Why Are Kids and Teens Struggling With Mental Health Right Now?
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America’s youth is not okay. Today’s adolescents, teens, and young adults have lived through an isolating and frightening global pandemic, are growing up in an increasingly polarizing and inequitable political and social climate, and are the first generation who has had social media access for most or all of their lives.
“The mental health of children and teens is at a critical tipping point,” says Lee Savio Beers, MD, former president of the American Academy of Pediatrics and medical director for community health and advocacy at Children’s National Hospital in Washington, DC. “Child mental health issues were of great concern before the pandemic, and COVID-19 has only exacerbated them.”
Worse, not every young person who needs help will be able to get it. “We’ve known for a long time that our mental healthcare system lacked the capacity to serve everyone who needed help,” says Rebecca Dudovitz, MD, an associate professor of pediatrics at the David Geffen School of Medicine at the University of California in Los Angeles. “Now that so many more children are experiencing mental health problems, it’s just impossible to ignore.”
What’s the Evidence That Kids Are Struggling?
Since the onset of the COVID-19 pandemic, several key health leaders and organizations have released reports and guidelines that raise alarm bells on the state of youth mental health in the United States.
Here are a few:
June 2021: CDC Report on Increased Rates of Youth Suicide Attempts
A report published in June 2021 by the Centers for Disease Control and Prevention (CDC) outlined how emergency department visits for suspected suicide attempts began increasing at the start of the pandemic. By March of 2021, the number of these visits had increased 50.6 percent for girls between 12 and 17 years old, and 3.7 percent for boys the same age.
October 2021: AAP-AACAP-CHA Declare a National Emergency in Youth Mental Health
In late 2021, the American Academy of Pediatrics (AAP), American Academy of Child and Adolescent Psychiatry (AACAP) and the Children’s Hospital Association (CHA) declared a state of national emergency for what they call a “worsening crisis in child and adolescent mental health” in a joint declaration.
In it, they state that rates of youth mental health concerns had been steadily increasing from 2010 to 2020, and that the start of the pandemic in 2020 created less stability and safety for many youth and families, leading to a drastic increase in mental health–related emergency room visits.
December 2021: Surgeon General Releases an Advisory Expressing Concern on the State of Youth Mental Health
In December 2021, U.S. Surgeon General Vivek Murthy, MD, released an advisory outlining the need to address the worsening mental health of youth in the United States. Dr. Murthy states that the challenges faced by today’s youth are “unprecedented and uniquely hard to navigate,” in part because of the “unfathomable” number of deaths due to COVID-19, fear, economic instability, and physical distancing from friends and loved ones.
The advisory also points out that certain groups may be more prone to mental health challenges, including those with intellectual disabilities, racial and ethnic minorities, youth in rural areas, members of the LGBTQ+ community, and those living in immigrant households.
October 2022: AAP Calls for Suicide Screening for All Adolescents and Depression and Anxiety Screenings
The U.S. Preventive Services Task Force concluded in 2022 that adolescents between 12 and 18 years old should be screened for depression (in a recommendation statement), and that those between 8 and 18 years old should be screened for anxiety (in another recommendation statement).
The task force cited insufficient evidence for suicide screening for adolescents, but the AAP released a statement in April 2022 recommending suicide screening for all youths ages 12 and over, and for those between 8 and 11 years old when clinically indicated by certain symptoms or risk factors.
February 2023: CDC Data Sheds Light on the Dramatic Increase in Suicide Rates Among Black Youth
Rates of suicide did increase during the COVID-19 pandemic, but this change didn’t happen equally among all groups. The suicide rate among young Black people between 10 and 24 increased 36.6 percent (to 11.2 per 100,000 people) between 2018 and 2021, while the suicide rate among white people decreased by 3.9 percent (to 12.4 per 100,000 people), according to a CDC report and the American Psychological Association.
May 2023: The Trevor Project Reports That 41 Percent of LGBTQ Youth Seriously Considered Suicide In the Past Year
In its annual survey of LGBTQ youth ages 13 to 24, advocacy organization The Trevor Project reports that 41 percent of LGBTQ youth reported seriously considering suicide in the past year, 14 percent attempted suicide (including 20 percent of transgender and nonbinary youths), 67 percent reported symptoms of anxiety, and 54 percent reported symptoms of depression. 81 percent of LGBTQ youth reported that they wanted mental health care, but 56 percent of those who wanted mental health care weren’t able to get it.
What’s Causing the Youth Mental Health Crisis
It’s easy to blame the COVID-19 pandemic for the alarming prevalence of mental health concerns among young people, but the mental health of America’s youth has been declining for over a decade.
Between 2018 and 2019, over 13 percent of children between 2 and 17 years old had a diagnosed mental illness, though only about half of these children received treatment from a mental health professional, according to data from the Health Resources and Services Administration.
Still, the pandemic did exacerbate existing problems. “Things have been getting progressively worse for a good 10 to 15 years, and COVID-19 accelerated that,” says Benjamin Shain, MD, PhD, head of child and adolescent psychiatry at NorthShore University Health System in Chicago, who has previously helped draft suicide screening guidelines for the American Academy of Pediatrics. Even four years after the start of COVID-19, that acceleration continues, Dr. Shain says.
There’s no single reason why young people are struggling so much more than generations prior. Instead, a perfect storm of factors contribute to increasing rates of mental health concerns.
Here are a few:
Social Media
According to a December 2023 survey from the Pew Research Center, 93 percent of teens report using YouTube, while 63 percent use TikTok, 60 percent use Snapchat, and 59 percent use Instagram. About 70 percent of teens visit YouTube daily, compared with nearly 60 percent for TikTok. Nearly 1 in 6 teens reports using either YouTube or TikTok “almost constantly.”
Evidence shows that all this usage can take a toll on mental health. A 2021 study found that gadget addiction can contribute to mental health issues among Generation Z (those born in the late 1990s and early 2000s). Another study found that those who use social media regularly are more likely to experience cyberbullying. According to the Social Media Victims Law Center, cyberbullying is linked to depression, anxiety, self-harm, and suicidal thoughts.
“Research is showing that highly visual social media sites (mostly based on images), like Instagram, can affect anxiety about appearance, body dissatisfaction, self-esteem, and depression,” says Carol Vidal, MD, PhD, a psychiatrist and assistant professor of psychiatry at John Hopkins Medicine in Baltimore, who studies the impact of social media on mental health. “The use of selfies and filters may create the perception that people look more attractive than they are in reality, which will likely become an even bigger issue with AI.”
Other studies have shown that the content of the information that spreads on TikTok is often not accurate, which can affect how people understand mental health disorders, Dr. Vidal says. For example, in a recent study that analyzed the content of the top 100 most popular TikTok videos about attention deficit hyperactivity disorder (ADHD), researchers classified 52 percent of the videos as “misleading”; only 21 percent were classified as “useful.”
Sky-High Pressure in Sports and School
When superstar American gymnast Simone Biles withdrew from the team final at the Tokyo Olympics in 2021 citing mental health struggles, the entire world took notice.
Unfortunately, the negative mental health impact that increasing performance pressure can have on young athletes isn’t contained to the highest levels of sports. Although there’s not much research into how increasing pressures and expectations impact athlete mental health, there are several examples of tragic headlines about young athletes that suggest the effects of these pressures and expectations are there.
In March 2022, Stanford University soccer goalie Katie Meyer, 22, died by suicide, and Today reported that the combined pressure of school and sports may have been a contributing factor. In April of the same year, James Madison University star softball player Lauren Bennett died by suicide, according to NBC News; days before, she had been named Colonial Athletic Association Player of the Week, according to JMU.
Young people are also subject to incredibly high expectations when it comes to academics and admissions to colleges and professional schools. “When I applied to medical school, I didn’t have to do hours and hours of shadowing, volunteer work, and a whole bunch of other things that are totally expected of people today to even have a shot at medical school,” Shain says.
In an older study that followed 121 gifted children for 11 years, researchers found that these high-achieving students were successful at school, but also that they were overextended and overwhelmed by the amount of schoolwork they had, combined with the amount of time spent on extracurriculars. The study is from 2009, when less was expected of students (particularly advanced ones) than it is now.
Climate Change
In a research article published in 2020, author Susan Clayton, PhD, the Whitmore-Williams Professor of Psychology and the chair of environmental studies at the College of Wooster in Ohio, wrote that there’s substantial evidence to support a link between mental health concerns and climate change, also referred to as “ecoanxiety.”
“Climate change threatens mental health in a variety of ways,” Clayton says. She points to the direct impacts of traumatic weather events like severe storms and wildfires, or the negative effects that high temperatures can have on cognitive functioning. She also notes that things like involuntary migration (having to leave your home because of extreme weather) and economic hardships caused by climate change have indirect negative impacts on mental health.
RELATED: What’s the Difference Between Eco-Anxiety and Ecological Grief?
Climate anxiety seems to impact young adults more than older ones, Clayton says. “Adolescents and young adults are trying to prepare themselves for a world whose attributes are unclear because so much is changing.”
In a global study, 45 percent of the 10,000 young adults (between 16 and 24) surveyed said that climate change negatively impacted their daily lives and functioning. More than 50 percent of these young adults reported feeling sad, anxious, angry, powerless, helpless, and guilty about climate change.
RELATED: How to Cope With Eco-Anxiety
Gender and Sexual Identity
Our understanding of gender and sexual identities have evolved over the years, which has been positive for mental health and well-being. It’s become increasingly well known over time that many aspects of gender and sexual identity — gender identity, gender expression, sexual orientation, and more — aren’t binary (meaning you’re only either gay or straight, or male or female), but instead exist on a spectrum that everyone falls somewhere within, according to The Trevor Project.
But increased awareness and expanded understanding of gender and sexuality hasn’t necessarily made things easier for LGBTQ+ teens. In The Trevor Project’s 2023 report on LGBTQ youths mentioned above, data shows that more than 4 in 10 LGBTQ youth reported seriously considering suicide in the past year, while nearly 7 in 10 reported symptoms of anxiety, and over half reported symptoms of depression. Only about 56 percent of those who wanted mental healthcare were able to get it.
It’s important to note that LGBTQ+ youth aren’t inherently prone to suicide because of their sexuality or gender identity, per The Trevor Project. Rather, it’s due to continued mistreatment and discrimination against LGBTQ+ people in society, which can include lack of support or acceptance from their families for some, as well as anti-LGBTQ+ legislation in the United States.
LGBTQ+ youth are coming out — meaning they’re deciding to share their sexual orientation and gender identity with others — at younger ages than ever before, according to research from The Trevor Project. But because of continued discrimination against LGBTQ+ people, coming out at younger ages can put LGBTQ+ youth at an increased risk of victimization at a time where they may be less equipped to cope with that, per The Trevor Project.
“Queer youth find themselves under attack at a time in their lives when fitting in is vital. Teens want to be accepted and understood,” says Kimberly Vered Shashoua, LCSW, an Austin, Texas–based therapist who works with LGBTQ+ teenagers. “Witnessing online hate and conspiracy theories about other LGBTQ+ people makes teens feel panicked, isolated, and fearful.”
In terms of acceptance, we still have a long, long way to go. Nearly one-third of the youth surveyed by The Trevor Project said “their mental health was poor most of the time or always due to anti-LGBTQ policies and legislation.”
“We need to codify protections for queer youth,” Vered Shashoua says. “Lawmakers and citizens need to stand up against bigotry, violence, and disinformation.”
Substances
The good news about substances is that their use among teenagers has actually declined in recent years, and continues to do so. According to a 2023 survey about substance use among students in grades 8 through 12, the percentage of 12th grade students who drink alcohol has dropped from 73 to 46 between 2001 and 2023 — and from 43 to 15 among 8th graders.
Illicit drug use is also on the decline, with 8 percent of 8th graders saying they’d ever used an illicit drug (excluding marijuana), compared with 12 percent of 12th graders. Nicotine vaping also decreased in 2023, but its use is still common; 11 percent of 8th graders report vaping in the past year, as did 23 percent of 12th graders.
Unfortunately, unintentional drug overdose deaths are on the rise among young people, despite decreasing levels of drug use. According to the National Institute on Drug Abuse, the number more than doubled at the start of the COVID-19 pandemic, from 0.89 deaths per 100,000 teens aged 15 to 19 in the final quarter of 2019, to 1.85 deaths per 100,000 teens in the second quarter of 2020. That number remains nearly double what it was pre-pandemic — the most recent data from the third quarter of 2022 shows 1.63 overdose deaths per 100,000 teens.
6 Tips for Helping Kids and Teens Who Are Struggling
America’s youth mental health crisis is rooted in systemic problems that require large-scale solutions.
In other words, parents and teens shouldn’t put pressure on themselves to solve these problems on their own — that would just lead to even more stress.
But for those who are struggling now, there are things that young people and those who love them can do to support mental health, according to experts.
RELATED: 7 Tips for Raising an Emotionally Healthy Kid
1. Don’t Ban Social Media Completely
As a researcher who studies the impact of social media on mental health, Vidal says that parents should think twice before they forbid their teenager from using social media platforms altogether.
“The positives of forbidding social media are that the child may be more engaged with school work and in-person activities, sleep better, and exercise more,” Vidal says. “The negative is that complete abstinence may impede their ability to maintain social connections with peers, especially now that the majority of kids have cell phones and communicate on social media apps like Snapchat and WhatsApp.”
RELATED: Is Social Media Safe for Kids, Teens? 11 Things Parents and Other Caregivers Should Know
2. Limit Social Media Use
Vidal recommends that parents keep certain spaces phone-free, like the dinner table and the car. She also recommends actively limiting a teenager’s social media and cell phone usage in other ways, like setting time limits on various social media apps (which is possible with parental controls on most smartphones) or taking phones away until schoolwork is finished.
3. Help Kids and Teens Be More Discerning About What They See Online
Vidal also wants to see schools teach media literacy skills so that young people can be more discerning about the information they consume online. She also recommends that parents make an effort to ask their kids about what they’re seeing on social media, so that kids feel comfortable sharing and discussing this.
RELATED: Top Mental Health TikTokkers and How to Know if Mental Health Info on Social Media Is Legit
4. Help Create Safe Spaces for Sharing
“If you are a parent, caregiver, or an adult who is concerned about a child’s mental health, it is important to reach out,” says Emily L. Bilek, PhD, a clinical psychologist and clinical associate professor in the department of psychiatry at the University of Michigan in Ann Arbor. “Children and teens often feel isolated, and connection with someone who cares about them goes a long way.”
Bilek acknowledges that it can be really hard for adults to know exactly what to say to a young person who seems like they’re struggling. “My main advice is to focus on connecting with the child rather than fixing the problem,” she says. “Of course, we want to help, and we should if we can. But we need to connect first.”
Make yourself available by asking often if they want to talk (without pressure). If and when they do start opening up, resist the urge to offer solutions and instead just validate when they’re feeling.
“That might mean saying something like ‘Oh, it is so hard to be excluded from your friends; tell me about what it’s like for you,’ or ‘I’m sorry you’re struggling with this. I can see you’re in pain,’” Bilek says.
RELATED: What Is Your Middle School Kid Really Thinking? How to Better Connect
5. Learn to Identify When There May Be a Problem
One huge way that parents and other adults can support young people’s mental health is to learn to identify when there may be a problem, and help the young person get professional support when needed. Shain admits that it can sometimes be really hard for parents to tell if a young person is struggling with depression, anxiety, or another mental health condition.
But he recommends looking out for certain behavior changes, like falling grades, not going to school as often, losing interest in things they used to enjoy, or sleeping a lot more than usual.
6. Get Professional Help if Needed
If you notice any of these changes, Shain says that bringing it up with the pediatrician or another primary care provider is a good start. Then, connect them with a licensed mental health professional if necessary and possible.
RELATED: How Do I Know if I Need Therapy?
If you don’t have access to individualized mental health care, look for community support groups or organizations that offer free or low-cost mental health resources.
RELATED: How to Find a Therapist Who’s Right for You
Additional reporting by Lisa Rapaport.
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