While everything seems to be back to normal, many adolescents struggle with anxiety attacks, depressive moods or eating disorders. Throughout Germany, the demand for therapy places for children and young people has increased enormously. Are young people in a psychocrisis? And what can help?
It feels like the corona pandemic is over, daycare centers and schools are operating normally, training is underway in sports clubs, music schools are open again. But the psychological consequences of lockdown times, social distance and fears of infection are only now becoming visible, especially for children and young people. In a survey of its own insured, the health insurance company DAK recently came to worrying numbers.
According to the study, there were 54 percent more eating disorders and 24 percent more anxiety disorders among girls aged 15 to 17, 23 percent more depression among girls aged 10 to 14 and 15 percent more obesity among boys aged 15 to 17. The results largely correspond to those of other funds. “More and more figures show that something has happened here,” says Prof. Jörg Fegert in an interview with ntv.de. The head of the clinic for child and adolescent psychiatry and psychotherapy at the University Hospital Ulm can compare the current figures with various studies in which the psychological stress in children and adolescents was recorded even before Corona. Above all, one can clearly see an increase in anxiety and depression symptoms among adolescents.
For Fegert, this can be explained in a comprehensible way. The increase in fears can be seen “because social avoidance was part of the anti-pandemic program,” he says. For example, anyone who has not spoken in front of a class for a long time is now very excited when they give a presentation. In addition, more children and young people with eating disorders are being treated in hospitals. It is not yet clear what the child protection cases will look like. In the youth welfare statistics of the federal government, there is a simultaneous increase in child endangerment and a decrease in the assistance granted, the taking into care and accommodation in homes. “One can calculate that there is still a lot to be done.”
Members of the health care professions from child and adolescent psychiatry and child and adolescent psychotherapy report an enormous increase in demand for therapy places throughout Germany. In many places the offer is not sufficient, without longer waiting times it is hardly possible. Things aren’t looking much better in the clinics. There, too, the rush of people seeking help is currently difficult to cope with.
However, Fegert warns against assuming a general psychological crisis among adolescents. It is by no means worse for everyone. “Some are very heavily burdened, while others have gotten through the time quite well. You simply survived Corona better in a terraced house with a garden than with several people in a three-room apartment,” says Fegert. It’s not just about economic conditions, but also about all possible previous burdens. It has become more difficult, especially for young people who previously needed support. “If there is an alcohol problem, mental illness in the family or domestic violence, then it was more difficult for the children to avoid or escape at the time. So these effects have increased.”
Families that previously got along well, for example with an inclusion child with school support, would have lost support. Every family usually has a certain balance, but when a stone falls away, the whole thing becomes more unstable. If even several stabilizing factors are missing, things quickly become precarious. “Then it depends on the remaining resources, such as grandparents or friends, so that you can still hold out,” estimates the expert.
Children in transition phases also proved to be particularly at risk. “For example, when children came to school from kindergarten, it was more difficult for them to find their way into a new group,” explains the child and adolescent psychiatrist. The same applies to secondary school and, above all, to the transition to working life or to university.
The fact that so many adolescents with mental symptoms are reacting to the concentrated crisis with a pandemic, war and inflation has to do with several factors. The children and young people are in the middle of their development, and the exchange with their peers is particularly important to them. However, this was neglected due to the restricted everyday life. Instead, the corona measures brought loneliness for many, increased media consumption and few opportunities to escape constant parental attention. This was already shown by a survey by the Bertelsmann Foundation 2021 and, among many others, the COPSY study on the effects and consequences of the Covid-19 pandemic on the mental health of children and adolescents in Germany. There was also a lack of sporting activities to compensate.
On the other hand, the burden has to do with the shorter lifespan. Adolescents simply lack the biographical experience that one can overcome crises. At the same time, they themselves have much less creative leeway than adults and they notice their major concerns. “There are hardly any corona or war-free zones where you can play and laugh,” says Fegert, describing the major changes. These existential themes have not been so ubiquitous in many families for decades. When it comes to emotional states, children are extremely dependent on parental role models. “And if they sit in front of the television all the time and look at what has happened, then the children realize that the adults are in a different mood than usual.”
The experienced child and adolescent psychiatrist believes it is important, especially in a time of scarce resources, to look at how support can be bundled and best distributed. During the Corona period, Fegert helped develop flyers for the mental health prevention competence area, which provide parents and teachers with information about possible abnormalities and offers of help. The Baden-Württemberg Ministry of Social Affairs passed them on to resident doctors. The idea behind it is the so-called stepped care approach. With these tiered approaches, there are some offers, for example, as tips for parents. Mothers and fathers can do a lot with their children themselves so that they trust themselves more or trust themselves more. It often helps to ask questions, to exchange ideas about possible fears or to offer shared experiences. “I’m sure that would be enough in many cases.” The expensive specialist treatment appointments should then be given to those who need them most.
Fegert also sees the current crisis as an opportunity to think about whether it really makes sense that the health care system and youth welfare often do not work together. Networking the support systems has long been considered the key to better protection for children and young people. Since 2021, it has finally been defined in the law to strengthen children and young people (Child and Youth Strengthening Act – KJSG) as interdisciplinary action in feedback loops. Specialists in the health care professions, youth welfare and family courts can coordinate with each other via the medical child protection hotline, which is available around the clock. In reality, however, comprehensive cooperation is still too rare. Fegert is hoping for a similar breakthrough here as there was in Corona with online therapies. Therapists had been fighting for this for years, but they finally became possible during the pandemic.
According to the child and adolescent psychiatrist, what helps many children and adolescents the most now is the right life, as they were not able to lead it enough during the pandemic. This includes everyday school life, but above all “going out again, meeting with others, maintaining social contacts”. For many, sporting activities have fallen asleep, the lack of exercise is an important risk point for obesity, which in turn can lead to psychological problems. Even in times of crisis, life has beautiful sides that are still fun. “You will always remember the incision that changed a lot. But now it’s important to stick your nose out again.”