Journal of Adolescent Health 68 (2021) 43e52

www.jahonline.org

Original article

Adolescents’ Perceived Socio-Emotional Impact of COVID-19 and

Implications for Mental Health: Results From a U.S.-Based
Mixed-Methods Study
Adam A. Rogers, Ph.D. a, *, Thao Ha, Ph.D. b, and Sydney Ockey a
a
School of Family Life, Brigham Young University, Provo, Utah
b
Department of Psychology, Arizona State University, Tempe, Arizona

Article history: Received June 10, 2020; Accepted September 27, 2020
Keywords: COVID-19; Adolescent; Mental health; Mood; Relationships

A B S T R A C T
IMPLICATIONS AND
CONTRIBUTION
Purpose: COVID-19 has disrupted many aspects of adolescents’ lives, yet little data are available
that document their subjective experiences of the pandemic. In a mixed-methods study of U.S.
Adolescents around the
adolescents, we examined (1) adolescents’ perceptions of how their social and emotional lives had U.S. have experienced
changed during COVID-19; and (2) associations between these perceived changes and indices of various challenges with
their mental health, above and beyond their prepandemic mental health status. COVID-19 and social
Methods: Four hundred seven U.S. adolescents (Mage ¼ 15.24, standard deviation ¼ 1.69; 50% distancing. As the
female; 52%, 20% African American, 17% Hispanic/Latinx) completed surveys before (October 2019) situation with COVID-19
and during (April 2020) the COVID-19 pandemic. They provided qualitative and quantitative continues to develop,
responses on their experiences with COVID-19 and reports of their mental health. those who wish to support
Results: Adolescents perceived various changes in their relationships with family and friends (e.g., youth can help adoles-
less perceived friend support) during COVID-19. They also perceived increases in negative affect cents maintain friendship
and decreases in positive affect. These perceived social and emotional changes were associated connections, ease family
with elevated depressive symptoms, anxiety symptoms, and loneliness in April 2020, controlling tensions, and regulate
for mental health problems before the pandemic. fluctuations in day-to-day
Conclusions: Our findings sensitize clinicians and scholars to the vulnerabilities (changes in affect.
friendship dynamics), as well as resiliencies (supportive family contexts), presented to U.S.
adolescents during the early months of COVID-19.
Ó 2020 Society for Adolescent Health and Medicine. All rights reserved.

On March 11, 2020, the World Health Organization declared COVID-19 in the U.S. had surpassed one million and over 90% of
the novel coronavirus outbreak (COVID-19) a global pandemic the population was under some form of “stay-at-home” guidance
[1]. Shortly thereafter, the U.S. declared a national emergency [2]. Within that short period, the pandemic and social distancing
and local and state governments took various measures to slow measures significantly impacted daily life for adolescents,
the spread of the virus. By the end of April, confirmed cases of resulting in school closures, movement to remote learning, re-
strictions on leaving their homes, and the inability to gather with
friends. Although data are now forthcoming regarding the pan-
Conflicts of interest: The authors declare no conflicts of interest.
* Address correspondence to: Adam A. Rogers, Ph.D., School of Family Life,
demic’s impact on individuals, including adults’ mental health,
Brigham Young University, JFSB 2086, Provo, UT 84602. [3] adolescents’ own experiences with the pandemic and its
E-mail address: [email protected] (A.A. Rogers). implications for their well-being remain relatively unknown.

1054-139X/Ó 2020 Society for Adolescent Health and Medicine. All rights reserved.
https://doi.org/10.1016/j.jadohealth.2020.09.039
44 A.A. Rogers et al. / Journal of Adolescent Health 68 (2021) 43e52

COVID-19 will remain a part of life for some time, and social COVID-19 (April 2020). We used a mixed-methods approach,
distancing continues to be among the strongest measures relying on adolescents’ open-ended descriptions of their expe-
available to combat its spread. As governments and institutions riences with COVID-19 and quantitative items regarding
shift in response to the pandemic, the inclusion of adolescent perceived changes in relationship dynamics and mood. This
perspectives is critical for orchestrating safe environments that approach assessed depth and breadth in adolescents’ subjective
remain supportive of adolescent well-being. experiences with COVID-19. Second, we explored whether these
We report results from a longitudinal mixed-methods study perceived changes in relationship dynamics and mood were
of U.S. adolescents that started before and ran during the first associated with depressive symptoms, anxiety symptoms, and
months of the COVID-19 pandemic. We explored adolescents’ loneliness during COVID-19, above and beyond mental health
subjective experiences of how COVID-19 had affected their re- levels prepandemic (October 2019). We hypothesized that ado-
lationships and their mood states. We then examined whether lescents who reported adverse changes in relationship dynamics
these perceptions were associated with their mental health and mood during COVID-19, such as decreased social support or
above and beyond their prepandemic mental health levels. increased negative affect, would report greater depressive
symptoms, anxiety symptoms, and loneliness, above and beyond
COVID-19 as a unique challenge to the adolescent experience prior mental health status.

Adolescence sees significant shifts in interpersonal relation- Method

ships, particularly with parents and peers. Physiological changes
associated with puberty usher in an increased sensitivity to so- Sample and procedure
cial belonging [4], and attachment needs shift to friends and
romantic partners to accommodate growing independence from Data were drawn from Project AHEAD (Advancing Health and
parents [5]. Adolescents spend more time with friends than with Education for Adolescent Development), a two-wave longitudi-
parents, and the parent-child relationship experiences tension nal study of adolescent development in the U.S. Adolescents
around adolescents’ emerging independence [6,7]. During this were reached through a third-party research service, Bovitz,
time, parent-child conflict intensifies [8] and parent-child in- which retains a nationally representative database of research
timacy slightly declines [9]. Meanwhile, friendships and participants gathered through digital advertising channels (e.g.,
romantic relationships emerge as a key source of social support social media, search engines) and address-based sampling
and identity exploration [10], as well as a unique training ground methods (e.g., mailing lists). A stratified random sample of par-
for long-term social competencies [11,12]. Many of the changes ents/guardians of adolescent children was drawn from this
during the early months of COVID-19 reshaped adolescents’ database, using national quotas for race/ethnicity, formal edu-
unique relational landscape. Social distancing measures cation, and child sex. Just under 1,000 parents were contacted
restricted interactions with friends and increased time spent at through the service’s online survey platform. A description of the
home with family. Prominent adolescent theories emphasize the study was provided that allowed parents to consent to their
importance of social environments that “fit” adolescent’s current child’s participation. Parents were then asked to provide the
developmental needs [13,14]. From this lens, COVID-19 and social survey to their adolescent child. In total, 609 adolescents
distancing may challenge adolescents’ unique intimacy and au- assented and completed the survey at time 1 (T1) in October
tonomy needs, creating a suboptimal person-environment fit 2019. Time 2 (T2) was administered between April 11 and April
that undermines mental health. 25, 2020. At both time points, participants completed question-
Adolescents also experience significant changes in emotion- naires assessing interpersonal relationships and mental health.
ality. On average, adolescents experience more intense positive The time 2 survey included additional questions about their
and negative emotions than adults, with higher frequency and experiences with COVID-19. Surveys took 30 minutes to com-
greater volatility [15]. Emotional experience plays a key role in plete and adolescents were compensated $10 USD per survey. All
the underlying mental health of youth [16], and so COVID-related procedures were approved by the Brigham Young University
stressors, such as worrying about infection and feeling socially Institutional Review Board.
isolated, may contribute to fluctuations in adolescents’ Of the original 609 participants, 407 completed both T1 and
emotionality. Positive and negative affect are two mood states T2 assessments and comprised the analytic sample. Attrition
that underlie the experience of day-to-day emotions. Positive analyses using t-tests and logistic regressions to compare those
affect is a high-arousal state of pleasure and engagement, such as who remained in the study with those who dropped out after T1
excitement and happiness; negative affect is a high-arousal state showed no differences on age, sex, ethnic minority status,
of aversive emotionality, including irritability and nervousness mothers’ education, depressive symptoms, anxiety, or loneliness
[17]. Positive and negative affect are relevant to adolescent (see Table 1 in online Supplemental Material for comparison of
mental health because fluctuations toward increasing negative T1 and T2 samples). Participants ranged from 14 to 17 years
affect and decreasing positive affect predict symptoms of (Mage ¼ 15.42, standard deviation ¼ 1.16), and resided in the four
depression and anxiety in youth, [16,18] and because adoles- major U.S. regions at rates comparable to U.S. Census estimates
cence is a sensitive period for developing internalizing symp- (18% Northeast; 22% Midwest; 41% South; 19% West) [20]. They
toms [19]. came from both urban (88%, includes suburban) and rural (12%)
communities and reported various racial/ethnic identities (52%
Current study White, 20% African-American, 17% Hispanic/Latinx, 3% Asian-
American, 1% American Indian or Alaska Native, 7% Mixed/
This study had two goals. First, we reported adolescents’ Other). Their parents had diverse educational backgrounds (27%
perspectives on how their mood states and their relationships high school or less, 42% some college, 30% 4-year college degree
with parents and friends changed during the early months of or higher). At time 2 (April 2020), the vast majority (94.8%)
 A.A. Rogers et al. / Journal of Adolescent Health 68 (2021) 43e52 45

resided in an area under “stay-at-home” guidance. A large ma- day). Items were averaged such that higher scores indicated
jority (79.1%) were receiving schooling online. Some were being higher levels of anxiety (a1 ¼ .92, a2 ¼ .94). Finally, loneliness was
homeschooled (12.5%), and some had school cancelled (1.7%). assessed using the Three-Item Loneliness Scale [25]. Participants
responded to three items (e.g., “I feel left out”) on a rating scale of
Measures 1 (hardly ever) to 3 (often). Items were averaged such that higher
scores indicated greater loneliness (a1 ¼ .86, a2 ¼ .84).
Open-ended responses regarding experiences with COVID-19. At
T2, adolescents were asked to provide brief open-ended re- Demographic controls. At T1, adolescents reported their sex,
sponses describing their experiences with COVID-19 and social mothers’ education, and racial/ethnic identity. Primary caregivers
distancing. To evoke responses about their relationships, they reported annual household income and adolescent address of
were asked, “Regarding the whole situation with COVID-19 and residence, which was coded for community of residence
social distancing, what has been the hardest thing for you in your (urbanized areas, population 50,000þ; urban clusters, pop.
relationships with your family or friends?” They were given a 25,000e50,000; and rural, pop. less than 25,000) and U.S. Region
follow-up: “Have any of these changes been good for your re- (Northeast, South, Midwest, and West) in accordance with U.S.
lationships with family or friends?” Concerning their mental and Census categorizations (see note in Table 2 for scaling) [20]. For
emotional health, they were asked, “Regarding the whole situa- analysis, dummy codes were created for African American, His-
tion with COVID-19 and social distancing, what has been the panic/Latinx, and Other ethnicities, with white/Caucasian as the
hardest thing for you mentally and emotionally?” In a follow-up reference group. The dummy variable for “Other” included Asian
question, they were asked, “Have any of these changes been good American, American Native, and mixed/other groups because each
for you, mentally or emotionally?” was too small to be treated as an independent group in the analysis.
Dummy codes were also created for urbanized areas and rural
Perceived relationship changes during COVID-19. At T2, adoles- communities, with the larger group of urban clusters used as
cents responded to six questions about how their relationships had reference.
changed during COVID-19, with the stem: “Since COVID-19, have
you noticed more or less of the following?” Three changes in parent Analytic strategy
relationships and friendships were measured: time spent with,
receiving support from, and conflict frequency. These six items Adolescents’ open-ended responses were analyzed with a
were rated on a five-point scale (1 ¼ much less than before, 2 ¼ less grounded theory approach, using inductive analysis rather than
than before, 3 ¼ about the same, 4 ¼ more than before, 5 ¼ much pre-existing theory [26]. The authors read participant responses
more than before) and were treated as single items. and used thematic analysis [27] to identify repeated patterns in the
data. These emergent themes formed the basis of a coding scheme,
Perceived mood changes during COVID-19. At T2, adolescents which was used by the first and third authors to categorize all re-
completed six items regarding mood changes during COVID-19. sponses. Inter-rater reliability was good for the coding process
They were presented with the stem: “Since COVID-19, have you (intraclass correlation ¼ .90), and disagreements were resolved by
felt more or less:” Six descriptors were included to assess posi- discussion among the authors. Once coding was complete, the first
tive and negative mood states that reflect elements of mood and second authors organized themes and codes hierarchically
examined in the affect literature (nervous, irritable, upset, dis- where appropriate (e.g., themes into subthemes) [28].
tressed, excited, happy; see the Positive and Negative Affect Quantitative data were then used to identify descriptive pat-
Schedule [PANAS]) [16,17]. All items were rated on a five-point terns among key variables. To test whether perceived changes in
scale (1 ¼ much less than before, 2 ¼ less than before, relationship dynamics and mood during COVID-19 were associated
3 ¼ about the same, 4 ¼ more than before, 5 ¼ much more than with mental health problems, we conducted separate hierarchical
before). We then averaged the six items into two subscales: linear regression models for depressive symptoms, anxiety symp-
Perceived Changes in Negative Affect (nervous, irritable, upset, toms, and loneliness. In step 1, demographic controls were entered
distressed) and Perceived Changes in Positive Affect (excited, (sex, race/ethnicity, income, mother education, community of
happy). Internal consistency was adequate for Changes in residence). At step 2, the T1 equivalent of the T2 outcome was
Negative Affect (a ¼ .85). The two items for Changes in Positive included as a control (e.g., T1 depressive symptoms were entered in
Affect were highly intercorrelated (r ¼ .70). the model predicting T2 depressive symptoms). Finally, in step 3,
perceived changes in relationship dynamics and mood during
Indices of mental health. At both time points, adolescents re- COVID-19 were entered as predictors. Thus, the model tested the
ported their mental health on three indices. Depressive symp- concurrent associations between perceived COVID-related socio-
toms were measured using the Children’s Depression Inventory emotional changes and their mental health at T2, while controlling
short version [21]. Participants completed 12 items indicating for prior mental health status prepandemic (e.g., T1 depressive
how often they had experienced symptoms in the past 2 weeks symptoms). Analyses were conducted in SPSS, version 26. Because
(e.g., “I feel cranky all the time” and “I am sad”) on a rating scale missing values were minimal (no more than .5% on any variable),
of 1 (rarely or none of the time) to 4 (most of the time). Items the SPSS default for listwise deletion was used.
were averaged such that higher scores indicated more severe
depressive symptoms (a1 ¼ .84, a2 ¼ .87). Anxiety symptoms Results
were measured using the seven-item Generalized Anxiety Dis-
order Scale [22], which has been shown to produce valid scores Open-ended responses regarding experiences with COVID-19
among adolescent respondents [23,24]. Participants rated their
symptoms over the past 7 days (e.g., “feeling nervous, anxious, or Several themes emerged among adolescents’ open-ended
on edge”) on a 4-point rating scale (1 ¼ never, 4 ¼ nearly every responses, indicating both negative and positive subjective
46 A.A. Rogers et al. / Journal of Adolescent Health 68 (2021) 43e52

Table 1
Themes and example quotes from open-ended responses about experiences with COVID-19

“Regarding the situation with COVID-19 and social distancing, what has been the hardest thing for you mentally and emotionally/for your relationships with family
and friends?”

n ¼ 309 Less In-Person Interaction

Missing friends or family
 “My mom was no longer able to take a flight to my state to visit me.” (Native American female, 17)
 “Not connecting with my friends.” (white male, 16)
 “The hardest thing is not having my friends around I don’t feel normal anymore.” (African American female, 16)
 “Not seeing my best friend who lives about a half hour away which is making me very emotional about missing her.” (white female, 14)
 “We have a large group of friends who get along very good together. I miss being with them all together.” (white female, 16)
 “It is so hard not seeing my friends and not being able to go out and have fun.” (white female, 15)
 “I just really miss my friends and my relationship.” (Hispanic female, 14)
 “Not being able to see and talk to my friends in person really puts a strain on your friendship.” (African American female, 16)
 “Not seeing my friends before I graduate and head off [to college].” (white male, 14)
 “We don’t have Sunday dinner together anymore I miss everyone being at my house.” (African American female, 14)
Electronic communication is not the same
 “I need to have face-to-face interaction with my friends.” (white female, 16)
 “We can only contact by social media.” (Asian American female, 14)
 “I only get to talk to them through snapchat and on the phone.” (white female, 14)
 “All my friends are still in touch on social media but it sucks not being able to go get a burger or something.” (African American male, 15)
 “We communicate about the same but it's not the same as seeing them in person and getting a hug from my grandma.” (white female, 16)
 “With social distancing and the schools closed and the state curfew, I don’t see my friends anymore. Video chats are OK but being in someone's
physical presence, that is how friendship and bonds are made and sustained.” (African American male, 15)
 “I don’t get to see my friends face to face. I don’t get to talk to them. Texting is a lot different than having a real conversation.” (white female, 14)
 “Not being able to see them, just video chat. Not the same.” (Hispanic female, 15)
 “With friends it's been a strain the only real time we spend is through online gaming.” (Hispanic male, 14)
Feeling Disconnected/Isolated
 “I haven’t been able to see my friends but I have been talking to them online everyday and for some reason I've recently been feeling like they don’t
actually care about me that much.” (white female, 14)
 “With friends it's we can't hang out, so like idk guys don’t talk on the phone we want to hang out and chill in person. So there isn’t much
communication going on.” (white male, 17)
 “With my friends, no one talks to me anymore.” (Hispanic male, 14)
 “It's been very hard to keep connected with my friends, it feels like we are drifting.” (white female, 14)
 I miss my friends, our communication is not the same.” (Hispanic female, 15)
 “I think maybe some friends might loose [sic] contact with me.” (white female, 14)
Don't have an outlet
 “[Not] having good outlets when I do feel down or upset.” (white male, 16)
 “Being away from my relationship and my friends. Being at school helped me relax and calm down. It was my break.” (African American female,
14)
 “Not having my friends to vent to when I need it.” (white female, 16)
n ¼ 117 Not Getting Out
Not going places
 “Staying inside, my mom only goes out for only absolutely needed things I have not been anywhere since March 10.” (white female, 14)
 “Not being able to go out in public.” (white male, 16)
 “Just the lack of going out for even a movie.” (white female, 14)
 “We can't even leave to go do anything. I can't even go to the store with my mom bc of this. I can't work to earn money for a car, like everything is
ruined and what's the point anymore.” (white male, 17)
Missing out on activities
 “It is hard emotionally because I miss all of the fun activities like chorus and doing the spring musical and all my music friends.” (white female, 15)
 “Not being able to play in my basketball team, this makes me really angry, sad, and depressed.” (Hispanic female, 15)
Cooped up and isolated
 “Sitting in the house all day and not really talking. My mom sleeps and my dad tinkers in the basement.” (African American male, 15)
 “I am alone a lot. (white female, 15)
 “I feel isolated” (white male, 14)
 “Being cooped up inside and board [sic].” (white male, 16)
 “These changes are not good for me. I feel like I am in jail.” (Hispanic male, 17)
n ¼ 81 Too much family time
 “My parents always know what I am doing it's hard to have privacy.” (Hispanic male, 15)
 “To actually get private time relaxing in my room. Everyone is home so there's always noise and someone knocking at my door.” (white female, 14)
 “Spending too much time at home everyone is on edge.” (white male, 14)
 “I spent time with my mom a lot before, now we're both so stressed and agitated that it’s putting a strain on our relationship.” (white male, 17)
 “I fight with my siblings a lot more.” (African American/white female, 14)
 “My family is annoyed because we are all spending so much time together.” (white female, 15)
 “My family supports me but it has been hard to have them all day long watching over me.” (Hispanic male, 17)
 “We're all home and can't go anywhere so we get kind of irritated and feel caged.” (white male, 14)
 “I'm with my family ALL THE TIME. We get on each other's nerves.” (white male, 16)
 A.A. Rogers et al. / Journal of Adolescent Health 68 (2021) 43e52 47

Table 1
Continued

“Regarding the situation with COVID-19 and social distancing, what has been the hardest thing for you mentally and emotionally/for your relationships with family
and friends?”

n ¼ 47 COVID-Related Angst
 “I'm worrying about my parents and grandparents getting Covid-19. Will they survive it? I'm afraid to hug my parents and grandparents. I could have
it and be asymptomatic.” (African American male, 15)
 “Worry that I might catch and give it to my mom. She has 3 different auto-immunes.” (white female, 15)
 “A few of my family members got sick and I thought they were going to die.” (African American female, 14)
 “I'm scared of getting the virus.” (white male, 15)
 “I feel helpless because so many people are getting sick.” (Asian American female, 16)
 “I feel so helpless that we cannot do anything about it” (Asian American male, 15)
 “I feel like after all this happens, I won’t look at things the same way” (Hispanic male, 16)
 “Just keeping calm from everything I hear on TV about COVID-19” (white male, 16)
 “I worry about what's gonna happen to our economy” (white female, 16)
 “This makes me sad, it is difficult to understand what is happening it's like we are part of a horror movie.” (Hispanic female, 15)
 “I'm nervous and sometimes I don’t know how to deal with it. My family doesn’t know how to deal with it either.” (Hispanic female, 14)
 “I cannot go to my great grandma's house (she is 87). Everyone is worried about germs with her.” (white female, 14)
n ¼ 28 In a Funk
 “I don’t feel like doing anything and I miss my friends.” (Hispanic male, 15)
 “Being able to stay happy and find reasons to get out of bed. Life has gotten very boring.” (white female, 14)
 “I sleep too much and have no schedule.” (white female, 15)
 “Having too much empty time at home.” (white female, 14)
 “I feel sad and bored.” (Hispanic male, 15)
 “Makes me lonely and depressed.” (African American/white female, 16)
 “Little harder to get through the day.” (white female, 15)
n ¼ 20 School Stress
 “Being able to get all of my daily school work done on time, it's mentally draining me.” (white female, 14)
 “Trying to focus on school work while worrying about staying safe.” (African American male, 17)
 “Stressing over my grades staying up” (white male, 14)
n ¼ 13 No Difficulties
 “Nothing comes to mind.” (African American male, 17)
 “Honestly, nothing.” (white female, 17)

“Have any of these changes been good for you mentally and emotionally/for your relationships with family or friends?”

n ¼ 169 There are No Benefits

 “No” (white female, 14)
 “Not at all, truth be told” (African American male, 17)
 “It's just been hard” (white male, 14)
 “No, it has mostly been bad mentally and emotionally” (Hispanic female, 15)
 “Not really, I get a little depressed sometimes because I'm missing out on my high school years.” (white male, 14)
n ¼ 91 More Time with Family
 “Getting to spend more time with my dad because he doesn’t have to go to work.” (white male, 16)
 “It's brought me closer to my brother.” (white male, 15)
 “We do a lot together, my dad is getting creative ways to get us learn and things for us to do.” (Hispanic male, 15)
 “I still have my mom and dad here with me. My dad still helps me work on my baseball skills.” (Hispanic male, 14)
 “Helping my mom more.” (white male, 14)
 “It made me talk to my parents a lot more so I have a better understanding of family stuff.” (white female, 14)
 “My relationship with my parents and other relatives seems much better. We're all talking much more, about the news, each other, emotional stuff.”
(African American male, 15)
 “With my father, I find that he cares more for me than I thought” (African American female, 17)
 “Yes, I love being with my mom.” (white female, 14)
 “Spending more time with my brother has been fun.” (white female, 17)
 “Yes I have a better bond with my mother and sister although my sister still gets on my nerves lol.” (African American male, 16)
 “I get to spend more time with my family and brother and sister, which is nice. But they still drive me nuts.” (white male, 14)
 “Maybe cuz my parents kinda know me a little better now.” (white male, 16)
n ¼ 40 More Time for Myself
More clarity
 “I have been able to focus more on self-care which is good for my physical and mental health.” (white female, 14)
 “I guess I can say that this time has given me the opportunity to think and realize how important people are to me.” (African American female, 16)
 “I'm trying to learn how to meditate.” (African American male, 15)
 “I guess I now feel a bit more relaxed than usual” (African American male, 15)
 “I have more time to think about how to be a better person by the time this is over.” (Hispanic male, 15)
Fewer social stressors
 “Not going to school means not being bullied so I'm good.” (white male, 16)
 “No friend drama.” (white female, 17)
 “More time for myself without hearing friends problems” (African American/white female, 17)
Do activities that I want
 “So good for me, I have had a lot of time to myself to focus on myself and I think it's amazing.” (white female, 15)
 “I am able to exercise more.” (Asian American male, 15)
 “I really enjoy the me-time a lot.” (white male, 14)
 “I get to sleep more and I like that.” (African American/white male, 14)
(continued on next page)
48 A.A. Rogers et al. / Journal of Adolescent Health 68 (2021) 43e52

Table 1
Continued

“Have any of these changes been good for you mentally and emotionally/for your relationships with family or friends?”

n ¼ 19 Improved Friendships
 “It has been good for our friendships that we can now talk about more personal things going on, such as how we are impacted by covid-19.” (white
female, 14)
 “Some changes have been good because I don’t hang around people that's not good for me.” (African American female, 16)
 “I now know who my best friends are because we try to connect daily.” (African American male, 15)
 “Makes me appreciate my friends more.” (Hispanic female, 15)

experiences with COVID-19. We summarize these themes and parents and grandparents. I could have it and be asymptomatic”
refer the reader to Table 1 for more examples of each. (African American male, 15). Adolescents also felt confused and
helpless about the current state of the world in general and its
future. One stated, “This makes me sad; it is difficult to understand
Challenges of COVID-19 what is happening it’s like we are part of a horror movie” (Hispanic
female, 15). Another expressed, “I feel so helpless that we cannot
Less In-Person Interaction (n ¼ 309): Many adolescents do anything about it” (Asian American male, 15).
identified the inability to physically gather with others as “In a Funk” (n ¼ 28): Another group reported emotional dif-
distinctly challenging. This typically referred to friends and ficulties and struggled to get going, as if they were “in a funk.”
romantic partners, but occasionally also included extended and They said that the lack of routine was challenging and led to
nonresidential family members. One adolescent stated, “The feelings of lethargy and sadness. In describing the most chal-
hardest thing is not having my friends around I don’t feel normal lenging thing for her, one adolescent said, “I sleep too much and
anymore” (African American female, age 16). Another said, “My have no schedule” (white female, 15). Another stated, “I don’t feel
mom was no longer able to take a flight to my state to visit me” like doing anything.” (Hispanic male, 15).
(Native American female, 17). These adolescents expressed a School Stress (n ¼ 20): The shift to online, remote learning
desire for emotional connection and social support. One created mental and emotional strain for others. One participant
adolescent expressed, “With my friends, no one talks to me noted that “Being able to get all of my daily schoolwork done on
anymore” (Hispanic male, 14). Digital means of connecting with time is mentally draining me” (white female, 14).
friends (e.g., face-time, online gaming) were often said to be
insufficient (e.g., “All my friends are still in touch on social media
but it sucks not being able to go get a burger or something” [African Positives of COVID-19
American male, 15]). Some felt they lacked an emotional outlet.
“Being away from my relationship and my friends [is hard]. Being There are no positives (n ¼ 169): In response to being asked if
with them helped me relax and calm down. It was my break,” one there were any positives about these changes, either emotionally
adolescent remarked (African American female, 14). or relationally, many reported that there were none (e.g., “no” or
Not Getting Out (n ¼ 117): Some adolescents were frustrated by “not at all”).
the inability to get out of the house. This included the inability to More Time with Family (n ¼ 91): Some reported positives in
socialize in outdoor settings with friends and family (e.g., “Staying the increased time with family. Being able to spend more time
inside, my mom only goes out for only absolutely needed things, I have with parents and siblings was enjoyable and a source of social
not been anywhere since March 10” [white female, 14]); the inability support. “I still have my mom and dad here with me. My dad still
to participate in activities that were important to them, such as helps me work on my baseball skills,” one adolescent said (His-
sports, choir, school plays, and prom (“Not being able to play in my panic male, 14). For these adolescents, the time together also
basketball team, this makes me really angry, sad, and depressed” resulted in improvements to their relationships, including more
[Hispanic female, 15]); and feeling cooped up, restless, and bored closeness and discovering new things about each other.
(e.g., “Sitting in the house all day and not really talking. My mom sleeps More Time for Myself (n ¼ 40): Other adolescents enjoyed the
and my dad tinkers in the basement” [African American male, 15]). increased personal time. Having this extra time helped them
Too Much Family Time (n ¼ 81): Some adolescents reported slow down, relax, and achieve more clarity (e.g., “I have been able
difficulties arising from increased time with their families, noting to focus more on self-care which is good for my physical and mental
particularly the lack of privacy and personal space. One partici- health” [white female, 14] and “It’s giving me more time to medi-
pant expressed, “To actually get private time relaxing in my room is tate and clear my mind of things” [African American male, 15]).
hard. Everyone is home so there’s always noise and someone Others appreciated having more time for solitary activities (e.g.,
knocking at my door” (white female, 14). For some, this led to “I am able to exercise more” [Asian American male, 14]).
increased irritation with one another and caused tension and Improved Friendships (n ¼ 19): A subgroup said that COVID-
conflict. One participant described, “I spent time with my mom a 19 and social distancing had led to improvements in their
lot before, now we’re both so stressed and agitated that it’s putting a friendships, often by proving these relationships (e.g., “I feel like I
strain on our relationship” (white male, 17). have found who my real friends are because they make an effort to
COVID-Related Angst (n ¼ 47): Some adolescents expressed text me every day” [white female, 15]).
fear and anxiety surrounding the virus. They expressed concerns
about their own and their family’s safety, and specifically the Quantitative results
possibility they could spread the virus to a loved one. One
participant stated, “I’m worrying about my parents and grand- Means and standard deviations for all continuous study vari-
parents getting Covid-19. Will they survive it? I’m afraid to hug my ables are presented in Table 2. On average, adolescents reported
 A.A. Rogers et al. / Journal of Adolescent Health 68 (2021) 43e52 49

Table 2 COVID-19. They spent far more time with their families and
Means and standard deviations for continuous study variables at both time- reported overall increases in family support with a slight
points
decrease in family conflict. They also spent far less time with
Time 1 Time 2 friends and reported decreases in conflicts/disagreements with
Mean (SD) SD Range Mean SD Range friends and slight overall decreases in friend support. Concerning
Depress. symptoms 1.75 .52 1.00e3.58 1.84 .56 1.00e3.75 mood changes, the majority of adolescents reported increases in
Anxiety symptoms 1.64 .77 1.00e4.00 1.85 .79 1.00e4.00 negative affect and decreases in positive affect during COVID-19
Loneliness 1.30 .47 1.00e3.00 1.44 .53 1.00e3.00 (histograms and response counts for each item are available in
NA – – – 3.24 .80 1.00e5.00 Figures 1 and 2 in the online Supplemental Material).
PA – – – 2.52 .81 1.00e5.00
We then examined whether these perceived socio-emotional
Time - parents – – – 4.41 .85 1.00e5.00
Sup e parents – – – 3.87 .87 1.00e5.00 changes during COVID-19 varied according to background char-
Con e parents – – – 2.76 1.00 1.00e5.00 acteristics for sex, ethnicity, community of residence, U.S. region,
Time e friends – – – 1.43 .91 1.00e5.00 family income, and mothers’ education. One-way analysis of
Sup e friends – – – 2.92 .92 1.00e5.00
variances showed a few significant differences across these traits
Con e friends – – – 2.38 .94 1.00e5.00
Income 2.65 .83 1e4 – – – (see Table 2 in online Supplemental Material for full results).
Mother education 4.64 1.53 1e11 – – – Girls perceived greater increases in friend conflict than boys
during COVID-19. White adolescents perceived greater increases
“–” indicates the variable was not included at that time point. Perceived Changes
in: NA ¼ Negative Affect; PA ¼ Positive Affect; Time ¼ Time spent with; in family conflict than Latinx adolescents and less family support
Sup ¼ support; Con ¼ conflict. There were significant mean level increases in than African American adolescents. Adolescents from urban
depressive symptoms (d ¼ .19), anxiety symptoms (d ¼ .27), and loneliness communities perceived more pronounced declines in positive
(d ¼ .28) between time 1 and time 2. Demographic background characteristics affect and greater time spent with family than adolescents
were coded as follows: sex (1 ¼ male, 2 ¼ female); mother education (1 ¼ no
formal schooling, 2 ¼ less than high school, 3 ¼ high school/GED, 4 ¼ some
residing in rural communities. We also examined zero-order
college, 5 ¼ 2-year college degree, 6 ¼ 4-year college degree, 7 ¼ master's degree, correlations with indicators of socio-economic status. Adoles-
8 ¼ doctoral degree, 9 ¼ professional degree), family income (1 ¼ less than cents from lower income households perceived greater increases
$20,000; 2 ¼ $20,000e$35,000; 3 ¼ $35,000e$50,000; 4 ¼ $50,000e$75,000; in negative affect and more pronounced decreases in positive
5 ¼ $75,000e$100,000; 6 ¼ $100,000e$150,000; 7 ¼ $150,000e$200,000,
affect. They also perceived greater conflict with parents and less
8 ¼ $200,000 or more); race/ethnicity (1 ¼ African American, 2 ¼ Asian American
or Pacific Islander, 3 ¼ Hispanic or Latinx, 4 ¼ Caucasian or white, 5 ¼ Native support from friends during COVID-19 (see Table 3 for correla-
American, 6 ¼ Mixed or Biracial); community type (1 ¼ Urbanized Area, tions). There were no differences in COVID-19 perceptions across
2 ¼ Urban Center, 3 ¼ Rural). geographic region.

low levels of mental health problems at T1, which were relatively Perceived changes during COVID-19 and associations with mental
stable over time, although paired samples t-tests revealed health. We then examined whether perceived changes in
small significant increases in depressive symptoms (t(406) ¼ 3.88, relationship dynamics and mood during COVID-19 were
p < .001; Cohen’s d ¼ .19), anxiety symptoms (t(406) ¼ 5.92, uniquely associated with mental health problems above and
p < .001; Cohen’s d ¼ .28), and loneliness (t(406) ¼ 5.52, p < .001; beyond mental health status prepandemic, as well as back-
Cohen’s d ¼ .27) from October 2019 to April 2020. Correlations ground characteristics for sex, race/ethnicity, family income,
among study variables are presented in Table 3. mother education level, and community of residence. Full results
of these models are presented in Table 4.
Perceived changes in relationship dynamics and mood. Adoles- In the hierarchical regressions for depressive symptoms at time
cents perceived various changes to their relationships during 2, demographic background characteristics (step 1) were generally

Table 3
Correlations among key study variables

Zero-order correlations

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

1. T1 Depression –
2. T2 Depression .69*** –
3. T1 Anxiety .70*** .57*** –
4. T2 Anxiety .47*** .66*** .56*** –
5. T1 Loneliness .69*** .54*** .71*** .42*** –
6. T2 Loneliness .50*** .64*** .50*** .62*** .53*** –
7. NA .06 .27*** .14** .44*** .10* .25*** –
8. PA .10* .24*** .09þ .34*** .08 .20*** .55*** –
9. Time e parents .13** .14** .02 .02 .05 .04 .09þ .03 –
10. Sup e parents .13** .11** .01 .03 .09þ .09þ .09þ .02 .31*** –
11. Con e parents .20*** .32** .19*** .20*** .15** .27*** .17*** .08 .07 .19*** –
12. Time efriends .03 .07 .01 .01 .01 .09þ .07 .11* .24*** .09þ .09þ –
13. Sup e friends .12** .20*** .10* .07 .19*** .20*** .11* .13* .02 .15*** .13** .23*** –
14. Con - friends .08 .11* .05 .11* .03 .03 .07 .10* .18*** .14** .25*** .29*** .08þ –
15. Income .28** .22*** .28*** .23*** .23*** .14** .12** .12* .06 .04 .12* .03 .13** .06 –
16. Mother Ed. .01 .08 .04 .04 .04 .01 .03 .04 .05 .01 .04 .02 .03 .12* .23*** –

Perceived Changes in: NA ¼ negative affect; PA ¼ positive affect; Time ¼ Time spent with; Sup ¼ support; Con ¼ conflict.
***p < .001, **p < .01, *p < .05, þp < .10.
50 A.A. Rogers et al. / Journal of Adolescent Health 68 (2021) 43e52

Table 4
Results of hierarchical multiple regression models predicting mental and emotional health indices from perceived changes during COVID-19

Depressive symptoms Anxiety symptoms Loneliness

b SE B b SE b b SE b
Step 1- Demographics
Sex .01 .04 .01 .04 .06 .03 .01 .04 .01
Race - African American .02 .05 .02 .11 .08 .06 .05 .06 .04
Race - Hispanic/Latinx .05 .05 .03 .10 .09 .06 .17 .06 .12*
Race e Other .11 .06 .06þ .13 .10 .05 .06 .07 .03
Community e Urban Area .01 .05 .01 .04 .08 .02 .01 .06 .01
Community e Rural .06 .06 .03 .01 .10 .01 .05 .07 .03
Income .01 .01 .03 .02 .02 .04 .02 .01 .06
Parent Education .03 .01 .08* .01 .02 .03 .01 .02 .01
R2¼ .04; F change in R2 ¼ 1.90ns R2¼ .03; F change in R2 ¼ 1.67ns R2¼ .02; F change in R2 ¼ .87ns
Step 2 - Predictors
Time 1 Mental health .69 .04 .64*** .56 .04 .50*** .55 .05 .49***
R2¼ .49; F change in R2 ¼ 42.18*** R2¼ .33; F change in R2 ¼ 21.71*** R2¼ .30; F change in R2 ¼ 18.61***
Step 3 - COVID responses
Perceived change in NA .13 .03 .18*** .28 .05 .28*** .09 .03 .13**
Perceived change in PA .05 .03 .07þ .14 .04 .14** .04 .03 .06
Perceived change in time .04 .02 .06 .05 .04 .05 .02 .03 .03
w/ family
Perceived change in .01 .02 .02 .02 .04 .03 .02 .03 .03
support-family
Perceived change in .07 .02 .13*** .03 .03 .04 .09 .02 .17***
conflict-family
Perceived change in time .04 .02 .06þ .01 .04 .01 .05 .02 .09*
w/ friends
Perceived change in .05 .02 .09* .02 .03 .03 .03 .03 .04
support-friends
þ
Perceived change in .01 .02 .01 .06 .04 .07 .01 .03 .01
conflict-friends
R2¼ .58; F change in R2 ¼ 31.14*** R2¼ .48; F change in R2 ¼ 20.73*** R2¼ .38; F change in R2 ¼ 13.61***

Time 1 Mental Health ¼ respective mental health indicator at T1; Dummy variables were created for African American (0 ¼ not African American, 1 ¼ African American),
Hispanic/Latinx (0 ¼ not Hispanic/Latinx, 1 ¼ Hispanic/Latinx), and Other (1 ¼ Asian-American, Native American, Other). Dummy variables were also created for Urban
Area (0 ¼ not Urban Area, 1 ¼ Urban Area) and Rural community (0 ¼ not rural, 1 ¼ rural).
***p < .001, **p < .01, *p < .05, þp < .10.

nonsignificant predictors of variance. The exception was a negative affect and conflict with friends were positively associated with
association with mothers’ education, such that adolescents whose anxiety at T2; perceived changes in positive affect were nega-
mothers had more formal education reported lower depressive tively associated with anxiety at T2. Adolescents who perceived
symptoms at T2. The addition of T1 depressive symptoms (step 2) more pronounced increases in negative affect and conflict with
accounted for a significant increase in variance explained friends during COVID-19, as well as those who perceived more
(DR2 ¼ .46, p < .001) and was the strongest indicator of adolescents’ pronounced decreases in positive affect, reported greater anxiety
depressive symptoms 6 months later. Regarding our main hy- symptoms in April 2020. These associations accounted for
potheses (step 3), adolescents’ perceived changes in relationship additional variance above and beyond anxiety symptoms at T1
dynamics and mood during COVID-19 accounted for additional (DR2 ¼ .15, p < .001).
variance explained (DR2 ¼ .09, p < .001), with several significant Loneliness at time two was unassociated with most de-
relations emerging. Specifically, perceived changes in negative mographic controls (step 1), except for a positive association
affect and conflict with family were positively associated with T2 with the dummy code for Hispanic/Latinx. Hispanic/Latinx youth
depressive symptoms. Perceived changes in friend support were reported higher levels of loneliness than white youth at T2. The
negatively associated with depressive symptoms. Interpreted, addition of T1 loneliness to the model (step 2) accounted for
adolescents who perceived greater increases in negative affect and additional variance explained (DR2 ¼ .29, p < .001) and showed
family conflict during COVID-19 reported higher depressive that loneliness at T1 was the strongest indicator of loneliness
symptoms in April 2020. Adolescents who perceived more 6 months later. Regarding the hypothesized relations (step 3),
pronounced decreases in friend support during COVID-19 also loneliness at T2 was positively associated with perceived changes
reported higher depressive symptoms in April 2020. These asso- in negative affect and family conflict and negatively associated
ciations were above and beyond their self-reported depressive with perceived change in time spent with friends. Adolescents
symptoms in October 2019, prior to the pandemic. who perceived more pronounced increases in negative affect and
Anxiety symptoms at time 2 were unassociated with any of family conflict and more pronounced decreases in time with
the demographic controls (step 1). The inclusion of T1 anxiety friends during COVID-19 reported higher levels of loneliness in
symptoms (step 2) accounted for additional variance explained April 2020, above and beyond their loneliness levels in October
(DR2 ¼ .30, p < .001) and showed that anxiety at T1 was the 2019. The inclusions of these variables accounted for additional
strongest indicator of anxiety symptoms at T2. Regarding the variance explained (DR2 ¼ .08, p < .001), above and beyond
hypothesized relations (step 3), perceived changes in negative loneliness at T1.
 A.A. Rogers et al. / Journal of Adolescent Health 68 (2021) 43e52 51

Discussion Mood fluctuations may also present challenges for adolescents

during COVID-19. Compared to adults, adolescents experience
COVID-19 has impacted adolescents’ lives significantly, yet more variable and intense emotions [15], which can play a role in
there is little data available to highlight adolescents’ subjective the elevated risk of mental health problems during this same
experiences with the pandemic and explore the implications for period [19]. From this lens, and given the various challenges
their mental health. We conducted a mixed methods study identified in relation to the pandemic, it is no surprise that ado-
among a U.S.-based sample of adolescents. First, we explored lescents experienced heightened negative affect and dampened
adolescents’ perceptions of how their relationships and positive affect during COVID-19. These increases in negative affect,
emotional lives had changed during the early months of COVID- particularly, were associated with greater depressive symptoms,
19 using qualitative and quantitative data. Second, we examined anxiety symptoms, and loneliness in April 2020, beyond prepan-
whether these perceived socio-emotional changes during demic mental health. One possible explanation is that
COVID-19 were related to their mental health challenges above COVID-related stressors may have challenged psychological and
and beyond their mental health status before the pandemic. This coping resources of some youth, leading to fluctuations in under-
study is among the first to provide insight regarding adolescents’ lying mood states that create vulnerabilities for mental health
self-reported experiences of COVID-19, as well as the implica- problems. It is also possible that adolescents with mental health
tions of COVID-19 for adolescent mental health. difficulties are more likely to experience or perceive more pro-
In both the quantitative and qualitative data, adolescents re- nounced and negative shifts in mood in response to COVID-19.
ported distinct changes in their friendships and family dynamics
during COVID-19. Particularly noted was the lack of in-person Implications and future directions
interaction with friends. Adolescents were spending far less
time with their friends, and despite the ability to interact elec- Adolescents reported additional experiences with COVID-19
tronically, they still noted a lack of emotional connection and a in our qualitative data that we could not examine further in
perceived decrease in overall friend support. Meanwhile, ado- our quantitative analyses because we did not include these
lescents reported much greater time spent with parents, a trend measures. These included the inability to leave their homes,
that our quantitative data suggested was generally taken posi- anxiety around contracting and spreading the virus, the loss of
tively. Adolescents perceived overall increases in family support daily routine, and struggling to focus on schoolwork. These
and some adolescents perceived decreases in family conflict themes help sensitize practitioners to other struggles faced by
during COVID-19. However, there was a significant minority who adolescents during this pandemic and will be fruitful avenues for
experienced increased conflict and/or decreasing support from continuing research on COVID-19. Notably, some adolescents in
parents. This suggests that although many families were func- our sample also reported positive experiences with COVID-19,
tioning well during the early months of the pandemic, some may including more quality time with family and more time to
have been uniquely challenged by changes in their family system. themselves. We believe that this signals opportunities for
Several of these perceived changes in friendship and family leveraging available resources (e.g., supportive family environ-
dynamics, in turn, were uniquely indicative of mental health ments) to promote resilience during the pandemic.
challenges above and beyond prior mental health status. Finally, our data indicated that background characteristics,
Perceived declines in friend support during COVID-19 related to particularly socioeconomic and geographic realities, shaped ad-
higher depressive symptoms, and perceiving more conflict with olescents’ experiences with COVID-19. For example, some of the
friends during COVID-19 related to more loneliness. Further- perceived impact of COVID-19 was more strongly felt for ado-
more, greater perceived increases in family conflict during lescents residing in urban environments and lower income
COVID-19 related to more depressive symptoms and more households. Indeed, families from certain communities, but
loneliness. It is possible that social distancing guidance changed especially from disadvantaged or marginalized backgrounds,
friendship and family dynamics, which may have strained ado- have been disproportionately affected by the pandemic [33].
lescents’ affiliation needs, potentiating declines in mental health. Continuing research on COVID-19 and related practice should be
Friendships become uniquely important sources of attachment, sensitive to how such factors shape adoelscents’ experiences
intimacy and social support during adolescence [29], and a with COVID-19.
perceived unavailability of friends can undermine these needs.
Meanwhile, the parent-child relationship is experiencing a Limitations
renegotiation of boundaries to facilitate emerging autonomy
needs [7e9]. Our data suggested that changes in family dynamics Limitations of the study must be acknowledged. Our quali-
during COVID-19 challenged autonomy needs for some (e.g., less tative assessments elicited brief responses, and so adolescents
privacy and personal space) and engendered significant psy- likely have additional experiences or perceptions of COVID-19
chological distress [30]. The opposite direction is also possible; that they did not share in this study context. It is also possible
mental health problems can shape perceptions of social support that some of the associations between perceived mood changes
and the quality of interpersonal interactions. This is consistent during COVID-19 and mental health can be explained by
with the stress generation theory of depression [31] and sup- conceptual overlap between affective states and mental health
porting research that shows that adolescents with depression status. The use of factor analytic techniques should be considered
perceive their social relationships to be more negative, which in in future studies that can partial shared variance among vari-
turn exacerbates their depression [32]. As such, mental health ables. Finally, although our study benefitted from survey
challenges may have shaped adolescents’ perceived or actual assessments before and during the pandemic, the situation with
relationship dynamics during early COVID-19. Thus, our findings COVID-19 continues to evolve rapidly in the U.S. It will be
also might point to mental health challenges as being a distinct important to continue tracking how these developments will
risk factor undermining coping efforts during COVID-19. continue to affect adolescent health.
52 A.A. Rogers et al. / Journal of Adolescent Health 68 (2021) 43e52

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