Introduction

The SARS-CoV-2 emergency affected health systems globally, compelling governments to implement strategies, like social distancing or confinements, and generating stress, anxiety, and depression which impacted the population well-being, and young people especially.¹In educational settings, measures such as suspending classes and accelerating the use of technology for learning, had an impact on the routines of students and their families.²Additionally, social distancing reduced the interpersonal interactions and leisure activities of adolescents, who lost social relations with peers, amongst other changes.³Previous systematic reviews have demonstrated that mental health problems in children and adolescents increased during the pandemic compared to pre-pandemic data, being gender, socio-economic status, previous state of mental and physical health, social support, and consistent routines among the most reported influencing factors.^4-8

Several studies have shown gender differences in the response of adolescents to the COVID-19 pandemic, with a worse effect on psychological well-being observed in girls girls.^9,10Reasons cited for the gender differences include a reduction in emotional support from social networks due to social distancing distancing¹¹and a greater increase in unhealthy lifestyle habits compared to boys.⁹Additionally, depression and anxiety increase during puberty, especially among girls,¹²which may partially explain these gender disparities. The pandemic highlighted gender differences in mental health that are a reflection of the distinct social processes for youth with different gender identities, as well disparities in mental health that emerge and intensify during this stage of life.¹³

Effective coping strategies, defined as cognitive and behavioural efforts made to manage situations that are potentially threatening or stressful,¹⁴have been reported in adolescents, such as physical activity, use of social networks and establishing routines.^15,16However, unhealthy coping strategies such as consumption of tobacco, alcohol and/or drugs, or unhealthy eating habits have been identified, although to a lesser extent¹⁷. Evidence indicates that positive coping strategies, such as connecting with friends and family members and/or engaging in physical activities, are closely related to better mental health outcomes during the COVID-19 pandemic,⁸whereas unhealthy coping strategies relate more strongly to greater negative impacts on stress and mental health, Also gender is one of the factors that influences which coping strategies are adopted to confront stress.^10,18A previous study in Spain on a sample of university students showed that men resorted to physical exercise during the pandemic, while women listened to more music and watched more television.¹⁹

The COVID-19 Sentinel Schools Network of Catalonia (CSSNC), main objective was to monitor and evaluate the COVID-19 situation and its impact in educational settings in order to gather evidence for the health policies, prevention and control of SARS-CoV-2 in schools. Since its implementation in 2020, mental health was identified as a priority challenge, leading us to include in the project new research questions to better explore this issue in schools and develop more effective strategies strategies.²⁰

This study aims to describe the impact of the COVID-19 pandemic on psychological well-being, defined as “a state of mind in which an individual is able to develop their potential, work productively, and creatively, and is able to cope with the normal stresses of life”,²¹in students over 15 years in CSSNC stratified by gender identity. Furthermore, the study aims to compare coping strategies adopted to manage the health crisis by gender and to investigate associations between strategies adopted and a worsening of mental health due to the COVID-19 pandemic. It is essential to explore how girls and boys were coping during the pandemic and what coping strategies positively or negatively influenced changes in mental health to be able to understand the impacts of the pandemic and to better inform appropriate school-based interventions, creating a safe and supportive environment that responds to their specific needs.

Method

Results

Of a total of 1171 participants, 626 (55.7%) identified as women, 478 (42.6%) identified as men, 12 (1.1%) as non-binary and 7 (0,6%) as other gender. Regarding complexity, 166 (14.2%) students were from low complexity schools, 140 (12.0%) medium low complexity, 700 (59.8%) medium high and the rest (14.1%) from high complexity schools.

The mean age of participating boys and girls was 16.9 and 16.8 years old, respectively, most were born in Spain (89.9% girls and 93.0% boys), and 9.3% of girls and 8.5% of boys reported a lower level of family income since the start of the pandemic. A higher proportion of boys compared to girls reported a university level of education for their mothers (36.4% boys and 29.7% girls) (Table 2).

Boys presented a better self-perceived general health compared to girls (95.3% good, very good or excellent for boys, and 92.3% for girls) and better self-perceived mental health (87.3% good, very good or excellent for boys, and 63.8% for girls). Additionally, the percentage diagnosed with anxiety before or after the pandemic started was higher in girls (20.6% girls and 7.3% boys) (Table 2).

A greater proportion of girls perceived a worsening in mental health due to the COVID-19 compared to boys (36.9% and 17.8%, respectively), while 5.7% of girls and 15.0% of boys perceived their mental health as improved in this same period (p < 0.001). Additionally, the level of stress caused by uncertainty about the future generated for COVID-19 was also greater in girls than in boys (M = 4.1, standard deviation [SD]: 1.7, and M = 3.1, SD: 1.8, respectively) (Table 3).

For all the emotions that can generate emotional discomfort, girls had statistically significant higher mean scores than boys, except for worry (Table 3). The main emotions reported for both girls and boys, respectively, were worry (M = 2.7, SD: 1.1, and M = 2.2, SD: 1.1) and boredom (M = 2.7, SD: 1.3, and M = 2.4, SD: 1.2), followed by frustration in girls (M = 2.5, SD: 1.3) and disappointment in boys (M = 1.9, SD: 1.1).

Most of the participants reported a high negative impact of the pandemic caused by the fact that friends or family could die (61.3% girls and 41.4% boys) and/or get sick (54.9% girls and 33.5% boys), together with the fear of losing jobs (themselves or family members) (46.5% girls and 29.6% boys) (Fig. 1).

Figure 1. Level of concern (a lot/a great deal) about the impact of the pandemic on distinct aspects of life according to gender identity. 

One of the most frequent coping strategies used by adolescents to deal with the pandemic (Table 4) was contact with friends online and/or social media (76.5% and 68.6% in boys and girls, respectively), and other solitary digital activities like watching TV and/or films (80.8% and 69.7% in girls and boys, respectively). On the other hand, playing videogames was an activity mainly reported by boys in comparison with girls (78.7% and 28.1%, respectively). In addition, other social activities related to family such as reserving time to spend with people they lived with were more frequently reported by girls in comparison with boys (26.4% and 20.6%, respectively). More than half the adolescents also referred to self-care strategies like taking exercise (59.7% and 63.2% in girls and boys, respectively), and/or other individual non-digital activities such as reading and/or writing, higher among girls (41.2% girls and 14.8% boys). Amongst unhealthy activities, girls reported smoking as a coping strategy more frequently than boys (9.9% girls and 5.4% boys), while eating less healthily (20.8% girls and 16.6% boys), and consumption of alcohol and/or drugs (11.2% boys and 8.1% girls) were reported similarly by gender. The percentage of girls who had spoken to a mental health professional was higher than boys (7.7% of girls and 2.6% of boys).

In the adjusted logistic regression analysis, we founded an association between the participation in family activities, such as playing games and/or sports, with a lower probability of declaring worsening of mental health due to the pandemic among girls (OR: 0.55; 95%CI: 0.38-0.79) (Table 5).

Playing board games, puzzles or crafting also showed a protective effect in relation to worsening of mental health among both girls and boys, respectively (OR: 0.62, 95%CI: 0.43-0.89 for girls and OR: 0.44, 95%CI: 0.22-0.88 for boys). Playing videogames also showed a protective effect in relation to worsening of mental health among girls (OR: 0.66, 95%CI: 0.45-0.97).

Among girls, other strategies related to unhealthy habits, like consumption of alcohol or drugs, were associated with a higher probability of declaring worsening of mental health due to the pandemic (OR: 2.61, 95%CI: 1.41-4.81). An association between smoking and a higher probability of declaring worsening of mental health due to the pandemic was seen among boys (OR: 2.45, 95%CI: 1.03-5.84).

Finally, adolescents who had spoken to mental health professionals reported a higher proportion of worsening of mental health (OR: 3.43, 95%CI: 1.82-6.46 for girls and OR: 4.56, 95%CI: 1.31-15.9 for boys) (Table 5).

Discussion

This study demonstrated the negative impact of the COVID-19 pandemic on psychological well-being in adolescents and a clearly worse impact on girls. The use of social and digital media to keep in contact with friends and reduce social isolation was the most commonly reported coping strategy for both girls and boys, whereas gender differences were seen in the use of other strategies used such as the higher proportion of girls using social activities related to family and/or friends in comparison to boys. This study also shows an association between coping strategies and self-perceived mental health status in adolescents in Catalonia. In this sense, the use of unhealthy habits during the early pandemic period (e.g., substance use) was associated with a higher probability of declaring worsening mental health among both girls and boys, whereas the use of other positive coping strategies (e.g., spending time with family) was associated with less adverse mental health among girls.

The higher percentage of girls than boys that perceived a worsening of mental health due to the pandemic and the higher level of stress caused by general uncertainty it produced is consistent with others studies studies.^4-10Emerging evidence indicates that girls perceive the impact of COVID-19 on their psychological well-being differently from boys.²⁴However, a higher prevalence of diagnoses of anxiety since the start of the pandemic observed in the study (8.7% girls and 2.4% boys) suggests that objective data exists to confirm the worsening of mental well-being in girls. All adolescents experienced more intense emotions than usual linked to the pandemic such as: worry, boredom, frustration, and disappointment, with girls presenting higher mean scores on most of the emotions that negatively affected psychological well-being. Other studies with children and adolescents in Spain during the first months of the pandemic revealed feelings like fear, sadness and boredom, typical of the break with routine and loss of predictability the pandemic supposed.⁷Although no difference was observed in type of concerns most reported according to gender, there were differences in intensity with girls showing the highest prevalence, as reported previously.²⁵The fact that family or friends could die if infected by SARS-CoV-2 was the commonest concern reported for both genders; a risk factor for poorer psychological well-being in young people observed in several studies.²⁶The second major stressor was fear of losing work, both for themselves and/or family members, consistent with a previous study in Catalonia where a decline in family income was associated with poorer overall well-being for girls and boys.²⁷

Amongst the most common strategies found in our study to cope with the pandemic, for both girls and boys, were maintaining contact with friends online or through social media, together with other solitary digital activities. Although that coping strategies alleviate the effects of social distancing, social network use has also been associated with negative psychological consequences in this context.²⁸

Girls reported in a higher proportion than boys the use of social activities related to family and/or friends as a coping strategy, as observed previously. In addition, among girls, spending time with family members was associated with less likelihood of declaring worsening mental health due to the pandemic.²⁹Other studies also show that better communication and emotional support from family members during the pandemic was a protection against developing symptoms of anxiety or depression in children and adolescents.³⁰

As in other studies³¹a large percentage of adolescents referred to self-care strategies like exercise to deal with the pandemic, which has shown mental health benefits for the young. However, other less healthy habits like smoking, and consumption of alcohol and/or drugs, were also used as coping strategies.¹⁷Compared to boys, more girls in our sample reported engaging in tobacco use to cope with the pandemic. This finding is consistent with evidence that girls may be more likely to use substances as a coping strategy and responds to their learning and development, as well as their mental health and psychosocial well-being needs.³² Worry and fear due to COVID-19, together with consumption to relieve feelings of emotional discomfort caused by anxiety, stress or depressive feelings, have been identified as factors associated with coping strategies involving substance use.³³

Finally, seeking professional help as a coping strategy was reported by a few number of adolescents, and more in girls, in line with previous studies showing young people will more often disclose their feelings to parents and friends than to professionals, this is in part due to mental health stigma and embarrassment, a lack of mental health knowledge and negative perceptions of help-seeking.³⁴

Some limitations of this study include a lack of pre-pandemic data to confirm a real decrease in mental health in adolescents using internationally validated scales. However, the questionnaire used was created specifically to measure perception of impact of the pandemic on psychological well-being in adolescents and was never intended to diagnose the real state of mental health of participants. On the other hand, as it is a transversal study, we cannot establish causality between worsening mental health and coping strategies adopted. Additionally, we cannot rule out a significant degree of memory bias, as in any retrospective survey. Finally, considering the non-probabilistic sampling method, the results cannot be generalized to the school population of Catalonia. However, one of the most important strengths of this study was the formation of a network of schools that worked together to develop, adapt and implement health protocols, studies and scientific dissemination in the face of the pandemic, providing safe attendance of face-to-face activities for students and education professionals. Still, in relation to the methodology, the study design, carried out concomitantly with the participatory research model, revealed a strengthening of science teaching and the strengthened student involvement, seeking to mitigate as much as possible the impact of the pandemic on their mental health.

In conclusion, this study presents evidence on the negative impact of the COVID-19 pandemic on psychological well-being in adolescents in schools in Catalonia, especially in girls. Although the generalized use of social media technology as a coping strategy stands out, other activities and strategies have been employed, and differently by boys and girls. Some of these strategies have been related to better psychological well-being, but we must not forget that unhealthy strategies, such as consumption of alcohol and/or drugs and smoking, have also increased to deal with difficult situations. Due to the pandemic adolescents experienced much stronger negative emotions than usual such as worry, irritability or frustration; with girls presenting a higher proportion of them. More focus must be put on feelings generating emotional discomfort, especially if they are very intense and prolonged, because the absence of adequate tools to manage them can put those who experience them at risk. It is important to keep monitoring the medium- and long-term secondary impacts of the pandemic on mental health outcomes and consequent coping behaviours, especially considering gender perspective.

Finally, access for adolescents to emotional support services must be improved, both within schools and in specialized mental health centres, taking into account the need to support young people as they develop the necessary positive coping strategies required during health crises such as that of COVID-19.

Transparency declaration

The corresponding author on behalf of the other authors guarantee the accuracy, transparency and honesty of the data and information contained in the study, that no relevant information has been omitted and that all discrepancies between authors have been adequately resolved and described.