The Mental Health Effects of COVID-19

The Mental Health Effects of covid-19

A Continuing Crisis, Especially for Emerging Adults Ages 18 to 29

Jeffrey Jensen Arnett, PhD Clark University

Executive Summary

This report examines the impact of covid19 on the mental health of American emerging adults ages 18 to 29, comparing them to older age groups as well as to adolescents. The report uses national data on assessments of mental health from before the pandemic began through the peak of the pandemic to the present. Here are the main findings:

• At the peak of the pandemic, emerging adults reported the highest rates of mental health distress. According to four national surveys conducted by the Pew Research Center from March 2020 through September 2022, when covid-19 prevalence was highest, rates of “high psychological distress” (including feeling depressed, feeling anxiety, loneliness, and trouble sleeping) were highest among Americans ages 18 to 29, compared to all older adult age groups.

• National data from before the pandemic to during the pandemic showed a shocking rise in anxiety and depression across adult age groups, but especially among Americans ages 18 to 29. According to the bimonthly National Health Interview Survey (NHIS) conducted by the U.S. Census Bureau on adults age 18 and older, in 2019, before the pandemic, symptoms of anxiety disorder and depression were relatively low across age groups—under 12% for anxiety

disorder and under 8% for depression. By the spring of 2020, after the pandemic began, rates rose dramatically across age groups, but most of all among emerging adults ages 18 to 29, to 40% for anxiety disorder and 35% for depression.

• Despite the containment of the pandemic and the return of normal economic and social life, rates of anxiety and depression remain stunningly high, especially among emerging adults. Throughout 2020, 2021, 2022, and into early 2023—even after the “lockdown” period of 2020 and 2021 was past, even after highly effective vaccines became widely available, even after rates of infection, hospitalization, and death from covid-19 had subsided substantially from their peaks—rates of mental health symptoms remained much higher than prior to the pandemic, across adult age groups but especially among Americans ages 18 to 29. Prevalence of symptoms of anxiety disorder and depression remain nearly as high now—nearly 40% for anxiety disorder and nearly 35% for depression—as they were in the first year of the pandemic.

• Rates of mental health distress remain especially high among young women and Asian Americans. The subgroups of emerging adults who were most vulnerable to the mental health effects of the pandemic were young women, due to a long-established

greater susceptibility to mental health distress, and Asian Americans, due to widespread hostility and racism directed at them by other Americans who blamed China for the initiation of the pandemic.

• Data are insufficient to test hypotheses about other potentially vulnerable subgroups. Other possible vulnerable subgroups of emerging adults include college students; emerging adults with pre-existing mental health problems; and emerging adults living with parents. So far there is not enough good data to determine their vulnerability with confidence.

• Data are also insufficient to compare emerging adults to adolescents in pandemic-triggered mental health distress. There are some claims that adolescents are also suffering severe mental health effects from the pandemic. Unfortunately, the available data on adolescents are deeply flawed, and consequently it is not possible to assess this question fully.

• The common experiences of emerging adults during the years from age 18 to 29 help explain why the impact of covid-19 on their mental health has been so widespread and enduring. For example, their identity explorations were disrupted during the crucial years when they were beginning to build a life for themselves in

education, work, and love relationships. The personal optimism that is typical during this age period was jarred by the unprecedented dislocation of adapting to the pandemic.

• How should we respond to the continuing crisis—and the next one?

On the basis of what we know, several steps should be taken to address the continuing mental health crisis from this pandemic and prepare for the next one, including: 1) undertake research now, urgently, to find out what is driving enduring mental health distress even after the pandemic has subsided, and to learn why it is especially severe for emerging adults; 2) develop a Telehealth Corps of mental health practitioners to find improved ways of delivering mental health services effectively for the next pandemic; 3) develop a website of resources for parents of emerging adults, to provide them with tools for responding to their children’s mental health needs, now and in the future; 4) convene a conference of college and university administrators to discuss what worked in their responses to the mental health crisis caused by covid-19, and what did not.

Despite the containment of the pandemic and the return of normal economic and social life, rates of anxiety and depression remain stunningly high, especially among emerging adults.

Author Biography

Jeffrey Jensen Arnett is the leading authority in the world on the age period from 18 to 29 that he named emerging adulthood. Dr. Arnett is a Senior Research Scholar in the Department of Psychology at Clark University in Worcester, Massachusetts. He has also taught at the University of Missouri. During 2005 he was a Fulbright Scholar at the University of Copenhagen, Denmark, and he has been a Visiting Professor at the University of Bordeaux, France. He is the author of the book Emerging Adulthood: The Winding Road from the Late Teens Through the Twenties, with a third edition to be published in 2024 by Oxford University Press. He founded the Society for the Study of Emerging Adulthood (www.ssea.org) and served as its first Executive Director. He has appeared on national television and frequently in print media, including a cover story in the New York Times Sunday magazine in August, 2010. His book (with Elizabeth Fishel) for parents of emerging adults, Getting to 30: A Parents Guide to the Twentysomething Years, was published in May 2013. For more information, see www.jeffreyarnett.com.

Since it first appeared in early 2020 the covid-19 pandemic has been devastating to people around the world. In the United States, over 100 million people have been infected and over one million people have died from the virus. In addition, the pandemic has had widespread effects on mental health. Life was suddenly disrupted in numerous ways. Children and adolescents lost learning time in school and were isolated from their friends during the lockdown period. Many of the oldest Americans were also isolated and vulnerable, as they suffered the highest rates of hospitalizations and deaths of any group. Millions of other adults were impacted by lost jobs, innumerable disruptions to daily life, and worries about their children and parents.

Although all age groups have felt the mental health impact of the pandemic, emerging adults ages 18 to 29 were the most vulnerable of all. In many ways, their lives were the most disrupted. Those who were in college or occupational training saw their programs suddenly shut down or switch to remote learning. Those who were working lost their jobs in vast numbers, as the employment sectors dominated most by emerging adults were the same sectors most likely to be crushed by the pandemic: restaurants, hotels, travel, and other areas where little experience is required and the pay is low. Emerging adults already experienced unemployment rates consistently three

times higher than the overall unemployment rate, but they were also the age group most likely to lose their jobs when covid-19 struck. Many were forced to move home with their parents because their colleges closed or they lost their jobs or both, creating additional disruptions for both them and their parents. Furthermore, as this report will show, the prominent features that are a typical part of development during the years from age 18 to 29 also made these young people more vulnerable to the mental health consequences of the pandemic.

Although the pandemic continues in the present, in many ways life has now returned to normal in the United States. Colleges, universities, and occupational training programs are open again. The unemployment rate has receded to where it was before the pandemic began, including among emerging adults. The percentage of emerging adults who live with their parents has also declined to its pre-pandemic level. Yet, as this report will show, the mental health impact of the pandemic continues at a shockingly high level. All age groups are affected, but emerging adults have been and continue to be affected most of any age group. This report details the pervasive and enduring crisis of mental health distress caused by the pandemic, including why age 18 to 29 has proven to be the most vulnerable age group in American society.

All age groups are affected, but emerging adults have been and continue to be affected most of any age group.

Methodology

To compile the evidence for this report, I investigated national data sources including the Centers for Disease Control and Prevention (CDC), the National Center for Health Statistics (NCHS), the U.S. Bureau of the Census, the National Opinion Research Center (NORC), and the Pew Research Center. These sources provided the basic epidemiological data presented in this report, including rates of mental health distress by age group from pre-covid 19 through early 2023. I also drew upon my 30 years of scholarship, research, and writing about the age period from 18 to 29.

I researched extensively the studies that have been published thus far that have focused on the mental health consequences of covid-19 for emerging adults ages 18 to 29. In my initial review of published studies on Google Scholar, a comprehensive source of research on all topics, there were over 300,000 studies published with the keywords “young/ emerging adults,” “mental health,” and “ covid-19.” To make the review possible, I focused mainly on longitudinal studies that included data both before and during covid-19. I included only studies on American samples, because the international studies are too numerous and too diverse to summarize here.

I compared emerging adults mainly to other adult age groups, because the methods of data collection in key studies on covid-19 and mental health were

consistent across these groups, but I include in this report a comparison to recent mental health trends among adolescents. I also focused on specific subgroups of emerging adults that were theorized to be especially vulnerable to the mental health consequences of the pandemic: young women, ethnic minorities, college students, young people with previous mental health problems, and young people living with their parents. In total, I reviewed over a thousand abstracts, and chose the best studies for a closer reading. Those are the studies summarized and cited in this report.

Mental Health Effects of the Pandemic on Emerging Adults

NATIONAL DATA ON MENTAL HEALTH DISTRESS BEFORE AND DURING THE PANDEMIC BY AGE GROUP

There are several excellent national data sources that provide information on how the pandemic has affected mental health across adult age groups. Figure 1 shows rates of psychological distress by age group during the period from March 2020 through September, 2022, the period when the spread of the pandemic was strongest. The Pew Research Center conducted four national surveys of American adults during that period, and the figure shows the percent in each age group who were classified as experiencing “high psychological distress” on at least one of the four surveys. Psychological distress was measured with a five-item scale that included items on feeling depressed, feeling anxiety, loneliness, and trouble sleeping, along with one covid-specific item on anxiety responses to the pandemic. As Figure 1 shows, 58% of 18-to-29-year-olds experienced high psychological distress during the survey period, and reported distress was lower in all older age groups. Notably, psychological distress was highest among the emerging adults even though their physical vulnerability to covid-19 was lowest, as it is for virtually all diseases, and psychological distress was lowest among the oldest Americans, those age 65 and older,

The mental health consequences of the covid-19 pandemic have been enormous across all segments of American society since early 2020. However, the Americans who have been impacted the most are the emerging adults ages 18 to 29.

Source: Pew Research Center (2022, December 12)

Figure

High Psychological Distress by Age Group

even though the risk of hospitalization or death from covid was highest for them.

It is striking that over half of American emerging adults have experienced high psychological distress since the beginning of the pandemic, and that their rates of distress were higher than for any other adult age group. However, it has long been known that emerging adults have especially high rates of mental health distress, compared to other age groups. This raises the key question: Did emerging adults respond psychologically to the pandemic more strongly than other age groups, or is their greater distress since early 2020 merely a continuation of their already higher rates of distress?

The answer to this question is emphatically that covid-19 triggered a widespread mental health crisis, but especially among young people ages 18 to 29. Figures 2 and 3 show rates of anxiety disorder and depressive disorder for America adults by age group, using data from the National Health Interview Survey (NHIS) conducted by the U.S. Census Bureau in 2019, before the pandemic, and at four points in the first year of the pandemic. The age patterns are vivid and dramatic, showing that emerging adults were more likely than adults in any other age group to respond to the early stages of the pandemic with symptoms of anxiety and depression serious enough to classify as a psychiatric disorder.

But what about now, in early 2023? For most emerging adults life has returned to

Source: Twenge et al. (2021)

Figure 2

Anxiety Disorder Symptoms by Age Group 2019 through 2020

Source: Twenge et al. (2021)

Figure 3

Depressive Disorder Symptoms by Age Group 2019 through 2020

normal, as jobs sprung back and colleges resumed and they were able to see their friends and romantic partners again. Has their mental health sprung back as well? Unfortunately, but again emphatically, no. As shown in Figures 4 and 5, their rates of anxiety and depressive disorders remain nearly as high now as at the peak of the covid-19 pandemic, during the lockdown period of 2020, before the first vaccines were available. Across adult age groups, anxiety and depression symptoms have remained far above pre-pandemic levels from fall 2020 through winter 2023.

LONGITUDINAL STUDIES

In addition to the national studies just reviewed, there are longitudinal studies that have charted emerging adults’ mental health functioning during the pandemic. Longitudinal studies are especially valuable, because they examine the same people at different points in time. Thus, they make it possible to identify definite effects of events that were experienced by the sample in-between the two time points—in this case, a deadly worldwide pandemic.

The largest and best longitudinal study on mental health and covid-19 shows results similar to the cross-sectional national studies reviewed in the previous section: widespread mental health distress in response to covid-19, especially among the youngest adults. McGinty and colleagues analyzed data from the National Opinion Research

Figure 4

Anxiety Disorder Symptoms by Age Group 2021 to early 2023

Figure 5

Depressive Disorder Symptoms by Age Group 2021 to early 2023

Center’s (norc ’ s norc ) longitudinal study of 35,000 American adults surveyed on-line in April and July 2020. Using a well-known six-item scale of mental health distress (four items on depressive symptoms and two on anxiety symptoms), they concluded that “serious psychological distress” was reported by one-fourth of 18-to-29-yearolds, about twice the prevalence of the overall sample (13%), at both time points. More than 60% of the participants with serious psychological distress attributed their distress to pandemic-caused disruptions in education, employment, and finances, all areas in which emerging adults experienced greater disruptions than adults in older age groups.

The following section includes many longitudinal studies focusing on emerging adults in potentially vulnerable subgroups.

VULNERABLE SUBGROUPS OF EMERGING ADULTS

In addition to overall age patterns showing greater mental health distress among young people ages 18 to 29 than among older age groups in response to covid-19, many studies have identified subgroups of emerging adults that were especially impacted by the pandemic. The most notable effects were found for young women and for Asian Americans. There are several other subgroups of emerging adults for whom evidence is sufficient but whose vulnerability should be explored

further: college students; emerging adults with pre-existing mental health problems; and emerging adults living with parents.

Young Women

Gender has long been known to be a major risk factor for mental health problems, with girls and women at greater risk from their teens through late adulthood. During the pandemic, among persons age 18 to 29 women were impacted more than men. Even though young women were already higher than young men in rates of depression and anxiety before the pandemic, the gap between them has enlarged since the pandemic began.

For example, Fuller-Rowell and colleagues examined changes in depressive symptoms, sleep problems, and physical problems in a longitudinal study of 263 college students before and during the pandemic. Women reported greater increases in all three areas of distress than men did. Similarly, Zimmerman and colleagues (2021) had 205 college students complete measures of depression and anxiety before the pandemic and then in April of 2020. Women experienced more severe distress in both areas than men did, even controlling statistically for distress prior to the pandemic. A study by Alzueta and colleagues (2021), with a five-site community sample of emerging adults, found that the rate of clinical depression tripled from before pandemic to during the pandemic, and that the effects were strongest among young women.

Asian Americans

When it became widely known that the covid-19 virus originated in China, Asian Americans became subjected to hateful and sometimes violent racism from other Americans. This racism has continued over two years into the pandemic. According to a national survey by the Pew Research Center in 2022, 63% of Asian Americans believe violence against their ethnic group is increasing, a far higher percentage than among other ethnic groups. Seventy-two percent of Asian Americans said they worry sometimes, almost every day, or every day that they might be threatened or attacked because of their ethnicity. Thirty-six percent have made changes to their daily schedule or routine due to the fear of being threatened or attacked because of their ethnicity.

The mental health consequences of this racism are evident in studies of Asian American emerging adults. For example, Fisher and colleagues (2022) surveyed an online sample of 399 emerging adults (ages 18 to 25) in various American ethnic groups in 2022. Rates of pandemic-based racial bias and distress over victimization were elevated among Asian American emerging adults and were in turn related to reported symptoms of depression and anxiety. Zhou and colleagues (2023), focusing on Asian American college students, found a 30% increase in severe anxiety and a 17% increase in severe depression from fall 2019 to fall 2020.

SUBGROUPS THAT MAY BE VULNERABLE College Students?

College students have long been identified as having high rates of mental health distress, compared to non-college emerging adults of the same age (see Kang and colleagues, 2021). The stress of academic work, the financial strain, the intensity of the peer environment when living among so many others of the same age, and the making and breaking of romantic relationships all seem to contribute to their mental health problems. Given this pre-existing pattern, were college students also especially vulnerable to the mental health effects of covid-19?

There is substantial evidence that college students, like emerging adults generally, suffered a downturn in mental health when the pandemic began. Buizza and colleagues (2022) reviewed seven studies of U.S. college students that assessed mental health both before and during the pandemic. All of the studies showed worse mental health once the pandemic struck. For example, Fruehwirth and colleagues (2021) reported increases in anxiety and depression in college students surveyed just prior to the outbreak of the pandemic and again in mid-2020, when the pandemic was spreading rapidly. Difficulties associated with social isolation and the transition to online learning contributed to their mental health problems.

Huckins

and colleagues (2020) followed a sample of students from 2017 through just after the pandemic broke in March 2020, and found higher anxiety and depression symptoms in the early pandemic period than in prior academic terms.

Although these studies show that college students experienced a negative impact on their mental health as a consequence of the pandemic, they do not demonstrate that college students were an especially vulnerable subgroup of emerging adults. No studies published so far have compared college students to non-students of the same ages—even when the samples have included both students and non-students. Thus, it remains to be seen if the stresses and disruptions specific to the college context had especially strong effects on emerging adults’ mental health.

Previous Mental Health Problems?

What if emerging adults were already experiencing mental health problems before the pandemic? Would their response to the pandemic be worse, because they were already vulnerable to mental health distress? Or would they show less of an effect of the pandemic on their mental health, because they were already distressed?

The studies available so far provide insufficient evidence to answer these questions. Two reviews of existing studies, by Berger and colleagues (2022) and by

Dragioti and colleagues (2022), included both age and previous mental health problems among the variables analyzed. Both reviews concluded that emerging adults were more vulnerable than other age groups, and that people with previous mental health problems showed worse mental health during the pandemic. However, it is unsurprising that people with previous mental health problems also reported mental health problems during the pandemic; the reviews did not show that the change from before to during the pandemic was greater for people with previous mental health problems, neither for emerging adults specifically nor for adults generally. Furthermore, a third review, by Robinson and colleagues (2022), focusing on longitudinal studies, concluded that there was no evidence of any change in symptoms among samples with a pre-existing mental health condition, comparing them before and during the pandemic.

Two longitudinal studies focusing specifically on emerging adults provide contradictory evidence to muddle the picture further. Shanahan and colleagues (2022) followed a community sample of 768 emerging adults from before the pandemic to early in the pandemic “lockdown” phase, and found that pre-covid-19 emotional distress was the strongest predictor of emotional distress during lockdown. In contrast, Haikalis and colleagues (2022) assessed their sample from before the

Seventy-two percent of Asian Americans said they worry sometimes, almost every day, or every day that they might be threatened or attacked because of their ethnicity.

pandemic to a similar point five months after the pandemic began, and reported that the emerging adults who experienced greater perceived stress before covid-19 struck showed less of an increase in anxiety and depression five months later. Thus, at this point it is not possible to say if pre-existing mental health problems made emerging adults more vulnerable to mental health distress caused by the pandemic, but it is an issue that merits further study.

Living with Parents?

Because emerging adults were more likely than any other adult age group to lose their jobs during the pandemic, and many of their colleges closed down and sent all the students home, the proportion of 18-to-29year-olds living with parents rose to 52%, the highest level ever recorded in the United States (with records going back to 1900), according to a Pew Research Center report by Fry and colleagues (2020). Rates of living with parents were exceptionally high for 18-to-24-year-olds, 71%, compared to just 28% of 25-to-29-year-olds. Was this return home a source of support for emerging adults, because they could rely on their parents’ homes as a safe haven from the pandemic, or a source of tension for both parents and emerging adults because neither of them was expecting to be living together at this time?

So far, only two studies, both of college student samples, provide evidence on this

question. A longitudinal study of college students by Song and colleagues (2022) reported that healthy attachments to parents served as a protective factor between covid-19 stresses and mental health problems. Van Stee (2023), in an interview study focusing on social class differences among college students from varying backgrounds, found that upper-middle-class students relied strongly on their parents’ emotional and financial support when the pandemic hit, whereas working-class students were more self-sufficient and more likely to be providing support to parents rather than receiving it.

By mid-2022, the proportion of 18-to-29year-olds living with parents had subsided slightly, but was still higher than any pre-pandemic level. According to national data presented by Cohn and colleagues (2022), a majority of adults living in these multi-generational households find it convenient and rewarding, although some (23%) also find it stressful. In contrast to this mostly favorable view of intergenerational living, Fadeyi and Horowitz (2022) reported that 36% of Americans view the phenomenon of young adults living with their parents as “bad for society,” whereas only 16% view it as “good for society” (the rest say it makes no difference). Further research will hopefully cast more light on emerging adults’ relations with parents during covid-19 as well as on the benefits and costs of the increasingly common pattern of intergenerational living.

Mental Health Treatment for Emerging Adults: Most in Need and Most Lacking

Given the strong evidence that the covid-19 pandemic has provoked a mental health crisis in emerging adults, it is crucial that they have access to mental health services. However, so far the crisis has not been met with effective policies. On the contrary, the enduring mental health effects of the pandemic on emerging adults may be partly explained by their insufficient access to mental health services. As Figure 6 shows, they were the adult age group most likely to need but not receive mental health

services at the height of the pandemic.

During the first year of the pandemic, mental health providers were among the many business services that were forced to close during the lockdown that was instituted to control the spread of the virus. This contributed to the lack of access to mental health services experienced by emerging adults. However, the pandemic inspired a rapid growth in “telemedicine,” that is, medical consultations delivered via phone or video calls, including for mental health problems.

Is telemedicine potentially an effective method of delivering needed mental health services to people continuing to suffer the effects of the pandemic? So far, the evidence indicates that telemedicine is better than no mental health treatment but in-person treatment is preferred. For example, Waselewski and colleagues (2022) surveyed a national sample of young Americans ages 14 to 24. Many of the youth were open to using telemedicine, but they preferred video calls to phone services, and viewed both as less effective than in-person treatment. Similarly, Barney and colleagues (2022) interview young Americans ages 12 to 26 about their experiences with telemedicine and also found a preference for in-person visits, although the young people appreciated the greater convenience and accessibility of telemedicine. Turner and Seigel (2022) interviewed 10 therapists about their experiences with telemedicine

Source: Vahratian et al. (2021)

6 Needed but Did Not Receive Counseling or Therapy, Past Four Weeks, by Age Group

delivery. They acknowledged its advantage for accessibility, but noted that it is often hindered by technical problems and, for young people, the difficulty they may have in finding a place where they are undistracted and undisturbed, especially those in low-income families. This suggests that the effectiveness of telemedicine may improve as the technology and methods of delivery improve. When there is a pandemic involving a highly contagious virus, and in-person therapy is impossible, telemedicine may be a vital way of providing mental health services.

How Do Adolescents Compare?

Recently, there has been a great deal of attention to new data indicating widespread mental health problems among adolescents. Specifically, the Centers for Disease Control and Prevention (CDC) issued a new report in March 2023 on trends in the biennial Youth Risk Behavior Survey indicating that adolescents’ reports of their mental health had substantially worsened from 2011 to 2021. In 2021, 42% of high school students reported that some time in the past year they felt “so sad or hopeless almost every day for at least two weeks in a row that they stopped doing their usual activities,” a substantial increase from 28% in 2011. Adolescent girls experienced an especially alarming increase, from 36% in 2011 to 57% in 2021, whereas the increase for boys was from 21% in 2011 to 29% in 2021. There were similar increases among adolescent girls (but not boys) in their reports of “seriously considering attempting suicide during the past year,” from 19% to 30%, and in having “made a suicide plan during the past year,” from 15% to 24%.

Clearly, there are pervasive mental health concerns among adolescents that deserve national attention. However, this mental health crisis does not appear to have been due mainly to the threat of covid-19. Most of the increase in the problems just summarized occurred from 2011 to 2019, before the pandemic began in early 2020. For example, feeling “so sad or hopeless almost every day for at

least two weeks in a row that they stopped doing their usual activities” had already increased from 28% to 37% from 2011 to 2019, then increased further to 42% by 2021. Furthermore, asking adolescents (or anyone else) to recount feelings they may have had “during the past year” is a methodological approach of dubious validity. A century of research on memory has demonstrated unequivocally that people have difficulty remembering what they had for breakfast yesterday. Asking them to remember feeling states they have experienced in the past year is highly unlikely to yield valid results. In sum, there are reasons to be concerned about the mental health condition of American adolescents, especially girls, but the data that are currently the basis for national discussion are questionable and in any case the recent trend cannot be attributed mainly to covid-19.

Why Has the Pandemic Especially Affected the Mental Health of 18-To-29-Year-Olds? Connecting Normal Development to the Current Mental Health Crisis

To understand why emerging adults have proven to be especially vulnerable to the mental health effects of covid-19, it is essential to understand the distinctive psychological features of this age group. My decades of research on 18-to-29-year-olds (see Arnett, 2023) have revealed five features that are distinctive to this new life stage:

1. Identity explorations: deciding “who I am” and trying out various possible futures, especially in love and work;

2. Instability, in love, education, work, and place of residence;

3. Self-focus, as ties to parents wane but new roles have not yet been entered;

4. Feeling in-between, on the way to adulthood but not there yet; and

5. Possibilities/optimism, when hopes are high and many bright futures still seem possible.

This theory helps to explain the greater mental health impact of covid-19 on emerging adults. Their identity explorations were disrupted at a crucial time, just as they were making efforts to build a life for themselves in education, work, and love relationships. The instability always common to this new life stage was exacerbated by the pandemic, as they lost their jobs in massive numbers, their educational institutions closed down, and the combination of lost jobs and closed colleges sent them home to live with their parents in unprecedented proportions. Their normal self-focus

veered into loneliness as they were cut off from their friends and romantic partners. Feeling in-between adolescence and adulthood was sharpened and extended by the unexpected delay in their progress toward building an independent life. Their habitual sense of wide-open possibilities received a rude shock and their optimism became dimmed by the crush of current circumstances.

More generally, emerging adulthood is a time of learning to become a self-sufficient person, showing that you can handle the duties of adult life independently before you eventually make commitments to others through marriage, parenthood, and stable work, as most people do. The three top criteria for adulthood named by emerging adults consistently in studies by me and many others are all independence-based: accepting responsibility for yourself, making independent decisions, and becoming financially independent. Emerging adults’ progress on all three of these criteria was delayed or reversed by the pandemic. Most required help from their parents or other adults when the pandemic hit, because they became unable to continue their progress toward becoming responsible for themselves due to disruptions in school and work. Their ability to make independent decisions was hindered by school closings, job loss, and the necessary retreat to living with their parents again after having moved out, because they could no longer afford to live on their own.

Similarly, few were able to remain financially independent because job loss was so pervasive among 18-to-29-year-olds, and most do not have any kind of savings to draw upon to tide them over when a financial crisis hits.

Another relevant feature of normal development in emerging adulthood that made them especially vulnerable to the mental health effects of the pandemic is that the twenties are the time of life when people change residences the most. Each time they move they must break ties with friends, co-workers, and romantic partners and start anew somewhere else. Thus, when the pandemic struck they were less likely to have others present to rely upon. True, many moved home to live with parents, but although that move provided social support for many of them, it also likely seemed like a step backward in their progress toward a self-sufficient adulthood. And, of course, many of their relations with parents are characterized by ambivalence or even hostility rather than support, yet they were required to move home anyway because they could no longer afford to live independently.

What Now? What Next Time? Five Recommendations

The mental health crisis triggered by the covid-19 pandemic has been pervasive and enduring. It continues now in exceptionally high rates of mental health distress, especially among emerging adults. What can be done to address the continuing crisis? What can be done to prepare for the mental health consequences of the next pandemic? Here are five recommendations.

1. More Research, Now, to Find Out Why

The continuing mental health crisis caused by covid-19 at least offers this opportunity: To investigate more deeply why it is occurring, in order to address the current crisis and also allow us to prepare for the mental health effects of the next pandemic. Right now, we have national excellent data showing persistently high levels of anxiety and depression symptoms in all adult age groups, much higher than 2019 baseline levels, especially among 18-to-29-yearolds. However, at this point we lack good national data showing why. Studies to date show that factors such as lost jobs, reduced income, closed colleges, and social isolation contributed to the initial rise in mental health distress—but none of those conditions are still occurring, yet rates of mental health distress remain appallingly high. Why? Qualitative studies with interviews of adults across age groups are necessary, and the sooner the better, while the crisis is still ongoing. We need to

ask adults why they are feeling depressed and anxious in response to the pandemic, and why those feelings are continuing now, long after the peak of morbidity and mortality from the pandemic has passed.

2. Build on the Telemedicine Revolution to Prepare for Next Time: The Telehealth Corps

Because its contagiousness required so much social distancing, the pandemic inspired a flourishing of growth in telemedicine, including for the delivery of mental health services. This new method promises to be especially appealing and suitable for emerging adults, because they change geographical locations more frequently than any other age group and because, as digital natives, most of them are comfortable with making virtual connections with others. Although during the covid-19 pandemic people have expressed a preference for in-person therapy over teletherapy, they have also welcomed teletherapy for its advantages of convenience and accessibility. To address the current mental health crisis, telemedicine delivery of psychotherapy should be greatly expanded, in order to reach the millions of American adults, especially the youngest adults, who are in need of mental health services but not receiving them.

To prepare for the next pandemic mental health crisis, a Telehealth Corps could be developed, of mental health professionals who would be ready to serve

in case of a sudden, pervasive need such as the one that has recently occurred. The next pandemic, like this one, will require social distancing that makes in-person psychotherapy difficult or impossible, so it is important to develop and improve telemedicine services now so that they will be more effective. The Telehealth Corps could be staffed mainly by people who have mental health treatment skills that are currently underused, such as mental health professionals who have retired but still have the ability and desire to provide treatment when needed, or those who have stepped away temporarily from the field due to family obligations and have not yet made their way back into professional service. Many talented and experienced clinicians will be aging out of the workforce in the years to come and could be recruited for the Telehealth Corps.

3. Services for Parents of Emerging Adults

Every parent of emerging adults knows: You are only ever as happy as your leasthappy child. Since the pandemic began, mental health distress has been highest at ages 18 to 29, but it has also been pervasive for their midlife parents, and the parents have had the additional challenge of dealing with their children’s anxiety and depression. They have also had to adjust to their emerging adult children’s returning home, as millions of them did during the pandemic. A website of parenting

resources for parents of emerging adults should be developed, including information about how to obtain evidence-based mental health information and contact potential therapists for themselves or their emerging adults,, either for telemedicine or direct treatment.

4. Colleges and Universities: What Worked and What Did Not?

One of the jarring effects of the pandemic in the lives of emerging adults was that their colleges and universities suddenly closed down and shifted to remote learning. As a consequence, millions of students retreated to their parents’ homes, or remained in their college towns but now socially isolated from their professors, their classmates, and most of their friends. Colleges and universities were forced to invent policies on the spur of the moment to address this crisis, including its mental health effects. What policies were most effective? Which turned out to be ineffective or counter-productive? What have we learned that can prepare us for next time? A national conference focusing on these questions could be highly productive. The goal of the conference should be to create a repository of programs and policies that were effective in addressing this crisis and that should be disseminated and expanded, both to address the enduring mental health effects of covid-19 and to establish a more effective campus mental health system going forward.

To address the current mental health crisis, telemedicine delivery of psychotherapy should be greatly expanded, in order to reach the millions of American adults, especially the youngest adults, who are in need of mental health services but not receiving them.

5. Enhance the Effectiveness of Online Learning

There is no doubt that the covid-19 pandemic disrupted education at all levels. Schools closed down, from primary schools through colleges and universities, and were then required to make a frantic and often ineffective transition to online learning. Educational progress was delayed, and the effects are evident in declining performance on national exams at the primary and secondary levels, as well as decreased enrollment in colleges and universities. Research should be conducted to identify the most effective ways of delivering online learning at all levels. When these methods are identified, instructors should be trained in how to use them effectively. Creating more engaging virtual classrooms could not only prepare us for the next pandemic, but promote ways to provide better learning for students now, especially for those who are in communities where resources are limited.

CLOSING THOUGHTS: TURNING CRISIS INTO OPPORTUNITY

The covid-19 pandemic has been a devastating worldwide calamity. Millions of people have died, and tens of millions are mourning people they loved. Billions of lives were disrupted, as people all over the world experienced the closing of schools, the loss of jobs, the abrupt termination of social activities, and the obliteration of their familiar and comforting daily routines. Even now, as the pandemic has receded and people have largely returned to their previous patterns of education, work, and social life, the mental health effects of

the pandemic continue, as this report has shown. The evidence here should be a call to action to learn more about why the distress is continuing and to provide the mental health resources that people need in order to overcome it. Clearly, it is not simply going away on its own.

The first step should be to listen, that is, to conduct research to interview people for their accounts of their current mental health distress, how the covid-19 pandemic helped trigger it, and why it persists. This research should especially focus on persons age 18 to 29, who were the most affected, but people of all ages should be included. Surveys like those summarized here are helpful, but numbers alone are not enough. We need to hear the voices of the people affected, their own accounts of why the mental health effects of the pandemic have occurred and why they are continuing. That is the best way, and the overwhelmingly necessary way, to gain insights that will enable us to respond in ways that ameliorate the current crisis and make the next one less likely.

The five recommendations presented here represent potentially effective ways to respond to the evidence of continuing mental health distress in response to covid19. Hopefully, they will be the start, not the end, of an ongoing national conversation about how to enhance Americans’ mental health. It is of vital importance to respond to the current crisis with evidence-based information that will lead to effective mental health policies and programs. If it is done well, the response to the crisis detailed here has the potential to provide a structure of mental health resources that could be the basis of long-term progress in mental health literacy and access to mental health resources, to the benefit of Americans of all ages, now and in the future.

Adams, S. H., Schaub, J. P., Nagata, J. M., Park, M. J., Brindis, C. D., & Irwin Jr, C. E. (2022). Young adult Anxiety or Depressive Symptoms and mental health service Utilization during the covid-19 pandemic. Journal of Adolescent Health, 70(6), 985–988.

Alzueta, E., Podhajsky, S., Zhao, Q., Tapert, S. F., Thompson, W. K., De Zambotti, M., . . . & Pohl, K. M. (2021). Risk for depression tripled during the covid-19 pandemic in emerging adults followed for the last 8 years. Psychological medicine, 1–8.

Arnett, J.J. (2023). Emerging adulthood: The winding road from the late teens through the twenties (3rd edition). New York: Oxford University Press.

Barney, A., Mendez-Contreras, S., Hills, N., Buckelew, S., & Raymond-Flesch, M. (2022). Telemedicine in an Adolescent and Young Adult Medicine Clinic: A Mixed Methods Study. Unpublished manuscript.

Berger, E., Jamshidi, N., & Reupert, A. (2022). Psychological impacts of coronavirus outbreaks on adults: A rapid evidence review. International Journal of Mental Health Promotion, 24(5), 619–634.

Buizza, C., Bazzoli, L., & Ghilardi, A. (2022). Changes in College Students Mental Health and Lifestyle During the covid-19 Pandemic: A Systematic Review of Longitudinal Studies. Adolescent Research Review, 1–14.

Cohn, D.V., Horowitz, J.M., Minkin, R., Fry, R., & Hurst, K. (2022, March 24). Financial issues top the list of reasons U.S. adults live in multigenerational homes. Washington, DC: Pew Research Center. Available: https://www.pewresearch.org/social-trends/2022/03/24/ financial-issues-top-the-list-of-reasons-u-s-adults-live-in-multigenerational-homes/ Dragioti, E., Li, H., Tsitsas, G., Lee, K. H., Choi, J., Kim, J., . . . & Solmi, M. (2022). A large-scale meta-analytic atlas of mental health problems prevalence during the covid-19 early pandemic. Journal of medical virology, 94(5), 1935–1949.

Fadeyi, D., & Horowitz, J.M. (2022, August 24). Americans more likely to say it’s a bad thing than a good thing that more young adults live with their parents. Washington, DC: Pew Research Center. Available: https://www.pewresearch.org/fact-tank/2022/08/24/americans-more-likely-to-say-its-abad-thing-than-a-good-thing-that-more-young-adults-live-with-their-parents/

Fisher, C. B., Tao, X., & Yip, T. (2022). The effects of covid-19 victimization distress and racial bias on mental health among AIAN, Asian, Black, and Latinx young adults. Cultural diversity and ethnic minority psychology.

Fruehwirth, J. C., Biswas, S., & Perreira, K. M. (2021). The Covid-19 pandemic and mental health of first-year college students: Examining the effect of Covid-19 stressors using longitudinal data. PLoS ONE, 16(3), e0247999. https://doi.org/10.1371/journal.pone.0247999

Fry, R., Passel, J.S., & Cohn, D.V. (2020, September 9). A majority of young adults in the U.S. live with their parents for the first time since the Great Depression. Available: https://www.pewresearch.org/fact-tank/2020/09/04/a-majority-of-young-adults-in-the-u-s-live-with-their-parents-forthe-first-time-since-the-great-depression/

Fuller-Rowell, T. E., Nichols, O. I., Doan, S. N., Adler-Baeder, F., & El-Sheikh, M. (2021). Changes in Depressive Symptoms, Physical Symptoms, and Sleep-Wake Problems From Before to During the covid-19 Pandemic Among Emerging Adults: Inequalities by Gender, Socioeconomic Position, and Race. Emerging Adulthood, 9(5), 492–505.

Haikalis, M., Doucette, H., Meisel, M. K., Birch, K., & Barnett, N. P. (2022). Changes in College Student Anxiety and Depression From Pre-to During-covid-19: Perceived Stress, Academic Challenges, Loneliness, and Positive Perceptions. Emerging Adulthood, 10(2), 534–545.

Huckins, J. F., da Silva, A. W., Wang, W., Hedlund, E., Rogers, C., Nepal, S. K., & Campbell, A. T. (2020). Mental health and behavior of college students during the early phases of the covid-19 pandemic: Longitudinal smartphone and ecological momentary assessment study. Journal of Medical Internet Research, 22(6), e20185. https://doi.org/10.2196/20185

Juvonen, J., Lessard, L. M., Kline, N. G., & Graham, S. (2022). Young Adult Adaptability to the Social Challenges of the covid-19 Pandemic: The Protective Role of Friendships. Journal of Youth and Adolescence, 51(3), 585–597.

Kang, H. K., Rhodes, C., Rivers, E., Thornton, C. P., & Rodney, T. (2021). Prevalence of mental health disorders among undergraduate university students in the United States: A review. Journal of Psychosocial Nursing and Mental Health Services, 59(2), 17–24. https://doi. org/10.3928/02793695-20201104-03

Kessler, R. C., & Wang, P. S. (2008). The descriptive epidemiology of commonly occurring mental disorders in the United States. Annual Review of Public Health, 29, 115–129.

MacDonald, J. J., Baxter-King, R., Vavreck, L., Naeim, A., Wenger, N., Sepucha, K., & Stanton, A. L. (2022). Depressive Symptoms and Anxiety During the covid-19 Pandemic: Large, Longitudinal, Cross-sectional Survey. JMIR Mental Health, 9(2), e33585.

McGinty, E. E., Presskreischer, R., Anderson, K. E., Han, H., & Barry, C. L. (2020). Psychological distress and covid-19–related stressors reported in a longitudinal cohort of US adults in April and July 2020. Jama, 324(24), 2555-2557.

National Center for Health Statistics (2023). U.S. Census Bureau, Household Pulse Survey, 2020–2023. Anxiety and Depression. Washington, DC: Author. Available: https://www.cdc.gov/nchs/ covid19/pulse/mental-health.htm

Pasquini, G., & Keeter, S. (2022, December 12). At least four-in-ten U.S. adults have faced high levels of psychological distress during covid-19 pandemic. Washington, DC: Pew Research Center. Available: https://www.pewresearch.org/fact-tank/2022/12/12/at-least-four-in-ten-u-s-adults-havefaced-high-levels-of-psychological-distress-during-covid-19-pandemic/?utm_source=Pew+Research+Center&utm_campaign=87be68d312-Weekly_2022_12_17&utm_medium=email&utm_term=0_-87be68d312-%5BLIST_EMAIL_ID%5D

Pettit, J.W., Roberts, R.E., Lewinsohn, P.M., Seeley, J.R., & Yaroslavsky, I. (2011). Developmental relations between perceived social support and depressive symptoms through emerging adulthood: Blood is thicker than water. Journal of Family Psychology, 25, 127-136.

Pew Research Center (May 9, 2022). About a third of Asian Americans say they have changed their daily routine due to concerns over threats, attacks. Washington, DC: Author. Available: https:// www.pewresearch.org/fact-tank/2022/05/09/about-a-third-of-asian-americans-say-they-havechanged-their-daily-routine-due-to-concerns-over-threats-attacks/

Robinson, E., Sutin, A. R., Daly, M., & Jones, A. (2022). A systematic review and meta-analysis of longitudinal cohort studies comparing mental health before versus during the covid-19 pandemic in 2020. Journal of affective disorders, 296, 567-576.

Schaeffer, K. (2022, April 25). In CDC survey, 37% of U.S. high school students report regular mental health struggles during covid-19 pandemic. Washington, DC: Pew Research Center. Available: https://www.pewresearch.org/fact-tank/2022/12/12/at-least-four-in-ten-u-s-adults-have-faced-highlevels-of-psychological-distress-during-covid-19-pandemic/?utm_source=Pew+Research+Center&utm_campaign=87be68d312-Weekly_2022_12_17&utm_medium=email&utm_term=0_87be68d312-%5BLIST_EMAIL_ID%5D

Shanahan, L., Steinhoff, A., Bechtiger, L., Murray, A. L., Nivette, A., Hepp, U., ... & Eisner, M. (2022). Emotional distress in young adults during the covid-19 pandemic: evidence of risk and resilience from a longitudinal cohort study. Psychological medicine, 52(5), 824–833.

Song, Q., Vicman, J. M., & Doan, S. N. (2022). Changes in Attachment to Parents and Peers and Relations With Mental Health During the covid-19 Pandemic. Emerging Adulthood, 10(4), 1048–1060.

Turner, B. J., & Siegel, S. (2022). Telemedicine and mental health care of young adults during covid-19: A qualitative study. Practice Innovations, 7(1), 64.

Twenge, J. M., McAllister, C., & Joiner, T. E. (2021). Anxiety and depressive symptoms in US Census Bureau assessments of adults: Trends from 2019 to fall 2020 across demographic groups. Journal of anxiety disorders, 83, 102455.

Vahratian, A., Blumberg, S.J., Terlizzi, E.P., & Schiller, J.S. (2021). Symptoms of anxiety or depressive disorder and use of mental health care among adults during the covid-19 pandemic: United States, August 2020-February 2021. MMWR Morbidity and Mortality Weekly report, 70, 490–494. Available: https://www.cdc.gov/mmwr/volumes/70/wr/mm7013e2.htm#suggestedcitation van Stee, E. G. (2023). Privileged dependence, precarious autonomy: Parent/young adult relationships through the lens of covid-19. Journal of Marriage and Family, 85(1), 215–232.

Waselewski, M. E., Waselewski, E. A., Wasvary, M., Wood, G., Pratt, K., Chang, T., & Hines, A. C. (2022). Perspectives on telemedicine from a national study of youth in the United States. Telemedicine and e-Health, 28(4), 575–582.

Zhou, S., Banawa, R., & Oh, H. (2023). Stop Asian hate: The mental health impact of racial discrimination among Asian Pacific Islander young and emerging adults during covid-19. Journal of affective disorders.

Zimmermann, M., Bledsoe, C., & Papa, A. (2021). Initial impact of the covid-19 pandemic on college student mental health: A longitudinal examination of risk and protective factors. Psychiatry research, 305, 114254.

About Ruderman Family Foundation

The Ruderman Family Foundation is an internationally recognized organization that works to end the stigma associated with mental health. The Foundation does this by identifying gaps in mental health resources and programs within the high school and higher education communities as well as by organizing other local and national programming and initiatives that raise greater awareness around the stigma.

The Ruderman Family Foundation believes that inclusion and understanding of all people is essential to a fair and flourishing community and imposes these values within its leadership and funding. For more information, please visit www.rudermanfoundation.org. @rudermanfamilyfoundation, @rudermandfdn, @therudermanfamilyfoundation

For additional mental health resources see https://rudermanfoundation.org/mental-health/

Call the 988 Lifeline 24/7 for confidential support if you or someone you know is in suicidal crisis or mental healthrelated distress.