Persistent anxiety among high school students: Survey results from the second year of the COVID pandemic

Abstract

Introduction National mental health surveys have demonstrated increased stress and depressive symptoms among high-school students during the first year of the COVID-19 pandemic, but objective measures of anxiety after the first year of the pandemic are lacking. Methods A 25-question survey including demographics, the Generalized Anxiety Disorder-7 scale (GAD-7) a validated self-administered tool to evaluate anxiety severity, and questions on achievement goals and future aspirations was designed by investigators. Over a 2-month period, all students from grade 9-12 in a single high-school (n = 546) were invited to complete an online survey after electronic parental consent and student assent. Bi-variate and chi-square analyses examined demographic differences in anxiety scores and the impact on outcomes; qualitative analyses examined related themes from open-ended questions. Results In total, 155/546 (28%) completed the survey. Among students with binary gender classifications, 54/149 (36%) had GAD-7 scores in the moderate or severe anxiety range (scores≥10), with a greater proportion among females than males (47% vs 21%, P<0.001). Compared to students with GAD-7<10, those with ≥ 10 were more likely to strongly agree that the pandemic changed them significantly (51% vs 28%, p = 0.05), made them mature faster (44% vs 16%, p = 0.004), and affected their personal growth negatively (16% vs 6%, p = 0.004). Prominent themes that emerged from open-ended responses on regrets during the pandemic included missing out on school social or sports events, missing out being with friends, and attending family events or vacations. Conclusion In this survey of high school students conducted 2 years after the onset of COVID-19 in the United States, 47% of females and 21% of males reported moderate or severe anxiety symptoms as assessed by the GAD-7. Whether heightened anxiety results in functional deficits is still uncertain, but resources for assessment and treatment should be prioritized.