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All of this flooded her mind as she sat in the exam room, and Grimes suddenly found herself sobbing. “The floodgates just opened,” she recalls. “There was the stress of the pandemic, and not knowing the right thing to do with my kids, and my husband was struggling with his own mental health, and I felt like I was supposed to hold everything together.”

For the first time in her life, Grimes, 38, left her doctor’s office with a prescription for Prozac — a choice she made not only for herself, she says, but also for the sake of her kids.

The pandemic’s profound toll on the mental wellbeing of children has been well documented — especially by parents, teachers, pediatricians, counselors and psychologists who have witnessed the impact firsthand. Suicide has become a leading cause of death for children ages 10 and up, and mental health problems were responsible for a surge of children’s visits to hospital emergency rooms during the first months of the pandemic, according to the Centers for Disease Control and Prevention.

But many kids are not grappling in a vacuum with life-altering changes to school, community and routine wrought by the coronavirus. Their families, too, have struggled — sometimes limiting the children’s ability to cope, or even amplifying the emotional impact on all members of a household. Meanwhile, demand for mental health resources has soared since 2020 even as the availability of therapy and other support, especially for families who are most vulnerable and in need, has plummeted.

Researchers like Jessica Borelli, a clinical psychologist and associate professor of psychological science at the University of California at Irvine, are trying to decipher exactly what all of this means for parents and children who are carrying the trauma of the past two years. In her work so far, which has included a national survey of parents conducted in the first few months of the pandemic, she has found that parents who reported higher levels of mental health symptoms often had children who were experiencing the same: “The more covid impacted parents’ lives, the more a parent’s mental health was adversely affected,” she says, “which in turn impacted their children’s mental health.”

Schools are struggling to meet rising mental health needs, data shows

Grimes had seen this pattern taking shape in her own household. In the weeks before her doctor’s appointment, she had noticed her son assuming a protective posture around her — if his little sister started throwing a tantrum, he would step in and try to intervene, behaving almost as a surrogate parent.

“That broke my heart and triggered something in me. I don’t want him to feel like he has to be another parent,” Grimes says. “It was a red flag. I knew I had to do something.”

The fact that so many parents and children are experiencing mental health crises right now is not surprising, Borelli says; the societal tumult of recent years has forced many families into impossible situations.

“Parents are not meant to meet all of a child’s needs, and when we are all of a sudden in a situation where parents need to meet all of their children’s needs — their social-emotional needs, their educational needs, their physical health and exercise needs, their nutritional needs, everything — the system cannot survive,” she says.

Her study was conducted in the early days of the pandemic, and much has changed since then. Schools, camps and day cares are largely available again, she notes. But parents are still facing extraordinary instability — unpredictable schedules, unexpected quarantines, shifting rules about masking and testing, children who are struggling to re-adjust to in-person schooling — and these constant fluctuations are mentally and emotionally taxing.

“We are asking so much of our kids, and we’re asking so much of our parents,” Borelli says. “The number of routines that children have had to transition between is just staggering, and parents are the ones who have to do that transitioning. It’s just a tremendous cognitive and emotional load.”

As a parent and an elementary school teacher in Baltimore City Public Schools, Samantha Altmann, 38, knows this better than most. When the lockdown began in March 2020, Samantha was teaching her third-grade students online, and her husband, Eben Altmann, was running a commercial kitchen for local food businesses. They had to balance those obligations with childcare for their then-2-year-old daughter, Mabel. Samantha, who was nearly four months pregnant at the time, soon learned that she could longer bring Eben with her to prenatal appointments.

This meant that she was alone when a grim-faced doctor told her, at 25 weeks pregnant, that their son no longer had a heartbeat. And she was alone as she underwent a subsequent dilation and evacuation procedure.

“Five days later, I was in front of my computer virtually teaching my students again,” she says. She felt she had to be there for them — she was a trusted presence in their lives amid so much upheaval, and her students were still reeling from the murder of George Floyd, and she wanted to support them, she says. “So in the middle of me losing the baby, and talking about what’s going on in the country and George Floyd — we’re talking about this virtually, with parents in the background, who are really engaged and wanting to contribute — I’m sitting here in my own trauma, with my daughter on my lap, and that was the start of the pandemic for me.”

When she became pregnant again a few months later, the doctor expressed concern about protecting Samantha’s mental health during another pregnancy — and wrote her an antidepressant prescription. Throughout the pregnancy, Samantha says she was dogged by constant fear of the worst happening again, until their son, Gus, arrived safely in March 2021.

How much of this experience did Mabel absorb? Her parents aren’t certain. “She’s just transitioned into the next age group at school, she’s changed classrooms, she’s left some of her friends behind. Sam’s grandmother recently passed away, and Mabel was very close to her,” Eben says. So when Mabel, now 4 years old, has a tantrum or struggles to listen or behave, there are many possible explanations, he says — “or it could be that she’s picking something up from our own issues and anxieties related to the pandemic.”

For Kim Alexander, 44, serving as director of an assisted living facility in Houston put her on the pandemic’s front lines, and she became fixated on making sure that she did not bring the virus home, where two of her adult children, her teenage son and her then-5-year-old granddaughter lived.

Teen suicides are increasing at an alarming pace

She was especially worried about her 13-year-old son, A. Jay, who has a chronic disorder called eosinophilic esophagitis that has resulted in 48 surgeries since his birth. The condition has led him to experience both depression and post-traumatic stress.

“One day I realized that I was no longer hugging my kids,” she said. “I was keeping myself away from them, which then made them feel more isolated, separate and apart from everybody else. The hurt for me was seeing their hurt, seeing how frustrated they were.”

The toll of isolation, virtual learning and the difficult return to in-person high school exacerbated her son’s anxiety and anger, Alexander says — and when he started running away from home several months ago, she was terrified. “It got to the point for us where I was scared to leave the house, because I didn’t know if when I got home he would still be here.”

Now 16, A. Jay longs to be seen as a “typical” kid, she says, which creates tension between them when she advocates on his behalf and pursues the accommodations he requires. “I’m doing what he needs and not what he wants,” she says. “I’ve become the parent who has put all of these things in place to try to safety-net him from a world that doesn’t want him. And now I’ve made him feel special, I’ve made him feel like he is the center of attention, and his anger with me is ‘I just want to be left alone.’”

All of this weighs on her heavily, she adds: “I’m mentally exhausted. I really am.”

When parents turn to her for help, Jessica Borelli says, she tries to emphasize one thing above all: That a strong parent-child relationship can help shield children from the damaging impact of a parent’s mental health issues. It is a pattern she has consistently observed in her own research, across a range of cultural and socio-economic groups. The strongest predictor of a child’s mental health, she says, is “attachment security” — the feeling of having an open relationship between parent and child, even if one party is battling depression or anxiety or post-traumatic stress.

“Do your kids feel safe? Do they feel loved? Do they feel accepted by you?” If the answers are yes, then that’s what matters, she says. “This isn’t necessarily a time to excel, it’s a time to survive. Focus on the connection that you have with your child.”

Hidden by isolation, schoolchildren struggled with mental health

For Eileen Grimes, that means being transparent. When she filled her first prescription for Prozac, she immediately told her children about the medication.

“I told them, ‘This is what Mommy’s taking, and there’s nothing wrong with it, it helps me to do what I need to do and be the mom I need to be for you,’” she says. “I want to normalize talking about this stuff. I don’t want mental health stigma to exist for them. And I want my kids to know they can come to me when life gets hard.”

Since April, Kim Alexander’s son A. Jay has lived with his father, Alexander’s ex-husband, in a nearby neighborhood. Alexander’s relationship with her youngest child has been strained by all they’ve endured, she says, but she hopes this distance might create a reset of sorts, and she has faith in the strength of their bond. “I’ve been a parent for 28 years, and I know there are ebbs and flows of parenting,” she says. “I’m not concerned about our relationship not being repaired. He will get there. I just want him to find his joy.”

For now, the temporary separation has helped her own anxiety level come down, and she knows that much is essential for both of them. “Honestly, I am relieved,” she says. “As a parent, you’ve got to put your own oxygen mask on first.”