The global coronavirus pandemic will surely leave psychological consequences and is having an impact already. It is expected that some children and young people may develop more serious psychological consequences in the form of a stress response, an adjustment disorder or even a post-traumatic stress disorder. It is the result of exposure to stress and fear due to the uncertainty that is accompanying the growing coronavirus pandemic worldwide. Overwhelming media news with negative outcomes (news about hundreds and hundreds of people dying daily from neighboring and nearby European countries) is contributing to uncertainty, while at the same time misinformation from various online sources that claim this is a seasonal flu variant that is dangerous only to the elderly, reduce the severity of the situation.

Verified and scientifically based information contribute to reducing uncertainty and fear

Well organized public services, that provide us with proven and scientifically based information, help reduce uncertainty and fear. But at the same time, many restrictions are being imposed, external borders are being closed. Our country, with 4.5 million people, is quarantined, all of which causes understandable reactive fear in youth, similar to that of adults, while children may be overwhelmed by uncertainty and consequently have anxiety symptoms.

Those who have had a psychological disorder or were anxious or depressed are certainly more vulnerable. Particularly vulnerable to new trauma may be children and young people who have been victims of some form of abuse, who often have post-traumatic stress disorder and are more susceptible to external stressors. Those who are anxious may become even more anxious, those who are depressed more depressed, those who cannot distinguish reality from the fantasy world can, for example, develop a belief that they are “guilty” of a pandemic or another distorted belief, that can lead to additional complications. At the very least, for people on the road to recovery, the recovery process may be slower or delayed.

Isolation contributes to the feeling of fear, especially in sensible children and youth

One of the specifics of the pandemic is isolation. Isolation is being imposed everywhere, state borders are closing, quarantine is often spoken about in public. Isolation in itself represents an unfavorable modality of functioning of society and civilizations, but also of the individual and family. Isolation will contribute to the feeling of fear, especially in sensible children and youth, as well as those with previously named risk factors, by increasing unpredictability, although no one is completely immune to fear and uncertainty that isolation leads to.

Online schooling and having regular school classes contribute to the normalization of children’s everyday life. In such situations, maintaining online school and communication with peers in the virtual world contributes to reducing feelings of isolation. It is adult and parental responsibility to explain to children in a new situation how by doing so, staying at home and fulfilling their main assignments from home, they actually contribute to the control of the pandemic through one fundamental aspect: there is no contact and therefore no infection transmission. This can be a way for children and young people to truly feel their contribution to combating the disease, which contributes to the empowerment and reduction of feelings of fear, and can represent the beginning of the development of resilience to stressors.

When to seek professional support and advice

In children and youth that are experiencing psychological difficulties related to fearful and threatening situations, it is important to seek help and advice on time to avoid complications and, if possible, to prevent the development of posttraumatic stress disorders. The first person to contact may be the child’s pediatrician or school psychologist. Having a conversation with a trusted person can sometimes help the child, such as an empathetic teacher or supportive and caring family member. If necessary and in the case of persistent problems, the assessment and support of mental health professionals specialized in working with children and adolescents, child psychiatrists or psychologists and psychotherapists, may be needed.

About posttraumatic stress disorder, 

Posttraumatic stress disorder is a psychiatric disorder that has existed since urbanization, but has been accurately described and diagnosed in the second half of the 20th century.

A traumatic event is any event that occurs suddenly and is inherently outside boundaries and limits of everyday experience, and as such brings into a state of a kind of shock and acts on the internal world of almost anyone affected by it, regardless of gender, age, previous mental abilities and previous life experiences. However, a traumatic event is not always shocking, and does not always lead to psychological trauma.

In order for psychological trauma to occur, a prior adaptation of the internal world must take place. To accept a traumatic event, the child must be able to understand that he or she is in danger or is witnessing something that is frightening or at least uncertain from the child’s worldview. Furthermore, at the very least, the child feels uncertainty in the environment, most importantly in the most important persons – parents. The child also feels helpless and registers at least one implicit or explicit traumatic memory.

Thus, in situations when children perceive danger, threat, their own helplessness to do anything, and process it in memory, it is expected that children express at least one or more symptoms that refer to psychological stress reaction, posttraumatic stress disorder, or psychological trauma.

Risk factors for the development of stress reaction difficulties in children

The risk factors that determine whether a child will develop difficulties from spectrum of stress responses are pre-existing psychiatric or physical disorder (referred to as comorbidity or comorbid condition), previous exposure to traumatic experience such as car accident, exposure to bullying or previous severe physical illness. The role of parents is also important, and their attunement and availability to provide emotional support to the child. The greater personal involvement in the traumatic event and the degree of exposure are, the greater the risk for developing stress reactions is.

These days, as in the immediate past, all of us, along with all our contemporaries on a global level, are witnessing coronavirus global pandemic. Again in everyday life we ​​hear words that come from the past or from another time, words like “quarantine, isolation, forty days of quarantine, two weeks of isolation, self-isolation”, that are all terms that do not belong to the everyday life of modern man, especially not everyday life of children and youth.

Our reality has changed

Gradually, the idea of ​​the currently present disease was drawing into our consciousness and everyday life. Until recently, what with time developed into a global pandemic, was perceived as a remote and exotic disease that exists in one equally distant and exotic country from another continent. We became gradually exposed to many information by the media, that we do not know where to place it or what to do with it. Suddenly, our reality is fundamentally changing from one everyday life, which had its current problems that we have learned to solve along the way, and have already started to look forward to longer days and the coming spring. Now we are in a situation of uncertainty, which can potentially become the point of change after which the world will no longer simply be the same. Slowly in the distance, as if the world as we know it was disappearing, something new appeared, a new way of working, living, studying, socializing, and last but not least, something unknown to us.

Let us not deceive ourselves, the reality in this situation is different, altered, though some are not yet able to grasp it. On the basis of knowledge of the medical history so far, many people can expect lasting consequences, both for adults as for children and youth. The reality we live in is changing, perhaps becoming more unpredictable with some new and not yet met circumstances. Children and young people who have been isolated, quarantined, who have lost loved ones or are in a situation to see that their loved ones, their friends, or persons they know, for example, someone’s grandparents, become ill and die, will surely have at least some consequences. These are frightening events for the child’s internal world, though not all of them will develop a psychological disorder.

Written by: Dijana Staver, MD, specialist psychiatrist

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