Coronavirus disease (COVID-19) is an infectious respiratory disease caused by the SARS-CoV-2 coronavirus, which was first detected in the city of Wuhan, Hubei Province of China, in December 2019.1 Due to its high morbidity and mortality, COVID-19 was declared a pandemic by the World Health Organization (WHO) on 11 March 2020.2 With the spread of COVID-19 and the rapid increase in confirmed cases worldwide, countries revised their public health strategies to prevent the transmission of the virus, including mask wearing, lockdowns and stay at home orders, and social distancing.3 The rapid implementation of these preventative approaches has had a profound influence on people's lives. It has led to social isolation, increased risk of unemployment, financial stress, disruption to education, media information overload, and uncertainty and fear about the future, all of which are associated with poorer mental health.4,5
According to the WHO, mental health is defined as a state of well-being in which individuals are able to fulfil their potential, cope with regular stresses in life, learn and work effectively, and contribute to their community.6 A recent review summarised the evidence relating to mental health problems during the COVID-19 pandemic, and found that the pandemic was associated with increasing symptoms of depression, anxiety, stress, irritability, panic, sleep problems, suicidal behaviours and post-traumatic stress disorder, especially for adolescents and young adults.7–9
Adolescence is an important life stage, a time in which young people acquire capabilities and resources that underpin mental health across their lifespan.10 Adolescents and young adults are particularly vulnerable to mental health problems and are likely to be at increased risk of detrimental mental health impacts of such preventative measures.11 As such, it is important to understand the mental health impacts of the COVID-19 pandemic on young people and how the impact may vary for different subgroups of this population.
One group that may be particularly at risk of poor mental health problems are adolescents with disability. Disabilities are broadly defined as health conditions or impairments that hinder functioning as a result of the interaction between people’s health conditions and the society in which people live.12,13 Currently, there are more than one billion people living with a disability globally, accounting for approximately 15% of the world's population, and one-third of them are young adolescents and young adults.13,14
Like people with disabilities in general, young people with disabilities are more likely to experience social and economic inequalities in relation to those without disabilities, and are at greater risk of poor mental health.12,15 Evidence suggests that their poorer mental health results, in part, from inequitable access to health services, socio-economic disadvantage (e.g., poverty, low education, higher rates of unemployment, stigma and discrimination), and lower levels of social support. 16–22 Firstly, young people with disabilities generally have higher healthcare needs compared to young people without disabilities.12,15 However, they experience barriers in accessing health services due to long waiting times, high costs, lack of communication and discrimination by health professionals,12,19 which have been exacerbated during the COVID-19 pandemic.22 Secondly, socio-economic inequalities are also likely to have been exacerbated during the COVID-19 pandemic.14,23−26 Young people with disabilities have lower levels of education,12,24 due to barriers in the existing education system, inadequate resources to address the needs of young people with disabilities, and discrimination.12,24 Prolonged school closures during the pandemic and an increasing reliance on online learning may have presented an additional barrier for young people with disabilities.27 For young people with disabilities in the labour market, increasing unemployment rates and decreased job security may have had a greater impact on young people with disabilities compared to people without disabilities,28 with implications for poverty and financial stress.12,28 Thirdly, young people with disabilities are more likely to be socially isolated compared to those without disabilities, experiencing low levels of social support, less social contact with family and friends, and increased feelings of not being part of the community, which is likely to have been exacerbated during the COVID-19 pandemic.20–24
As such, young people with disabilities may experience disproportionately large mental health impacts associated with the COVID-19 pandemic, further widening existing inequalities, because of the impacts of the pandemic on these known determinants of mental health including access to health services, socio-economic disadvantage, and poor social support.22–24 A growing number of studies have been published examining the impact of the COVID-19 pandemic on the mental health of young people with disabilities.29–33 Yet, no systematic review has been performed to summarise the evidence, which is necessary for providing a more comprehensive understanding of the mental health impact of COVID-19 on young people with disabilities. Therefore, this review aims to systematically review the published literature on the impact of the COVID-19 pandemic on the mental health of adolescents and young adults with disabilities aged 15 to 29 years. The findings of this review will provide insight into the impact of the COVID-19 pandemic on mental health, which may provide the basis for future research to develop effective interventions to manage such crises, as well as to inform government in the development of response plans for future pandemics which address the needs of young people with disabilities.