Research shows that social isolation, loss of predictable routine and uncertainty about the future brought on by the COVID-19 pandemic negatively affects mental health of youth, especially children and adolescents. Even before the pandemic, compared to other developing and developed nations, Kazakhstan has had a higher suicide rate among children aged 5-14 and young people aged 15-24. Now more than ever, with the pandemic worsening suicide risk factors, mental health support systems at home and at school need to adapt to coronavirus realities.
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The COVID-19 pandemic that began in early 2020 has changed the ordinary course of life in countries around the world. Kazakhstan is not unique in that regard: on 15 March 2020, to stop the spread of coronavirus in the country, President Tokayev declared a state of emergency that lasted until May 11th, restricting movement and confining many at home under quarantine rules. Even after the state of emergency was lifted, many of these arrangements like work-from-home and distance learning have stayed and persisted in 2021.
The pandemic-related measures are not without consequences. Studies show that the effects of the coronavirus pandemic have adverse consequences for mental health and well-being of people, especially so when it’s young people. Forced isolation, loss of daily routine and stability, uncertainty about the future, are all listed as factors that contribute to increased feelings of depression, anxiety, and fear, feelings that are considered to be suicide risk factors for children and adolescents.
According to the most recent suicide statistics released by the Committee on the legal statistics and special accounts of the state office of public prosecutor of Republic of Kazakhstan, in the first 11 months of 2020 there were reported 125 suicides and 261 attempted suicides committed by minors under 18 years of age, with peak numbers registered in March (15 suicides and 34 attempts).
Situation in Kazakhstan in pre-pandemic period
Even before the COVID-19 pandemic, the problem of adolescent mental health was a major pain point of the country, and yet it has not received a lot of attention from the government until recently, when Kazakhstan started to consistently be listed among countries with higher-than-average suicide rates among children aged 5-14 and youth aged 15-24. Suicide was named as the leading cause of death from external causes among the adolescents and youth in Kazakhstan by the World Health Organization.
In recent years, the government recognized suicide as a major threat to public health and approved a roadmap to implement a program for early detection and prevention of suicides that was piloted in Kyzylorda region in 2015. The three-tiered approach of the program included the introduction of a) informational, b) educational and c) preventative measures at school-level. These measures were focused on the early identification of children at risk of suicide and mental health problems as well as awareness-raising about mental health and coping strategies among the students. They also included specialized gatekeeper training provided to teachers and other school staff, social workers, and general practice physicians that frequently work with children, as well as thematic workshops and informational campaigns targeted at school children.
Initially showing promising results, the program was scheduled for the staggered implementation in other regions to take place during 2016-2017. However, due to a number of interrelated factors like lack of cooperation between local municipalities and the inability of some regions to set aside funds from the local budget, the implementation has been uneven across the regions. At the beginning of 2018, the program covered only a third of all secondary schools in the country. As a result, for any individual school it is unclear how well the school staff are prepared to correctly identify and intervene in high-risk cases, or if a formal mental health support and identification system exists at all.
Research conducted by the UNICEF in 2018 shows that the underlying factors to increase the risk of suicide in children are not qualitatively different in Kazakhstan than the rest of the world. These risk factors may include feelings of loneliness and social exclusion (including bullying), conflicts with parents or relatives, financial difficulties in the family or otherwise unstable home situation, and uncertainties about and fear of the future. Taking root in larger issues like financial instability/poverty, economic and racial inequality, or lack of access to quality education and healthcare, they are indicative of the socio-economic problems and processes taking place in each society.
Considered a tragedy that primarily impacts individuals, families, and communities, suicide has an economic dimension that is often overlooked, where each suicide represents lost economic value in the form of lost future earning potential and years of productive life. A recent study showed that the lives lost to suicide in 2014 from the 10 most developed countries “resulted in a loss of 406,730 years of life at a cost of $5.53 billion in lost economic income with the average cost of suicide estimated at $802,939.”
In Kazakhstan, addressing the problem of suicide effectively is further complicated by the local cultural context that affects how society at large views suicide and translates to the less-than-stellar policy practices. For example, the persistent stigma surrounding mental illnesses may make children reluctant to seek help from parents/teachers or to confide in peers out of fear or shame, making it harder to detect children at risk. These same stigmas may also subconsciously influence the way professionals like school psychologists and social workers form opinions about the mental illnesses and consequently interact with children. Even if the stigmas were not a factor, considering that these professionals are often chronically underpaid and may also be unsuited or unqualified for the job, the quality of care they provide may need to be called into question.
The Impact of the Pandemic
Directly or indirectly, the pandemic has affected the underlying risk factors and, in many cases, made them worse.
When the state of emergency was first declared, students were sent on their March holiday break ahead of schedule while the Ministry of Education started to rapidly develop the necessary mechanisms for distance learning. On April 6th, schools switched from in-person instruction to distance learning for the last quarter of the 2019-2020 academic year.
While it is expected that, with rare exceptions, the students will continue to distance learn from home for the foreseeable future, a recent study by a group of experts from PaperLab found that schools were woefully unprepared to function in distance learning mode, which only served to expose the critical weaknesses of the education system. With the implementation of distance learning practices, it became harder for children to have access to school-based mental health support, both formal in the form of trained school staff and informal in the form of their peers.
As part of PaperLab’s study, both upper-class students (Grade 8-10) and parents of elementary school students (Grade 2-4) were asked to keep a daily log detailing their experience with distance learning for 2 weeks. In these logs, many students expressed that they missed their friends from school and that interactions via social media and other online platforms were qualitatively different from talking in-person. One person wrote that they were not able to talk about everything they wanted with friends out of fear that parents may overhear their private conversation. A similar sentiment about lack of social interaction was echoed in the entries made by parents, as well.
These sentiments seem to be confirmed by survey results. According to a survey by DEMOSCOPE, 32% of respondents think that the main drawback of remote learning is the stress it places on children, parents, and teachers. A similar survey conducted in Russia studying the effects of distance learning on students found that in 83.8% of students, the stress associated with self-isolation and distance learning led to adverse psychological reactions, with depressive signs detected in 42.2% of students and physical weakness/tiredness in 41.6% of students.
Evidently, changes to in-person schooling practices and increased time spent at home made it more difficult for children and adolescents to maintain social connections with their peers, who are an important part of their life and often serve as a primary support network, especially for those children with unstable or unsafe home environment. On the other hand, those children who experience bullying at school may feel safer studying at home; for this category of students, distance learning may actually improve their mental health and school functioning.
COVID-19 psychologically affects not only children, but also their parents. The daily log entries made by parents for the same PaperLab study indicated that the extended periods of time spent at home with children contributed to increased interpersonal conflicts between parents and children. Unused to having their child around 24/7 and not knowing how to keep them on school schedule at home, some parents confessed to feeling stressed and on edge, in some cases letting the temper and frustration get the better of them and resort to yelling. For some families where the pandemic resulted in temporary unemployment, the financial problems may have become an added stress factor, as well. In more serious cases, these conflicts may result in instances of child abuse, verbal and physical, which is one of the major suicide risk factors in children. Increased instances of violence against children at home were observed in Kyrgyzstan because of the pandemic.
This is critical because for children and adolescents, who at this stage of life are developing vital cognitive and emotional skills such as self-control, social interaction and productive learning, negative experiences like conflict with parents may have lifelong implications for their mental well-being that may persist into adulthood.
Taking the next steps
Many effective responses and interventions put emphasis on school-based programs that focus on both promoting healthy coping mechanisms and preventing suicide through detection of early warning signs. With schools remaining closed, these tools/resources have become very difficult to access for students. Thus, the recommendations should be such that the mechanisms for screening/identification are shifted more from school to home. Parents can no longer afford to simply ‘check out’ and let the schools deal with the issues their children may be having, whether at school or in their personal life.
Instead, it is better to actively involve and inform parents about risk factors and effective communication tools they may use with their child.
Therefore, the first priority in building effective child suicide prevention strategies in post-COVID climate should be engaging parents as a first line of defense. This can manifest in the form of information campaigns and training workshops to give them easy access to necessary resources and techniques. For instance, teaching parents how to recognize unusual behavior patterns that may be a signal of depression or anxiety, or giving them access to healthy communication tools they may use to build a more open, honest dialogue with their child will encourage the development of a more trusting relationship. Putting together and distributing resource packs like these is another easy option.
Second, even under remote learning arrangements, it is vital for schools to make psychological services accessible online to students (Skype sessions by appointment, etc.) where possible. That way, the school can catch those students who may be actively looking for help and where family environment is the main cause of stress and pressure. International practice also includes complementary systematic screening of students through self-assessment questionnaires or mechanisms where teachers may refer students they suspect to be at risk for further assessment.
Third, the preventative measures should also incorporate direct work with students on healthy coping mechanisms, stress management, and interpersonal relationship dynamics, be it through discussions, hands-on workshops, or easily available informational packs and brochures that also list emergency support hotlines and other crisis resources.
All of these strategies have long-term benefits even after schools return to normal, where parents, students, and educators are better informed and better equipped to manage children’s mental health needs.
This material has been prepared as part of the Giving Voice, Driving Change – from the Borderland to the Steppes Project. The opinions expressed in the article do not reflect the position of the editorial board or the donor.