Transitions to adulthood among U.S. young adults with mental health disabilities before and during the COVID-19 pandemic: traveling multiple pathways in uncertain times.

Purpose: The impact of the COVID-19 pandemic on young adults with serious mental illnesses is poorly understood despite the high likelihood that important milestones for this group were affected by the pandemic and its economic aftermath. This study explored how U.S. young adults with disability due to mental health disorders experienced transitions to adulthood before and during the pandemic. Methods: Semi-structured qualitative interviews with 20 emerging adults, age 18-25 (mean age, 22.3) including 10 female, 4 male, and 6 gender non-binary or other gender individuals, covered 7 life transitions identified from the literature: residential independence, school completion, friendship network development, individuation from family, full-time employment, marriage/intimate partner establishment, and parenthood. Summative content analysis and inductive thematic analysis were conducted by a team including young adult co-researchers with lived experience of mental health challenges and disabilities. Results: A substantial number of transitions completed before the pandemic included graduation, residential independence, forming friendship networks, and individuation from family. Lockdown often derailed transitions, especially education and employment; and led to abandonment or postponement of other transitions, especially romantic relationships and full-time work. Educational interruptions reverberated beyond academics to include food insecurity, economic instability, and residential uncertainty. Life course concerns included not meeting cultural expectations of timely transitions, and distress over the disconnect between personal aspirations and current circumstances. Resilience was also observed, especially concerning mutual assistance from social networks and feelings of pride at being able to successfully negotiate pandemic stressors. Conclusion: Despite significant psychiatric multi-morbidity and pandemic-related disruptions, participants demonstrated a largely normative pre-pandemic life trajectory and showed notable resilience in the face of adversity. Findings suggest the need for transition-focused wraparound service systems, early intervention strategies to avoid development of further comorbidities, and supports incorporating informal social networks such as friends and family.