A New York City doctor shares how the pandemic is hurting the young people she serves

As the director who oversees one of the nation's largest adolescent health centers, Dr. Angela Diaz worries how the coronavirus pandemic will affect the already vulnerable young people she and her co-workers serve.

"Our patients have challenging lives," Diaz recently told journalists at the 2020 National Fellowship. "Seventy percent have a history of trauma."

A survey recently conducted by the Mount Sinai Adolescent Health Center in New York City, where Diaz is the director, found that many teenagers and young people are using more drugs. They're showing symptoms of clinical depression. In some cases, some teens are performing sex acts to be able to afford food during a pandemic that has isolated them to at home, away from friends, jobs and school.

Of the 400 teenagers ages 15 to 25 who took the survey conducted in June, 65% said that someone in their household lost a job or hours of employment because of the coronavirus. At least 33% said they had lost a loved one, relative, teacher or friend to COVID-19, and 41% mentioned that they had recently used marijuana.

"Some said they were fearful, that their worries overwhelm them, and they couldn't focus beyond their anxiety," Diaz said. "This population has many vulnerabilities."

Based in New York, the Mount Sinai Adolescent Health Center serves more than 12,000 youth, including those who are uninsured and lack access to health services, Diaz said. It has been one of the few clinics focused on teens to remain open during the pandemic, she added.

The adolescent population is often overlooked by health care providers. Their ailments are treated as if they were adults, but their needs as a whole person are seldom taken into account, Diaz said. During the pandemic, when teens can’t socialize in person regularly with friends, when the usual routine of school is gone and jobs are out of reach, Diaz said distressing patterns emerge, including high levels of anxiety.

Some of those who completed the center’s survey revealed they were being pressured to have sex for survival or are experiencing domestic or interpersonal violence. Diaz said she has submitted the results to policymakers, hoping they cast a sharper light on the needs of youth during the pandemic.

Youth trauma is an issue close to Diaz's heart. Born in the Dominican Republic, Diaz was forced to wait to come to the United States while her parents were already in New York, working in a factory. After her parents secured enough savings, Diaz was able to obtain a visa, reuniting with her family as a young teenager. But she overstayed her visa and had to return to the Dominican Republic until she was allowed reentry.

That instability during her childhood led to depression, and Diaz dropped out of high school. But the staff at Mount Sinai, where she went for care, encouraged her to give high school another chance. Little by little, she graduated, went to college while working at the same factory where her parents worked, eventually attending medical school. She became a clinician at the very place she received such crucial words of encouragement at a vulnerable time.

As a physician, she noticed young teenagers coming into the clinic who were pregnant. She began to ask teens if they had experienced sexual abuse, a question few physicians were asking. She found that 23% of the adolescents who she was seeing had a history of sexual trauma. 

The clinic sees patients ages 10 to 26. Diaz said many of the young people  — including trans youth —who come in have nowhere else to turn. She has seen teens who have survived human and sex trafficking as well.

Many of the youth seen at the clinic have experienced multiple adverse childhood experiences or ACEs, which the federal Centers for Disease Control and Prevention defines as potentially traumatic events that occur in childhood. That includes physical, emotional or sexual abuse, violence, and growing up in a family with mental health or substance use problems. Such experiences can trigger toxic stress, which in turn can interfere with healthy brain development and affect the way the body reacts to other stressful events. Chronic physical and mental health problems and substances abuse have all been linked to ACEs.

"The more ACEs you have, the more likely you are to have poor outcomes," Diaz said.

Her expertise in adolescence and sexual trauma has led her across the globe. She has studied youth in Asia, Africa and Latin America. She has been struck by what unites many of these young people.

"There's commonalities among youth regardless where they live and the language (they speak)," she said. "They all want privacy. The all want to be listened to and understood. They don't want to be judged."