{"doi":"10.1371/journal.pmen.0000409","title":"Impact of COVID-19 school learning model on mental health, suicidal thoughts and behaviors, substance use, and violence related behaviors and experiences among U.S. high school students","abstract":"The COVID-19 pandemic and associated prevention measures reshaped students' lives. We estimated the effects of virtual learning during the pandemic on adolescents' mental health, suicidal thoughts and behaviors, substance use, and violence-related experiences and behaviors. Using Youth Risk Behavior Survey data from 25 local jurisdictions, we compared overall and relative changes from 2019 (n = 49,740) to 2021 (n = 42,995) between jurisdictions where high school students predominantly attended school virtually vs. in-person during the 2020-2021 school year with Rao-Scott chi-square tests and difference-in-differences logistic regression. P-values<0.050 were considered significant. From 2019 to 2021, reported persistent feelings of sadness/hopelessness (2019 = 36.3%, 2021 = 41.3%), seriously considering suicide (17.0-18.7%), making suicide plan(s) (14.2-16.9%), and experiencing sexual dating violence in past 12 months (6.7-7.8%) increased significantly, while alcohol use (22.5-17.1%), binge drinking (8.5-6.2%), and marijuana use (20.2-14.3%) in past 30 days, ever prescription opioid misuse (16.0-13.2%), and gun-carrying (5.5-4.5%), physical fighting (22.3-17.3%), and any sexual violence (11.3-10.4%) in past 12 months decreased significantly. Students in virtual learning jurisdictions reported relative decreases in injury during suicide attempt(s) (OR=0.68, 95%CI = 0.52-0.88), experiencing sexual violence (OR=0.78, 95%CI = 0.67-0.91), using electronic vapor products (OR=0.81, 95%CI = 0.70-0.95), using alcohol (OR=0.84, 95%CI = 0.74-0.95), and misusing prescription opioids (OR=0.82, 95%CI = 0.72-0.94). Learning model was not associated with relative changes in persistent feelings of sadness/hopelessness, seriously considering suicide, making suicide plan(s), attempting suicide, binge drinking, marijuana use, gun-carrying, physical fighting, experiencing sexual dating violence, or being electronically bullied. Additional efforts to support schools in providing safe, supportive environments are needed, particularly where schools returned in-person in fall 2020.","journal":"PLOS mental health.","year":2025,"id":575057,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9499,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":310950,"name":"Sanjana Pampati","orcid":"0000-0003-2202-1884","position":1,"is_corresponding":false},{"id":259754,"name":"Sarah DeGue","orcid":"0000-0003-4257-526X","position":2,"is_corresponding":false},{"id":422564,"name":"Jean Y. Ko","orcid":"0000-0003-0961-9793","position":3,"is_corresponding":false},{"id":391312,"name":"Dawn Pepin","orcid":"0000-0002-0128-2949","position":4,"is_corresponding":false},{"id":779396,"name":"Casey E. Copen","orcid":"0000-0001-8354-0464","position":5,"is_corresponding":false},{"id":937306,"name":"Ari Fodeman","orcid":"0000-0002-8671-0518","position":6,"is_corresponding":false},{"id":506465,"name":"Deven T. Hamilton","orcid":"0000-0003-4334-958X","position":7,"is_corresponding":false},{"id":289071,"name":"David A. Katz","orcid":"0000-0002-7786-0194","position":0,"is_corresponding":true}],"reference_count":28,"raw_metadata":null,"created_at":"2026-07-19T02:57:44.572630Z","pmid":"41445805","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}