Audrey Wang was in her first year of high school when she started frequently feeling stressed and nervous. She became reluctant to seek help from teachers when a concept didn鈥檛 click and felt frustrated with herself for not figuring it out on her own. She felt a knot in her stomach for hours before an exam, and she鈥檇 feel inadequate when her classmates got the hang of a new lesson before she did.
She had just gone through a major life transition, switching from middle to high school, and she had done it physically apart from her classmates and teachers, with all classes still remote during the COVID-19 pandemic.
As her feelings of stress and anxiety persisted, 鈥淚 would go back into that really worried ... kind of state where I couldn鈥檛 sit still, and just feeling really overwhelmed,鈥� said Wang, now 17 and a senior at Mission San Jose High School in Fremont, Calif. 鈥淚t definitely felt difficult to navigate all of those things.鈥�
Whether it鈥檚 from stress, anxiety, depression, or thoughts of suicide, the mental health of America鈥檚 adolescents and teens has grown steadily worse for more than a decade, with the COVID-19 pandemic exacerbating the trend.
Forty-two percent of high school students in 2021 for at least two consecutive weeks in the previous year that they stopped engaging in their usual activities, up from 26 percent in 2009. Girls and LGBTQ+ young people are particularly likely to report those feelings. and have also risen in that period, with Black children , according to the U.S. Centers for Disease Control and Prevention鈥檚 biennial and CDC statistics. Depression and anxiety among young people, by some measures, .
More and more, schools their array of mental health services in recent years鈥攖hough shortages of mental health professionals and inconsistent funding have . In fact, the CDC credited one recent small sign of improvement in adolescents鈥� mental health鈥攁 decline in mental health-related emergency room visits among teens between the fall of 2021 and fall 2022鈥攊n part to schools鈥� expansion of mental health services.
Solving the problem of American adolescents鈥� declining mental health will take more than schools, but schools no doubt are a big part of the solution, according to experts. They鈥檙e in a key position to address students鈥� existing mental health problems by bringing treatment to young people who might otherwise have trouble accessing it. And they鈥檙e in a position to help prevent some of these problems from developing unchecked and later becoming diagnosable conditions鈥攖hrough a variety of strategies including mental health screenings, and education that helps students recognize and manage their emotions.
鈥淵oung people spend more of their waking hours in school than anywhere else, so we have a responsibility as a society to make school a place where their mental health is supported and where they鈥檙e learning emotional skills that will help them to develop and thrive as adults,鈥� said Dr. Laura Erickson-Schroth, a psychiatrist and chief medical officer at The Jed Foundation, which works with schools and districts on a comprehensive approach to supporting students鈥� mental health and suicide prevention.
Many mental health problems emerge in adolescence
Ninety-three percent of school health workers say they鈥檝e seen an increase in students with anxiety since 2019, and 42 percent say they鈥檝e seen more students with eating disorders, according to a March survey by the EdWeek Research Center that included school nurses, psychologists, social workers, health teachers, and others in school-based health roles.
But the upward trend in adolescents鈥� mental health problems was already underway before pandemic shutdowns.
鈥淕lobally, the levels of child and adolescent depression and anxiety did increase pretty significantly during the pandemic, but a decade before the pandemic, we were already seeing pretty concerning trends related to mental health and suicide rates for young people,鈥� Erickson-Schroth said.
Why?
To begin with, 鈥攚hich starts with puberty and can stretch to age 20 or later鈥攊s a period in life when problems ranging from anxiety and depression (in earlier adolescence) to mental illnesses such as bipolar disorder and schizophrenia (in later adolescence) tend to emerge.
The reason isn鈥檛 fully known, but there are both biological and social explanations, said Deborah Offner, a Boston-area clinical psychologist who works with middle and high school students at schools and in private practice.
In adolescence, young people鈥檚 brains are growing and new connections are forming between different parts of the brain. That growth makes adolescents capable of higher-order thinking and reasoning, but it can also make them more prone to worry and sadness, Offner said.
鈥淜ids can contemplate meaning in different ways because of their better cognitive capacities, and this can lead to worries or sadness in ways that may be different from what they might have experienced as a younger child, because you can sort of think yourself into a corner in ways that you couldn鈥檛 before,鈥� she said.
Such 鈥渢hought loops鈥� that emphasize the negative are a common characteristic of depression, Erickson-Schroth said.
鈥淭hese thought loops can really become entrenched patterns over time and can be really hard to break down,鈥� she said. 鈥淭he younger these thought loops start and the longer they last, the harder they are to change.鈥�
Kids are also going through major social changes in adolescence, increasingly comparing themselves to peers, experiencing growing academic pressure, forming new friendships, and developing their sense of self-identity. And they鈥檙e doing all of that without adult problem-solving skills, Erickson-Schroth said.
Different parts of the brain are developing at different speeds, and there鈥檚 a biological mismatch between how the human body matures in adolescence and the society for which it鈥檚 maturing, said Mitch Prinstein, chief science officer for the American Psychological Association and a psychology and neuroscience professor at the University of North Carolina at Chapel Hill.
鈥淭he way that our body changes and matures is based on the social needs of our predecessors 60,000 years ago, and today we have a very different environment than we did back then,鈥� he said. 鈥淭here are a lot of ways in which kids are being exposed to worlds and expectations, or levels of autonomy, that may or may not match up with how it is that we were initially built to survive.鈥�
Mental health problems can also have genetic roots. Additionally, they can stem from childhood trauma鈥斺�攕uch as abuse, neglect, exposure to violence, and economic stress. These factors can lead to toxic stress, which affects brain development and can put people at risk for a number of mental and physical health conditions.
Experiencing racial discrimination throughout life can also make someone more vulnerable to mental health problems, according to U.S. Surgeon General Vivek Murthy鈥檚 .
Why is adolescent mental health getting worse?
Those factors have long existed in young people鈥檚 lives, however, so why has adolescents鈥� mental health worsened so much in the past decade-plus? There鈥檚 no conclusive answer, but much of it is societal, according to experts.
The 2008 financial crisis and subsequent recession, for example, put more economic pressure on parents and introduced more uncertainty about their ability to provide for their families, Offner said. 鈥淎nd that trickles down to kids,鈥� she said.
In the years since, young people, through the proliferation of cellphones and social media, have had easier access to information about a host of difficult problems, nationally and globally, that can easily make someone stressed, whether it鈥檚 climate change and related disasters, racial injustice, international strife, or gun violence.
An EdWeek Research Center survey last year found 37 percent of teens felt anxious when thinking about climate change, and more than a third felt afraid. In another EdWeek Research Center survey, from August and September, 43 percent of high school students said events and issues in the news caused them anxiety or stress at least some of the time. Wang, the 17-year-old senior in California, said news about climate change can cause her and her peers to feel 鈥渋mpending doom about our future,鈥� but can also inspire action.
The rise in the amount of time young people spend on social media and using smartphones in the past decade-plus with growing mental health problems. Eighth and 10th graders in 2021 spent an average of 3陆 hours daily on social media platforms, according to . Thirty-five percent of teens last year said they used social media 鈥渁lmost constantly,鈥� .
More research is needed, but some studies have at least established an association between excessive social media use and poor mental health in young people.
One 2019 found that those who spent more than three hours daily on social media were twice as likely as peers who spent less time to report poor mental health, including symptoms of depression and anxiety. Another study of college-age students in their mental health when they limited social media use to 30 minutes a day or less. And found a correlation between greater social media use and poor sleep habits, poor body image, and a higher likelihood of experiencing online harassment, particularly among girls.
鈥淎dolescents naturally compare themselves to other people and often find themselves lacking, but when you鈥檙e comparing yourself to a curated profile, it鈥檚 easier to get FOMO [fear of missing out],鈥� Offner said. 鈥淚t鈥檚 easier to feel inadequate.鈥�
Wang, the 17-year-old senior, said she sees peers on social media glamorizing getting very little sleep, posting pictures of themselves studying or partying late at night. Sleep is crucial for brain development, and poor sleep habits have been linked to symptoms of depression and suicidal thoughts. Sufficient sleep can also help young people more successfully manage stress, but more than 70 percent of high school students don鈥檛 get enough of it, .
Wang said she also sees taking a toll.
鈥淚f someone doesn鈥檛 leave a very nice message, that could be harmful to how we see ourselves and our mental health,鈥� she said.
Another side effect of an increasingly online life is that young people are spending less time with friends in person. This is happening across age groups, but the drop in time spent with friends over the past two decades .
鈥淲e鈥檙e really social creatures,鈥� Erickson-Schroth said. 鈥淩esearch shows that social isolation [and] loneliness are risk factors for poor mental health, poor physical health, and actually predict earlier deaths from all causes. And we know that social connection and community decrease depression and suicidality.鈥�
At the same time, social media offers young people some chances for connection they wouldn鈥檛 otherwise have, Erickson-Schroth said, including LGBTQ+ youth and young people of color who might have fewer in-person opportunities to communicate with people going through similar experiences.
When COVID-19 hit and shut down school buildings, it introduced many triggers for poor mental health at the same time. Young people were apart from friends and social connections, they suddenly had little structure and routine, and more of their lives went online. Many families were under added financial stress, and many young people endured the trauma of losing loved ones to COVID-19.
One potential upside during this period for teens鈥� mental health? There鈥檚 that during pandemic shutdowns.
What will improve adolescents鈥� mental health?
To Prinstein, of the American Psychological Association, there鈥檚 little surprise that America has gotten to this point.
鈥淚 think the primary issue is that we鈥檝e been ignoring mental health for decades, and we鈥檙e now seeing the effects of that catch up with us,鈥� he said.
The last major federal investment in a national mental health care system came just after World War II, he said: which established the National Institute of Mental Health, a key to boosting the country鈥檚 capacity to research, diagnose, and treat psychiatric disorders.
But the improvements were aimed at adults鈥攁t the time, veterans returning from war. 鈥淲e鈥檝e never made a similar investment in youth mental health care,鈥� Prinstein said.
That leaves schools to address one of the primary public health crises of the era without federal direction or a permanent infusion of resources.
Schools traditionally have had an array of mental health services鈥攁nd staff such as school psychologists鈥攂ut often only for students in special education, said Mark Weist, a professor of psychology at the University of South Carolina who for decades has worked with schools on boosting their capacity to provide mental health services, often through school-based clinics and bringing in outside providers.
Even with treatment services increasingly common in schools, there isn鈥檛 enough emphasis on prevention of mental health problems and early intervention, Weist said. That work involves everybody who works with kids assuming some role in mental health promotion, he said.
鈥淲e need this holistic emphasis on social-emotional, behavioral functioning and mental health,鈥� he said. 鈥淲e know that when students are doing well in those realms that they tend to do better in the academic realm.鈥�
One preventative measure is universal mental health screenings in schools, which can alert educators to students who might be having problems鈥攅arly signs of depression or anxiety, for example鈥攁nd need help. But only 20 percent of schools perform such screenings, . And although there鈥檚 been some momentum to screen more, there鈥檚 also been resistance from parents鈥� rights advocates who claim that such screenings infringe on their rights and their children鈥檚 privacy.
Another prevention strategy is to teach children strategies to identify, regulate, and manage their emotions鈥攚hich is happening more and more as schools invest in social-emotional learning鈥攁kin to teaching them about physical health and nutrition, Prinstein said.
鈥淲e clearly think that it鈥檚 important enough to do that when it comes to issues related to our physical health,鈥� he said. 鈥淚鈥檓 not sure why we don鈥檛 provide just as much investment in our emotional and psychological health.鈥�
And another strategy is to equip all school staff, particularly teachers, with basic knowledge on responding to kids when they have mental health difficulties and referring them to the right place for help, said Offner, the Boston-area psychologist, who last year published a guide for teachers on adolescent development and mental health called Educators as First Responders.
鈥淚f you end up with a kid sitting in your office or on your team who confides in you, you just have to know what to say and how to listen,鈥� she said. 鈥淎nybody can be a good listener, a kind adult, and you can ... refer that kid to the school counselor, or the dean of students, the school nurse or someone else who is trained and capable and willing to pick up the ball.鈥�
Some of Weist鈥檚 has involved integrating mental health professionals and supports with schools鈥� use of Positive Behavioral Interventions and Supports, an approach used to set and reinforce behavior expectations for students, and intervene when students have more serious behavior problems. This kind of integration led to a broader variety of students鈥攏ot just those with the most severe mental health and behavior problems鈥攚orking with mental health clinicians at schools, and less discipline that removed students from their classrooms, Weist and his colleagues found.
With help, teens can develop strategies to manage stress
Wang鈥檚 first step to seek help for her mental health challenges was seeing her school counselor, helping students plan for their futures as well as helping them work through emotional challenges. Then, during her junior year, she was put on a waitlist to see the school鈥檚 therapist for more intensive, ongoing help; she was able to get in after a couple of months.
Wang has since developed a number of strategies for managing her stress鈥攎editating, recognizing when to take a break and a walk outside, spending time on hobbies such as calligraphy. She even put her coding skills to use and developed a website that allows users to see their social media feeds, but without the posts with negative sentiments and other material they decide they don鈥檛 want to see.
This year, Wang was one of The Jed Foundation鈥檚 . She hopes to study cognitive science in college. Ultimately, she鈥檇 like school to be a place where students find the mental health support they need.
鈥淗opefully, the mental health stigma would definitely be reduced, and we would be more open to talking about struggles and what we鈥檙e dealing with,鈥� she said.
