Management of Youth and Young Adult Mood Disorders (Anxiety and Depression) During COVID-19

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The following condition-specific resources were developed in the context of the COVID-19 pandemic, when necessity required deviation from existing evidence-based guidelines as in-person visits were significantly limited. Certain frameworks and guidance within the resources are applicable only to the “crisis care” needs during the COVID-19 pandemic and should be reviewed with this consideration in mind. Established Clinical Practice Guidelines are the authoritative source for evidence-based care for each condition.

Youth’s self-rating of mental health has dropped by approximately 20% during the COVID-19 pandemic.1 This resource will guide primary care providers on how to adapt usual practices for managing youth and young adults with anxiety and depression during the pandemic. Since the care of these patients has not changed significantly, this tool is intended to supplement the CEP’s Youth Mental Health Tool (2017).

How to conduct virtual visits and when to see patients in-person

Patient preferences
 and privacy
Strengthen the patient-provider relationship
Patients to see in-person
  • New patients or patients who you have not seen in person for an extended time.
  • Patients who have privacy and confidentiality concerns at home.
  • Patients who present with concerning sudden weight loss, psychosis, or other medical conditions
  • Patients who are more complex.

Click on the sections below to get started:

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Tips for Providing Care During COVID-19

Screening, diagnosis and prescribing therapy
  • Continue screening, diagnosing, and prescribing therapy as per usual practice (see CEP’s resource: Youth Mental Health).
  • Consider sending screeners (e.g., PHQ-9, AUDIT-10, GAD7) in advance when possible. See the Virtual care during COVID-19 resource.
  • Consider directing patients to online counseling services (e.g., CBT) or referring to Bounceback.
  • Timing of follow-ups should follow usual practice and can be conducted virtually.

Patient resources

Lifestyle education
  • Empathize about deviating from routine during the pandemic, and remind patients that getting back to basics is important for mental health:
    • Proper sleep is 8-10 hrs for <18 or 7+ hrs for ≥ 18
    • Patients can learn to cook healthy meals as a fun activity
    • Exercise can be indoors, or outdoors if following public health guidance (HealthLinkBC, 2020)
    • Socializing can occur via video chatting, online games, phone, or text (CAMH, 2020)

Patient resources

Harm reduction
  • Socializing virtually is possible for many, and the safest approach. If patients feel the need to socialize in person, encourage them to follow public health guidance.
  • Consider providing tips for harm reduction (TPH, 2020).

Patient resources

* Note: reference to brand names does not imply endorsement of any of these products

HEEADSSSS During COVID-19

The HEEADSSSS framework helps to inform the screening process and documentation of patient history.

H – Home

School closures and increased distress among caregivers have increased the risks of child abuse and domestic violence (University of Toronto, 2020).

  • “Have your relationships at home (e.g., caregiving), or who you live with changed during the pandemic?”
  • “Are you worried about getting COVID-19 at school/work/outside and bringing it home?”

Provider resources

Patient resources

E – Education / Employment

Youth and other vulnerable populations have been bearing the brunt of job losses, with youth unemployment at 22% (FAO, 2021).

  • “Are you working, and has your employment changed during the pandemic?”

Remote learning may exacerbate the symptoms of ADHD and social anxiety for youth who have returned/are returning toin-person classes (J Adolesc Health, 2020).

  • “Have your plans for school (e.g., university) changed during the pandemic?”
  • “Have you been working/learning in person, or virtually? How has that been going?”

Provider resources

Patient resources

E – Eating

The pandemic has negatively impacted individuals with eating disorders, and in some studies, almost half of respondents reported a change in eating habits (Nutrients, 2020).

  • “Have your eating habits changed during the pandemic?”
  • “Do you or your parents ever worry about running out of food before having enough money to buy more?”
  • “Has your weight changed during the pandemic?”
  • “Has your perception of your body and/or body image changed during the pandemic” 

Provider resources

Patient resources

A – Activities

Less than 5% of youth met recommended physical activity guidelines during the first month of the pandemic in Canada (BC CDC, 2021). Many youths and young adults feel fatigued from virtual meetings/hangouts.

  • “What have you been doing for fun during the pandemic?”
  • “Have you found it difficult to socialize or exercise during the pandemic?“

Provider resources

Patient resources

D – Drugs / Drinking

Alcohol and cannabis use in youth has increased during the pandemic, with 21% of Canadians aged 18-34 reporting increased drinking (Drug Free Kids Canada, 2020).

  • “Do you drink alcohol or use tobacco, electronic cigarettes, cannabis, or any other drugs? Is your use the same as it was before the pandemic?”

Provider resources

Patient resources

S – Sexuality and Gender

During the pandemic, risky sexual behaviours (e.g., sexting) may increase among youth (SIECUS, 2020).

  • “Have you had any physical or online sexual relationships during the pandemic?”
  • “Have the types of sexual relationships you have changed significantly during the pandemic?”

Provider resources

Patient resources

S – Suicide / Self-harm

Kids Help Phone has seen an increase in volume to their phone line of 170% and an increase of 114% to their text line (Mental Health Commission of Canada, 2020). Marginalized groups (e.g., LGBTQ+ and indigenous youths) are particularly at risk (CAMH, 2020; Statistics Canada, 2020)

  • “Do you feel more stressed or anxious than usual?”
  • “Have you thought about hurting yourself or someone else?”

Provider resources

Patient resources

S – Safety (from injury and violence)

When considering perceptions of neighbourhood safety during the pandemic, younger people were more likely to feel an increase in crime and race-based violence (Statistics Canada, 2020).

  • “Have you felt safe in your neighbourhood since the start of the pandemic?” (Starship, 2019)
  • “Do you feel vulnerable or at risk of harm because of your culture, race, and/or sexual orientation?”

Provider resources

Patient resources

S – Social Media

Reports of online sexual exploitation of children have increased by 88% during the pandemic (Cybertip, 2021).

  • “Have you or a group that you identify with (e.g., culturally, racially, sexually) been picked on or bullied online more often/severely during the pandemic?”

Provider resources

Patient resources

Caring for patients during the pandemic is stressful, and feelings of extreme exhaustion and burnout are normal. For help during these times, see mental health and well-being supports and take care of yourself!

Virtual patient resources for Management of Youth and Young Adult Mood Disorders

Due to the COVID-19 pandemic, many resources to support patients are now available virtually. The following is a list of virtual resources that you can use in the management of your care.

General

Screening, diagnosis and prescribing therapy
Lifestyle education

HEEADSSSS