Dr. Luisa Lázaro: “Social media do not help adolescents with low self-esteem”

Interview with Dr. Luisa Lázaro, Head of the Child and Youth Psychiatry and Psychology Service. We speak to her about how the restrictions derived from the COVID-19 crisis have affected the mental health of children and adolescents. We discuss how prevention is important in this area, because half of all psychiatric disorders begin before the age of 18, and treating them in the early stages is a key factor.

Why is it so important to start looking after mental health in childhood?

Mental health is fundamental for any individual, and the sooner we start to treat it the better, because there will be less risk of suffering a disorder.  Moreover, studies reveal that 50% of psychiatric disorders, such as psychotic disorders, bipolar disorders, obsessive compulsive disorders, or eating disorders, appear before the age of 18. They need to be treated as soon as possible, because the evolution will be better if treatment begins in the early stages.

Is society prepared for children with mental health problems?

No, not sufficiently.  It seems that now, after the pandemic, there is a generalized idea that we have to take care of children and young people, that mental health is very important and that it should form part of health in general.  But I also think that mental health has always been one of the most neglected areas of public health: for a long time, the idea prevailed that only a few people were mentally ill. People thought, “that doesn’t affect me”, and it affects everyone, regardless of their social class. Clearly, the more social issues there are, the greater the vulnerability. But no one is immune to depression or anxiety disorders, etc.

So, prevention is very important. What should we focus on?

Lately, different initiatives have started, aimed at improving situations that affect the most vulnerable sectors of the population. For example, school bullying, a very common type of bullying that does a great deal of harm to children and hinders their full development. Now society has become aware of this issue and is ready to tackle it. Another topic is social media, which are very good for society in general, but we are also aware that they can have negative consequences for children and young people.  These negative impacts need to be prevented, to stop them causing the harm they do to some young people under the age of 18.

Studies have been leaked about the impact of Instagram on adolescents’ self-esteem.

The number of interactions, whether or not people are following you, the follower count, etc., are a series of issues that lead to excessive anxiety in some people, especially children and adolescents, and even in adults under 20 years old.   Not everyone is affected, but the way that some social networks work does not help adolescents at all with their need for social approval or their low self-esteem.  These personality traits can mean that social media are not helpful at all, and end up leading to certain types of disorder.

How have COVID-19, lockdown and restrictions affected the mental health of young people and adolescents?

Lockdown was very hard for everyone, but it was especially complicated for the under-18s. Children were unable to leave their home for a long time, and a part of the population that really needed to get out of the house–even if they were supervised–was left to last. I think this was a major oversight. On the other hand, it is also true that children and adolescents in general were able to cope well with the lockdown. In fact, during the first months of COVID-19, the number of consultations dropped significantly. There are many reasons for this: ranging from not wanting to go to a health centre or a hospital because of fear of infection, to them not going to school, which for many children is a major focus of tension.

However, this drop in the number of consultations only occurred at the start of the pandemic…

Exactly: in autumn 2020, the number of cases started to rise sharply. In reality, within the COVID-19 pandemic there was another pandemic, a mental health pandemic among the under 18s. What we have seen is that, on the one hand some pre-existing diseases have worsened and, on the other, there has been an increase in new patients.

What are these diseases?

Above all eating disorders (ED), which have increased significantly. Also anxiety and affective disorders. And also, with the affective disorders we have seen that there has been a rise in the number of requests for admission due to attempts at self-harm by adolescents. Moreover, the latter is not something we have only seen rising in hospitals. It is a trend on a national scale, and also across the whole of Southern Europe, which is what we can compare ourselves with in terms of trends.

What is the reason for the rise in the cases of eating disorders?

It has taken a long time to treat some cases because, although the families knew that something was wrong since they were spending more time with their children, the networks allowing patients to reach the places they needed to go for treatment were not working so smoothly. Some diseases are detected more frequently in schools than at home, but the schools were focused on the fight against COVID-19. What I mean to say is that it was harder to detect cases and the referrals took longer, and for that reason when we received the cases they were more serious. In the case of eating disorders in particular, sometimes when they reach us the patients have lost a lot of weight and are in a situation that forces us to treat them in a specialist unit instead of via a health centre.

The data show that, in 2020, there was a 27% rise in the suicide rate among young people in Catalonia.

Both successful suicide attempts and attempts at self-harm have increased, and the latter mean that a lot more adolescents are being admitted to hospital.  There are more adolescents suffering from depression and anxiety disorders. The pandemic has led to a great deal of uncertainty. We no longer live in a safe world. Many families’ purchasing power has decreased considerably and that causes anxiety, sadness, irritability, tension, etc. And what families experience has repercussions on their children. Moreover, there is the direct fear created by the pandemic: the fear of being infected, or getting ill...

Has the pandemic led to a delay in early detection?  

Yes, it has been a problem. There is an explanation for why the number of consultations decreased during the first few months: people didn’t want to go to health centres because the primary care centres were overwhelmed by COVID-19. Moreover, paediatricians, who are usually the ones who refer patients to us, were focused on the fight against the pandemic, with the successive waves that have occurred. There has been a lot of telemedicine, and little face-to-face care… and that means that some patients with diseases in the early stages have taken longer to come to our surgery.

A new specialty of child and adolescent psychiatry has finally been approved.

This August, the Council of Ministers approved the specialty, and the positions will be available in 2023. We had been fighting for this for many years, because during the 4-year general psychiatry speciality, only a 4-month rotating internship in child psychiatry was required.  And that is very little in order to specialize in such a specific and important area because, as we have already said, some mental illnesses begin in the early stages of life. We cannot forget neurodevelopmental disorders.