The COVID-19 pandemic significantly impacted individuals with mood and anxiety disorders, particularly emerging adults (ages 18-25), a population already at higher risk for these conditions. Emerging adulthood is a critical developmental period characterized by identity exploration, relationship reorganization, and vocational planning. The pandemic disrupted these developmental tasks through restrictions on social interaction, education, and employment. While some emerging adults regained stability as the pandemic progressed, a substantial minority experienced ongoing mental health deterioration, especially those with pre-existing mental illness. This study aimed to describe the experiences of emerging adults with pre-existing mood and anxiety disorders during the third wave of the pandemic in order to understand the impact of prolonged societal stressors on this vulnerable population. Existing literature focuses primarily on the acute effects of the pandemic, with less research on the longitudinal impact on individuals with pre-existing mental health conditions. This study fills this gap by providing in-depth qualitative data from this specific group, whose input is crucial for informing mental health interventions.

Prior research demonstrates that individuals with mood and anxiety disorders experienced increased mental health challenges during the COVID-19 pandemic, with emerging adults potentially being disproportionately affected. Studies have highlighted increased prevalence of depressive and anxiety symptoms in this age group, linked to factors like fear of infection, death, economic uncertainty, educational disruptions, and social isolation. While some studies showed improvements in mental health as the pandemic progressed, others indicated that deterioration persisted in those with pre-existing distress or mental illness. Emerging adults' unique developmental stage makes them particularly susceptible to pandemic-related stressors, as lockdowns and restrictions hindered their ability to accomplish typical developmental tasks such as identity exploration, relationship development, and career planning. The lack of research on the long-term impact of the pandemic on emerging adults with pre-existing mental illness underlines the significance of this qualitative study.

This qualitative study utilized data from the First Episode Mood and Anxiety Program (FEMAP) in London, Ontario, Canada. FEMAP provides outpatient mental health services for emerging adults (ages 16-29) with minimal prior mental health treatment. During the third wave of the COVID-19 pandemic (April 2021), all active FEMAP patients (N=434) were invited via email to participate in a survey. The survey included an abbreviated version of the Pandemic Response Questionnaire (PRQ) and an open-ended text box prompting participants to elaborate on their feelings, activities, coping mechanisms, and future expectations. Of the 114 respondents, 85 provided usable data after excluding those who declined to answer the open-ended question. Thematic analysis was employed to analyze the qualitative data, following the methodology of Nowell et al. (2017). Two independent teams of coders conducted inductive coding, followed by a consensus-building process to identify and refine themes. The data were analyzed using QSR NVivo software.

The analysis revealed two primary themes: "Languishing" and "Coping through Intentional Action." The "Languishing" theme encompassed three subthemes: 1. **Dominance of Negative Emotion:** Participants predominantly reported negative emotions such as depression, anxiety, loneliness, and isolation. These negative emotions were often exacerbated by pandemic restrictions. 2. **Waiting and Stagnating:** Participants described a sense of purposelessness and futility in their daily activities, often feeling stuck and lacking self-efficacy. Many reported difficulty finding motivation for hobbies and school work. 3. **Loss of Opportunity:** Participants expressed sadness and grief over their inability to achieve typical developmental milestones due to pandemic restrictions, impacting identity development, relationships, and career goals. The contrasting theme, "Coping through Intentional Action," characterized participants who demonstrated resilience by setting and achieving meaningful goals despite the challenges. These individuals engaged in proactive coping strategies and reported more balanced affect, showing gratitude and a sense of purpose. Attending in-person mental health appointments was highlighted as a significant coping mechanism for many. The majority of the participants in the study (those experiencing "Languishing") did not describe any positive affect, and nearly half did not answer the question of what they were looking forward to.

The findings highlight the significant negative impact of the prolonged COVID-19 pandemic on emerging adults with pre-existing mood and anxiety disorders. The prevalence of "Languishing," characterized by emotional, psychological, and social distress, underscores the importance of addressing the long-term mental health consequences of the pandemic. The contrast between "Languishing" and "Coping through Intentional Action" suggests that proactive coping strategies and goal-oriented behaviors may be protective factors. The study's findings support previous research on the deterioration of mental health among emerging adults with pre-existing mental illness during the pandemic. The disruption of typical developmental tasks during this period may have contributed to feelings of helplessness, purposelessness, and lack of mastery, highlighting the need for supportive interventions that foster agency and promote personal growth. The findings also relate to the concepts of "sliding" versus "deciding" in emerging adulthood, where inaction and avoidance contribute to long-term negative outcomes.

This study demonstrates the significant impact of prolonged pandemic-related restrictions on the mental wellbeing of emerging adults with pre-existing mood and anxiety disorders. The concept of "Languishing" effectively captures the pervasive negative experiences reported, while "Coping through Intentional Action" highlights the potential protective effects of proactive strategies. Future research should investigate the long-term effects of the pandemic and the development of tailored interventions that address the unique needs of this population and other high-risk cohorts. The importance of supportive relationships and structures for promoting personal growth should also be highlighted in future policy and interventions.

This study's limitations include its cross-sectional design and the specific sample of emerging adults with pre-existing mood and anxiety disorders who were engaged in treatment. This limits the generalizability of the findings to other emerging adults, particularly those without pre-existing mental health conditions or from different demographic groups (such as males or individuals from BIPOC communities). The predominantly female and Caucasian sample also limits the generalizability of the findings. Future research using longitudinal designs and more diverse samples is needed to explore the broader implications of the pandemic on emerging adults' mental health and development.