The COVID-19 pandemic is an unexpected global event that has a wide impact on different populations in different parts of the world (Zhang-James et al., 2025). In response to the occurrence of the pandemic, Shek (2021a) raised twelve reflections on the pandemic, such as digital, gender and health inequalities, economic disadvantage, family well-being, holistic well-being, prevention of negative well-being, and promotion of positive well-being. With particular reference to the quality of life of young people, the COVID-19 pandemic has created many stressors for young people, particularly in the early stage of the pandemic (Ma et al., 2021; Ravens-Sieberer et al., 2022; Temple et al., 2022). Studies showed that school lockdown and reduced social interaction, involuntary online learning, reduced family income and anxiety about infection had negative impacts on the well-being of young people. Hence, it is important to reflect on the issue of quality of life in young people, including the nature of available studies and how child and adolescent mental health can be understood, assessed and intervened (Chai & Shek, 2024a, b; Close et al., 2024; Shek, 2021b).

Quality of Life in Young People: A Multi-Dimensional Concept

The concept of quality of life is a multi-dimensional concept with different components, including health, well-being and wellness (Felce & Perry, 1995; Wallander & Koot, 2016). Generally speaking, quality of life can be defined in terms of health, happiness, and subjective fulfilment and it covers individual well-being. For health, the World Health Organization defines it as a state with “complete physical, mental and social well-being” which is not simply “the absence of disease or infirmity” (Schramme, 2023). Hence, besides physical health such as absence of disease, mental well-being (or mental health) is an important dimension of quality of life.

There are different conceptions of mental health in the scientific literature (Dodge et al., 2012). Generally speaking, researchers have defined mental health in terms of two perspectives. First, mental health has commonly been conceived in terms of “psychological ill-being” or “negative mental health”. The focus of this approach is to look at mental health in terms of psychological distress and morbidity, where researchers use psychological distress symptoms (e.g., depression and anxiety) and deficiencies (e.g., lack of positive affect) to define mental health. In mainstream Psychology and Psychiatry, researchers have used symptoms and “break in normal functioning” (Wood & Joseph, 2010) to define mental health based on symptoms described in manuals on mental disorders, such as the 5th edition of the Diagnostic and Statistical Manual for Mental Disorders and International Classification of Diseases (ICD-11). Based on this “negative” view of mental health, researchers have conducted epidemiological studies to find the “prevalence” of psychological disorders using measures of depression such as the Center for Epidemiologic Studies Depression Scale (CESD, Radloff, 1977) and its revised version (Eaton et al., 2004). At the same time, researchers develop “therapies” to “treat” psychological disorders such as behavioral modification and cognitive-behavioral therapies.

On the other hand, researchers have argued that the absence of psychological distress is a necessary but not sufficient condition of wellness (Fergusson et al., 2015; Karademas, 2007; Saldivia et al., 2023; Varga et al., 2024). According to the World Health Organization, mental health is “a state of mental well-being” (Schramme, 2023), a quality that makes an individual to cope with the stresses of life, unleash their abilities and potential, learn and work well, and make meaningful contribution to the community. Keyes (2006, 2014) proposed that there are three components of mental health, including emotional well-being, psychological well-being and social well-being. While emotional well-being covers happiness, psychological well-being includes life satisfaction, and social well-being refers to positive functioning, social contribution, social contribution, social actualization and social coherence. Similarly, Ryff (1995, 2014) proposed six dimensions of positive well-being. These include autonomy (e.g., confidence), environmental mastery (e.g., feeling that one is in charge of one’s situation), personal growth (e.g., gaining new life experience and self-transformation), positive relations with others (e.g., kind and willing to share), purpose in life (e.g., having life direction), and self-acceptance (e.g., having positive evaluation of one’s life). Similarly, Ryan and Deci (2001) pointed out that well-being focuses on optimal experience and it has been addressed from two perspectives. While the hedonic approach focuses on happiness and pleasure attainment, which are commonly indexed by life satisfaction, the eudaimonic approach emphasizes the importance of life meaning, self-actualization and fully human functioning.

During the COIVD-19 pandemic, researchers have highlighted the importance of positive mental health in helping people cope with the pandemic. Mathew et al. (2021) identified five dimensions of positive mental health, including emotional support, interpersonal skills, spirituality, general coping and global affect in maintaining wellness. Waters et al. (2022) also highlighted several positive psychological constructs that would help people face the stresses arising from the pandemic. These include life meaning, coping with stress, self-compassion, courage to face life adversities, gratitude despite adversities, character strengths, positive emotions in times of crisis, positive interpersonal relationships and high-quality connections. From a prevention perspective, positive psychological attributes can be regarded as protective factors helping reduce psychological morbidity in young people under the pandemic.

In this review article, we address four issues on the quality of life of young people in the pandemic and post-pandemic eras. First, we examine empirical studies on the mental health of young people in the COVID-19 pandemic and post-pandemic eras and highlight their characteristics. Second, we examine the theoretical models that can be used to make sense of the quality of life of young people. These include micro, macro, and ecological perspectives. In particular, as the pandemic has an impact on the family, we also look at quality of life of young people from a family resilience perspective, focusing on the importance of family social capital. Third, we discuss the methodological issues on the assessment of quality of life in young people. These include objective versus subjective measures of well-being as well as measures of negative mental health and positive mental health. In particular, as prevalence of psychological morbidity is commonly assessed by rating scales, we discuss the related assessment issues in this area. Finally, we explore intervention issues surrounding the quality of life of young people during the COVID-19 pandemic and post-COVID-19 eras. In particular, we examine whether young people are adequately prepared for future global crises such as pandemics.

Empirical Studies on Child and Adolescent Mental Health

To understand the mental health of young people in the pandemic and post-pandemic period, many studies have been conducted in the global context. Regarding negative mental health, studies generally showed that child and adolescent mental health problems during the initial stage of the pandemic were high (Luthra et al., 2023; Pettersen et al., 2024). For example, based on 2,000 + children and adolescents, Ravens-Sieberer et al. (2022) reported a decline in the mental health and health-related QOL in the first year of COVID-19. Although there was a rebound in these measures, the drop in well-being was still high compared to the pre-COVID-19 period. Racine et al. (2020) conducted a meta-analysis (N = 80,879) and reported that the pooled prevalence was 25.2% for depression and 20.5% for anxiety disorders.

Based on a review of 61 studies (N = 54,999 children and adolescents), Panchal et al. (2023) showed that different prevalence rates of depression and anxiety symptoms had been reported, with depression and anxiety symptoms as high as 63.8% and 49.5%, respectively. Studies also reported high levels of irritability (73.2%) and anger (51.3%) in young people. They concluded that the COVID-19 pandemic created psychological distress in young people, particularly in vulnerable groups and especially those with preexisting psychological challenges. Miao et al. (2023) reviewed longitudinal studies and found that psychological distress was a rising problem under the pandemic. Kiviruusu et al. (2024) reported findings based on a national, repeated cross-sectional, population-based study in Finland in 2015–2023, with 119,681 to 158,897 participants per round. They found that the prevalence rates of psychological distress (including generalized anxiety, depression and social anxiety symptoms) increased from pre-COVID pandemic time to 2021 and remained high in the COVID-19 years. When the pandemic gradually subsided in 2023, around 73% of girls and 33% of the boys showed at least one psychological symptom, and around 48% of the girls and 14% of the boys showed comorbid psychological problems. Furlong et al. (2024) reported the findings of a 4-wave longitudinal study recruiting high school students from 2019 to 2022 (N = 1,299). Latent profile analysis showed that 26% and 20% of the participants could be regarded as “stable-low” and “succumbing”, respectively. They also observed that there was a pervasive decrease in social well-being across the pandemic and many adolescents did not return to the pre-COVID level by 2022.

In the Chinese context, there are also studies showing that negative mental health of children and adolescents deteriorated during the COVID-19 pandemic. Wang et al. (2021) conducted a meta-analysis of 28 papers (N = 436,799 college students) with 25 studies with Chinese college student participants. Results showed that 29%, 37% and 23% of the students showed excessive anxiety, depression and stress responses, respectively. Based on 4,981 young people aged 11 years and above in Sichuan of mainland China, Shek et al. (2021) showed that roughly one-tenth of the participants could be classified as having post-traumatic stress disorder (PTSD). Shek et al., (2022) used the Depression, Anxiety and Stress Scale (DASS) to examine the psychological symptoms of 1,648 university students in Hong Kong. Using the cutoff scores in DASS, around 40%, 51% and 22% of the participants could be regarded as showing excessive depression, anxiety, and stress symptoms, respectively. Using latent profile analysis of 978 university students, Chai and Shek (2024b) showed that the percentages of students who could be identified as having “moderate” and “severe” comorbid anxiety and depression were 38.4% and 35.7%, respectively.

As far as positive mental health is concerned, many studies showed that there was a decline in positive mental health under the pandemic. For example, researchers showed that there was a drop in life satisfaction during the pandemic years (Neugebauer et al., 2024; von Soest et al., 2020). Interestingly, there are also studies showing an increase in positive well-being over time (O’Connor et al., 2020). Besides, studies showed that positive mental health attributes or positive psychological attributes can moderate the negative effect of pandemic stress on psychological morbidity. For example, Reutter et al. (2024) argued that coping with pandemic stress can help reframe, which can stabilize impaired mental health.

Several observations can be highlighted in the studies on child and adolescent mental health during the pandemic and post-pandemic periods. First, many studies showed that there was a general increase in mental health symptoms and decrease in life satisfaction in young people during the pandemic (Delgado-Rodríguez et al., 2024). Second, child and adolescent mental health varied across studies in participants with different socio-demographic background. In fact, there are studies showing that some people could thrive and their mental health was not seriously impaired under the pandemic. For example, Petersen et al. (2021) reported that “first wave of the Covid-19 pandemic only had minor impact on mental and physical health in the Danish general population” (p. 1). Third, there was a rebound in the mental health of the participants in the post-COVID-19 period, although child and adolescent mental health issue is still a serious one in the post-pandemic period. Fourth, based on PsycINFO, we compared the number of citations on negative mental health (anxiety and depression) and positive mental health (hope and resilience). Results showed that there are relatively more studies on negative mental health than positive mental health. Fifth, comparatively more studies have been conducted in non-Chinese than Chinese societies. In fact, existing studies have been criticized as “WEIRD” studies with participants who were recruited from Western, educated, industrialized, rich and developed societies. Table 1 shows these observations.

Understanding of Quality of Life in Young People: Theoretical Considerations

How can we make sense of the well-being of young people in the COVID-19 pandemic and post-pandemic eras? What are the factors influencing the mental health of young people during the pandemic? Conceptually speaking, theories are lens through which we see the world and they have practical implementations as far as interventions are concerned. Hence, it is important to understand how the mental health of young people can be understood in terms of different perspectives.

In social sciences, human behavior is generally addressed by three general perspectives. The first one is a “micro” perspective that looks for factors within a person as explanations of human behavior and such factors are commonly covered in textbooks of mental disorders. For example, in Biological Psychology, mental health is explained in terms of genetic, neuropsychological and/or physiological mechanisms. In the classical Freudian perspective, early childhood experience and weak ego are factors leading to mental problems. In the neo-Freudian theories such as the Eriksonian perspective, more focus is put on the role of social relationship (such as attachment) and environment influences. In contrast to the Freudian perspectives which focus on psychological processes that cannot be observed (e.g., unconsciousness), the behavioral approach focuses on processes that are relatively more observable. These include explanations of mental health problems in terms of conditioned reflexes (i.e., classical conditioning), reinforcement (i.e., operant conditioning), and imitation (i.e., observational learning). In the cognitive and socio-cognitive perspectives, faulty information processing, biased interpretations, dysfunctional attitudes, irrational beliefs and misattribution have been proposed to explain mental problems. Finally, humanistic and existential perspectives view mental problems as inability to satisfy higher-order needs (e.g., self-actualization), self-incongruence, lack of life meaning and neglect of spirituality.

However, understanding the mental health of young people solely based on the “micro” perspective is not alone because humans do not grow up in a social vacuum (Lai et al., 2015). According to the “macro” perspective, there are different macro factors shaping mental health. Primarily, social environment has been used to explain mental problems because some mental health problems exist more strongly in deprived social groups. According to this perspective, poverty, social disadvantage, exploitation and inequalities in accessing health and social services are factors contributing to mental health problems. In other words, individual mental health problems are just reflections of “social pathologies”. Besides, the functional approach posits that mental illness serves certain functions, such as having gains in taking up a sick role. Furthermore, the socio-cultural and social constructionist perspectives assert that mental problem is an outcome of social constructions because mental problems manifest differently under different cultures. In its extreme form, it is argued that mental problem is actually a product of social construction (i.e., human beings actually “invent” mental problems). Finally, we can view child and adolescent mental health in terms of the capital perspective, which commonly includes the lack of human capital (e.g., lack of life skills), social capital (e.g., lack of social support) and financial capital (e.g., poverty).

As explanations within the person (i.e., micro perspective) or the environment (i.e., macro perspective) alone are not adequate, the third approach is a combination of both the micro and macro explanations, which are commonly referred to as the ecological, social-ecological and social-systems perspectives. There are different versions of the ecological perspective. A common ecological model embraced by researchers is the ecological model proposed by Bronfenbrenner and Morris (1998). According to this perspective, there are different systems influencing human behavior, including the micro system (e.g., family influence on a person), meso system (e.g., family influence on a young person’s school performance), exosystem (e.g., parent’s work influences the family atmosphere), macro system (e.g., cultural influence on mental health) and chrono system (e.g., change in the global economy). Besides, other ecological systems models highlight the importance of different developmental contexts (culture, social, community, school and family) in shaping adolescent development (Lerner & Castellino, 2002). In the same vein, socio-ecological models also highlight the influence of different systems, including the personal system (e.g., attitudes and skills), school system (e.g., school climate the teacher support), interpersonal system (e.g., peer support and rejection), family system (e.g., parenting), community system (e.g., community support), and social system (e.g., political and economic changes). In the COVID-19 pandemic, studies were conducted to identify the internal and external factors shaping child and adolescent well-being (Rozi et al., 2023).

How can the above models be applied to understand the mental health of young people in the pandemic and post-pandemic periods? There are two points related to the family that should be noted. The first point is that because of city lockdown, family members normally stay in the family, hence creating more conflicts and/or more opportunities for family interaction. Second, because of economic slowdown, family finance may be adversely affected. Besides, because of fear of infection and actual infection, family burden would increase. In short, as the impact of the pandemic on the family would eventually affect individual adjustment, using a family ecological model to understand the mental health of young people is helpful. However, Shek et al. (2023) pointed out that there are few studies using family ecological models to understand the mental health of young people.

With reference to different models such as the Beavers Model, McMaster Model and Circumplex Model, a common proposition is that family functioning is positively related to the mental health of the family members and it is a key protective factor for family members particularly under adversity (Zeng et al., 2024). Besides the concept of individual resilience, family resilience has been emphasized in the scientific literature. The basic idea is that if the family (i.e., not just the individuals) is resilient, the family can rebound and thrive under adversity, which would eventually contribute to individual mental health.

Prime, Wade and Brown (2020) proposed a family ecological model on the impact of the COVID-19 pandemic on the adjustment of young people. It is proposed that the pandemic leads to social disruption (e.g., job loss, financial insecurity, social distancing and lockdown) which negatively affects the well-being of the caregivers (e.g., psychological distress, parenting strains and mental health problems), which eventually influences the family at the systemic and dyadic (marital, parent-child and sibling subsystems) levels. As a result, change in family well-being in turn affects the adjustment of the child, including well-being and mental health problems. Prime, Wade and Brown (2020) argued that by enriching family resilience through beliefs, communication and organization, young family members are protected from the negative influence of the pandemic.

According to the Family Resilience Model proposed by Walsh (2003, 2016), there are three domains of family resilience. The first domain is family beliefs systems, which includes meaning-making in adversity (e.g., positive meaning of adversity), positive outlook (e.g., there is always a silver lining) and transcendence and spirituality (e.g., loving each other under adversity). The second domain is organizational patterns, which include flexibility (e.g., family members play different roles if necessary), connectedness (e.g., family members are cohesive), and social and economic resources (e.g., neighborhood, relatives and social support). The final domain is communication, which includes clarity (e.g., direct communication), open emotional expression (e.g., no hidden emotions) and collaborative problem solving (e.g., family members work together to cope with family stress).

There are several observations regarding the conceptual models on children and adolescent mental health during the pandemic and post-pandemic periods. First, for many studies on the prevalence of psychological morbidity, they are fairly atheoretical although some studies might simply look at demographic and psychosocial correlates of mental health problems without reference to any theory. Second, compared to studies focusing on individual and socio-cultural predictors of child and adolescent mental health under the pandemic, there are relatively fewer theories focusing on family processes. Third, most of the theories used to explain child and adolescent mental health problems are based on Western theories, which are more individualistic values. With reference to Chinese people, there are very few indigenous theoretical accounts of child and adolescent mental health in the pandemic and post-pandemic eras. For example, Chinese family beliefs are shaped by Confucianism. Finally, one reflection is on the “best” theory of child and adolescent mental health and the criteria that can be used to make this decision.

Assessment of Mental Health: Methodological Considerations

The fundamental issue in the assessment of quality of life of young people is what indicators can accurately reflect the construct of child and adolescent mental health. On the one hand, we can use official statistics and figures to reflect the well-being of young people, such as unemployment rates (Barford et al., 2021) and mortality rates (e.g., Flaxman et al., 2023). While official statistics has objectivity, it has two drawbacks. First, it can only produce a static “map” without “flesh”, hence cannot enable us to understand the subjective experience of the quality of life of young people. Second, there is always a time lag in official statistics. For example, the number of suicide cases cannot be properly determined before the verdicts of the coroner’s court. On the other hand, qualitative methods can help to reveal the subjective experiences of young people, but the interpretations of findings may not be easy and comparability across studies is low. Of course, to understand the lived experiences of young people under COVID-19, qualitative studies are indispensable (Gogoi et al., 2022; Keshoofy et al., 2023). The related arguments and challenges can be seen in Shek and Wu (2018). In terms of the number of studies on child and adolescent mental health during the pandemic and post-pandemic periods, more quantitative than qualitative studies have been conducted (Dewa et al., 2024). Besides, if we collect data using different methods, how to integrate the information across different systems is a challenge to be considered.

Another issue that should be considered is that rating scales are commonly used in the assessment of child and adolescent mental health. It is noteworthy that rating scales or psychological tests are based on many assumptions which may not be fully met in reality (Reynold, Altmann & Allen, 2021). Faravelli (2004) reasoned that rating scales have pitfalls that are “evidence-biased” rather than “evidence-based” because the assumptions underlying rating scales are untenable. These assumptions include: (a) a mental disorder is the sum of the symptoms; (b) the “numbers” associated with specific behavior on a rating scale represent the symptoms; (c) the “numbers” on a rating scale reflect the clinical condition in reality; (d) number of symptoms can be added although they also interact. Bech (2006) discussed the issue of statistical versus clinical significance with reference to the dose-response relationship and effect size. With reference to the Hamilton Depression Rating Scale (HAM-D), Bech (2006) concluded that the total score indicated by the total HAM-D score has “limited use” analogous to major depression diagnosis in the DSM (p. 213) because of several pitfalls.

Based on an integration of criticisms against the use of rating scales, Uher (2022) argued that rating scales have 12 logical errors and conceptual problems. Based on three central principles for transdisciplinary research (i.e., complexity, complementarity, and anthropogenicity), she argued that researchers have to re-think about the need for building a metatheory of assessment. In particular, she argued that human beings must be regarded as complex human living systems, utilization of different research strategies may lead to contradictory information about the same phenomenon, and knowledge is theory-laden and subject to social and historical influences. In short, she presented 12 logical errors and conceptual problems of using rating scales for assessment. These include:

1. 1.Unintended influence on researchers’ own role in research: the use of rating scale produces intersubjective confusion, assuming that the phenomenon conscious to the researcher is also conscious to the research participants. This ignores the researcher’s worldview and confusion of psychological knowledge and psychical phenomenon. Finally, its over-emphasis on “scientific” methods and wrong use of language and ignorance of contextual use of language also confuse the role of the researcher.
2. 2.Illusion of scholarly distance: the use of rating scales may create the impression that the participants are anonymous and distant from the researcher, hence creating the impression of “independent” researchers and “neutral” subjects.
3. 3.Mistaken dualistic assumption: the belief that researcher is “independent” and “far away” from the research participants masks the fact that participants are in fact part of a complex open system with interactions with different ecological systems that may “confound” the findings.
4. 4.Lack of clear definitions and theoretical distinction of phenomena under study: psychological concepts are often poorly defined, unclear, internally contradictory and not distinct in rating scales and there is a need to develop a metatheoretical distinction between “behavioral” and “psychic” phenomena.
5. 5.Reductionist assumption: although ontological, epistemological and methodological reductionism are common in science, rating scale suffers from the problem of “atomistic fallacy”, assuming that ratings as chunks of information can be objectively understood in a decontextualized and non-holistic manner.
6. 6.Problems related to operationalism: although operational definitions are common to Physics and Psychology, they are misleading in rating scales because mere specification of the assessment procedures is not equivalent to theoretical concepts, and there is a confusion of proceduralism with conceptual definitions.
7. 7.Confusions arising from the use of psychological constructs: inconsistent use of constructs as study phenomena and theoretical concepts, as well as their interpretations, do exist. This problem arises from the lack of conceptual understanding of the constructs and the inability to differentiate scientific constructs to their indicators.
8. 8.Uncritical use of language-based research methods: psychologists do not know much about the meaning of sign systems underlying the use of rating scales. As such, rating scales can only capture the participants’ knowledge about the phenomena under study but not the phenomena themselves.
9. 9.Problems arising from variable-based Psychology and data-driven approaches: psychologists commonly overlook the semiotic nature of data and reinforce the problems of data-driven or data-oriented approaches.
10. 10.Overuse of numbers and over-quantification: although quantitative data may appear to be precise, reliable, valid, rigorous, objective and subject to statistical analyses, a “number” on a rating scale does not have any quantitative meaning. Besides, over-quantification fails to create justified alignment of the results to the measurands, and clouds public interpretability of the meaning based on the quantitative data.
11. 11.Over-reliance on statistics: statistical analyses in Psychology appear to be an end rather than a means to explore questions. With the adoption of complex statistics, the analyzed data may not be able to capture the phenomena under investigation. Although researchers may use statistics to establish the psychometric properties of the scales, the related measures have problems regarding data generation traceability and numerical traceability.
12. 12.Nomothetic focus: psychologists analyze inter-individual variability to deduce intra-individual processes, which creates the problem of ergodic fallacy. Also, the assumption that every individual is the same (i.e., psychical homogeneity) who can be assessed by standardized rating scale is untenable.

With reference to these challenges, Uher (2022) proposed different solutions. These include promotion of reflexivity in researchers, clarification of one’s metatheory and ambiguous concepts, building theories and concepts on the phenomena under study, development of refined philosophies and theories of research methods, and development of relevant research methods to study phenomena in an appropriate manner. Obviously, these points are good food for thought, although there are also arguments in defense of the use of psychological rating scales (Wiggins, 1981).

Uher (2023) further outlined the epistemological and methodological problems of rating scales, particularly the conflation of the study phenomena (such as mental health issues) with the language-based methods. She pointed out several challenges, including differentiation of the phenomena under study and the means to study them (i.e., psychical versus psychological), debate on the dualistic assumption (i.e., subject versus object), phenomena (e.g., mental health problems) are heterogenous and complex, and overlooking the complexity of language as a means for investigation. She also argued that psychologists commonly adjust data to statistical theories instead of fitting them to the study. Obviously, more dialogues and debates on these issues surrounding the use of rating scales to assess mental health are necessary.

Intervention for Adolescent Mental Health in the Pandemic and Post-Pandemic Era

Prevention Perspective

Regarding intervention of child and adolescent mental health problems, mental health problems are prevalent in the COVID-19 and post COVID-19 period, which obviously deserves intervention. There are three related issues to be considered here. These include a prevention perspective from public health and allied professions, different forms of capital from the Sociology perspective, and child and adolescent mental health policies. Finally, we highlight the importance of preparing young people for future global crises such as the pandemic.

From a public health perspective, there are several strategies for promoting the mental health among young people during the pandemic and post-pandemic period. Regarding tertiary prevention, initiatives to “treat” adolescent mental health problems within the context of the pandemic are needed. However, as COVID-19 was lethal at the beginning, treatment was primarily put on treating physical symptoms. Hence, relatively fewer intervention strategies target psychosocial and family problems during COVID-19 time. In fact, although COVID-19 impairs physical health, it also creates psychosocial consequences such as trauma, separation from loved ones, unemployment and financial hardship that cannot be “treated” by medical procedures alone. Based on qualitative analyses, Stewart et al. (2023) reported several interventions that were helpful for young people under the pandemic, including recreational activities (such as aerobic) and engagement with friends. Interestingly, they also reported that disruption to school might bring positive impact on student mental health.

There are few tertiary prevention programs based on a family perspective. As mentioned, as family processes are disrupted under the pandemic and family resilience is an important protective factor for both the individual and the family, further thoughts should be spent on the development of family resilience enhancement under the pandemic. Again, it depends on whether a practitioner adopts a family perspective in treating youth mental health problems. Furthermore, besides reducing psychological distress symptoms, we should pay attention to thriving and positive development under adversity. Hence, it is not coping alone but also thriving.

For secondary prevention, the reality is that Governments commonly encourage people to use testing kits to test whether one is infected by COVID-19 virus. At some stage, young people have to show that they are COVID-19 negative before they can enter the school premises. In contrast, early identification of family and personal mental health has been relatively neglected by the Government and the community globally. In times of adversities, early identification of people who are at risk of mental health problems and families that are dysfunctional is of paramount importance. With delay, the problems would intensify which require more financial resources to solve. Although many epidemiological studies on child and adolescent mental health were conducted during the pandemic, downstream service could not catch up. During the post-pandemic period, psychological screening has been used as a primary strategy to cope with the post-pandemic crisis, such as a surge in suicide cases. However, there are three problems with such a screening strategy. First, there must be valid and reliable tools appropriate for different socio-cultural contexts. This is a problem particularly when translated screening tools without validation of the cutoff points are used. Second, with short mental health screening scales, it is not easy to detect students who deliberately exaggerate their “symptoms” or hide their difficulties. Third, assuming that the screening is accurate, whether we can have sufficient downstream services is another issue to be considered.

For primary prevention, there are two critical issues to be considered. The first one is how to promote individual and family resilience during the pandemic. Promotion of individual resilience is similar to inoculation because resilience can help young people cope with stressors and traumas arising from the pandemic. The scientific literature shows that there are psychosocial competencies that can help individuals cope with stress and maintain positive functioning under adversities. Besides problem solving skills, individual resilience (adversity quotient), emotional competence (emotional quotient) and spirituality (spiritual quotient) are important. Resilience can help an individual bounce back and remain endurance; emotional competence can help an individual cope with negative feelings arising from adversity; spirituality can provide an individual life purpose and life direction. However, although studies have shown that positive youth development programs or developmental assets building programs can help young people thrive in the pandemic (Shek, 2024), few prevention programs exist particularly in non-Western contexts (Shek, 2006a, b). Looking into the future, another issue to be considered is how to enhance the psychosocial competencies of young people so that they can be fully prepared to face the next pandemic.

Capital Perspective

There are several forms of capital that shape well-being (Pelinescu, 2015; Sarwar et al., 2021; Shek et al., 2023). Primarily, human capital such as possession of mental health literacy and social skills is important. Second, social capital such as family resilience and community cohesion protects. Finally, financial capital is important because it provides the resources for meeting the needs of the individuals and families.

Under adversities such as pandemics, “capital” is very important in shaping the mental health of young people according to sociological perspective. First, pandemic affects the economy and it impairs financial capital such as reduced income and taxation. Because of city lockdown, many economic activities (such as tourism) slowed down and even stopped completely. Hence, how to help families and people to overcome financial strains is an important question to be considered. Around the globe, governments used different financial policies to maintain financial security for the citizens (Shek et al., 2023). However, financial capital alone is not enough. Besides money, human capital such as psychosocial skills are important. One example is resilience (i.e., adversity quotient) and emotional competence (i.e., emotional quotient) and spirituality (i.e., spiritual quotient) are foundations for coping with adversities arising from the COVID-19 pandemic. Furthermore, because of adversities, social capital such as family social capital (i.e., family resilience capacity) is also important. Besides, interpersonal networks, social support and community cohesion are important (Mucci et al., 2023). In short, human capital such as psychosocial competence and coping skills and family resilience are basic building blocks for positive life, which are vital to the maintenance of happiness under adversities. In a discussion of social policies under COVID-19, Shek et al. (2023) argued that the emphasis on family social capital is not widespread. One example is that while we encouraged people to seek help when they have COVID-19 symptoms, we seldom saw publicity material (such as announcements for the public interest) on encouraging people to seek help from NGOs when they encountered psychological problems and family problems during the pandemic.

With specific reference to social capital, family social capital is an important capital that can help people cope with stress under the pandemic. Based on the family resilience model proposed by Walsh (2003), through strengthening family belief system, organization and communication, families can have better coping ability in times of pandemic. Primarily, development of positive beliefs (e.g., we have more time with each other during the pandemic), hope (e.g., today is a gift of life), and transcendental belief (e.g., God will provide) are the foundations of family resilience. Besides, strengthening of flexible roles within the family, kinship support and social and economic resources would be beneficial. However, under city and school lockdown, kinship and social support would not be easy. The final area of family resilience is family communication covering clear dialogue and understanding of adversity, open emotional expression and working together to solve problems in a collaborative manner. As information is confusing under the pandemic (e.g., lack of information, misinformation and disinformation), a clear understanding of the reality is important. This may not be easy in Asian cultures where communication is sometimes indirect and subtle. Regarding emotional expression, negative emotions and prolonged inhibition may constitute chronic stressors. Faced with family problems under the pandemic (e.g., reduced financial resources), there is a need to work together with family members to solve such problems. Besides family social capital, interpersonal support such as community support can help to maintain community cohesion. Similarly, positive community climate is helpful to individuals. Because of city lockdown, there was a weakening of community network. Hence, how to build up community support and cohesion is an important strategy but not much emphasized in different societies.

With reference to the capital framework, several points should be noted. First, prevention is always better than cure. Hence, we should step up the basic psychosocial competencies of the general public (i.e., human capital enhancement). This is analogous to the recommendation that one should start doing exercise as early as possible and do not wait until one has a heart attack. Second, as family is an important unit, promotion of family resilience, such as development of positive family beliefs, developing an efficient family structure and fostering communication patterns, is the recipe for good adjustment. Similarly, enhancement of friendship, support from neighbor and community, and hopeful community climate are important forms of social capital that can help an individual to cope with adversities.

Help-Seeking and Child and Adolescent Mental Health (CAMH) Policy

Mental health issues amongst children and adolescentsunder the pandemic are growing which require intervention. Unfortunately, there are two challenges surrounding intervention for child and adolescent mental health under the pandemic. The first challenge is that adolescents with mental health problems seldom seek help and their access to mental health services is low. This problem exists even in countries with a high level of development before the pandemic because of stigmatization and low health literacy. According to Shidhaye (2023), young people showed growing mental health problems even before the pandemic and the problem was intensified by COVID-19, with around 70–80% of adolescents commonly not seeking help. They pointed out that there are supply and demand side barriers of mental health utilization during the pandemic preventing young people from receiving evidence-based interventions, including low emotional competence, negative views about help-seeking, and stigma. On the other hand, facilitators to help-seeking included positive experiences with health services, emotional competence, and mental health literacy.

Regarding ways to reduce the barriers, Shidhaye (2023) suggested the importance of reducing supply-side (e.g., availability or affordability) and demand-side barriers (e.g., enhancing health care needs). In particular, they argued that the use of school-based interventions and digital health technologies would be helpful. Similarly, Werlen et al. (2019) proposed universal interventions for the general adolescent population, school-based intervention for high-risk young people, and digital health intervention as strategies to enhance help-seeking. Palinkas et al. (2021) conducted a qualitative study to understand the impact of the COVID-19 pandemic on the implementation of mental health services via semi-structured interviews. Regarding barriers to telehealth services, they reported limited access to internet and technology, family preference for face-to-face services, lack of privacy, difficulty and reimbursement challenges. They made several solutions for facilitating help-seeking in children and adolescents, including increased collaboration between federal, state and local levels in formal and informal network establishment, development of a hybrid face-to-face and telehealth care system for consultation, increased flexibility, and routine collection of data collection to facilitate data-driven decision.

Child and adolescent mental health policy is also an important consideration during the pandemic and post-pandemic periods. While there are many factors adversely affecting the mental health of children and adolescents, such as insufficient financial resources, manpower issues, obstacles in getting mental health services, inadequate school-based mental literacy programs, and societal misconceptions about mental problems (Belfer, 2007; Kieling et al., 2011), the lack of a comprehensive child and adolescent mental health (CAMH) policy is particularly damaging (Belfer, 2007; Belfer & Saxena, 2006). According to Shatkin and Belfer (2004), there were few policies designed specifically to support child and adolescent mental health worldwide. They found that only 35 countries (roughly 18% of countries worldwide) showed identifiable mental health policies (p. 104). Obviously, the absence of policy is a barrier to the development of systematic and responsive systems of mental healthcare for children and adolescents and this problem was further worsened during the pandemic.

Based on a review of 31 studies, Zhou et al. (2020) highlighted six challenges on child and adolescent mental health policy. These include low public awareness and poor political willingness, negative labelling of mental problems, biased cultural values, lack of data and statistics regarding service and evaluation, inadequate resources on CAMH, and unintended effects of external support such as planning fragmentation. They made six recommendations, including deep reflection on CAMH, development of stand-alone CAMH policy and financial resources, involvement of different stakeholders, evidence-based policy making, creating innovation in resources utilization, and creating synergy on the positive impact of international organizations and non-governmental organizations. Luthra et al. (2023) conducted a bibliometric review identifying five clusters of studies and 16 propositions. They argued that there is a need for a long-term national strategy on child and adolescent mental health with multidisciplinary collaboration.

The importance of CAMH during the pandemic is highlighted by many organizations in different places. As mentioned by OECD (2021), “with adequate support and timely intervention, young people experiencing mental distress may be able to bounce back as we recover from the COVID-19 crisis. This will require a scaling up of existing mental health support in education systems, workplaces and health systems, and comprehensive policies to support young people to remain in education, or to find and keep a job.” (p.2). The European Education and Culture Executive Agency (2022) analyzed child and adolescent policies and measures between March 2020 and March 2022 using data from multiple sources. They concluded that “European countries reacted proactively to these challenges” and highlighted many mitigating measures, such as psychological support, homework support, digital technologies, youth work, and leisure and sports project to promote social engagement. Ironically, it is also concluded that “if the COVID-19 pandemic has had any positive result, it is that it has placed youth mental health in the spotlight” (p. 29).

In Korea, Kim and Lee (2023) pointed out that Ministry of Education, Ministry of Gender Equality and Family, and Ministry of Health and Welfare worked together to deal with increased children and adolescent mental health burdens during the pandemic, with identified high-risk students taken care by several institutions, such as youth counseling and welfare centres and healing centre. However, although different projects were launched by different ministries, confusion may arise when school and clinical sites do not understand. They suggested the need to strengthen collaboration between projects, sharing of case-management systems, reducing stigma of mental illness in different stakeholders, and promoting mental health literacy education initiatives.

Definitely, there will be other pandemics in the future. The human race experienced Black Death in the Middle Age, Spanish flu roughly one century ago, and numerous and regular flu infections in the past century. Hence, one burning question is: are young people adequately prepared for crises, such as pandemics, in the future? Do we have any evidence-based and effective policies and programs to prepare young people? Based on the preceding discussion, we argue that primary prevention and cultivation of capital are important initiatives. For primary prevention, cultivation of psychosocial skills of children and adolescents is vital as inner psychological strengths can help them cope with adversity in a more adaptive and healthy manner. Empirically, there are studies showing that the programs focusing on positive youth development and social emotional learning can help to promote resilience of young people. Adopting the human capital perspective, cultivation of psychosocial skills can help young people face future uncertainties. Furthermore, utilizing family strengths and resources would also be helpful to prepare young people for future challenges.

Several observations are highlighted from the current review on adolescent mental health in COVID-19 and post-pandemic eras. First, while many studies focus on negative mental health, relatively fewer studies examine positive mental health. Theoretically, an ecological and systems perspective helps to understand the risk and protective factors in adolescent mental health under the pandemic. Particularly, the family resilience perspective provides a more complete picture on youth adjustment in the pandemic and post-pandemic eras. In terms of research methods, more quantitative than qualitative studies have been conducted, and many studies focus on prevalence of mental health symptoms. While epidemiological studies provide important information on service needs and policies, the use of rating scales has been criticized. For intervention of adolescent mental health, while different levels of prevention are important, focus on primary prevention is weak. From the capital perspective, while the focus is on financial capital, social capital and human capital are also weak. There is a weak effort addressing the need to prepare young people for future pandemics and to enhance their holistic quality of life under future global crises.