Mental health is one of the most important public health challenges of our time, and America’s children and teens are facing unprecedented struggles, according to the U.S. surgeon general, who in 2023 declared a mental health crisis among young people. Even before COVID-19, rates of depression, anxiety, and suicidal thoughts were on the rise—and the pandemic only amplified these issues.
In the decade prior to 2020, feelings of persistent sadness and hopelessness, as well as suicidal ideation and behaviors, increased by about 40% among young people, according to the Youth Risk Behavior Surveillance System at the Centers for Disease Control and Prevention (CDC). In fact, in 2022, 13.4% of adolescents—just over 1 in 8—had suicidal thoughts.
Today, mental health disorders are some of the leading causes of illness and death among young people. And while these problems are critical and demand for mental health care is high, there are reasons for hope, including solutions through research, diagnostics, education, and prevention. Here’s what the experts have to say.
What Is Mental Health?
It’s important to remember that mental health is a spectrum that can fluctuate over time. According to the CDC, mental health includes children’s mental, emotional, and behavioral well-being, which affects how they think, feel, act, handle stress, and relate to others. Mental disorders commonly diagnosed in children and teens are attention-deficit/hyperactivity disorder (ADHD), anxiety, depression, and behavior disorders. One report in 2022 found that 20% of those ages 3 to 17 have been diagnosed with at least one.
In Delaware, the youth suicide rate surpasses the national average, according to a report by Mental Health America (MHA). So too does the number of children (11.7%) ages 3 to 17 who received mental health care in 2021. But beyond the diagnoses, what are health care experts seeing?
“Anxiety is through the roof,” says Sarah Robins, LCSW, a clinical social worker and therapist who works with Delaware kids, teens, and families. “I’m talking about academic anxiety, social pressures, anxiety about leaving home, anxiety about school, anxiety about [their] bodies.”
Anxiety disorders can lead to social isolation, which can increase the risk of developing depression. What’s more: The two can share symptoms. “I think [kids are] feeling very stressed and overwhelmed,” says Amy Schiowitz, LPCMH, a licensed professional counselor in Delaware. “They’re dealing with low self-esteem, and maybe their parents or the generation above them doesn’t really get it…so they feel this sense of disconnection.”
What’s Causing This Spike?
Experts agree there isn’t a singular specific cause. However, you can point to high academic expectations, social media use, and the fallout of the pandemic on top of growing concerns about mass violence, political polarization, climate change, and more.
According to a 2023 Nemours KidsHealth study, which surveyed more than 500 children ages 9 to 13, a majority (86%) reported that they worry. Prolonged worry can trigger emotion-regulation problems, especially in young, developing children. It can affect sleeping and eating. It can lead to feeling anxious or afraid, and it can make it hard to enjoy activities or friends. The survey found that children were most often worried about school (64%) and friendships (41%).
“We’ve got high academic stakes,” Robins says. “I have 12-year-olds telling me they’re anxious about college—at 12.” Research shows that globally, academic pressure is a common source of stress reported by adolescents.
Schiowitz, who works with mostly older adolescents, has found that her clients struggle with the idea of academic perfectionism and being an ideal college candidate. “They have to do well in school, do well in sports, have an active social life, have an active dating life, and present these lives on social media in a way that makes it look like they have it all figured out,” she points out.
The Prevalence of Social Media
Social media’s impact on adolescents cannot be understated. In fact, recently, the U.S. surgeon general called for social media platforms to include health warnings for younger users. But why are young brains especially vulnerable?
As children change physically and psychologically, the way they think about themselves—and the importance of others’ opinion of them—also changes. According to the American Psychological Association (APA), between ages 10 and 12, changes in the brain make social rewards feel a lot more satisfying. Compliments and positive social interactions become more important. Preteens are über sensitive to attention and admiration from peers, the APA reports.
While some kids use social media to fulfill connection and validation in a healthy way, others may be susceptible to online bullying, peer pressure, or unrealistic body standards. And unlike adults, young teens and children have a limited capacity to self-regulate. According to a meta-analytic review of the relationship between social media use and body image disturbance published in “Computers in Human Behavior,” younger social media users are more likely than older ones to have body image issues.
“This is part of their reality,” Robins says. “And someone who didn’t grow up with social media can look at it and say, ‘Well, that’s social media. That’s not reality.’ But for [these kids], this is their reality.”
Social media use is nearly universal. A Pew Research Center survey found that 95% of young people ages 13 to 17 use a social media platform—and more than one-third say they use social media “almost constantly.”
“We live in this world where we’re all so connected virtually, but everyone I see talks about how profoundly lonely they are and how they have no authentic connection,” Robins says. “They are constantly comparing themselves socially. Plus, the constant intake of information—which wasn’t the case 20 years ago—is going to increase anxiety.”
Of course, social media isn’t entirely harmful. There are positives, including shared belonging and shared space, as well as opportunities for connection, communication, and collaboration with peers and teachers, says Joanna Smith, Ph.D., an adolescent psychologist at Nemours Children’s Hospital. She encourages caregivers to be aware of what young people are doing online. “We don’t want to intrude, but we should be really open with communication about how and where we’re spending our time when we’re on social media.”
The Lasting Effect of COVID-19
As human beings, we’re hardwired to live among community. Connection brings us happiness and fulfillment, and it’s essential for all our well-being. So, it’s no surprise that the pandemic exacerbated (and created) mental health challenges for young people. Kids experienced changes to routine, virtual schooling, and isolation at home. Their social connection and community support was interrupted, and researchers continue to study the influence on cognitive, social, and emotional development.
“COVID was traumatic for everybody,” Robins says. “There was so much grief and loss. The amount of social isolation that we had to experience is not good for anyone, especially someone who is going through developmental milestones. Parents struggled with financial insecurity and housing instability. And so of course that really exacerbated underlying mental health issues, which we know then impacts the kids.”
At least 204,000 U.S. children and teens lost parents and other in-home caregivers to COVID-19, according to the COVID Collaborative. But the effects of the pandemic aren’t limited to death. The CDC also reports that during the pandemic, 29% of high school students had a parent or caregiver lose their job, while 44% reported they persistently felt sad or hopeless during that time. Schools keep kids safe and connect them with services, and those supports were disrupted during the pandemic.
And, of course, not everyone was affected equally. The mental health decline during the pandemic was more pronounced among communities of color, who experienced higher rates of COVID-related deaths and greater exposure to pandemic-related stressors. “This was especially traumatic for Black and Brown communities, where there was a disproportionate [lack of] access to resources, especially when everything shut down,” Robins notes.
So What Can Parents and Caregivers Do?
Our experts agree that fostering a safe and connected space at home is paramount. For our youngest kids, Jessica Hardaway, LCMFT, a licensed clinical child and family therapist, suggests loosely structured or unstructured time focused specifically on the child, where they’re delivering the action and can engage their problem-solving skills—and importantly, allow them to get bored.
“It’s really about having responsive, trusting relationships,” Hardaway says. “So, it’s about time spent and the quality of time spent.”
According to Robins, bigger-picture methods like providing structure and routines can be beneficial for both kids and teens. “This creates a sense of stability and safety,” she explains. “When we have a consistent routine or a consistent schedule or just consistent rules, we see less anxiety and a bit more resilience. And having parents who can be firm about holding those expectations with some wiggle room to give the kid a sense of agency is important.”
Another preventive measure is helping kids build social connections outside of the home, whether that’s with other families, extracurriculars, neighbors, communities, or clubs, Hardaway says. “I don’t think we have a crisis because there’s something changing in our brains—I think the crisis is because these external, systemic things are changing,” she suggests.
Hardaway points to a crisis on all three levels of support for children: within the community, within schools, and within families. An increased cost of living, skyrocketing child care costs, and career fallout from the pandemic have meant that some parents are working multiple jobs or are unable to spend as much time with their children. In schools, teachers are underfunded and overburdened with the sheer number of students. Without proper support, she says teachers might struggle to connect with individual students in ways they could if they had more resources. Additionally, kids are becoming less involved in civic activities, teams, organizations, and neighborhood communities than previous generations.
“Bolstering all [these things] will help our children’s mental health,” Hardaway asserts. That can include supporting education funding, supporting a living wage, and engaging more with extended family or supportive community influences. The main goal, she says, is “building capacity through every system that is a part of a child’s life.”
Warning Signs
While these preventive measures may work for some children, mental health treatments, including medication, therapy, and peer support are important. But how do you know if your child needs additional help?
According to Robins and others, the most important thing to look out for is noticeable shifts in mood—shifts that are disproportionate to the situation and shifts that are different from the child’s baseline. “Look at the temperament of the kid as a whole—what’s in range and what’s out of range?” she says.
“If you have a baby whose temperament is a little colicky, we can kind of assume that you might have a 5-year-old who has big feelings,” Robins explains. On the other hand, if you have a kid who functions well socially and behaviorally, and who is generally able to communicate and regulate their emotions, and they are suddenly withdrawing, isolating, or not able to keep up with work, that might hint at something more serious.
Significant changes in physical symptoms with no obvious cause may also be a red flag. “We know that psychological stress can show up as physical symptoms,” Robins says, noting to be aware of repeated stomachaches or headaches, or other unexplained aches and pains that are persistent.
“Of course, we never, ever want to disregard or not take seriously self-harm or suicide,” Robins urges. Suicide is already the second-most common cause of death for young people, but in 2020, emergency room visits for suspected suicide attempts increased 31% for adolescents ages 12 to 17, according to the CDC.
If you hear comments about hopelessness or about worthlessness, or if you’re seeing chronic low self-esteem, take that very seriously.
If you notice any of these shifts, start by talking to your primary care physician, Smith advises.
“Between improved screening practices and increased mental health education, families are just better informed,” she says. “[Parents and caregivers] are bringing their kids in early. And then we’re actually able to help with that crisis stabilization and getting the kiddo where they need to go.”
Related: A Look Into Children’s Mental Health in Delaware
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