DOI: https://doi.org/10.21203/rs.3.rs-1920309/v1
COVID-19 has affected innumerable lives across society, including in the spheres of education, economy, and religion. Economic problems and inequality are related to the poor mental health of adolescents. This study was to identify the relationship between the economic damage to families due to COVID-19 and various mental health problems for Korean adolescents, and evaluate the risk factors of mental health.
A total of 54,948 students were surveyed from 398 middle and 395 high schools. Complex sample logistic regressions were performed to calculate the odds ratios (ORs) and the 95% confidence interval (CI) of depression and suicidal ideation. Generalized linear model analysis were used to examine the association between mental health (unhappiness, lonely and stress) and economic impact of COVID-19. Theses analyses were adjusted for age, gender, school grade, perceived academic achievement, perceived family economic status, economic support.
The ORs of depression (OR = 1.77, 95% CI : 1.57-2.00), suicide ideation (OR = 2.14, 95% CI : 1.84–2.50), unhappiness (OR = 1.51 95% CI 1.42–1.60) and lonely (OR = 1.38 95% CI 1.27–1.49) for the low level of perceived family economic status was higher compared to middle level. Adolescents who experienced economic deterioration at household as COVID-19 showed a higher risk of depression (OR = 1.42, 95% CI : 1.35–1.49), suicide ideation (OR = 1.36, 95% CI : 1.28–1.44), unhappiness (OR = 2.23 95% CI 2.19–2.27), lonely (OR = 1.20 95% CI 1.17–1.22), and stress (OR = 1.14 95% CI 1.12–1.16) than those who did not.
The findings revealed an association between the decline in household economic status due to COVID-19 and mental health problems such as stress, loneliness, suicidal ideation, depression, and unhappiness.
According to the World Health Organization (WHO) [1], as of May 30, 2022, the coronavirus disease (COVID-19) pandemic has resulted in more than 6.2 million deaths and approximately 520 million cases have been confirmed worldwide. COVID-19 has affected innumerable lives across society, including in the spheres of education, economy, and religion [2]. Unemployment increased substantially, and inequality in the economic system deepened [3]. Research has shown that economic problems and inequality are related to the poor mental health of adolescents [4], and a systematic literature review examining the relationship between COVID-19 and the mental health of children and adolescents showed that fear, depression, and anxiety were higher than before the pandemic [5]. Additionally, the relationship between loneliness and the stay-at-home order issued by the state to mitigate the COVID-19 pandemic has been confirmed. Loneliness has been reported to be a serious public health issue in the fight against the infectious disease [6]. Previous studies have reported that the association between policies such as social distancing and the prevalence of mental health vary by age [7].
As of May 30, 2022, the total number of confirmed cases in South Korea was 18,086,462, and the death toll was 24,167. Of them, 2,369,089 (13.1%) confirmed cases and nine (0.04%) deaths were among teenagers aged 10–19 years [8]. The Ministry of Education of the Republic of Korea announced a policy to conduct online classes during the pandemic and designated the dates on which each grade could attend school to minimize crowding in educational institutions. Studies indicate that COVID-19 rarely affects children and adolescents directly [9], but research shows that there may be direct or indirect effects on mental and physical health due to isolation resulting from school closure, the stay-at-home and limited peer interactions [10]. Studies have also highlighted the urgent need to protect children and adolescents from the potential side effects of the COVID-19 pandemic [11]. However, confirming the long-term negative effects from the social isolation created by COVID-19 on human physical and mental health is a challenge [2].
Therefore, a need has arisen to identify and evaluate the risk factors related to mental health problems in adolescents during the COVID-19 pandemic using data representing the youth in Korea. The purpose of this study was to identify the relationship between the economic damage to families due to COVID-19 and various mental health problems for Korean adolescents, and evaluate the risk factors of mental health.
Sample and data collection
The current study was based on the 16th 2020 Korean Youth Risk Behavior Web-based Survey (KYRBS), which is a nationally representative survey of Korean youth’s health status such as smoking status, drinking status, physical activity, obesity, nutrition, mental health, etc [12]. The purpose of the KYRBS is to collect the data to plan and evaluate health promotion projects of youth. In addition, this data has been also used by international organizations such as the WHO to compare the adolescent health conditions in each country. This survey has been conducted annually by The Korea Disease Control and Prevention Agency (KDCA) and is an anonymous online surveys to ask middle and high school students to self-report [13]. The KYRBS was consisted of 103 questions and 93 indicators and collected from August to November 2020. For a representative sample of Korean adolescents, complex sampling was designed through stratification, cluster, and multi-level sampling, and weight was assigned to sample to represent the Korean adolescents. A total of 54,948 students were surveyed from 398 middle and 395 high schools. The Institutional Review Board at the Catholic University of Korea reviewed and approved the design of this study (IRB approval number: MC22ZASI0021).
Economic variables
In our study, economic variables were perceived family economic status, economic support, and economic impact of COVID-19. Perceived family economic status was measured using the question “What is the economic status of your family?” with response options : “High”, “Middle-High”, “Middle”, “Middle-Low”, and “Low”. Economic support was assessed using the following question: “In the last 12 months, have you received financial help from non-family members or institutions due to poor family economic status?”. Responses options were “Yes” and “No” Economic impact of COVID-19 was asked respondents through the following questions : Do you think the economic status of the family has become more difficult than before due to COVID-19?”. response options were “Extremely likely”, “Somewhat likely”, “Not too likely” and “Not likely at all”. We categorized these response into one of two groups: an “Yes” and an “No”.
Mental health
Depression and suicidal ideation was measured with the following questions : “Have you experienced sadness or despair to the point that you stopped your daily routine for two weeks?” and “In the past 12 months, have you ever thought of committing suicide?” The response options were : “Yes” or “No.”, Unhappiness was measured with following question : “How happy do you usually feel?”. The response options were : (1) I'm very happy, (2) I'm a bit happy, (3) It's normal, (4) I'm a little unhappy and (5) I'm very unhappy. Lonely was measured with following question : “In the last 12 months, how often have you felt lonely?”, The response options were : (1) I didn't feel lonely at all, (2) I almost never felt lonely, (3) Sometimes I felt lonely, (4) often felt lonely and (5) always felt lonely. Stress was measured with following question : “How much stress do you usually feel?”. The response options were : (1) I don't feel it at all, (2) I don't feel much, (3) I feel a little, (4) I feel a lot, and (5) I feel very much.
Based on the analytical guidelines of the KDCA, all analyses and were carried out using the IBM SPSS Statistics 28.0 software. Complex sample weights were applied to reflect nationally representative samples. We identify general characteristics and economic impact of COVID-19 to using descriptive statistics. Chi-square tests were conducted to compare the differences between groups. Complex sample logistic regressions were performed to calculate the odds ratios (ORs) and the 95% confidence interval (CI) of depression and suicidal ideation. Generalized linear model analysis were used to examine the association between mental health(unhappiness, lonely and stress) and economic impact of COVID-19. Theses analyses were adjusted for age, gender, school grade, perceived academic achievement, perceived family economic status, economic support. The significance level was set at P < 0.05.
Table 1 presents adolescents’ demographic characteristics and economic impact of COVID-19. A total of 54,948 study participated in our study, among which 26,595 (48.4%) were girls and 28,353 (51.6%) were boys. The number of participants decreased as school grade increased in the group after 10,005 (18.2%) of Middle school 1st. The 16,585 (30.2%) participants reported the middle academic achievement. The perceived family economic status of participants was high in the order of 26,397 (47.5%) for middle, 15,300 (28.6%) for middle-high, and 6,039 (11.2%) for high. In the last 12 months, 5,563 (10.1%) participants received economic support as family economic difficulties. 16,839 (30.6%) participants reported that the economic status of the family became more difficult than before due to COVID-19.
| Variables | Participants N(%) |
|---|---|
| Total | 54,948 |
| Age(median) | 15(14–17) |
| Gender | |
| Boys | 28,353(51.6) |
| Girls | 26,595(48.4) |
| School grade | |
| Middle school 1st | 10,005(18.2) |
| Middle school 2nd | 9,564(17.1) |
| Middle school 3rd | 9,392(17.1) |
| High school 1st | 8,907(16.2) |
| High school 2nd | 8,907(16.2) |
| High school 3rd | 8,173(14.9) |
| Perceived academic achievement (in the last 12 months) | |
| High | 6,736(12.3) |
| Middle-High | 13,410(24.4) |
| Middle | 16,585(30.2) |
| Middle-Low | 12,684(23.1) |
| Low | 5,533(10.1) |
| Perceived family economic status | |
| High | 6,039(11.2) |
| Middle-High | 15,300(28.6) |
| Middle | 26,397(47.5) |
| Middle-Low | 5,937(10.4) |
| Low | 1,275(2.2) |
| Economic support (in the last 12 months) | |
| No | 49,385(89.9) |
| Yes | 5,563(10.1) |
| Economic impact of COVID-19 | |
| No | 38,109(69.4) |
| Yes | 16,839(30.6) |
Table 2 shows ORs of the depression and suicide, which were adjusted for age, gender, school grade, perceived academic achievement, perceived family economic status, economic support and economic impact of COVID-19. Compared with boys, girls had a higher risk of depression (OR = 1.80, 95% CI: 1.72–1.88) and suicide ideation (OR = 1.88, 95% CI : 1.76-2.00). Compared to Middle school 1st, High school 2nd present a higher risk of depression (OR = 1.37, 95% CI : 1.14–1.65) and High school 3rd also show a higher risk of suicide ideation (OR = 1.64, 95% CI : 1.20–2.24). The low level of perceived academic achievement was more likely to present higher risk depression (OR = 1.61, 95% CI : 1.51–1.73) and suicide ideation (OR = 1.78, 95% CI : 1.62–1.95) compared to middle level. The depression (OR = 1.77, 95% CI : 1.57-2.00) and suicide risk (OR = 2.14, 95% CI : 1.84–2.50) of low level of perceived family economic status was higher compared to middle level. Adolescents of family which have received financial support in the past 12 months had a higher risk of depression (OR = 1.59, 95% CI : 1.39–1.82) and suicide ideation (OR = 1.59, 95% CI : 1.39–1.82) than those who did not. Adolescents who experienced economic deterioration at household as COVID-19 showed a higher risk of depression (OR = 1.42, 95% CI : 1.35–1.49) and suicide ideation (OR = 1.36, 95% CI : 1.28–1.44) than those who did not(Fig. 1).
| Variables | Depression | Suicide ideation | ||
|---|---|---|---|---|
| aOR | (95%CI) | aOR | (95%CI) | |
| Gender | ||||
| Girls vs Boy | 1.80 | (1.72–1.88) | 1.88 | (1.76-2.00) |
| School grade | ||||
| Middle school 2nd vs Middle school 1st | 1.14 | (1.04–1.25) | 1.26 | (1.11–1.42) |
| Middle school 3rd vs Middle school 1st | 1.27 | (1.13–1.42) | 1.36 | (1.16–1.59) |
| High school 1st vs Middle school 1st | 1.22 | (1.05–1.42) | 1.29 | (1.05–1.58) |
| High school 2nd vs Middle school 1st | 1.37 | (1.14–1.65) | 1.62 | (1.25–2.09) |
| High school 3rd vs Middle school 1st | 1.18 | (1.18–1.84) | 1.64 | (1.20–2.24) |
| Perceived academic achievement (in the last 12 months) | ||||
| High vs Middle | 0.89 | (0.83–0.96) | 1.14 | (1.03–1.26) |
| Middle-High vs Middle | 0.94 | (0.89–0.99) | 1.06 | (0.98–1.14) |
| Middle-Low vs Middle | 1.20 | (1.13–1.26) | 1.25 | (1.15–1.36) |
| Low vs Middle | 1.61 | (1.51–1.73) | 1.78 | (1.62–1.95) |
| Perceived family economic status | ||||
| High vs Middle | 1.11 | (1.04–1.20) | 0.97 | (0.87–1.08) |
| Middle-High vs Middle | 1.12 | (1.07–1.17) | 1.09 | (1.02–1.17) |
| Middle-Low vs Middle | 1.30 | (1.22–1.39) | 1.55 | (1.42–1.70) |
| Low vs Middle | 1.77 | (1.57-2.00) | 2.14 | (1.84–2.50) |
| Economic support(in the last 12 months) | ||||
| Yes vs No | 1.16 | (1.09–1.23) | 1.21 | (1.11–1.33) |
| Economic impact of COVID-19 | ||||
| Yes vs No | 1.42 | (1.35–1.49) | 1.36 | (1.28–1.44) |
| *Adjusted for age, gender, school grade, perceived academic achievement, perceived family economic status, economic support, economic impact of COVID-19 | ||||
Table 3 presents result of multivariate logistic regression analysis. We estimated adjusted ORs and 95% confidence intervals of unhappiness, lonely and stress related to general characteristics, the economic impact of COVID-19. Girls were more likely to feel unhappiness (OR = 1.21 95% CI 1.19–1.23), lonely (OR = 1.46 95% CI 1.43–1.49) and stress (OR = 1.36 95% CI 1.34–1.39) as compared with boys. High school 3rd were more likely to feel unhappiness (OR = 1.23 95% CI 1.12–1.36) and stress (OR = 1.27 95% CI 1.15–1.40) than Middle school 1st. Adolescent in low level of perceived academic achievement had higher risk of unhappiness (OR = 1.31 95% CI 1.26–1.36), and those in low level had higher risk of lonely (OR = 1.17 95% CI 1.13–1.22) than those who reported middle level. Those reported the low status of perceived economic were more likely to feel unhappiness (OR = 1.51 95% CI 1.42–1.60), lonely (OR = 1.38 95% CI 1.27–1.49) than those who reported middle status. Adolescents who have received financial support over the past 12 months were more likely to feel more lonely (OR = 2.59 95% CI 2.50–2.67) than those who have not. Adolescents who experienced economic deterioration due to COVID-19 had a higher risk of unhappiness (OR = 2.23 95% CI 2.19–2.27), lonely (OR = 1.20 95% CI 1.17–1.22), and stress (OR = 1.14 95% CI 1.12–1.16) than those who did not(Fig. 1).
| Variables | Unhappiness | Lonely | Stress | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| β | SE | aOR | 95%CI | p | β | SE | aOR | 95%CI | p | β | SE | aOR | 95%CI | p | |
| Gender | |||||||||||||||
| Girls vs Boy | 0.19 | 0.01 | 1.21 | 1.19–1.23 | 0.000 | 0.38 | 0.01 | 1.46 | 1.43–1.49 | 0.000 | 0.31 | 0.01 | 1.36 | 1.34–1.39 | 0.000 |
| School grade | |||||||||||||||
| Middle school 2nd vs Middle school 1st | 0.08 | 0.02 | 1.08 | 1.05–1.12 | < 0.001 | 0.07 | 0.02 | 1.07 | 1.04–1.11 | < 0.001 | 0.05 | 0.02 | 1.05 | 1.01–1.09 | 0.01 |
| Middle school 3rd vs Middle school 1st | 0.11 | 0.02 | 1.12 | 1.07–1.17 | < 0.001 | 0.11 | 0.03 | 1.12 | 1.06–1.17 | < 0.001 | 0.09 | 0.02 | 1.09 | 1.04–1.15 | < 0.001 |
| High school 1st vs Middle school 1st | 0.01 | 0.03 | 1.01 | 0.95–1.08 | 0.004 | 0.15 | 0.03 | 1.16 | 1.09–1.24 | < 0.001 | 0.09 | 0.03 | 1.09 | 1.03–1.16 | 0.007 |
| High school 2nd vs Middle school 1st | 0.17 | 0.04 | 1.19 | 1.10–1.28 | < 0.001 | 0.17 | 0.04 | 1.19 | 1.09–1.29 | < 0.001 | 0.17 | 0.04 | 1.19 | 1.10–1.28 | < 0.001 |
| High school 3rd vs Middle school 1st | 0.21 | 0.05 | 1.23 | 1.12–1.36 | < 0.001 | 0.15 | 0.05 | 1.16 | 1.05–1.29 | 0.006 | 0.24 | 0.05 | 1.27 | 1.15–1.40 | < 0.001 |
| Perceived academic achievement | |||||||||||||||
| High vs Middle | -0.10 | 0.02 | 0.90 | 0.87–0.94 | < 0.001 | 0.05 | 0.02 | 1.05 | 1.01–1.09 | 0.008 | -0.01 | 0.02 | 0.99 | 0.95–1.03 | 0.76 |
| Middle-High vs Middle | -0.04 | 0.01 | 0.96 | 0.94–0.98 | < 0.001 | 0.04 | 0.01 | 1.04 | 1.02–1.06 | 0.002 | 0.01 | 0.01 | 1.01 | 0.99–1.03 | 0.69 |
| Middle-Low vs Middle | 0.10 | 0.01 | 1.11 | 1.08–1.13 | 0.000 | 0.10 | 0.01 | 1.11 | 1.08–1.13 | < 0.001 | 0.08 | 0.01 | 1.08 | 1.06–1.10 | < 0.001 |
| Low vs Middle | 0.27 | 0.02 | 1.31 | 1.26–1.36 | 0.000 | 0.16 | 0.02 | 1.17 | 1.13–1.22 | 0.000 | -0.17 | 0.02 | 0.84 | 0.81–0.88 | 0.000 |
| Perceived family economic status | |||||||||||||||
| High vs Middle | -0.31 | 0.01 | 0.73 | 0.72–0.75 | 0.000 | -0.17 | 0.02 | 0.84 | 0.81–0.88 | 0.000 | 0.13 | 0.02 | 1.14 | 1.10–1.18 | < 0.001 |
| Middle-High vs Middle | -0.13 | 0.01 | 0.88 | 0.86–0.90 | 0.000 | 0.02 | 0.01 | 1.02 | 1.00-1.04 | 0.062 | -0.004 | 0.01 | 1.00 | 0.98–1.02 | 0.69 |
| Middle-Low vs Middle | 0.25 | 0.02 | 1.28 | 1.23–1.34 | 0.000 | 0.25 | 0.02 | 1.28 | 1.23–1.49 | 0.000 | -0.18 | 0.01 | 0.84 | 0.82–0.85 | 0.000 |
| Low vs Middle | 0.41 | 0.03 | 1.51 | 1.42–1.60 | 0.000 | 0.32 | 0.04 | 1.38 | 1.27–1.49 | 0.000 | -0.31 | 0.03 | 0.73 | 0.69–0.78 | 0.000 |
| Economic support(in the last 12 months) | |||||||||||||||
| Yes vs No | -0.52 | 0.02 | 0.59 | 0.58–0.61 | < 0.001 | 0.95 | 0.02 | 2.59 | 2.50–2.67 | < 0.001 | -0.03 | 0.014 | 0.97 | 0.94-1.00 | 0.033 |
| Economic impact of COVID-19 | |||||||||||||||
| Yes vs No | 0.80 | 0.01 | 2.23 | 2.19–2.27 | 0.000 | 0.18 | 0.01 | 1.20 | 1.17–1.22 | 0.000 | 0.13 | 0.01 | 1.14 | 1.12–1.16 | 0.000 |
| * Adjusted for age, gender, school grade, perceived academic achievement, perceived family economic status, economic support, economic impact of COVID-19 | |||||||||||||||
Our study identified the connection between the economic damage to households due to COVID-19 and poor mental health problems in adolescents during the pandemic and evaluated the risk factors for mental health problems. Our study found that mental health issues were worse in girls than in boys. Previous studies reported that the prevalence of mental health problems is higher in women than in men [14, 15] and have discussed genetics, hormones, endocrine stress reactivity, and personality factors to explain this phenomenon [16]. A major global event such as COVID-19 could be related to endocrine stress reactivity.
Our results showed that, during the COVID-19 pandemic, women experienced depression 1.8 times more compared with men. A study investigating the prevalence of depression in all age groups in Korea before the pandemic found that the prevalence was slightly higher among female adolescents compared with male adolescents [17], a finding similar to ours. In addition, the prevalence of depression increased only in men, according to a study that used 2020 data to compare such prevalence among Korean adults before and after the COVID-19 pandemic [18]. COVID-19 has been prevalent worldwide for two years, and more data need to be collected and evaluated to understand the change in mental health by gender due to the pandemic.
Compared with first-year middle-school students (aged 14 years), our study found a greater prevalence of mental health problems in students in other grades (ages 15–19). Third-year high-school students (aged 19 years), in particular, showed higher levels of suicidal ideation, unhappiness, and stress. A previous study reported that Korean adolescents experience stress and mental health problems due to concerns related to academic performance, which tends to be worse in high school [19]. The Korea Institute for Health and Social Affairs confirmed, in a study conducted before the COVID-19 outbreak, that the prevalence of poor mental health in adolescents increased as they advanced in school years [20]. During the COVID-19 pandemic, adolescents attended online classes and faced limitations in private tutoring while being isolated, and also lost formal educational opportunities. The mental health of third-year high-school students (aged 19 years) during the COVID-19 pandemic was significantly poor compared with that of students in other grades. Thus, the country should follow up on the potential impact of COVID-19 on adolescents, such as deterioration in mental health and economic status in adulthood.
In addition, we observed that adolescents with low or high academic performances experienced suicidal ideation and loneliness more frequently compared with average performers. Adolescents in the low-performing group also reported high levels of depression and unhappiness. Even before the COVID-19 outbreak, youth education played an important role in society due to the cultural characteristics of Korea, and the stress produced by the highly competitive education system has had a negative impact on the physical and mental health of adolescents [21]. Previous studies reported a link between academic stress and depression [22, 23]. In a study investigating the risk factors related to suicidal attempts among 106 depressed adolescents, 47.2% were classified into the suicidal attempt group, and depressive symptoms were found to have a relationship with suicidal thoughts and suicidal attempts [24]. Another study reported that implementing intervention programs according to adolescents' grades could help reduce suicidal impulses [25].
Our study found that adolescents who perceived their household economic status to be low had higher levels of depression, suicidal ideation, unhappiness, and loneliness. In addition, youths who had received financial support from others in the past 12 months had higher levels of depression, suicidal ideation, and loneliness and lower levels of unhappiness. A previous study using representative data from adolescents in Korea reported that low household economic levels were associated with poor mental health [25]. The Ministry of Education of the Republic of Korea provided online classes when in-person classes had to be restricted because of COVID-19 [26], but it has been a challenge for groups with low household income to prepare for such classes, as they require equipment such as smartphones and computers [27]. This has deprived young people of many important physical and mental health-related opportunities that could have been obtained through student‒teacher interactions [2], which indicates that COVID-19 has deepened inequality.
Our study found that levels of stress, loneliness, suicidal ideation, depression, and unhappiness were 1.14‒2.23 times higher in groups that had been economically affected by COVID-19 than in the unaffected group. A study in Japan reported that adolescents experiencing unhappiness followed poor health behaviors and had poor mental health [28]. In a meta-analysis investigating the connection between socioeconomic inequality and mental health problems among adolescents, poor mental health was found to be associated with low economic status [4]; another study reported that the economically vulnerable group had a high fatality rate from COVID-19 [29]. Problems such as social isolation and economic deterioration caused by COVID-19 resulted in irregular workers losing their jobs worldwide and worsened the situation of the poor [30]. Previous studies reported that parental unemployment and financial difficulties were factors that could negatively affect the mental health and well-being of adolescents [31, 32]. Economic inequality and mental health problems also manifested differently according to the family structure. Adolescents from single-parent and reconstituted families in Korea were at risk for poor mental health [33]. The most of these families belonged to the low socioeconomic group [34]. The poor mental health of these adolescents was likely to worsen as their treatment would have been discontinued because of financial hardships and lockdown measures during the COVID-19 pandemic [35, 36]. Previous studies showed that differences in mental health problems among adolescents may affect their future families, income, and employment [33]. The high incidence of suicidal ideation in the group that experienced economic damage due to COVID-19 may lead to increased suicidal rates in the future. Since suicidal ideation and planning are important predictors of suicide [37], appropriate monitoring and interventions are needed to prevent increasing suicidal rates due to prolonged COVID-19 measures. The incidence of COVID-19 is decreasing because of the development of vaccines and treatments, but problems associated with the after-effects of the disease are emerging [11]. Our findings can serve as a basis for formulating appropriate policies and government measures to protect Korean youth from the potential side-effects of the COVID-19 pandemic that could impair the rest of their lives. Our study has some limitations. First, as this was a cross-sectional study, causal inferences on COVID-19 could not be drawn. The potential impact of COVID-19 on adolescents' mental health should be investigated in depth by monitoring and collecting data. Second, because this study used secondary data collected by the state, we could not use a standardized questionnaire to specifically measure mental health problems, and factors such as social distancing, which could negatively affect mental health, were not adjusted in the analysis. However, the data used in this study are relevant for understanding the current state of mental health during the pandemic as we used data representing Korean adolescents. Third, as the web survey was based on adolescents' self-awareness, their responses may have been biased. The strength of our study is that we used nationally representative probability-based samples at the same time point, enabling us to estimate and understand the link between the economic damage caused by COVID-19 and mental health problems.
The findings revealed an association between the decline in household economic status due to COVID-19 and mental health problems such as stress, loneliness, suicidal ideation, depression, and unhappiness. COVID-19 may have accelerated economic and mental health inequality among adolescents. Our findings can serve as a basis for formulating appropriate policies and government measures to protect Korean youth from the potential side-effects of the COVID-19 pandemic that could impair the rest of their lives.
COVID-19 : the coronavirus disease-19,
KYRBS : Korean Youth Risk Behavior Web-based Survey,
KDCA : The Korea Disease Control and Prevention Agency,
ORs : odds ratios, CI: 95%confidence interval
Ethics approval and consent to participate
The KYRBS (https://www.cdc.go.kr/yhs/) were managed by the KDCA and approved by the Institutional Review Board of the Catholic University of Korea (IRB approval number: MC22ZASI0021). All participants voluntarily participated and provided written informed consent prior to participating in the study
Consent for publication
Not applicable.
Availability of data and materials
The datasets for the study are available from the corresponding author on reasonable request. KYRBS data can be accessed and downloaded from the KDCA website (https://www.kdca.go.kr/yhs/home.jsp)
Competing interests
None to declare.
Acknowledgements
Not applicable.
Authors’ contributions
Conceptualization: Park H, Lee KS. Data curation: Park H. Formal analysis: Park H. Funding acquistion: None, Methodology: Lee KS, Park H. Project administration: Park H. Visualization: Park H. Writing - oringinal draft:Park H. Writing - review & editing: Lee KS, Park H.
Funding
Not applicable.