67Literature Review
Available online at https://e-journal.unair.ac.id/JPS/indexJPS. Volume 11 No 2. Nov 2022
e-ISSN:2716-358X; p-ISSN:2355-2409

Prevention of Mental Health Disorder among Adolescents during the
COVID-19 Pandemic
Aqidah Khariri1, Arya Ivan Mahendra1, Maesarah1, Nadhira Rahma Augustria1, Rayhan Alma Shafannisa
Heru1, Zulfa Zahra1
,2
1
Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
2
Department of Psychiatry, Faculty of Medicine, Universitas Syiah Kuala - Teaching Hospital Universi-
tas Syiah Kuala, Banda Aceh, Indonesia
ABSTRACT
Introduction: The COVID-19 pandemic has negative impacts on mental
health and is commonly found in adolescence. Mental health disorders,
such as anxiety and depression, can increase the risk of many physical
health problems and reduce performance in the work and social environ-
ments as well. Several studies about COVID-19 and anxiety showed that
the younger population (especially young adults) tended to have more anx-
iety. When compared to the older population, the younger population also
uses social media more often which can cause anxiety due to information
overload and misinformation. Objective: This literature review is aimed
to discuss further and broaden insight into the importance of mental health
awareness and efforts to prevent mental health disorders among teenagers
during the COVID-19 pandemic. Methods: Conduncting previous studies
from PubMed and Google Scholar using these following keyword (mental
health) AND (anxiety) AND (depression) AND (covid 19) AND (adoles-
cents) by the journal publication filter for the last ten years. Results: Health
promotions are mainly concerned with mental health determining factors
and hope for people to be healthy or healthier. Mental health promotions
intend to increase an individual’s mental capacity, overcome difficulties,
and encourage someone to seek the necessary health help if they feel men-
tal health disorder. It also promotes the prevention of stigma against men-
tal disorders. In the COVID-19 pandemic, protective intervention such
as resilience and enhanced social support plays important role in lifestyle
changes. Conclusions: Understanding the symptoms and prevention of
mental health disorders such as health promotion and protection from spe-
cific mental illnesses are becoming the primary prevention of mental health
problems.
ARTICLE INFO
Received: September 21,
2021
Revised: December 7, 2021
Accepted: December 10,
2021
Published: November 30,
2022
*) Corresponding Author:
[email protected]
air.ac.id
Keywords: Mental Health,
Anxiety, Depression, Covid 19,
Adolescents
This is an open access article
under the CC BY-SA license
(https://creativecommons.org/
lic enses/by-sa/4.0/)
DOI: 10.20473/jps.v11i2.29688
Cite this as: Khairiri. A., Mahendra. A. I., et al. “Prevention of Mental Health Disorder among Adolescents during the
COVID-19 Pandemic”. Jurnal Psikiatri Surabaya, vol. 11, no. 2, pp. 67-76, 2022, doi: 10.20473/jps.v11i2.29688

68 Jurnal Psikiatri Surabaya
INTRODUCTION
An individual’s health is not only physi-
cal but also includes mental health. Mental
health is an aspect that must be considered
since it is related to daily events that hap-
pened to an individual [1]. Mental health
disorder are a condition when there is an
impairment in the mental health of an in-
dividual which is characterized by chang-
es in emotional status, thinking, behavior,
or the combination of these changes [2]. It
can occur in all groups of age, from chil-
dren to the elderly. According to related
studies, the median age at onset occurred
during the neurodevelopmental, which is at
the age of adolescence, 14 years old, and
has a peak at the onset before the age of 18
years old [3]. This Corona Virus Disease
2019 (COVID-19) pandemic not only caus-
es physical problems, but also it becomes
a stressor and gives problems to mental
health. Self-quarantine and isolation have
negative impacts on mental health because
of loss of freedom, boredom, and separa-
tion from others [4]. Depression and anx-
iety have reported an increase three times,
compared to before quarantine. The most
affected groups are aged 16-44 years old,
women, and students [5].
According to the Centers for Disease Con-
trol and Prevention (CDC), physical and
mental health is equally important. Mental
health disorders, such as depression, can
increase the risk of many physical health
problems, especially long-term conditions,
for example diabetes, heart disease, and
stroke [6]. Meanwhile, during this pan-
demic, good immune and physical health
are needed to prevent getting the disease.
Therefore, this literature review is aimed to
discuss further and broaden insight into the
importance of mental health disorders and
efforts to prevent mental health disorders
among teenagers during the COVID-19
pandemic.
REVIEW
Mental Health Issues among Adoles-
cents during COVID-19 Pandemic
Definition
Anxiety is defined as mood and affect
disorders, including anxiety and fear. Anx-
iety is a feeling of anxiousness or unknown
fear and anticipation towards an unspec-
ified threat or object, whereas fear is an
emotional response to a known or immi-
nent threat or object. Anxiety is followed
by psychological and somatic components.
Psychological components such as anx-
iousness, nervousness and tension, a sense
of unsafe, scared, and easily startled and
the somatic components consist of palpi-
tations, sweaty palms, increase in blood
pressure, and heart rate [7, 8]. All of those
components above arouse in response to
an unreasonable perception of ascertaining
danger or threats. Anxiety disorders com-
monly found in adolescence are separation
anxiety disorder, generalized anxiety disor-
der, social anxiety disorder, and selective
mutism [9].
Based on DSM-5, anxiety can mani-
fest as excessive anxiety and worry, hy-
peractivity of the motoric and autonomic
nervous systems. In Generalized Anxiety
Disorder (GAD), free-floating anxiety is
the pathognomonic feature of this disorder.
Whereas, panic disorder is an immense at-
tack response with anxiety, confusion, and
unorganized hyperactivity which happen
episodically.
Depression is a mood and affects disorders
with psychological components and so-
matic components. Psychological compo-
nents present are sadness, worthlessness,
feelings of failure, loss, hopelessness, and
pathological guilt. The somatic compo-
nents included are anorexia, constipation,
clammy skin, decrease in blood pressure,
and heart rate. Depressive patients usually
have sleeping disorders, anorexia, and loss
of desire to work and socialize, and it is
commonly found to have a negative view
of the world and themself. Depressive dis-
orders can manifest as withdrawal from so-
ciety or can be seen as agitation or anxiety
[7, 9]. According to the Diagnostic and Sta-
tistical Manual of Mental Disorder – Fifth
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November 2022 69
Edition (DSM-5) included in Depressive
disorders are disruptive mood dysregula-
tion, major depressive disorder, persistent
depressive disorder, premenstrual dysmor-
phic disorder, depressive disorder induced
by substances/drugs, and depressive disor-
der due to other medical conditions [8].
Adolescence is a critical period of a
developmental and transitional stage in
humans. It is characterized by the matu-
ration of the brain and body, increased so-
cialization, improvement in abilities, and
the transition to independence. The devel-
opments are critical for both physical and
interpersonal skills required to live in so-
ciety, and those skills improve throughout
adolescence to adult levels [10]. According
to the World Health Organization (WHO)
and Indonesia’s Ministry of Health in its
program, an adolescent is a person aged 10
to 19 years. Whereas, according to Indone-
sia’s constitution No. 4 of 1979 regarding
child welfare, adolescents are individuals
who have not reached the age of 21 years
and are not married [11, 12].
Adolescence takes place through 3 stag-
es. Early adolescence (10-14 years) is char-
acterized by a rapid increase in growth and
physical maturation. Middle adolescence
(15-16 years) is characterized by almost
complete pubertal growth. They also de-
velop new thinking skills, recognize their
maturity, and establish emotional and psy-
chological distance from their parents. Late
adolescence (17-20 years) is marked by
preparation for adult roles, including clari-
fication of job goals and internalization of
a personal value system [12].
Epidemiology
The 2018 Indonesian Basic Health
Research data shows that mental health
problems are around 9.8%. It can further
increase with the current COVID-19 pan-
demic due to increased risk factors during
pandemic. Depression and anxiety are the
most common mental health conditions
in the general population with more than
264 million people affected [13–15]. At
its worst, depression can lead to suicide,
which is the second leading cause of death
in 15-29-year-olds with almost 800,000
death per year [16].
In 2015, about 4.4% of the world’s pop-
ulation experienced depression. Depres-
sion occurs in 5.1% of the total female pop-
ulation and 3.6% of the male population.
The prevalence of depression varies from
region to region in the world, with most
cases occurring in Southeast Asia (27%)
and the lowest in Africa (9%). Depression
can occur in all age groups and is highest
at the age of 55-74 years [14, 17]. Based on
data from Basic Health Research in 2013,
depression and anxiety disorders occur in
about 14 million people (6%) of the entire
population in Indonesia [18]. Depression
does not cause death directly. The number
of deaths due to depression is due to sui-
cide. There are about 42,000 suicide deaths
due to depression per year or about 13
deaths per 100,000 people [19]. The pres-
ence of depression also increases the risk
of death of a person with chronic diseases,
such as diabetes mellitus, cardiovascular
disease, and so on [20, 21]. According to
Basic Health Research (Riskesdas) records
from the Ministry of Health of the Repub-
lic of Indonesia 2018 [22], the prevalence
of emotional disorders in the population
aged 15 years and over increased from 6%
in 2013 to 9.8% in 2018. The prevalence
of depression sufferers in 2018 by 6.1%.
The impact of the COVID-19 pandemic
on psychosocial conditions in Indonesia is
also evident from the results of Moh Ab-
dul Hakim’s survey for 7 days at the begin-
ning of the PSBB or local lockdown and
the Policy Brief of the Social Psychology
Association [23]. Hakim’s survey results
showed that 27% of the 1,319 participants
experienced acute stress due to social re-
strictions, lack of basic needs, threats of
infection, and behavioral adjustments.
In Indonesia, one out of five people af-
fected by the COVID-19 pandemic may
suffer anxiety [24]. Several studies about
COVID-19 and anxiety show, the young-
er population (especially young adults) is
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70 Jurnal Psikiatri Surabaya
more prone to suffer anxiety compared to
the older population [25–27]. It happens
because most the young adults had to adapt
to additional changes in their daily routine,
such as a new online educational or work
environment [25]. Moreover, young adults
are also likely to overthink their future. The
delay in academic study has made students
feel anxious because it is considered that
it can interfere with their plans to continue
their further academic studies. In addition,
social media which is more used by young
adults often causes anxiety due to misinfor-
mation and/or information overload. Older
people are presumed to have less anxiety,
more resilience, and better emotional man-
agement because they have more life expe-
riences than young people [27].
Etiology
The etiology of anxiety disorder is caused
by an interaction of biopsychosocial fac-
tors. Clinically significant syndromes are
produced when genetic vulnerability inter-
acts with stressful or traumatic situations.
Anxiety can be caused by various rea-
sons, such as medication, substance abuse,
trauma, childhood experiences, and panic
disorders [28]. Some studies said anxiety
disorders are vastly heterogeneous and that
the relative roles of these factors are likely
to differ. For example, panic disorder has
a stronger genetic basis than others, how-
ever, it has not been identified yet. While
others are mostly based on stressful life
events [29].
The etiology of major depressive disorder
is multifactorial. On genetic factors, de-
pressed individuals’ children have a 3 times
greater risk of developing depression than
the general population. Apart from genet-
ics, environmental factors also play a major
role in depression. However, depression is
not always related to genetic factors, it can
also occur in people with no family history
[30, 31]. Based on some available evidence
it was found that the role of genetic factors
was lower in late-onset depression than in
early-onset depression. In the elderly, sev-
eral potential biological risk factors for de-
pression have been identified. Higher rates
of depression are mostly associated with
neurodegenerative diseases, stroke, seizure
disorders, cancer, and chronic pain. In ad-
dition, psychosocial risks, such as traumat-
ic events, lack of social support, caregiver
burden, financial problems, interpersonal
difficulties, and conflict can trigger depres-
sion [32].
Risk Factor
Anxiety
Teenagers from all over the world are
facing mental problems due to COVID-19.
Many adjustments must be done by soci-
ety, especially teenagers during this pan-
demic. These adjustments may become one
precipitating factor among several factors
that can affect the mental health of teenag-
ers during this pandemic such as stressful
life events, extended home confinement,
worries, excessive internet use, and social
media. Therefore, the individual’s ability
to seek and utilize all available resources
and therapies in these limited circumstanc-
es is very important [33].
Another particularly interesting risk fac-
tor is the status of an only child. Teenagers
who are only children tend to think their
parents are overprotective during this pan-
demic, which will result in more symptoms
of depression and anxiety. In addition,
during this pandemic, teenagers are also
isolated from their peers and other support-
ing adults. Therefore, sibling relationships
may be a protective factor for adolescents’
mental health, where the presence of sib-
lings can make them feel less lonely and
can also be a supportive persons for one
another [34].
One of the factors that should not be
ignored as well as the family health con-
dition. In a recent study, it was found that
when a teenager has a family member who
has a COVID-19 infection, they could be
predicted to have symptoms of depression
and anxiety. Children perceive their par-
ents would be more protective and harsh-
er toward them during the COVID-19
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November 2022 71
pandemic. Other risk factors that can also
place adolescents at a higher risk of mental
disorders during the pandemic are adoles-
cent girls, the upper class, the only child
in the family, and known family members
[34].
Depression
There are two types of depression risk
factors, which are specific and non-specific
depression risk factors. In terms of the spe-
cific ones, a parent’s history of depression
boosts their children’s risk by 2 to 4 times.
Poverty, marital violence, and child mal-
treatment are among the non-specific fac-
tors that raise the risk. There are protective
factors that include adequate family sup-
port, emotional abilities, and coping mech-
anisms. It helps people deal the problems
more effectively [35]. Adolescents with a
history of depression who have lost family
support often experience prolonged psy-
chological suffering.
During the COVID-19 pandemic, Senior
high school student is at risk factors for de-
pression and anxiety symptoms in terms of
grades; the higher the grade, the higher the
risk of depressive and anxiety symptoms
[36]. The unexpected death of someone
dear to them, such as family members or
friends, can increase the risk of depression.
The female gender has a higher risk fac-
tor for depression and anxiety symptoms
as well. Family confinement may be a
source of intra-familial violence during the
COVID-19 pandemic, particularly among
adolescent girls. Because women and girls
are more vulnerable to gender-based abuse,
adolescents escape the surveillance of ex-
perts or other adults who might have no-
ticed their discomfort in normal social sit-
uations, especially sexual violence. Harsh
lockdown, fear of infection, and its conse-
quences could increase the risk of depres-
sion as well [37].
Diagnostic Criteria
Diagnosis of depression contains the
triad of symptoms, which are depressed
mood, loss of interest or pleasure, and
loss of energy or increased fatigue. Other
symptoms include reduced concentration
and attention, reduced self-esteem and
self-confidence, feeling worthless or guilty,
pessimistic about the future, thoughts of
death or suicide, trouble sleeping or sleep-
ing too much, and changes in appetite
(weight loss or gain unrelated to dieting).
The symptoms appear for at least 2 weeks,
but shorter periods may be clarified if
symptoms are severe and progress rapidly.
As stated by DSM-5, Diagnostic for gener-
alized anxiety disorder is excessive anxiety
and worry that is difficult to control lasting
for at least 6 months about several events
and activities. The anxiety and worry have
to also be associated with three or more
of the following symptoms (with at least
some symptoms having been present for
more days than not for the past 6 months);
restlessness or feeling keyed up or on edge,
being easily fatigued, difficulty concen-
trating or mind going blank, irritability,
muscle tension, and sleep disturbance (dif-
ficulty falling or staying asleep, or restless,
unsatisfying sleep). These physical symp-
toms, anxiety, and worry cause clinically
significant distress or impairment in social,
occupational, or other important areas of
functioning. These complaints are not at-
tributed to the physiological effects of a
substance or another medical condition,
nor should they be better explained by an-
other mental disorder [8].
Mixed anxiety and depression disorder is a
category that should be used when symp-
toms of anxiety and depression are both
present, but neither is predominant, and
neither type of symptom is present to the
extent that justifies a diagnosis if consid-
ered separately. When both anxiety and de-
pressive symptoms are present and severe
enough to justify individual diagnoses,
both diagnoses should be recorded, and
this category should not be used.
Prevention of Mental Health Issues for
Adolescents during the COVID-19 Pan-
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72 Jurnal Psikiatri Surabaya
demic
Health Promotion
According to WHO, mental health pro-
motion is an activity to create supportive
environmental conditions and enable in-
dividuals to make healthy lifestyle adjust-
ments. It aims to strengthen and improve
health behavior and preventive measure-
ments which can help prevent and tapers
risk factors of diagnosable mental disorder
emergence [38]. Health promotions are
mainly concerned with mental health de-
termining factors and hope for people to be
healthy or healthier. In conclusion, mental
health promotions intend to increase an in-
dividual’s mental capacity, overcome diffi-
culties, and encourage someone to seek the
necessary health help if they feel mental
health disorder. In addition, health pro-
motion promotes the prevention of stigma
against mental disorders [39]. WHO ex-
plained that mental health policy covers the
promotion of mental health and is not lim-
ited to health, but also education, employ-
ment, justice, transportation, environment,
etc. Mental health promotion uses a system
or organizational approach, therefore, re-
quires the involvement of various sectors.
It includes whole organization such as the
government and not just medical person-
nel. In the end, mental health services are
for those who tend to need support before
serious problems occur [38].
The COVID-19 pandemic had a signifi-
cant impact on our lives. Many of us face
challenges that can create stress, exagger-
ate, and cause emotional changes in adults
and children [40]. There are many ways to
manage stress, including:
● Take a break from watching, reading, or
listening to the news
● Take care of your body: Take deep
breaths, healthy diet, exercise routinely,
rest accordingly, avoid excessive alcohol,
tobacco, and substance use, and get vacci-
nated with a COVID-19 vaccine as well.
● Try to practice your hobbies
● Talk about your concern and feelings to
someone you trust
● Participate more in your community on-
line, through social media, or by phone or
mail.
Effective intervention strategies and risk
factors for major mental health problems
differ according to the age and gender of
the target population [39]. In adolescence,
there are developmental changes due to
physical and chemical alteration in the
brain. These changes affect adolescents
mental health.
The most distressing issue for teenagers in
the pandemic is not being able to see their
friends, with the second place being fear of
their friends or family getting sick or dying
from COVID-19. On the contrary, they are
indifferent towards getting ill or dying from
COVID-19 [41]. Health promotion in ado-
lescents can involve all sectors, including
the education sector. What could be done is
to create a curriculum containing physical
and mental health to introduce teenagers
to a healthier life. In addition, for adoles-
cents outside of school, it may be possible
to do so through the leader of the residence
(village head, family head, and others). It
could be started with life skills training
to prevent the spread of COVID-19 and
maintain the mental health of teenagers.
COVID-19. For teenagers who use social
media, certain groups or sectors can carry
out health promotions such as conducting
seminars on mental health during a pan-
demic or online posters containing ways
of mental management during a pandemic
[38].
Protection from Specific Mental Illness
Modifying risk factors and reinforcing
protective factors are substantial to prevent
mental illnesses such as depression [42].
Depression has modifiable and unmodi-
fiable risk factors which predispose to an
increase in the onset, severity, and longer
duration of the health problems. Protective
factors are conditions that can increase peo-
ple’s resistance to risk factors and disorders
[42]. Risk factors and protective factors for
mental disorders include social, economic,
Khairiri et al./JPS, 11 (2): 67-76

November 2022 73
environmental, individual, and family fac-
tors. Risk factors of mental illness such as
lack of education, peer rejection, isolation
and alienation, poverty, access to drugs
and alcohol, violence, unemployment,
child abuse, and parental mental illness
during infancy and early childhood, etc.
are associated with increased incidence
of depressive disorder [42, 43]. Protective
factors such as empowerment, social sup-
port, positive interpersonal relationships,
etc. [42]. Preventive interventions such as
school-based programs targeting cogni-
tive, problem-solving, and social skills of
children and adolescents are reported to be
able to reduce major depressive symptoms
[44]. A study by Klim-Conforti et al., also
showed that cognitive-behavioral therapy
can reduce the incidence of suicide, emo-
tional management, self-concept, inter-
personal difficulties, depression, and anx-
iety in junior high school students during
the COVID-19 pandemic. Prevention of
risk factors is influenced by prenatal and/
or early childhood programs that can sup-
port parents’ skills by teaching them about
children’s behavioral patterns and social
skills [42, 45]. Based on the study by Wolf
et al., college student that does physical
exercise (moderate to intense particular-
ly) during the COVID-19 pandemic have
lower chances of presenting depression or
anxiety symptoms [46].
In the COVID-19 pandemic, protec-
tive intervention such as resilience and en-
hanced social support plays important role
in lifestyle changes (50,51). It is supported
by a study that shows that a high level of
resilience results in a low level of anxiety
[48]. Messages of hope and social protec-
tion when implemented in hospitals and
the community are said to enhance resil-
ience and the ability to successfully react
in social settings. These messages not only
discuss the actual risks of being infected
but also mentions containment measures
that are available (53). A higher and more
significant perception of social support can
reduce the likelihood of increased psycho-
logical distress and psychiatric conditions.
Therefore, effective communication and
adequate psychological services should be
implemented in the community to reduce
the psychological and psychosocial effects
of the COVID-19 Pandemic [49].
CONCLUSION
The COVID-19 pandemic gives rise
to various mental health problems among
adolescents, with the most frequent prob-
lems happening are depression and anxi-
ety. As previously explained, knowledge
about mental health is important, as well
as its effort to prevent health problems.
Both depression and anxiety are mood and
effects disorder which is also followed by
psychological and somatic components.
By understanding the symptoms well, we
could do some treatments to reduce fatal
incidents such as suicide. Health promo-
tion and protection from specific mental
illnesses are becoming the primary pre-
vention of mental health problems. Health
promotions for teenagers are best done at
school, such as creating a curriculum con-
taining physical as well as mental health
and life skills training. Besides that, social
media can also be helpful for mental health
promotion, especially in this pandemic era.
While specific protection is carried out by
modifying risk factors and reinforcing pro-
tective factors. Risk factors as well as pro-
tective factors are individual and can arise
from various aspects of life.
ACKNOWLEDGEMENT
This literature review is supported by
Clinical Years Students in The Department
of Psychiatry in the period from May 24th
to June 13th 2021. We would also like to
thank our lecturers in Departement of Psy-
chiatry, Faculty of Medicine, Universitas
Airlangga.
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