Languishing: Experiences of emerging adults in outpatient mental health care one year into the COVID-19 pandemic

The study investigates how emerging adults (approximately ages 16–29) with pre-existing mood and anxiety disorders responded to the prolonged stressors of the COVID-19 pandemic during the third wave in Ontario, Canada (April 2021). Emerging adults were already at elevated risk for mood and anxiety difficulties before the pandemic and faced increased hopelessness, loneliness, and anxiety due to infection fears, educational and economic uncertainty, and social disruption. Developmental tasks of emerging adulthood—identity exploration, relationship reorganization, and attainment of material markers like education and employment—were broadly disrupted by lockdowns and remote modalities. Prior research largely examined acute impacts; little was known about how emerging adults with pre-existing mental illness responded to enduring restrictions one year into the pandemic. The purpose was to describe their emotional states, activities, coping strategies, and outlook, to characterize their response to this prolonged societal stressor.

Pre-pandemic, emerging adults had high prevalence of depressive and anxiety symptoms, with over half of U.S. adults aged 18–24 reporting such symptoms in early pandemic surveys. Pandemic-related stressors included fear of infection and death, financial and educational uncertainty, and social isolation, paralleling general adult experiences but compounded by developmental stage challenges. University students experienced decreased physical activity and socialization, increased screen time, poorer sleep, and rises in substance use, with difficulties persisting into later waves despite partial normalization in some cohorts. Developmentally, emerging adults typically pursue identity formation, relationship restructuring, and milestones like education completion and employment; however, the pandemic led to remote learning, job and income losses, and reduced resources, impeding these tasks. Those with higher pre-existing distress or mental illness appeared more likely to deteriorate over time, although broader longitudinal findings were mixed, with some cohorts stabilizing. Calls for including individuals with mental health challenges in research highlighted the need to understand their perspectives during COVID-19.

Design: Descriptive qualitative study using thematic analysis. Setting and participants: The First Episode Mood and Anxiety Program (FEMAP) in London, Ontario, an outpatient service for emerging adults (entry 16–25) with minimal prior treatment engagement. Context: Ontario's third lockdown (April 2021) with discouraged socializing, capacity limits, and limited vaccine availability for ages 16–25. Recruitment and data collection: All active FEMAP patients were invited via email to complete REDCap-based questionnaires between April 16–21, 2021. Participants provided electronic informed consent. Measures: An abbreviated FEMAP Pandemic Response Questionnaire asked about mood in the past week, COVID-19-related changes to work, schooling, finances, and included a single open-ended prompt covering feelings, activities, coping, and what participants looked forward to when "back to normal". Analysis: Reflexive thematic analysis with an inductive approach using NVivo. An initial coder team independently coded a random 20% to generate preliminary codes and reached consensus. A second team applied and expanded codes, followed by team discussions to refine and agree on themes. The analysis emphasized description and organization over quantification. Ethics: Approved by the Western University Human Research Ethics Board; procedures adhered to the Declaration of Helsinki.

Sample and response: 434 patients were invited; 114 provided some response; 29 declined ("I do not wish to answer"), leaving 85 responses for thematic analysis. Demographics (n=85): mean age 20.95 (SD 3.10; range 16–29); 83.5% female, 14.1% male, 2.4% non-binary; 75.3% Caucasian. Prompt response rates: How are you feeling? 78/85; What are you doing? + How are you coping? 73/85; What are you looking forward to? 51/85. Primary themes: 1) Languishing—comprised of subthemes: a) Dominance of Negative Emotion (prominent depression, anxiety, loneliness, and isolation; worsening symptoms compared to pre-COVID), b) Waiting and Stagnating (purposelessness, reduced self-efficacy and autonomy, fatigue with hobbies, increased use of avoidance or substances for temporary relief, work/school not functioning as effective coping), and c) Loss of Opportunity (perceived missed developmental milestones and social/educational/vocational experiences, linked to sadness and grief). Many left the future-oriented prompt unanswered, indicating diminished future orientation. 2) Coping through Intentional Action—minority reported relative stability and progress through deliberate, goal-directed behaviors (e.g., pursuing personal goals, structured productivity, journaling), expressing balanced affect including gratitude. Engagement with mental health services (face-to-face interactions) was described as helpful, providing structure, connection, and a sense of productivity.

The findings indicate that emerging adults with pre-existing mood and anxiety disorders largely experienced emotional, psychological, and social elements of languishing one year into the pandemic. The predominance of negative affect and limited positive emotion align with emotional languishing; feelings of stagnation, purposelessness, and reduced autonomy reflect psychological languishing; and perceived loss of opportunities for growth and contribution suggests social languishing, consistent with Keyes' mental health continuum. Compared to earlier-phase observations in the same clinical population that included mixed positive and negative reactions, the current affective tone suggests deterioration over time in this vulnerable group, mirroring literature showing greater risk for those with pre-existing mental illness. Developmental disruptions hindered identity formation and mastery, while coping often involved "sliding" (inertia, avoidance, substance use) rather than "deciding" (intentional, value-consistent choices). However, participants who engaged in intentional, goal-directed actions exhibited more balanced affect and resilience, aligning with therapeutic approaches like Acceptance and Commitment Therapy. Public health and organizational messaging during prolonged crises might enhance youth agency by encouraging small, daily intentional actions and maintaining supportive infrastructures (educational, vocational, clinical) that facilitate developmentally appropriate exploration and commitment, including in-person or high-quality relational supports where feasible.

Emerging adults engaged in outpatient care for mood and anxiety disorders largely described languishing during the third COVID-19 wave, characterized by negative affect, stagnation, and perceived loss of opportunity. A subset who practiced intentional, goal-directed coping reported better emotional balance and continued progress despite restrictions. The study contributes nuanced, patient-reported perspectives on the prolonged pandemic’s impact on a high-risk developmental group and highlights intentional action as a potential protective factor. Future responses to societal crises should prioritize structures and relationships that support agency, exploration, and commitment toward personal growth for youth, particularly those with pre-existing vulnerabilities. Further longitudinal work is needed to assess developmental trajectories, identify who is at greatest risk, and refine interventions that restore momentum and well-being.

Generalizability is limited to treatment-engaged emerging adults with pre-existing mood and anxiety disorders, predominantly female and non-Hispanic white. The cross-sectional, exploratory design precludes causal inference and does not capture longitudinal developmental trajectories. The study did not a priori assess identity formation or decision-making processes, and findings may differ for emerging adults not in treatment or from underrepresented demographic groups.