Even before the COVID-19 pandemic, the prevalence of emotional issues in adolescents - particularly anxiety disorders - was increasing, and the lockdown and its associated disruptions have likely made this worse. Educational disruption, job or university uncertainty may be particularly anxiety-inducing for older adolescents, and the pandemic has coincided with rising rates of such issues.

Meg Attwood, a PhD researcher at the University of Bristol’s School of Psychological Science, and her supervisor Professor Chris Jarrold looked at the impact of the COVID-19 pandemic on both the psychological wellbeing and the cognitive function of older school-aged adolescents, funded by grants from the Elizabeth Blackwell Institute. The funding was used to increase the scope of their work - and increase its impact at the same time.

Three studies, the first in June 2020, one in September 2020 and a final study in February 2021, recruited young people for online surveys about their subjective pandemic-related experiences and cognitive function. Some of these volunteers then participated in follow-up studies designed to objectively assess their cognitive performance.

Initial studies

“In the first study, most of the young people we surveyed reported decreased levels of wellbeing, and increases in anxiety related to COVID-19,” said Meg. “Girls were significantly more anxious than boys, reported worse wellbeing scores, and had a greater predisposition towards anxiety. A key finding from this study was a pattern of association between pandemic-related anxiety and self-identified cognitive difficulties relating to prioritisation and planning, and focus and concentration.”

The results for the second study in September 2020 were similar to their previous findings, despite the criteria having changed (schools had re-started). “Findings from Study 2 demonstrated the continued negative impact of COVID-19 on young people as they returned to school,” said Meg. “The majority of young people surveyed reported decreased wellbeing and increased anxiety”. Participants reported the same three aspects of their psychosocial function being most affected by COVID-19-related anxiety: mood, motivation, and focus and concentration.

Within these two sets of 2020 studies, the team found a (not exactly unexpected) detrimental relationship between COVID-19 and older adolescents’ psychological wellbeing. Both boys and girls experienced detrimental impacts of the pandemic, but girls were more likely to report increased anxiety than boys and also experienced lower levels of wellbeing overall.

“Interestingly, in early follow-up studies we found little evidence for a strong association between anxiety and actual working memory impairment,” said Meg. “In line with the findings from our survey studies, we got strong associations between anxiety and self-reported cognitive difficulties on a variety of measures, but finding correlations in our online computer-based tasks was more difficult.”

“We’ve since designed a new paradigm that divides young peoples’ attention within a working memory task. This has yielded interesting findings relating to young peoples’ ability to ignore negative information. We’re really excited about this! Future work would need to disentangle the role of subjective, self-reported cognitive difficulties vs objective, experimental ones, as related to perceived anxiety.”

Evidence that suggests COVID-19-related anxiety negatively impacts cognitive function warrants further investigation, both to determine the nature and extent of these difficulties, and their potential implications for academic performance. Indeed, work to highlight and identify the differences and similarities between subjective experiences of cognitive difficulties and “real”, measurable performance impairments might also help in the development of new intervention or treatment approaches.

Study 3 - Impacts and networks

As the pandemic continued, Meg and Chris started a third set of studies based on their previous work, with funding from the Elizabeth Blackwell Institute and Research England Quality-Related Strategic Priorities Fund - for activity that supports evidence-based policymaking.

“As part of the recruitment process, we shared initial results from the first two studies with schools and colleges as they were preparing to open again,” said Meg. “Several schools used our findings to inform discussions around wellbeing and safeguarding, to help determine how best to support those who are most vulnerable.”

Once the network of contacts was established, the team recruited and collected data from young people all over England in February 2021, during a further period of national lockdown and before schools had opened once again.

“An even greater proportion of our respondents this time reporting decreased wellbeing and increased anxiety,” said Meg. “Mostly, they attributed their anxiety to uncertainty about the future, limited social contact and concerns regarding school and examination disruption - and this increased anxiety was again associated with a range of self-reported cognitive difficulties.”

Adolescence is a critical period for the development of anxiety disorders, yet there is limited understanding of the cognitive mechanisms that underpin the onset and maintenance of these symptoms. Understanding the relationship between anxiety and cognitive function in older adolescents will inform targeted interventions for vulnerable young people in both clinical and educational settings.

Workshops

The researchers hosted a series of online workshops with key stakeholders from education (including senior researchers from the Department for Education, academic colleagues from the University of Bristol and representatives from local schools, colleges and Trusts), mental health (the Off The Record charity, Avon and Wiltshire Mental Health Partnership NHS Trust (AWP) and BristolMind) and community-based settings (organisations included Young Carers and the Creative Youth Network).

“What was striking during these discussions was the agreement shared by stakeholders regarding both the extent of the impact of the pandemic on young people, and the challenges of providing targeted, appropriate support in difficult and shifting circumstances,” said Meg. “You can't take approaches off the shelf; we're in a different milieu now, and we need something that's fit for purpose.”

“We got some hugely positive feedback - and there is a real appetite to build on the conversations started, and to find ways to share resources, build capacity and establish ongoing partnerships. There was a shared belief that supporting the mental health needs of young people, both now and beyond COVID-19, requires a joined-up approach that brings together different skill-sets and resources. As one attendee said, “COVID-19 is going to cast a long shadow over the lives of our children and young people”: it is going to take a collective effort to respond to the challenges ahead.”

In addition to partnerships forged during the workshops, the project also supported a collaboration with Education South West, a Multi-Academy Trust. Through the Trust’s mental health program, the researchers worked with the wellbeing lead and Year-13 mental health ambassadors to conduct a school-based anxiety and cognitive function study. This study has led to ongoing work that involves young people as co-researchers. 

OTR

The charity OTR (Off The Record), which describes itself as ‘a mental health social movement by and for young people aged 11-25’, was also a key player in the workshops, and the team and charity also developed several new projects.

“We’re now working with young people to co-produce studies around their experiences of repetitive negative thinking, a key feature in a variety of mental health difficulties such as anxiety and depression. This work, funded by the Elizabeth Blackwell Institute, uses participatory approaches (led by our artist collaborator, Catherine Lamont-Robinson) to explore what it means to experience negative thinking in everyday life. OTR are supporting us with recruitment, and also with the design and delivery of this project.”

“The initial Elizabeth Blackwell Institute project was our opportunity to initiate communication with OTR”, said Meg. And that initial dialogue has flourished into a dynamic working relationship, with a variety of projects in the pipeline.”

McPin

Another new collaborator is the McPin Foundation, a mental health research charity working across the UK. Meg Attwood explains:

“The main aim of the Foundation is to transform mental health research by ensuring that young people's lived experiences are at the heart of any research project. We've worked with the Foundation and their Young Person’s Advisory Group to gather feedback on initial ideas for our project and they are also supporting us with recruitment and project delivery.”

“We've had lots of feedback from young people in their advisory group saying that what we’re doing really resonates with them. When we involve them in the process of developing and designing the studies, their voices come through as well. During our creative engagement sessions, young people are exploring different materials and producing work that expresses their everyday experiences of worry and rumination. Their work is beautiful, insightful and thought-provoking – we are learning so much from this approach.”

Image: Adolescents use a variety of visual, auditory, and tactile media to express responses to questions about repetitive negative thinking and resilience. 

Broadening reach

The initial COVID-19 workshops have linked the team with a wide range of key local stakeholders, many of whom have links to larger regional and national organisations. Two keynote speakers from these workshops (one from AWP and the other from OTR) are involved in the new Mental Health Support Teams In Schools service, which is placing specialist mental health support within schools in the Bristol, North Somerset and South Gloucestershire area.

"A collective aim amongst our stakeholders is to respond to priority areas of need that emerge, as the context shifts, and that are relevant to policy at national level,” said Meg. “For example, during the workshops there was a request from the Mental Health Support in Schools service to facilitate discussions around how best to respond to the spike in eating disorders in young people over the course of the pandemic – which would also draw new members into our existing group and broaden our reach and impact”.

Thanks to the Elizabeth Blackwell Institute funding, the team has also established dialogue with national policymakers.

“We presented our research findings at a seminar series with colleagues from the Department for Education” explained Meg. “While there, we also established links with senior research officers in the DfE working in the Longitudinal Studies Team, and gave insights into our methodologies. Colleagues from the DfE were then able to join us at our online stakeholder workshop, and we will continue to foster these links.”

Beyond the lab

“What this funding has done is to allow us to take what was a very focused project - and expand it beyond the lab. The feedback has been invaluable: how might this feed into thinking around repetitive negative thinking? What and how can we learn from co-produced research with young people? The sorts of questions we ask and how we can make them and our measurements more meaningful - all of these things have benefitted hugely from these inputs, and that's really exciting.”

“The research feels very dynamic and lively. It doesn't mean that we're abandoning the ways that we do our work, but we can develop our techniques and refine them in ways that we wouldn't be able to do without the collaborations we now have. All of these partnerships have been pivotal in making this work happen.”