Being a teenager during the Covid-19 pandemic: perspectives from the Winnicott’s theory of maturation

Abstracts

This article aims to reflect, based on Winnicott’s theory of maturation, on the impacts of the Covid-19 pandemic and measures of social isolation in the adolescents’ mental health. Some of the adolescents’ paradoxical experiences when facing the pandemic are: need for separation from parents or caregivers and confinement; need for group coexistence and social isolation; need for continued care by society and blockage or changes in service priorities. This population experiences the impossibility of carrying out the healthy processes of maturation, inserted in an invasive and scarcely supportive environment, which may result in a generation of sick adults and adults characterized by the development of a false self. This study sheds light on the ideo-affective life of a population that has been overlooked during the pandemic and brings important reflections on interprofessional practices aimed at adolescents.

Keywords
Adolescents; Covid-19; Mental Health; Psychoanalysis

Este artigo objetiva refletir, a partir da teoria do amadurecimento de Winnicott, sobre as implicações da pandemia de Covid-19 e das medidas de isolamento social para a saúde mental dos adolescentes. Algumas das vivências paradoxais dos adolescentes frente à pandemia são: necessidade de separação dos pais ou cuidadores e confinamento; necessidade de convivência grupal e isolamento social; necessidade de cuidado continuado da sociedade e fechamento ou mudanças em prioridades de atendimentos em serviços. Tal população vivencia a impossibilidade de realização dos processos saudáveis do amadurecimento, inseridos em um ambiente invasivo e pouco sustentador, o que pode provocar uma geração de adultos adoecida e caracterizada pelo desenvolvimento do falso Self. Este estudo lança luz sobre a vida ideoafetiva de uma população que tem sido pouco olhada durante a pandemia e traz importantes reflexões para as práticas interprofissionais voltadas aos adolescentes.

Palavras-chave
Adolescentes; Covid-19; Saúde mental; Psicanálise

El objetivo de este artículo es reflexionar, a partir de la teoría de la maduración de Winnicott, sobre las implicaciones de la pandemia de Covid-19 y de las medidas de aislamiento social para la salud mental de los adolescentes. Algunas de las vivencias paradojales de los adolescentes delante de la pandemia son: necesidad de separación de los padres o cuidadores y confinamiento, necesidad de convivencia grupal y aislamiento social, necesidad de cuidado continuado de la sociedad y cierre o cambios en prioridades de atención en servicios. Esa población vive la imposibilidad de realización de los procesos saludables de maduración, inseridos en un ambiente invasivo y poco sustentador, lo que puede causar una generación de adultos enferma y caracterizada por el desarrollo del falso self. Este estudio lanza luz sobre la vida ideoafectiva de una población que ha sido poco considerada durante la pandemia y brinda importantes reflexiones para las prácticas interprofesionales enfocadas en los adolescentes.

Palabras clave
Adolescentes; Covid-19; Salud Mental; Psicoanálisis

Introduction

Despite the aging process experimented by the Brazilian population, adolescents and youth still constitute about 37% of the national population. Adolescence is presently considered as a social category, experiencing a unique process of being, as well as ‘being in the world’. It represents a moment in the life cycle that is usually healthy, in which most diseases result from cultural and social determinants that may increase their vulnerability with regard to rights and opportunities¹. Due to the peculiar process of development, characterized by the ongoing process of organizing internal and external resources to build their identities and deal with the vicissitudes of life towards maturation, adolescents, although not being the group most at risk for getting sick from the Covid-19 disease, they may suffer biopsychosocial impacts.

On March 11, 2020, the World Health Organization (WHO) declared a global pandemic, with Covid-19 and SARS-CoV-2 considered the greatest threats to individual and collective health². Adolescents do not fall into the risk populations for disease severity, but non-pharmacological measures to control the infection, such as social distancing/isolation and school closures, can significantly affect them. Some of these impacts are already documented in the literature, and encompass the peers’ distance, increased screen time, more time with family members, and the accentuation of inequalities already experienced by certain populations. Such elements have specific consequences for the mental health of adolescents, who may experience increased stress, anxiety, aggressiveness, and increased risk for suicidal ideation or behavior³,⁴.

Therefore, considering (1) that adolescents are a significant portion of the Brazilian population, and that the adolescence process is essential and produces consequences for the future generation of adults, and (2) the little society preparation facing the changes experienced in the face of the Covid-19 pandemic, this theoretical essay aims to reflect on the implications of the Covid-19 pandemic and social isolation measures for the mental health of adolescents, based on Winnicott’s theory of maturation. This study, given the still incipient literature of empirical research, may help to illuminate paths and reflections for the understanding and interventions for health promotion aimed at adolescents, during and after the pandemic.

In terms of organization, the essay has three sessions. Initially, we will present the Winnicottian conception of adolescence. Next, we stablish a reflection about the vulnerabilities imposed by the pandemic on adolescence anchored in Winnicott’s theoretical contributions. Finally, we describe in the conclusion possibilities of caring for adolescents in this course.

Adolescence and Winnicott

In order to build this study, we rely on the theory of maturation enunciated by the pediatrician and psychoanalyst Donald Woods Winnicott that helps understanding the emotional and maturation processes that is typical of adolescence. Winnicott starts from the concept that every individual has an innate tendency towards maturation, which depends fundamentally on the presence of a good enough (or healthy) environment, that is, one that supports her/him, offering continuity and adapting to her/his needs, so that the innate tendency can be carried on⁵. It is a continuous process of development that begins even before birth and continues throughout life, experiencing moments of more and less integration, even though not necessarily in a linear path⁵.

His theory highlights the fundamental role that the environment plays in healthy maturation in all stages of the life cycle. In the presence of a healthy environment, the individual is able to feel real, integrate a self, and achieve psychic health. On the other hand, in the face of the impossibility of support (unhealthy environment), the development of the falseself may occur, in which the individual may be able to function in society, but without experiencing a sense of reality and spontaneity.⁵ In a cyclical movement, these processes are constant throughout life starting when the person is born.

At birth, for example, babies do not yet identify themselves as integrated units. There is not yet a separation between what is the internal and external world, what is the newborn and what is the environment - the environment being everything surrounding, including the physical environment, people and affections⁶. When finding themselves in an environment that is capable and supportive (holding, in Winnicott’s terms) and adapting to their needs, babies can achieve integration and acquire the status of a unity, and at this moment the self and the world start to exist separately, an occasion Winnicott calls “i am”⁵. The newly integrated baby can then participate in their first group: the family, or the group formed by caregivers. It is expected that throughout development the individual will be able to identify with increasingly larger groups, such as school, friends, and work, until they are able to identify with the society in which they live⁷.

Another important achievement that comes from the I AM stage is the stage of concern. From the moment the baby recognizes that he/she is a person separate from the others, that is, that the mother and the other figures around him/her are individuals separate from him/herself, he/she can start imagining that his/her actions and experiences affect other people. From this moment on, there is an increasing capacity to feel concern, to feel guilt, to recognize one’s own potential to cause harm, and to repair it⁸. This capacity will become important for staying in groups and, at the same time, be improved by the socialization provided by them.

The entry into groups has a particular importance during adolescence, since at this stage groups expand and are differentiated from those that fostered the childhood sense of belonging. The groups are re-signified and become a space for socialization, experimentation, exploration, and identity construction. The identification with peer groups is characteristic and important in this period , as opposed to the major family identification that occurs in childhood. This process integrates the development of the ability to identify with society, without experiencing the loss of the notion of self and its spontaneity⁷.

In summary, the movements during the adolescence stage lead adolescents to search for personal identities - to be unique, but at the same time belonging to the group, to the society. Adolescents live the struggle to establish such identities, to feel real and to be themselves, beyond the roles previously experienced⁷. However, adolescents are not yet clear about what they want and the place they will occupy in society. This is a period of discovery that may bring up feelings of unreality, raising the need to take attitudes that promote meaning to their existence, as they affect society. Stemming from this period comes also the need to separate from the environment, to experience rebellion, to act in such a way as to provoke a reaction.⁷

According to Winnicott, all human beings at birth are in a state of absolute dependence, in which they are totally dependent on the environment and the care present in it, in order to live and constitute themselves as individuals. During maturation, we gradually move towards relative independence, that is the highest degree of independence proposed by the author⁵. Regarding adolescence, the focus of this study, there is a relevant and curious characteristic: the adolescent transits at all times between the idea of independence and dependence, and may experience the concomitant existence of both extremes. The same teenager can be rebellious and fight to individualize himself, and still be as dependent as a child or even a baby⁷.

There is the need to rebel and separate psychically from the first group (family), in order to understand the self, already constituted by the family’s behaviors and imaginary ( biological or adopted). However, this need to separate needs a reliable environment that also supports and welcomes the dependency. The recognition of this paradox as healthy and important in the maturing process is fundamental and reminds us of the role that the environment plays in adolescence. The environment plays a vitally important role in this process. The adolescents need the continuity of their families’ interest in them, even if for this family the process is difficult and even painful⁷.

It may be noticed that the constitution of subjectivity in adolescence is a crucially challenging experience. Elements such as: the alternation between stages of dependence, the beginning of responsibility for one’s own actions and their consequences for self and for others, the separation, the need to feel alive and real, and the need to react, represent a challenge for the adolescent and for the society⁹. Winnicott clarifies that society’s attitude towards the process of adolescence should not be one of absolute permissiveness, it’s not about that. It’s about the fact that this process challenges us, we should face this challenge, instead of trying to cure something that is essentially healthy⁷. It is necessary to look at adolescence, understand it, listen to it, welcome it, and not cure it. The question brought up by Winnicott, which instigates us to do this reflection is: “Is our society healthy enough to do this?”⁷ (p. 127) And we also add: would society today, in the midst of a pandemic, be healthy enough to sustain its adolescents or guarantee them the maintenance of their psychic health?

The adolescence period is marked by biological, psychological and social insertion transformations, in which the search to feel real is rekindled. It is a second chance to experience the initial stages of maturation, when there is a need to integrate the personality, experience the “i am”, and move towards independence. In “The Family and Individual Development”⁷, Winnicott states that there is no way to avoid, delay, or prevent this process, because it is healthy and necessary for maturity. However, when facing the invasions and intrusions of an environment that does not provide holding, this process can be interrupted and lead to the development of a false maturity or a non-integrated adult, which can cause suffering and psychological disorders⁹. This is the key that allows us to explore this moment of development in the interface with the pandemic moment we are experiencing.

Adolescence, pandemic and Winnicott

Considering the particularities that the socialization process takes on during adolescence, both in relation to family and peers, social isolation measures can have a special impact on this population group. The increased use of the Internet, as an alternative to keep socialization going on, can also cause significant harm especially when done unsafely¹⁰. The exacerbated family interaction increases the risk of conflict and violence within the family. In addition to these issues, we also face the closing of schools and other services in the health and protection network for children and adolescents. All these issues contribute to make adolescents uniquely vulnerable to the consequences of the pandemic, as well as to the health measures to contain the disease and the contagion by the new coronavirus⁴.

It is well known that the Covid-19 pandemic has changed the configurations, the dynamics of coexistence, the spaces occupied, the media appeals, the risks, the concerns about the present and, especially, the future. Even those that did not respect the isolation experienced, at some level, the closing of public spaces and the intensification of internal coexistence in families or more intimate groups¹¹.

Adolescents, by spending a significant part of their days in schools, and experiencing in these spaces different aspects of socialization, protection, and nurturing, had this dynamic altered for an extended period - which is still uncertain and undefined in terms of duration¹². This group endured important incompatibilities in the processes that should happen in the healthy maturation experience. We listed some of the experiences that marked adolescence in this time of pandemic: the need for separation from caregivers and confinement; the need for group coexistence and social isolation; the need for continued care from society and the closure or changes in priorities of care in services; as well as reflections about death and dying.

There is an expected shift that happens during adolescence, to the extent that the environment allows, and through that movement the subject seeks to separate momentarily from parents, or from guardian figures. This movement occurs in the process of developing personal identity, of discovering one’s place in society, and is of great importance for the maturing of adolescents and the adults they will become¹³. This phenomenon is inevitably hindered by the need to be confined at home, with the same people and influences from whom they should be differentiating themselves. The boundaries of privacy between the residents of the home can become blurred, and that essential separation may not occur, impacting on the construction of the adolescent’s identity and understanding of belonging in society. The usual structure of the dwelling units may not be prepared to be the only environment for its residents, and may have insufficient space and lack of privacy, leading to excessive coexistence³. This whole scenario can amplify conflicts or manifestations of aggressiveness⁴.

Also, non-pharmacological measures to contain Covid-19 (social isolation and closing of schools and other services, for example) can severely impact the groups that are most vulnerable to situations of interpersonal violence, among them adolescents, due to the fact that the home is the main place of occurrence of this type of violence¹⁴. The intensification of family conflicts, the increased stress among members and the greater proximity to abusive figures are all elements that contribute to the construction of an invasive environment, where there is no possibility of support or holding, hindering the maturing process and compromising health. Some international institutions such as UNICEF, WHO, and Arigatou International have produced materials aimed at orienting parenting practices and family coexistence¹⁴-¹⁷. However, it is uncertain how much the population may have had access to these materials, and how much they are idealized or naïf to be applied in the specifics of the Brazilian population.

Another process that seems to be affected by the present situation is the group socialization. The interaction among peers assumes an intense and important character in adolescence and in the course of life; it is from this interaction that they can expand socialization and move towards independence⁷. With the measures of social isolation, face-to-face interaction among peers was restricted, forcing adolescents to live exclusively with their original group (family), in a period when it is expected that they are gradually expanding the groups with which they identify. It is in the experiences among peers and in diversity that many of the experimentations, discoveries, and affective exchanges take place, and through them it is possible to experience a sense of social identity⁷. It seems reasonable to state that the lack of such experiences will affect how the adolescents integrate into society and their experience of health.

Moreover, with the interruption of face-to-face interactions, online interactions have increased substantially, being the only alternative to maintain some socialization, and these online activities bring other elements that require attention and understanding¹⁰. The intensified use of the Internet by adolescents brings important risks for mental health, and can even generate a form of addiction¹⁸. The unlimited access to content that addresses the pandemic situation also has a great anxiogenic potential¹⁹. The UNICEF guide “How teenagers can protect their mental health during coronavirus (Covid-19)” also mentions the possibility of increases in cyberbullying cases among adolescents due to the growing exposure time to digital social media¹⁵. In this sense, it is worth noting that peer violence, such as cyberbullying, is a major enhancer of mental health problems in adolescence, being a direct risk factor for self-inflicted violence behaviors²⁰. Also in this direction, there is an increase in the demand for online challenges involving some kind of self-injury, disguised as a “joke”. Obviously, the intensive use of the Internet already represented a delicate challenge in the pre-pandemic: while adolescents are skilled with the Internet, often more than their guardians or caregivers, they have not reached the maturity to select and interpret what content they will consume, nor to assess the risks involved in some digital socialization practices¹⁰.

In this phase, specifically, dysfunctional relationships (among peers or with family members, for example) have been identified as one of the risk factors for self-inflicted violence in adolescence. The increased exposure to cyberbullying, the weakening of support networks, the increase in intra-family conflicts and violence, and the intensive use of the Internet are risk factors for the occurrence of non-suicidal self injury (NSSI)²¹-²³. In addition to the factors mentioned, NSSI seems to be related to the way the subject deals with environmental invasions. Faced with an environment that does not allow support, welcoming, and expression of suffering, the search for pain relief turns to the body, to the mutilation of the body. Therefore, it is inferred that the impossibility of carrying out the psychological processes of adolescence and the environmental invasions promoted by the Covid-19 pandemic can directly impact the mental health of adolescents and contribute to the occurrence of NSSI and other self-injurious behaviors.

In light of all the transformations that society has faced during the Covid-19 pandemic, it is necessary to look at the environmental support that adolescents have received. As mentioned earlier, the environment plays a key role in adolescence, and healthy maturation depends on the presence of an environment that offers holding and a perspective of continuity. It is only in this environment that the adolescent is able to freely explore his immaturity, his paradoxes and his oscillations, to then feel existing and real⁷. In this same sense, the Brazilian Statute of the Child and Adolescent states that ensuring access to rights and the healthy development of adolescents is a duty of the family, the community, the society in general, and the government²⁴. This implies that the various sectors of society should assume essential roles in ensuring the maturation of adolescents. However, with the sanitary measures to contain the disease and the contagion by the new coronavirus, many of the services that support this public (health services, education, social assistance, NGOs) are currently with their activities interrupted, reduced, or focused on the attention to Covid-19 cases¹⁴,²⁵.

We observe that, in addition to the lack of family support that this population may be suffering, the other actors for the protection and welcoming of adolescents are also enfeebled, creating a non-supportive environment in multiple areas, which threatens the adolescents’ ability to maintain their mental health. We experience a paradox between the need for society’s care and the experience of social isolation, further intensified in populations that have restricted access to the Internet.

It may be observed that there are multiple consequences that the current conjuncture presents to the healthy maturing of adolescents both in Brazil and in the world. The impossibility of experiencing healthy maturation processes and environmental invasions may have long-term repercussions on the health of this population. The short-term repercussions have already been studied internationally. In a study conducted in Pakistan, adolescents negatively evaluated their status in the group and in interpersonal relationships due to social withdrawal²⁶. Just two weeks after the WHO declared a pandemic state by Covid-19, a study conducted with 584 Chinese adolescents and young people showed that 14.4% had already manifested symptoms of post-traumatic stress²⁷. This scenario increases the tendency to anxiety, depressed mood, and to adopt behaviors that risk their own health, such as suicidal ideation or attempts, and NSSI, as previously reported²⁸.

In view of the above, it is understood that the conditions imposed by the pandemic scenario of Covid-19, social isolation and the possible compromises that this context causes in the processes of contemporary adolescence represent a large risk of mental illness for adolescents, both in the short and in the long term, and it is not yet possible to measure the extent of its consequences. Therefore, we reassert the need to understand and develop care strategies focused on this population group.

Conclusion

Using Donald W. Winnicott’s theory of maturation as a cornerstone, and focusing on the conditions imposed on adolescents by the Covid-19 pandemic, it can be concluded that adolescents are currently a highly vulnerable group to psychological illness. Therefore, the pandemic of Covid-19 may become a concrete obstacle that hinders the transition to the young adult phase, given the isolation, the fear of being contaminated or experiencing the contagion of a loved one, the fear of death or dying, the reaffirmation of dependence, and the exacerbation of the fear of the unknown. Such population group experiences the impossibility of carrying out the healthy processes of maturation, inserted in an invasive and unsupportive environment, which can cause a generation of adults who are sick and characterized by the development of the false self, as proposed by Winnicott.

It is urgent to consider the particularities of adolescents in this pandemic situation, and to think about care strategies that reduce it’s traumatic potential. It is also necessary that the various sectors may find ways to offer a minimum of support to adolescents, especially to those in highly vulnerable situations and with restricted access to the internet, because this reduces the possibility of connecting to social support networks or even essential services. Regarding family coexistence, we observe that even with some initiatives from international bodies to guide good parenting and coexistence practices, they are still out of place in the Brazilian reality, that is marked by extreme social inequality – inequality that is only increasing every day due to the pandemic.

This study sheds light on the ideo-affective life of a population that has been scarcely explored during the pandemic, bringing up important reflections, as well as helping professionals from different areas to understand this public in terms of development and its particularities in the experience of the pandemic. The areas of health, education, social assistance, security, and justice, for example, should be aware of the possible consequences that living the pandemic of Covid-19 and the non-pharmacological control measures have for adolescents, in order to work towards attention and promotion of a society that welcomes and supports them in all dimensions of development. Furthermore, it signals gaps for the development of future empirical research that may illuminate new proposals for care for adolescents, their families, and communities.

• Financing

  This work was carried out with financial support from the Sao Paulo Research Agency-Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), Brazil - Master’s grant, process number 19/27564-8. This work was carried out with support from the Coordination for the Improvement of Higher Education Personnel - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brazil (CAPES) - Funding Code 001.
• Costa LCR, Gonçalves M, Sabino FHO, Oliveira WA, Carlos DM. Adolescer em meio à pandemia de Covid-19: um olhar da teoria do amadurecimento de Winnicott. Interface (Botucatu). 2021; 25(Supl. 1): e200801 https://doi.org/10.1590/Interface.200801

Referências

• ¹
  Brasil. Ministério da Saúde. Proteger e cuidar da saúde de adolescentes na atenção básica. Brasília: Ministério da Saúde; 2017.
• ¹
  World Health Organization. WHO coronavirus disease (COVID-19) dashboard [Internet]. Geneva: WHO; 2020 [citado 25 Mar 2020]. Disponível em: https://covid19.who.int/
  » https://covid19.who.int/
• ²
  Marques ES, Moraes CLde, Hasselmann MH, Deslandes SF, Reichenheim ME. A violência contra mulheres, crianças e adolescentes em tempos de pandemia pela COVID-19: panorama, motivações e formas de enfrentamento. Cad Saude Publica [Internet]. 2020 [citado 14 Out 2020]; 36(4):e00074420. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2020000400505&lng=en Doi: 10.1590/0102-311x00074420.
  » https://doi.org/10.1590/0102-311x00074420» http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2020000400505&lng=en
• ³
  Oliveira WA, Silva JL, Andrade ALM, Micheli DD, Carlos DM, Silva MAI. A saúde do adolescente em tempos da COVID-19: scoping review. Cad Saude Publica [Internet]. 2020 [citado 14 Set 2020]; 36(8):e00150020. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2020000802001&lng=en Doi: 10.1590/0102-311x00150020.
  » https://doi.org/10.1590/0102-311x00150020» http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2020000802001&lng=en
• ⁴
  Winnicott DW. O ambiente e os processos de maturação: estudos sobre a teoria do desenvolvimento emocional. Porto Alegre: Artmed; 1983.
• ⁵
  Silva SG. Do feto ao bebê: Winnicott e as primeiras relações materno-infantis. Psicol Clin [Internet]. 2016 [citado 30 Ago 2020]; 28(2):29-54. Disponível em: http://pepsic.bvsalud.org/scielo.php?script=sci_arttext&pid=S0103-56652016000200003&lng=pt&nrm=iso
  » http://pepsic.bvsalud.org/scielo.php?script=sci_arttext&pid=S0103-56652016000200003&lng=pt&nrm=iso
• ⁶
  Winnicott DW. A família e o desenvolvimento individual. São Paulo: Martins Fontes; 2001. Adolescência: transpondo a zona das calmarias; p. 115-128.
• ⁷
  Winnicott DW. Da pediatria à psicanálise – Obras escolhidas. Rio de Janeiro: Imago; 2000. A agressividade em relação ao desenvolvimento emocional; p. 288-304.
• ⁸
  Winnicott DW. Privação e delinqüência. São Paulo: Martins Fontes; 1987.
• ⁹
  Deslandes SF, Coutinho T. O uso intensivo da internet por crianças e adolescentes no contexto da COVID-19 e os riscos para violências autoinflingidas. Cienc Saude Colet [Internet]. 2020 [citado 30 Set 2020]; 25 Suppl 1:2479-86. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232020006702479&lng=en Doi: 10.1590/1413-81232020256.1.11472020.
  » https://doi.org/10.1590/1413-81232020256.1.11472020» http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232020006702479&lng=en
• ¹⁰
  Nabuco G, Pires de Oliveira MHP, Afonso MPD. O impacto da pandemia pela COVID-19 na saúde mental: qual é o papel da Atenção Primária à Saúde? Rev Bras Med Fam Comunidade. 2020; 15(42):2532. Doi: 10.5712/rbmfc15(42)2532.
  » https://doi.org/10.5712/rbmfc15(42)2532
• ¹¹
  Wazlawick P, Schaefer R, Volkova E, Dmitrieva V, Vereitinova T, Mikhalyuk O. Para a definição do conceito de socialização positiva de jovens. Rev Interdiscip Cientif Apl [Internet]. 2017 [citado 1 Out 2020]; 11(2):78-100. Disponível em: https://www.researchgate.net/publication/330509700_Para_a_definicao_do_conceito_de_socializacao_positiva_de_jovens
  » https://www.researchgate.net/publication/330509700_Para_a_definicao_do_conceito_de_socializacao_positiva_de_jovens
• ¹²
  Tozze KF, Bolsoni-Silva AT. Intervenção em grupo com pais de adolescentes com problemas de comportamento internalizantes. Rev Bras Ter Comport Cogn. 2018; 19(4):6-24. Doi: 10.31505/rbtcc.v19i4.1091.
  » https://doi.org/10.31505/rbtcc.v19i4.1091
• ¹³
  World Health Organization. Addressing violence against children, women and older people during the COVID-19 pandemic: key actions, 17 June 2020 [Internet]. Geneva: WHO; 2020 [citado 22 Set 2020]. Disponível em: https://apps.who.int/iris/handle/10665/332458
  » https://apps.who.int/iris/handle/10665/332458
• ¹⁴
  United Nations Children’s Fund (UNICEF). How to talk to your child about coronavirus disease 2019 (COVID-19) [Internet]. New York: Unicef; 2020 [citado 22 Set 2020]. Disponível em: https://www.unicef.org/coronavirus/how-talk-your-child-about-coronavirus-covid-19
  » https://www.unicef.org/coronavirus/how-talk-your-child-about-coronavirus-covid-19
• ¹⁵
  World Health Organization. Covid-19 parenting [Internet]. Geneva: WHO; 2020. [citado 22 Set 2020]. Disponível em: https://www.covid19parenting.com/home
  » https://www.covid19parenting.com/home
• ¹⁶
  Arigatou International. Learning to live together- an activity booklet for children during the Covid-19 pandemic [Internet]. Geneva; 2020 [citado 22 Set 2020]. Disponível em: ethicseducationforchildren.org
  » ethicseducationforchildren.org
• ¹⁷
  Salicetia F. Internet Addiction Disorder (IAD). Procedia Soc Behav Sci. 2015; 191:1372-6.
• ¹⁸
  Ribeiro GL. Medo Global. Cientistas sociais e o coronavírus. São Paulo: Anpocs; 2020 [citado 22 Set 2020]. (Boletim nº 5). Available from: http://www.anpocs.com/index.php/ciencias-sociais/destaques/2311-boletim-n-3
  » http://www.anpocs.com/index.php/ciencias-sociais/destaques/2311-boletim-n-3
• ¹⁹
  Almeida RS. A prática da automutilação na adolescência: o olhar da psicologia escolar/ educacional. CGHS UNIT-AL. 2018; 4(3):147.
• ²⁰
  Lemes DCM, Câmara SG, Alves GG, Aerts D. Satisfação com a imagem corporal e bem-estar subjetivo entre adolescentes escolares do ensino fundamental da rede pública estadual de Canoas/RS, Brasil. Cienc Saude Colet [Internet]. 2018 [citado 14 Out 2020]; 23(12):4289-98. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232018001204289&lng=pt Doi: 10.1590/1413812320182312.14742016.
• ²¹
  Silva AC, Botti NCL. [Self-injurious behavior along the vital cycle: integrative literature review]. Rev Port Enferm Saude Mental. 2017; 18:67-76. Doi: 10.19131/rpesm.0194. Portuguese.
  » https://doi.org/10.19131/rpesm.0194
• ²²
  Klomek AB, Snir A, Apter A, Carli V, Wasserman C, Hadlaczky G, et al. Association between victimization by bullying and direct self injurious behavior among adolescence in Europe: a ten-country study. Eur Child Adolesc Psychiatry. 2016; 25(11):1183-93. Doi: 10.1007/s00787-016-0840-7.
  » https://doi.org/10.1007/s00787-016-0840-7
• ²³
  Brasil. Lei nº 8.069, de 13 de Julho de 1990. Dispõe sobre o Estatuto da Criança e do Adolescente e dá outras providências. Diário Oficial da República Federativa do Brasil. 16 Jul 1990.
• ²⁴
  Ragavan MI, Culyba AJ, Muhammad FL, Miller E. Supporting adolescents and young adults exposed to or experiencing violence during the COVID-19 pandemic. J Adolesc Health [Internet]. 2020 [citado 30 Set 2020]; 67(1):18-20. Doi: 10.1016/j.jadohealth.2020.04.011.
  » https://doi.org/10.1016/j.jadohealth.2020.04.011
• ²⁵
  Imran N, Zeshan M, Pervaiz Z. Mental health considerations for children & adolescents in COVID-19 pandemic. Pak J Med Sci. 2020; 36(COVID19-S4):S67-72
• ²⁶
  Liang L, Ren H, Cao R, Hu Y, Qin Z, Li C, et al. The effect of COVID-19 on youth mental health. Psychiatr Q. 2020; 91:841-52. Doi: 10.1007/s11126-020-09744-3.
  » https://doi.org/10.1007/s11126-020-09744-3
• ²⁷
  Schmidt B, Crepaldi MA, Bolze SDA, NeivaSilva L, Demenech LM. Saúde mental e intervenções psicológicas diante da pandemia do novo coronavírus (COVID-19). Estud Psicol (Campinas). 2020; 37:e200063.

Edited by

Editor

Rosana Teresa Onocko Campos

Associated editor

Tiago Rocha Pinto

Publication Dates

• Publication in this collection
  19 May 2021
• Date of issue
  2021

History

• Received
  20 Nov 2020
• Accepted
  28 Feb 2021