Adolescents Saw Mental Health Gains After School Reopened Post Pandemic

For future public health emergencies, findings from a new study may provide a blueprint for action so that children can have access to the social and emotional resources their schools provide. Future policies need to balance the need for socialization with the need to curtail infection risk so that schools can be safely reopened with minimal impact on children’s mental health, according to research published online today in Epidemiology.1

Data from across 24 California counties and 224 school districts from March 2020 through June 2021 were used for the new analysis. Claims from the Healthcare Integrated Research Database and the California Department of Education provided these data on health diagnoses and spending on 185,735 children aged 5 to 18 years, who accounted for 2,176,318 observations.

“We used difference-in-differences analysis to examine how staggered implementation of school reopenings affected diagnoses with depression, anxiety, and attention-deficit/hyperactivity disorder [ADHD], and related health care spending among school-aged children,” the authors explained. They also highlight that schools’ staggered reopenings (August 2020 through June 2021) allowed them to more easily examine the impact on the children, from the 13 months before the pandemic to 9 months after schools reopened.

Overall, this investigation determined there was a 25% jump in total mental health diagnoses and a 30.5% jump in mental health–related monthly medical costs over the study period: from 2.8% to 3.5% and $49.50 to $64.60. respectively. However, by the ninth month after school reopenings, there was a 1.2 percentage point reduction (95% CI, –1.59 to –0.74) in the children being diagnosed with any mental health condition. The leading indicator was the decrease seen in depression diagnoses: 0.6 percentage points (95% CI, –1.0 to –0.3). This means that of the preopening student sample, the probability of being diagnosed with a mental health condition dropped from 60% to 43%.1,2

Digging down to the mental health diagnosis considered, by the fifth month after schools started to reopen, drops were seen in diagnoses of depression, anxiety, and ADHD. Individually, anxiety diagnoses slightly rose again from the sixth to the seventh month, before seeing a steep drop through month 9, “suggesting a delayed effect of the reopening,” the authors wrote; the overall change was 1.7% to 2.2%. Depression diagnoses remained steady from month 6 to month 7 before dropping through month 9; this overall change was 1.0% to 1.3%. ADHD diagnoses fluctuated, first rising between months 5 and 7, then dropping between months 7 to 8, and finally rising sharply from mont8 to month 9; this overall change was 1.2% to 1.3%.

There was a 25% jump in total mental health diagnoses and a 30.5% jump in mental health–related monthly medical costs over the study period, from March 202 to June 2021. | Image Credit: © JenkoAtaman-stock.adobe.com

Spending on related costs also dropped during the study, with the first decreases in nondrug medical, drug, and ADHD drug being seen by month 6 and continuing through month 9. Total nondrug medical costs dropped by 10.6% (95% CI, –13.4% to –7.8%), drug costs dropped by 7.5% (95% CI, –12.5% to –2.5%), and ADHD drug costs dropped by 5.0% (95% CI, –8.2% to –1.8%).

A subgroup analysis conducted between female and male students determined that the overall impact of school reopening was more pronounced in the former vs the latter. There was an overall 1.9 percentage point drop by the ninth month, with ADHD being the only individual diagnosis that did not change. Female students also saw overall medical and pharmacy costs decrease by 15.34% (95% CI, –18.45% to –12.24%) and 9.94% (95% CI , –16.43% to –3.45%), respectively, by the ninth month after schools reopened. In contrast, mental health–related spending had only fallen by 2.69% (95% CI, –4.57 to –0.81) among male students by month 6 and 6.0% (95% CI, –10.36 to –1.63) by month 9.

Among the children included in this study, the mean (AD) age at study start was 11.6 (3.7) years, 49% were female students, 7.5% lived in a rural area, most (61.3%) were from the highest Census block income quartile, and 49.5% had medical costs related to a mental health diagnosis.

“As we consider future public health emergencies, this study suggests we need to prioritize safe school reopenings and ensure children have access to the social and emotional resources that schools provide,” said senior author Rita Hamad, PhD, MD, MPH, professor of social epidemiology and public policy, Harvard TH Chan School of Public Health, in a statement.2 “Policies should focus not only on infection control, but also on the mental well-being of children, recognizing that schools are a critical part of their support system.”

Adding to her statement, the authors also put forth several ways of how school closings adversely impacted student mental health. Changes in social interactions, irregular sleep patterns, more device screen time, less balanced diets, and learning difficulties were also proposed as risk factors in worsening mental health. Socioeconomic hardship, losing access to school-provided mental health services, and socially constructed gender norms were also proposed.

Limitations on these findings are that the school reopenings could have coincided with loosening of other COVID-19 policies or the dropping of infection rates. Also, changes in telehealth access, trends in seeking health care, and students being able access services in districts not theirs could have influenced outcomes independent of school reopening. Further, generalizability may be limited by only including children from California.

References

1. Ozluk P, Romine J, Sylwestrzak G, Hamad R. Effect of school reopenings on children’s mental health during COVID-19. Epidemiology. Published online December 8, 2024. doi:10.1097/EDE.0000000000001930
2. School reopening during COVID-19 pandemic associated with improvement in children’s mental health. News release. EurekAlert. December 8, 2025. Accessed December 8, 2025. https://www.eurekalert.org/news-releases/1108368