For teens, pandemic restrictions may have meant months of virtual school, less time with friends and canceling activities like sports, band concerts and prom.

And for young people who rely heavily on social connections for emotional support, these adjustments may have taken a heavy toll on their mental health, a new national poll suggests.

Forty-six percent of parents say their teen has shown signs of a new or worsening mental health condition since the start of the pandemic in March 2020, according to the C.S. Mott Children's Hospital National Poll on Children's Health at Michigan Medicine. Parents of teen girls were more likely to say their child had a new onset or worsening of depressive symptoms and anxiety than parents of teen boys.

"Just as young people are at the age of being biologically primed to seek independence from their families, COVID-19 precautions have kept them at home," says poll co-director and Mott pediatrician Gary L. Freed, M.D., M.P.H.

"Pandemic-related lifestyle changes have wreaked havoc on teens' lives, with many experiencing disruptions to their normal routines. Our poll suggests that pandemic-era changes may have had a significant mental health impact for some teenagers.

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The nationally representative report is based on responses from 977 parents of teens ages 13-18.

One in three teen girls and one in five teen boys have experienced new or worsening anxiety, the poll suggests. More parents of teen girls than parents of teen boys note an increase in anxiety/worry (36% vs. 19%) or depression/sadness (31% vs. 18%).

But similar proportions of parents report negative changes in their teen's sleep (24% for girls vs. 21% for boys), withdrawing from family (14% vs. 13%) and aggressive behavior (8% vs. 9%).

Recent research has shown teen depression during the pandemic to be associated with teens' own fears and uncertainties, as well as high levels of parental stress, Freed notes.

"Isolation during the pandemic may be triggering new problems for some teens but for others, the situation has exacerbated existing emotional health issues," Freed says.

Parents in the poll say their kids seem hardest hit by changes in social interactions over the last year, with three in four reporting a negative impact on their teen's connections to friends.

Many parents say their teens have been texting (64%), using social media (56%), online gaming (43%) and talking on the phone (35%) every day or almost every day. Few parents say their teens have been getting together in person with friends daily or almost every day, indoors (9%) or outdoors (6%).

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"Peer groups and social interactions are a critical part of development during adolescence. But these opportunities have been limited during the pandemic," Freed says. "Many teens may feel frustrated, anxious and disconnected due to social distancing and missing usual social outlets, like sports, extracurricular activities and hanging out with friends."

Parents who note negative changes in their teens' mental health have tried different strategies to help their teen, the Mott Poll suggests, including relaxing COVID-19 rules and family rules on social media, seeking professional help and even using mental health apps.

SEE ALSO: Many Parents Say Teens With Anxiety, Depression May Benefit From Peer Confidants at School

"Parents play a critical role in helping their teens cope with the stress of the pandemic," Freed says. "There are strategies parents can engage to help, whether or not their teen is showing signs of problems. One of the most important things for parents to do is keep lines of communication open; ask their teen how they are doing and create the space for them to speak honestly so they can provide help when needed."

More Mott Poll findings on different methods parents have used to improve children's mental health and what Mott experts recommend:

1. Relaxing family rules
   
   Half of parents have tried relaxing family COVID-19 rules to allow their teen to have more contact with friends, with most (81%) saying it has helped. Freed says families should encourage social interactions that follow COVID-19 safety guidelines, such as spending time outside or participating in activities wearing masks and socially distanced.
   
   Half of parents have also loosened social media restrictions – and most (70%) say it helped. Experts recommend that families allow teens to engage with peers on age-appropriate platforms but to continue providing boundaries to ensure screen time doesn't interfere with other health-related behaviors, such as physical activity and sleep. This could mean banning electronics close to bedtime, encouraging  or only allowing social media use during designated times of the day.

SEE ALSO: Keeping Our Patients Safe During COVID-19

2. Talking to an expert
   
   One in four parents sought help for their teen from a mental health provider, with three-fourths feeling it helped.

A third of parents also talked to teachers or school counselors, with over half (57%) saying that strategy was helpful.

"Teens may experience a wide range of severity of mental health problems, but if parents hear their teen express any thoughts of suicide or self-harm, they should seek mental health assistance immediately," Freed says.

3. Trying a Web-based program
   
   A quarter of parents encouraged their teen to try a web-based program or app to improve their mental health, and 60% say it has helped. A third of parents in the poll also looked for information online (58% say it helped.)

Apps may make therapy more accessible, efficient, and portable, Freed notes, but parents should consult their primary care provider or other trusted sources for app recommendations as well as for online resources about teen mental health.

4. Keeping communication open but also giving space

One in seven parents in the poll reported their teen has withdrawn from family since the start of the pandemic.

Parents may try to show teens they're not alone by sharing some of their own worries and successful strategies that help them cope while asking questions that create a safe space for candid conversations.

At the same time, Freed notes, it's also normal for teens to crave privacy from their family. Giving them space for some quiet time, creative time or music time can be helpful to their mental health.

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5. Encouraging sleep hygiene

Child health experts emphasize the importance of sleep for teens, especially when they are under stress. Almost one in four parents in the Mott Poll say their teens were experiencing negative changes in their sleep since the pandemic started.

Experts recommend helping teens craft a healthy and productive routine to their days and nights – whether they're in virtual or in-person school. This includes a regular sleep and wake cycle that fits with their online learning schedule, other responsibilities around the house and their interactions with peers and family. Making time to get outside is also helpful in regulating sleep.