Mental Health Risks and Resilience Factors of Adolescents in Under‐Resourced Schools

The COVID-19 Pandemic: Setting the Mental Health Research Agenda

Deaths related to drug overdose and suicide in the USA have increased 500% and 35%, respectively, over the last two decades. The human and economic costs to society associated with these 'deaths of despair' are immense. Great efforts and substantial investments have been made in treatment and prevention, yet these efforts have not abated these increasing trajectories of deaths over time. The COVID-19 pandemic has exacerbated and highlighted these problems. Notably, some geographical areas (eg, Appalachia, farmland) and some communities (eg, low-income persons, 'essential workers', minoritised populations) have been disproportionately affected. Risk factors have been identified for substance use and suicide deaths: forms of adversity, neglect, opportunity indexes and trauma. Yet, the biological, psychological and social mechanisms driving risk are not uniform. Notably, most people exposed to risk factors do not become symptomatic and could broadly be considered resilient. Achieving a better understanding of biological, psychological and social mechanisms underlying both pathology and resilience will be crucial for improving approaches for prevention and treatment and creating precision medicine approaches for more efficient and effective treatment. The State of Ohio Adversity and Resilience (SOAR) study is a prospective, longitudinal, multimodal, integrated familial study designed to identify biological, psychological and social risk and resilience factors and processes leading to mental health disorders, substance use disorders, substance overdose, suicide and associated psychological/medical comorbidities which reduce life expectancy and quality of life. It includes two nested longitudinal samples: (1) WD Survey: an address-based random population epidemiological sample of 15 000 individuals (unique households) representative of the state of Ohio assessed for psychosocial, psychiatric, behavioural health and substance use factors and (2) Brain Health Study: a family-based, multimodal, deep-phenotyping study conducted in 1200 families (up to 3600 persons aged 12-72 years) including MRI, electroencephalography, blood biomarkers and psychiatric diagnostic interviews, as well as neuropsychological, psychosocial functioning and family/community history, dynamics and support assessments. SOAR is designed to discover, develop and deploy advanced predictive analytics and interventions to transform mental health prevention, diagnosis, treatment and recovery. All participants will provide written informed consent (or parental permission and assent for minors). The study was approved by The Ohio State University Institutional Review Board (study numbers 2023H0316 (Brain Health) and 2023H0350 (Wellness Survey). The Brain Health study was also approved by institutional review boards at each partnering institution involved in conducting participant assessments. Findings will be disseminated to academic peers, clinicians and healthcare consumers, policymakers and the general public, using local and international academic channels (academic journals, evidence briefs and conferences) and outreach (workshops and seminars).

BackgroundRecent studies have shown that air pollution is among the most important triggers of mental health risks. However, little is known about the resilience strategies that reduce mental health risks among individuals exposed to pollution. The interconnections of protective and risk factors further complicate the understanding of mental health resilience. Therefore, this study developed a resilience assessment framework accounting for factor interconnections to evaluate the short-term air pollution-related mental health resilience.MethodsAligned with mental health resilience theory, a Bayesian network model and network analysis were applied to construct a quantitative network of factor interconnections, analyzing 2019–2020 data for 24,261 older adults from the Shandong Aging and Mental Health Survey. On the basis of the network, mental health resilience was assessed via multiple-criteria decision-making method. The most influential pollutants, vulnerable populations and strategies to increase mental health resilience were then proposed.ResultsAir pollution exposure directly and indirectly affected mental health outcomes, defining a directional network where fine particulate matter emerged as the most influential pollutant. The mean index for short-term air pollution-associated mental health resilience was 0.52 ± 0.18. Resilience was significantly lower among females, adults aged 65–75, and less-educated individuals (mean index: 0.518 (95% CI: 0.515–0.521), 0.517 (95% CI: 0.515–0.520), and 0.516 (95% CI: 0.513–0.519), respectively). Memory lapses for sex/education disparities, irritability and feeling afraid for age disparities demonstrated the steepest disparities across demographic subgroups and bridge nodes—critical junctures that mediate resilience dynamics between populations. In terms of conditional probability, adjusting resilience factors proved more effective than merely reducing exposure.ConclusionsThis study has illuminated a directional network linking air pollution to mental health, with a specific focus on fine particulate matter. Thus, enhancing mental health resilience against air pollution requires a coordinated yet targeted approach, prioritizing interventions for fine particular matter exposure. Furthermore, policymakers should address resilience disparities by tailoring interventions to mitigate memory lapses (which exhibit sex/education gaps) and irritability and feeling afraid (associated with age-related vulnerabilities).Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-24052-w.

Mental health of displaced and refugee children resettled in high-income countries: risk and protective factors.

As young people's mental health difficulties increase, understanding risk and resilience factors under challenging circumstances becomes critical. To explore the outcomes of the COVID-19 pandemic on secondary school students' mental health difficulties, as well as the associations with individual, family, friendship, and school characteristics. For this cohort study, follow-up data from the My Resilience in Adolescence (MYRIAD) cluster randomized clinical trial were collected across 2 representative UK cohorts. Mainstream UK secondary schools with a strategy and structure to deliver social-emotional learning, with an appointed head teacher, and that were not rated "inadequate" in their latest official inspection were recruited. A total of 5663 schools were approached, 532 showed interest, and 84 consented. Cohort 1 included 12 schools and 864 students, and cohort 2 included 72 schools and 6386 students. COVID-19 was declared a pandemic after cohort 1 had completed all assessments (September 2018 to January 2020), but cohort 2 had not (September 2019 to June 2021). Cohort 2 was exposed to the COVID-19 pandemic, including 3 national lockdowns. Associations of individual, family, friendship, and school characteristics with students' mental health were explored. Changes in students' risk for depression (Center for Epidemiological Studies-Depression scale); social, emotional, and behavioral difficulties (Strengths and Difficulties Questionnaire); and mental well-being (Warwick-Edinburgh Mental Well-Being Scale). Of the 7250 participants included, the mean (SD) age was 13.7 (0.6) years, 3947 (55.4%) identified as female, and 5378 (73.1%) self-reported their race as White. Twelve schools and 769 of the 864 students (89.0%) in cohort 1 and 54 schools and 2958 of the 6386 students (46.3%) in cohort 2 provided data and were analyzed. Mental health difficulties increased in both cohorts but to a greater extent among students exposed to the pandemic, including for risk of depression (adjusted mean difference [AMD], 1.91; 95% CI, 1.07-2.76); social, emotional, and behavioral difficulties (AMD, 0.76; 95% CI, 0.33-1.18); and mental well-being (AMD, -2.08; 95% CI, -2.80 to -1.36). Positive school climate, high home connectedness, and having a friend during lockdown were protective factors during the pandemic. Female gender and initial low risk for mental health difficulties were associated with greater mental health deteriorations. Partial school attendance during lockdown was associated with better adjustment than no attendance when returning to school. This cohort study of secondary school students demonstrated that to promote mental health and adjustment, policy interventions should foster home connectedness, peer friendship, and school climate; avoid full school closures; and consider individual differences.

Mental health challenges and resilience among mothers with intellectual and developmental disabilities

The Journal of Adolescent Health's Editor-In-Chief's Annual Reflection: A Year of COVID, Coping, and Creativity

When Pandemics Collide: The Impact of COVID-19 on Childhood Obesity

Research highlights several risk and resilience factors at multiple ecological levels that influence individuals’ mental health and wellbeing in their everyday lives and, more specifically, in disaster or outbreak situations. However, there is limited research on the role of these factors in the early days of the COVID-19 crisis. The present study examined if and how potential risk factors (i.e., reduction in income, job insecurity, feelings of vulnerability to contracting the virus, lack of confidence in avoiding COVID-19, compliance with preventative policies) and resilience factors (i.e., trait resilience, family functioning, social support, social participation, and trust in healthcare institutions) are associated with mental health and well-being outcomes, and whether these resilience factors buffer (i.e., moderate) the associations between risk factors and said outcomes. One to two weeks after the government recommended preventative measures, 1,122 Canadian workers completed an online questionnaire, including multiple wellbeing outcome scales in addition to measures of potential risk and resilience factors. Structural equation models were tested, highlighting that overall, the considered risk factors were associated with poorer wellbeing outcomes, except social distancing which was associated with lower levels of stress. Each of the potential resilience factors was found to have a main effect on one or more of the wellbeing outcomes. Moderation analysis indicated that in general these resilience factors did not, however, buffer the risk factors. The findings confirm that the COVID-19 crisis encompasses several stressors related to the virus as well as to its impact on one’s social, occupational, and financial situation, which put people at risk for lower wellbeing as early as one to two weeks after the crisis began. While several resilience factors emerged as positively related to wellbeing, such factors may not be enough, or sufficiently activated at that time, to buffer the effects of the numerous life changes required by COVID-19. From an ecological perspective, while mental health professionals and public health decision-makers should offer/design services directly focused on mental health and wellbeing, it is important they go beyond celebrating individuals’ inner potential for resilience, and also support individuals in activating their environmental resources during a pandemic.

Adolescence on the health agenda

Transdiagnostic factors in the COVID-19 pandemic: Examining the role of childhood abuse and neglect in establishing latent profiles of risk and resilience

BackgroundThe coronavirus disease 2019 (COVID-19) is profoundly affecting life around the globe. Isolation, contact restrictions and economic shutdown impose a complete change to the psychosocial environment in affected countries. These measures have the potential to threaten the mental health of children and adolescents significantly. Even though the current crisis can bring with it opportunities for personal growth and family cohesion, disadvantages may outweigh these benefits. Anxiety, lack of peer contact and reduced opportunities for stress regulation are main concerns. Another main threat is an increased risk for parental mental illness, domestic violence and child maltreatment. Especially for children and adolescents with special needs or disadvantages, such as disabilities, trauma experiences, already existing mental health problems, migrant background and low socioeconomic status, this may be a particularly challenging time. To maintain regular and emergency child and adolescent psychiatric treatment during the pandemic is a major challenge but is necessary for limiting long-term consequences for the mental health of children and adolescents. Urgent research questions comprise understanding the mental health effects of social distancing and economic pressure, identifying risk and resilience factors, and preventing long-term consequences, including—but not restricted to—child maltreatment. The efficacy of telepsychiatry is another highly relevant issue is to evaluate the efficacy of telehealth and perfect its applications to child and adolescent psychiatry.ConclusionThere are numerous mental health threats associated with the current pandemic and subsequent restrictions. Child and adolescent psychiatrists must ensure continuity of care during all phases of the pandemic. COVID-19-associated mental health risks will disproportionately hit children and adolescents who are already disadvantaged and marginalized. Research is needed to assess the implications of policies enacted to contain the pandemic on mental health of children and adolescents, and to estimate the risk/benefit ratio of measures such as home schooling, in order to be better prepared for future developments.

This mini review examines the mental health challenges and resilience mechanisms among frontline workers. This includes healthcare professionals, emergency responders, and essential service providers, who face heightened psychological risks due to prolonged exposure to high-stress and crisis environments. The objective is to synthesize recent evidence on coping strategies, resilience factors, and mental health issues, while identifying key gaps and potential directions for intervention and research. Accordingly, a comprehensive literature search was conducted in the Scopus database on 27 October 2025 using the following keywords: (“mental health” AND resilience AND “frontline workers” OR “first responders” AND stress OR burnout). At the same time, peer-reviewed articles, including original research, systematic reviews, and meta-analyses, were included. Studies were screened based on inclusion and exclusion criteria, focusing on mental health outcomes, coping strategies, and resilience frameworks among frontline workers. Correspondingly, findings revealed consistently high prevalence rates of anxiety, depression, burnout, and Post-Traumatic Stress Disorder (PTSD) among frontline workers. Notably, effective coping mechanisms, such as mindfulness, emotional regulation, and social support, along with resilience factors such as self-efficacy and adaptability, were demonstrated to mitigate psychological distress. However, significant gaps persist in standardizing resilience assessment, evaluating longterm intervention outcomes, and integrating systemic reforms with individual-level strategies. While resilience and coping interventions show promise, future research must adopt interdisciplinary, longitudinal, and technology-enhanced approaches to develop sustainable models of psychological support. Additionally, embedding resilience training and organizational mental health policies can foster well-being and strengthen workforce readiness for future crises.

Why Adolescent Depression Is a Global Health Priority and What We Should Do About It

Mental Health, Minority Stressors, and Resilience Factors Among Early Adolescent Immigrant Youth.