Mental health during the pandemic. Photo collage by LA Johnson/NPR

American teens have spent a lot of their formative years isolated from friends and learning environments. According to a new Centers for Disease Control and Prevention survey of high school students, more than 2 in 5 have reported persistently feeling sad. Many people who were struggling with trauma or mental health problems were affected by the isolation.

Young people have shown grace and resilience in dealing with the challenges of COVID-19. The two year anniversary of the Pandemic was marked by a newfound sense of self and big dreams for the future by four high school students.

If you or someone you know is thinking about suicide, you can call the National Suicide Prevention Hotline at 1-800-273-8255 or send a text to 741741.

Ruby, 17: "I left a toxic friendship, I explored myself more."

By the time the school closed due to the Pandemic, Ruby had already been trying to ignore her mom's warnings. Her mom is Chinese, and her relatives back in China have been keeping her updated on the spread of the virus. Ruby says that when her spring break was extended, her mom told her she wouldn't be going back to school soon.

Ruby felt a lot of anxiety about her high school at first. She was struggling to fit in because many of her new classmates came from wealthier families. NPR doesn't use Ruby's last name to protect her privacy.

She said that she was afraid to even move in class. I was sitting and not moving because I was so worried about what they were thinking about me.

Ruby was a freshman when school went online and she was self-conscious about showing her house on camera. She had a hard time finding a quiet place to concentrate as her two siblings also switched to remote learning. She says she didn't learn anything during remote school.

Ruby was not the only one. In the first few months of the Pandemic, two-thirds of U.S. students in grades nine through 12 told the CDC that they had trouble finishing their schoolwork.

"I would say [the pandemic] has definitely made me a stronger person." - Ruby, 17

It was an upside to remote school that it put some distance between Ruby and her friend.

She was the only person I really knew, so I felt safe around her.

When her school transitioned to hybrid learning in her sophomore year, Ruby decided to leave her friendship. Three people are now her best friends.

She says she explored herself more after leaving a toxic friendship.

Teja, 18: "The lack of structure just led to me becoming obsessive."

When her Seattle high school closed, her world began to fall apart. Her jazz choir trip and swim practices were canceled, her clubs were restricted to meetings, and her entire life was devoted to her family.

During her freshman year of high school, she was diagnosed with an eating disorder and was 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 NPR is not using her last name to protect her privacy.

Staying on track for recovery is something I love, and school was a huge motivator for me. I like to learn. It was only possible because I was eating.

The early months of the Pandemic were very destabilizing for girls with eating disorders. The proportion of emergency room visits for eating disorders increased among adolescent girls.

Her family noticed that she relapsed. After a difficult conversation with her dad about how she might have to go to the hospital, Teja called a friend who talked her down.

She said the conversation was a wake-up call.

I realized the only way I would be happy and have structure is if I created it for myself. Teja says that he made a schedule and set goals.

In the summer of 2020 she started going on daily walks with her dog, planning outdoor meetups with friends and writing music on a regular basis, all in addition to regular meetings with her psychiatrist. She was able to attend outdoor swim team practices.

It was great to be back in the water with my teammates. Those things helped me understand why I wanted to continue in recovery.

"I think the primary thing was the isolation. There was no one to catch me from spiraling." - Teja, 18

But that was short-lived. When remote learning continued into her junior year, she says, she became really anxious about school.

The lack of structure led to Teja becoming obsessive.

The things that usually brought her joy, like practicing with the jazz choir, did not feel the same without her classmates singing by her side. There was no one to catch me.

My friends had my parents on a speed dial when I had seizures.

There is a person named Teja.

In the fall of 2020, his anxiety was getting worse. She says that the seizures started at least 10 times a day.

Three weeks after her first seizure, she was diagnosed with a rare neurological disorder that can be triggered by things like anxiety, stress and trauma.

It was hard because I couldn't do anything. You could not see friends without having seizures. My friends had my parents on speed dial when I had seizures.

She and her family had to travel all the way to Colorado to get treatment in February 2021. She returned to in-person classes for the first time since the Pandemic started after she started having fewer seizures. She says being back at school has been good.

On my first day of school, my schedule was messed up, and I thought it was weird. It has been so long since I had an issue like that.

She needs to return to some of the activities she loves most. She says getting back to some semblance of normal has helped her recover from everything she went through.

I was able to do a live production. It was the first time that I thought it was important to be here. It would matter if I got sick and couldn't be here. It was the first time in my high school experience that I felt that way.

Alex, 16: "I was asking myself, 'Am I a male? I don't look like the typical guy.' "

Alex lives in northern Minnesota and he had a mixed bag about Pandemic isolation.

On the other hand, the isolation made it harder for him to deal with his mental health issues. Alex was 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 Alex's last name is not being used to protect his privacy as a minor.

He wanted to feel safer and less paranoid when he was at home. But it did not.

I started getting braver. I began to express what I was feeling.

Alex.

He says that it made it worse. He was trapped and worried his abuser would find him.

Alex had a lot of time to think. He began to ask himself questions about his gender identity. I look different than the typical guy. He doesn't act like the other trans people he sees online or in school.

He began to identify as trans masculine after months of contemplation.

At the end of his freshman year, he started seeing a new therapist via video conference, which he liked better than in-person therapy. He was able to do therapy from his bed.

He was able to open up in a new way.

I started getting braver. He explains that he started expressing what he was feeling.

"I'm working on my trauma, but trauma processing is all your life. You just learn new ways to cope with it." - Alex, 16

It was similar to Jenga. Everything else fell after one thing fell. The word vomit was kind of like that.

Alex started his sophomore year at a new school in the fall of 2020.

He became his best friend after he reconnected with an old friend. Alex enjoys cosplaying and they like to hang out.

Recovery is not always a straight line. Alex was hospitalized after attempting to take his own life. According to the CDC, in the first few months of the Pandemic, 1 in 5 U.S. high school students considered suicide and 9% tried to kill themselves.

Alex has been working with his therapist to find healthy ways to cope with his traumas, like drawing and getting out into the community.

He says he is doing pretty good. I'm a high school student and I'm stressed. I work on my trauma, but trauma processing is all you can do. You learn new ways to deal with it.

Daniela Rivera, 17: "I just lost all motivation"

When she doesn't understand the material, school is hard for her, which was the case during the Pandemic. In March 2020, she was in high school. At first, her school's remote learning option didn't include live instruction, just packets of optional work.

Her school began using online lessons in the fall. She was alone in her room and she was clicking through hours of pre-recorded videos.

I have always been a quiet person. I feel like I'm quieter and shyer than usual.

The person is Daniela Rivera.

I did not get a lot of things. I gave up completely. I would wake up in my bed and go to eat.

I was behind in all my classes and that changed her motivation for schoolwork. I would go out to the living room and talk to my mom while the video was playing. 30 minutes later, I come in and the video is still playing. I lost my motivation.

I got into the mindset of being trapped in a house and not being able to do anything. I have stuff I can do outside, but I just felt like I couldn't open the door.

According to the CDC, nearly 2 in 5 teens had poor mental health during the Pandemic. That was something that Daniela struggled with. She and her boyfriend would talk in the evenings about how the days were starting to blur together.

"Every day I'd just stay in my bed. I'd wake up...be on school in my bed and just get up to go eat." - Daniela Rivera, 17

She had a part-time job as a hostess at a restaurant on the weekends that made it hard for her to maintain her friendship because her friends worked weekday shifts.

When her school started offering a hybrid option during the fall semester of her sophomore year, she was excited. It was not the same. The lessons were the same as before. She sat in a classroom with a single teacher watching her from a laptop while other students sat by a row of desks.

Being back in school didn't make it any easier to keep in touch with her friends, they chose to stay online so they could keep their jobs

They went from being one of the closest people to me to becoming a stranger. I don't know how they are, I don't know what they are doing, and I don't know what happened in their life.

The school transitioned back to regular, in-person learning in the spring of 2021. After returning to business as usual, she realized how much she had changed. I feel like I'm quieter and shyer than usual.

She has a fear of public speaking because she hasn't been, and she noticed words don't roll off her tongue as easily as they used to.

The past two years gave her time to get to know herself better. She discovered that she loves to go fishing with her boyfriend, and she is now a big fan of independent music.

I know who I am.