Family Lifestyle and Behavior Changes During COVID-19 Pandemic Associated with Youth Mental Health

Children and teens who experienced significant changes in their lifestyle and health behaviors during the COVID-19 pandemic may be more likely to experience symptoms of pandemic-related post-traumatic stress (PTS), according to a recent ECHO Cohort study led by Amy Margolis, PhD of The Ohio State University.

The United States is facing a growing youth mental health crisis with a significant increase in mental or behavioral health conditions, partly linked to changes during the COVID-19 pandemic. To understand how changes in family hardships, behaviors, and coping strategies during the COVID-19 pandemic influenced youth PTS symptoms, researchers collected information from 7,786 children and 1,353 teens and young adults and their parents or caregivers across the United States between April 2020 and August 2021.

Key Takeaways include:

  • Two groups of families were identified based on their experiences of hardships, changes in daily behaviors, and coping strategies during COVID-19. The first group had minimal changes in their lifestyle and behaviors, while the second group had significant changes. The low change group included a higher proportion of Black families, single-parent households, and lower income and education levels.
  • Children and teens in the group with significant changes had higher Pandemic-related Traumatic Stress Scale (PTSS) scores compared to the group with minimal changes.
  • Some aspects of parent or caregiver experiences, including their ability to isolate during the pandemic, were associated with lower PTSS scores in children. Youth whose parents or caregivers reported no change in their own behaviors were more likely to report lower PTSS scores.
  • Changes in youth health behaviors (like eating, physical activity, and media use) and access to healthcare were important factors associated with PTSS scores. Stability in these areas was linked to lower PTSS scores.
  • The use of coping strategies by children and teens did not significantly reduce PTSS scores. Some coping strategies, like increased media use and substance use, were linked to higher PTSS scores.

This study provides valuable insight that could help improve youth mental health now and in the wake of future public health emergencies. It demonstrates the importance of stability in health behaviors, access to healthcare, and the ability for parents to isolate safely as key factors in reducing youth PTS symptoms.

This collaborative research, titled “Changes to Family Life, Youth COVID-19 Pandemic-Related Traumatic Stress, and the Youth Mental Health Crisis,” is published in the Journal of Clinical Child & Adolescent Psychology.

Read the research summary.

ECHO Study Examines the Effects of COVID-19–Related Changes in Caregiver and Child Behavior on Youth Mental Health

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ECHO Study Examines the Effects of COVID-19–Related Changes in Caregiver and Child Behavior on Youth Mental Health

Authors: Amy Margolis, Andrew Law, et al.

 

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

 

Why was this study needed?

The United States is facing a growing youth mental health crisis with a significant increase in mental or behavioral health conditions, partly linked to changes during the COVID-19 pandemic. This study examined changes in family hardships, behaviors, and coping strategies during the COVID-19 pandemic and evaluated whether these changes were associated with youth pandemic-related post-traumatic stress (PTS) symptoms.

 

What were the study results?

The study identified two groups of families based on their experiences of hardships, changes in daily behaviors, and coping strategies during COVID-19. The first group had minimal changes in their lifestyle and behaviors, while the second group had significant changes. The low change group included a higher proportion of Black families, single-parent households, and lower income and education levels.

Children and teens in the group with significant changes had higher Pandemic-related Traumatic Stress Scale (PTSS) scores compared to the group with minimal changes. Some aspects of parent or caregiver experiences, including their ability to isolate during the pandemic, were associated with lower PTSS scores in children.  Youth whose parents or caregivers reported no change in their own behaviors were more likely to report lower PTSS scores. Changes in youth health behaviors (like eating, physical activity, and media use) and access to healthcare were important factors related to PTSS scores. Stability in these areas was linked to lower PTSS scores. The use of coping strategies by children and teens did not significantly reduce PTSS scores. Some coping strategies, like increased media use and substance use, were linked to higher PTSS scores.

 

What was the study's impact?

This study provides valuable insight that could help improve youth mental health now and in the wake of future public health emergencies. It demonstrates the importance of stability in health behaviors, access to healthcare, and the ability to isolate safely as key factors in reducing youth PTS symptoms.

 

Who was involved?

The participants included 9,139 youth and their parents or caregivers from across the United States, including 7,786 children (aged 2-12 years) and 1,353 teens and young adults (aged 13-21 years).

 

What happened during the study?

The study looked at information from ECHO families between April 2020 and August 2021 to understand how the pandemic affected them. Researchers grouped families into different categories based on their experiences and background characteristics from before the pandemic. The researchers then looked at symptoms of PTS in both children and teens within these family groups. The study explored how COVID-19 influenced family hardships, changes in parent and child behavior, and the ways families coped.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What happens next?

Future studies could help researchers examine what factors contribute to ongoing PTS symptoms or the occurrence of mental health diagnoses. Interviewing participants about acute stress when collecting PTSS survey responses could also help researchers confirm the validity of the survey.

 

Where can I learn more?

Access the full journal article, titled “Changes to Family Life, Youth COVID-19 Pandemic-Related Traumatic Stress, and the Youth Mental Health Crisis,” in the Journal of Clinical Child & Adolescent Psychology.

 

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published October 17, 2025

Read the associated article.