key: cord-270113-cdqhs4bg authors: Sharma, Vinita; Reina Ortiz, Miguel; Sharma, Nandita title: Risk and Protective Factors for Adolescent and Young Adult Mental Health Within the Context of COVID-19: A Perspective From Nepal date: 2020-05-20 journal: J Adolesc Health DOI: 10.1016/j.jadohealth.2020.04.006 sha: doc_id: 270113 cord_uid: cdqhs4bg nan The following are some COVID-19erelated mental health risk factors in Nepalese youths: (1) deficient youth mental health services funding; (2) social media use; (3) a suddenly-imposed lockdown; (4) lack of understanding of lockdown restrictions; (5) sudden work/student life changes; (6) abrupt postponement of the Secondary Education Examination (SSE); and (7) exposure to devastating earthquakes in 2015. In Nepal, there is insufficient funding of youth mental health services [10] . Underfunded mental health services may lead to increased negative mental health outcomes. Access to Internet and social media has increased in recent years in Nepal. Social media use has been correlated with negative mental health outcomes such as stress and depression [11] . In addition, social media may become a source of health-related information during crises [12] . Youths might not have the capacity to handle the frequency or to analyze the accuracy [7] of information shared via social media. Recency [12] and sender (i.e., echo chambers [13] ) of information may play an unbalanced role in assessing credibility, which may lead to misinformation and related stress/ anxiety. The implementation of a lockdown mandate with only a few hours of notice in Nepal left people unprepared for a long-term restriction on mobility. In addition, the social distancing and isolation that accompanies long-term lockdowns might be a risk factor for anxiety, mood disorders, and addictive and thought disorders [14] . Working youths cannot continue their work, either because their places of employment are closed or because they lack resources (i.e., computers) at home. For students, engagement in schools, in colleges, and with peers, which is a protective factor against adverse mental health outcomes [15] , was suddenly interrupted. Previous and multiple experiences of Nepali "lockdowns" (i.e., strikes or bandha and curfews) may have created a false expectation of "life-as-usual" activities during evenings. Conflicting information is associated with higher stress [7] . Misplaced expectations (arguably a type of conflicting information) may lead to anxiety and/or depression if and when authorities enforce the COVID-19 lockdown more strictly. The SEE, a national examination that is commonly associated with stress/anxiety [16] , was also postponed just hours before the scheduled time [17] . This abrupt cancellation and lack of information about SEE's future course left everyone involved in confusion and stress. Nepalese youths experienced negative post-2015-earthquake mental health outcomes, including post-traumatic stress disorder [18] . A new emergency/crisis scenario may exacerbate those negative outcomes or generate new ones. Post-traumatic stress symptoms have been reported in Wuhan in the middle of the COVID-19 outbreak [19] in addition to adverse COVID-19 mental health outcomes associated with vicarious exposures [20] . Mental health protective factors in Nepal may include the following: (1) cultural acceptance of facemasks; (2) family structure; (3) school space repurposing; and (4) availability of free counseling. Facemasks are a common sight in Nepalese urban centers due to air pollution [21] . In the wake of COVID-19, traditional tailors (suchikar) have been sewing and gifting cloth masks. Altogether, these habits/measures may facilitate the implementation of CDC facemasks recommendations [22] . Joint and extended families are common in Nepal, which provide youths with a support system. As a result, youths are reconnecting with their family values and cultural identity. Increased support from friends and family have been reported in the context of COVID-19 [23] . School campuses are being used as potential quarantine and food collection sites, instilling a sense of social responsibility and community support that may negate adverse mental health outcomes [24] . Finally, trained counselors and psychologists are offering suggestions and psychological first aid (mostly free) via the Internet. COVID-19 pandemic challenges are likely to lead to negative mental health outcomes among youths, especially in Nepal. Table 1 WHO. Novel coronavirus e China COVID-19) and the virus that causes it Coronavirus disease (COVID-19) pandemic Figure 1. Chronological order of events related to risk and protective factors for COVID-19erelated negative mental health outcomes among adolescents and youths in Nepal. A/Y ¼ adolescents and youths MHS ¼ mental health services SSE ¼ secondary education examination detail/30-01-2020-statement-on-the-second-meeting-of-theinternational-health-regulations-(2005)-emergency-committee-regardingthe-outbreak-of-novel-coronavirus-(2019-ncov) Available at: https:// www.who.int/dg/speeches/detail/who-director-general-s-opening-remarksat-the-media-briefing-on-covid The outbreak of COVID-19 coronavirus and its impact on global mental health The psychological impact of quarantine and how to reduce it: Rapid review of the evidence The Government of Nepal; Ministry of Health and Population Child and adolescent mental health problems in Nepal: A scoping review Internet addiction in Korean adolescents and its relation to depression and suicidal ideation: A questionnaire survey Social media as information source: Recency of updates and credibility of information Rumor propagation is amplified by echo chambers in social media Mental health during and after the COVID-19 emergency in Italy Social and school connectedness in early secondary school as predictors of late teenage substance use, mental health, and academic outcomes The school leaving certificate (SLC) examination of Nepal: Exploring negative consequences Notification about postponement of SEE exams'. 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