Mental Health and Health-related Quality of Life in German Adolescents After the Third Wave of the COVID-19 Pandemic

Abstract Background: From March – June 2021, the third wave of the COVID-19 pandemic occurred in Germany. First and second wave evaluations showed an increase in mental health problems and a reduction of quality of life in adolescents. In August 2021, two vaccines against COVID-19 were approved for adolescents aged 12-17 years in Germany. Aim of the study was to assess mental health and health-related quality of life (HRQoL) after 1.5 years of COVID-19 pandemic in adolescents who decided to receive a vaccination. Methods: In the German region of Siegen-Wittgenstein, all students from 12-17 years from secondary level schools, vocational schools and universities were offered a prioritized vaccination against COVID-19. Mental health and HRQoL were assessed at the first vaccination appointment by self- and parental report. Adolescents and their parents completed the Strength and Difficulties Questionnaire (SDQ) and the KIDSCREEN-10. Results: Data from 1412 adolescents (49.2% female, 47.7% male; mean age 14.3 years, SD=1.64) and 908 parents were collected. Mean self-reported HRQoL was T=53.7 (SD=11.2), in boys significantly higher than in girls (56.0 vs. 51.3), and significantly higher in younger (12-14 years) than in older (15-17 years) adolescents (56.2 vs. 51.5). Parental-reported HRQoL was T=51.8 (SD=12.8). In total, 18.5% of adolescents reported clinically relevant psychological symptoms, especially peer problems (23.7%), emotional problems (16.7%) and hyperactivity (17.2%). Girls reported significantly higher scores on emotional, peer and total problems than boys, whereas younger adolescents reported more hyperactivity and less emotional and peer problems than older ones. Comparing the present data to evaluations after the first and second wave of COVID-19 in Germany, adolescents facing vaccination after the third wave rated a higher HRQoL and reported less mental health problems. The data from the present study are comparable to those from pre-COVID evaluations. Conclusion: After 1.5 years of living with the pandemic, adolescents may have adapted to the changes in everyday life which has lowered the anticipated stress. Further, the relaxation of restrictions, better school organization and the prospect of the vaccination may have increased optimism, wellbeing and contentment, leading to declining but still alarming rates of psychological symptoms.