Emotional and behavioral problems in adolescents in the context of COVID-19: a mixed method study

Peterle, Carolina Ferreira; Fonseca, Caroline Lima; Freitas, Bruna Hinnah Borges Martins de; Gaíva, Maria Aparecida Munhos; Diogo, Paula Manuela Jorge; Bortolini, Juliano

doi:10.1590/1518-8345.6273.3744

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Revista Latino-Americana de Enfermagem

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Original Article • Rev. Latino-Am. Enfermagem 30 (spe) • 2022 • https://doi.org/10.1590/1518-8345.6273.3744 copy

Emotional and behavioral problems in adolescents in the context of COVID-19: a mixed method study^* * This article refers to the call “Adolescent health and the role of nurses”. Edited by Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil. Publication of this supplement was supported by the Pan American Health Organization (PAHO/WHO). Articles have undergone the journal’s standard peer-review process for supplements. The views expressed in this supplement are those of the authors alone and do not represent the views of PAHO/WHO. Supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Grant # 23108.067616/2021-09, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

to estimate the prevalence of emotional and behavioral problems in adolescents in the context of the COVID-19 pandemic e to explore adolescents’ perception of emotional and behavioral problems identified.

Method:

mixed-method explanatory sequential design. Participants were 479 adolescents aged 15 to 18 from a Brazilian Central-West region capital.

Results:

with a total of 479 participants, mean age was 16.03 years (SD=1.01). The prevalence of emotional and behavioral problems was 61.17%, and there was a difference between the sexes (ORb=2.93; p<0.01). The highest prevalence was related to peer relationship problems (54.49%) and emotional symptoms (52.40%). Adolescents noticed an increase in loneliness, anxiety, sadness, distancing from friends and difficulties in socializing during the pandemic.

Conclusion:

most of the investigated adolescents were classified as having emotional and behavioral problems, and girls were more likely to have them than boys. The adolescents’ statements reinforce the quantitative findings. In this way, there is a need to implement actions to promote and restore the adolescents’ mental health, in order to mitigate the COVID-19 pandemic socio-emotional impact on this population.

Descriptors:
Emotions; Behavior; Mental Health; Adolescent; COVID-19 Pandemic; Nursing

Highlights:

(1) The COVID-19 pandemic had a negative impact on emotions and behaviors. (2) 61.17% of adolescents were classified as having emotional and behavioral problems (EBPs). (3) Girls presented the highest level of prevalence of EBP in the pandemic context. (4) Peer relationship problems and emotional symptoms were the most prevalent.

SDQ items		n (%)
Emotional symptoms	I get a lot of headaches, stomach aches or sickness
	Normal	207 (43.22%)
	Borderline	120 (25.05%)
	Abnormal	152 (31.73%)
	I worry a lot
	Normal	62 (12.94%)
	Borderline	135 (28.18%)
	Abnormal	282 (58.87%)
	I am often unhappy, depressed or tearful
	Normal	167 (34.86%)
	Borderline	123 (25.68%)
	Abnormal	189 (39.46%)
	I am nervous in new situations. I easily lose confidence
	Normal	92 (19.21%)
	Borderline	125 (26.10%)
	Abnormal	262 (54.70%)
	I have many fears, I am easily scared
	Normal	211 (44.05%)
	Borderline	137 (28.60%)
	Abnormal	131 (27.35%)
Conduct problems	I get very angry and often lose my temper
	Normal	91 (19.00%)
	Borderline	169 (35.28%)
	Abnormal	219 (45.72%)
	I usually do as I am told
	Normal	237 (49.48%)
	Borderline	205 (42.80%)
	Abnormal	37 (7.72%)
	I fight a lot. I can make other people do what I want
	Normal	287 (59.92%)
	Borderline	137 (28.60%)
	Abnormal	55 (11.48%)
	I am often accused of lying or cheating
	Normal	335 (69.94%)
	Borderline	70 (14.61%)
	Abnormal	74 (15.45%)
	I take things that are not mine from home, school or elsewhere
	Normal	445 (92.90%)
	Borderline	25 (5.22%)
	Abnormal	9 (1.88%)
Hyperactivity	I am restless, I cannot stay still for long
	Normal	240 (50.10%)
	Borderline	144 (30.06%)
	Abnormal	95 (19.83%)
	I am constantly fidgeting or squirming
	Normal	129 (26.93%)
	Borderline	105 (21.92%)
	Abnormal	245 (51.15%)
	I am easily distracted, I find it difficult to concentrate
	Normal	79 (16.49%)
	Borderline	151 (31.52%)
	Abnormal	249 (51.98%)
	I think before I do things
	Normal	214 (44.68%)
	Borderline	209 (43.63%)
	Abnormal	56 (11.69%)
	I finish the work I’m doing. My attention is good
	Normal	125 (26.10%)
	Borderline	236 (49.27%)
	Abnormal	118 (24.63%)
Peer relationship problems	I would rather be alone than with children of my age
	Normal	137 (28.60%)
	Borderline	126 (26.30%)
	Abnormal	216 (45.09%)
	I have one good friend or more
	Normal	331 (69.10%)
	Borderline	73 (15.24%)
	Abnormal	75 (15.66%)
	Other people my age generally like me
	Normal	181 (37.79%)
	Borderline	214 (44.68%)
	Abnormal	84 (17.54%)
	Other children or young people pick on me or bully me
	Normal	335 (69.94%)
	Borderline	93 (19.42%)
	Abnormal	51 (10.65%)
	I get along better with adults than people my own age
	Normal	159 (33.19%)
	Borderline	156 (32.57%)
	Abnormal	164 (32.24%)
Prosocial behavior	I try to be nice with other people. I care about their feelings
	Normal	359 (74.95%)
	Borderline	95 (19.83%)
	Abnormal	25 (5.22%)
	I usually share with others, for example, CDs, games, food
	Normal	198 (41.34%)
	Borderline	177 (36.95%)
	Abnormal	104 (21.71%)
	I am helpful if someone is hurt, upset or feeling ill
	Normal	354 (73.90%)
	Borderline	101 (21.09%)
	Abnormal	24 (5.01%)
	I am kind to young children
	Normal	298 (62.21%)
	Borderline	139 (29.02%)
	Abnormal	42 (8.77%)
	I offer to help others (parents, teachers, children)
	Normal	240 (50.10%)
	Borderline	165 (34.45%)
	Abnormal	74 (15.45%)

SDQ domains		Sex		Logistic Regression
SDQ domains	General n (%)	Male n (%)	Female n (%)	OR_b ^†(_95%CI^‡)	p-value
Total difficulties
No	186 (38.83%)	72 (58.06%)	114 (32.11%)	1
Yes	293 (61.17%)	52 (41.94%)	241 (67.89%)	2.93 (1.92; 4.46)	<0.01
Emotional symptoms
No	228 (47.60%)	91 (73.39%)	137 (38.59%)	1
Yes	251 (52.40%)	33 (26.61%)	218 (61.41%)	4.39 (2.79; 6.89)	<0.01
Conduct problems
No	305 (63.67%)	88 (70.97%)	217 (61.13%)	1
Yes	174 (36.33%)	36 (29.03%)	138 (38.87%)	1.55 (1.00; 2.42)	0.05
Hyperactivity
No	268 (55.95%)	87 (70.16%)	181 (50.99%)	1
Yes	211 (44.05%)	37 (29.84%)	174 (49.01%)	2.26 (1.46; 3.50)	<0.01
Peer relationship problems
No	218 (45.51%)	65 (52.42%)	153 (43.10%)	1
Yes	261 (54.49%)	59 (47.58%)	202 (56.90%)	1.45 (0.96; 2.19)	0.07
Prosocial behavior
Yes	430 (89.77%)	108 (87.10%)	322 (90.70%)	1
No	49 (10.23%)	16 (12.90%)	33 (9.30%)	0.69 (0.36; 1.31)	0.26

Domain/Theme	Quantitative results	Qualitative results	Integrated analysis
Emotional symptoms	251 (52.40%)	Loneliness: “From the beginning of the pandemic I felt lonely”	Most adolescents were classified as having emotional symptoms, which were intensified during the pandemic period, especially among girls.
		Anxiety: “I’m very anxious, and it got worse because of the pandemic”
		Sadness: “I start to cry, then I feel bad, sad” feeling of powerlessness: “I found myself in this powerlessness situation”
		Repressed feelings: “I’d rather keep it to myself than tell people”
Conduct problems	174 (36.33%)	Impulsivity and aggressiveness: “I can’t control myself at the time of fight;” “I’m very rude”	Most of the adolescents had conduct problems. The pandemic context generated more impulsivity, aggressiveness and feelings of anger, in addition to a greater difficulty in socializing.
		Anger: “I get angry with the person”
		Difficulty in socializing: “I’m not that good at socializing;” “I avoid talking to people”
Hyperactivity	211 (44.05%)	Psychomotor agitation: “bouncing legs, shaking hands, biting nails;” “like those tics of moving my legs, moving my hand”	The prevalence of the hyperactivity symptom was high among adolescents, and the COVID-19 pandemic intensified this symptom, especially in view of the emergency remote teaching adopted in this period. Girls were the most affected by these symptoms.
		Lack of attention: “getting distracted by other things;” “I can’t just sit down and eat;” “lack of focus”
		Difficulty in absorbing learning: “I’m having trouble studying”
Peer relationship problems	261 (54.49%)	Distancing from friends: “I distanced myself;” “I distanced myself form many friends;” “many friends distanced from me”	Most of the adolescents presented conduct problems. The pandemic has impacted these relationships and symptoms, generating emotional distress for adolescents.
Peer relationship problems	261 (54.49%)	Renewing friendships: “My cycle of friends changed”
Prosocial behavior	430 (89.77%)	Participation in social movements: “I’ve always participated in social movements”	Almost all adolescents presented prosocial behavior. With pandemic outbreak, adolescents began to value actions to benefit someone else even more.
		Family cooperation: “I help my mother take care of my sister”
		Socio-economic support: “We bought basic food baskets;” “We also helped with the issue of providing Internet access to many students”
		Emotional support: “I’ve helped all my friends” Sharing knowledge: “teaching other people”

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

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[1] Corresponding author: Carolina Ferreira Peterle E-mail: carolsce18@gmail.com https://orcid.org/0000-0003-3930-8080