously considering attempting suicide (hereafter, considering suicide) in the past 12 months (response options: yes/no); and (4) persistent symptoms of depression over the past 2 weeks, assessed by the Patient Health Questionnaire 9-item adolescent [[18]], with students experiencing ≥۳ symptoms on more than half of the past 14 days (response options: 0, 1 or 2, 3–۶, ۷–۱۴) considered to have persistent symptoms of depression (hereafter, persistent symptoms of depression). Links to mental health resources and a toll-free national suicide prevention hotline were provided to all respondents.

     Scales were used to assess both school connectedness and family connectedness. School connectedness was measured using the six questions from the National Longitudinal Study of Adolescent Health’s School Connectedness Scale, including items such as “I feel like I am a part of this school” and “The teachers at this school treat students fairly” [[۱۹]]. Standardized Cronbach’s alpha = .89. Family connectedness was measured using responses to five questions assessing parental monitoring, parent–adolescent communication, and emotional support such as “How often do you and a parent/caregiver eat dinner together” and “How comfortable do you feel talking to a parent or caregiver about how you are feeling (for instance, stress, anxiety, and depression)?” The standardized Cronbach’s was alpha = .70. As continuous variables, school connectedness ranged from 6 to 30 and family connectedness ranged from 6 to 20. Low connectedness was defined as at or below the 25th percentile (≤۱۶ for school connectedness and ≤۱۳ for family connectedness).

Results

     Within the final sample of 567 adolescents, 460 (80.2%) reported enrollment in public school, 36 (7.1%) in private school, and 69 (12.6%) in some other type of school, for example, a school that is completely online all of the time, regardless of the pandemic. A majority (56.3%) of respondents received virtual instruction; 24.4% received combined instruction and 19.4% received in-person instruction. Virtual instruction was more prevalent among black (68.2%) and Hispanic students (69.0%) compared to white students (48.1%) (Table 1).

     All four mental health indicators were associated with mode of instruction (Table 2). Students in virtual learning were more likely than students attending school in-person to report high or very high stress (44.7% vs. 25.0%). Students in virtual learning more frequently reported negative mental health risk on three indicators than students receiving combined or in-person instruction: ≥۷ days not good mental health (14.5%, 7.6%, and 3.9%, respectively); considering suicide (13.5%, 8.4%, and 3.8%, respectively); and persistent symptoms of depression (19.1%, 15.3%, and 7.6%, respectively). When continuous variables for school and family connectedness were dichotomized (lowest quartile compared to the three upper quartiles), low school connectedness was more common for students attending virtually than those receiving combined or in-person instruction (34.8%, 19.1%, and 13.3%, respectively) and the association was statistically significant (p = .006). Reported levels of family connectedness did not vary significantly by mode of school instruction (27.4%, 21.2%, 17.6%, respectively) (p = .212).