The Adolescent Mental Health Crisis

Written by guest author and SelfWorks' therapist, Megan Lothian LCSW

American adolescence is undergoing a drastic change as it relates to mental health. 30 years ago, the greatest public health threats to teenagers were binge drinking, drunk driving, pregnancy, and smoking. These have since been replaced by a new public health concern: soaring rates of mental health difficulties among adolescents. Emergency room visits have risen sharply for anxiety, mood disorders, and self-harm since 2019, and for young people ages 10 to 24, suicide rates rose 60 percent since 2018, according to the CDC. In 2022, the U.S. Preventive Services Task Force recommended that all children and adolescents (ages 8-18) are screened by their pediatricians for anxiety and other disorders.

Mental health issues were understandably intensified by the Covid-19 pandemic. However, the decline in our teenagers’ mental health preceded Covid, spanning various racial/ethnic groups, both urban and rural communities, and differing socioeconomic status. So, we must ask ourselves, why are our teens suffering so much, and what can we do about it?

As a therapist specializing in working with adolescents, I have seen this decline in my practice firsthand. Teens are reporting more depression, self-harm, anxiety, and suicidal ideation now than in previous years. In Why Are American Teens So Sad, a distinction is made that “aloneness isn’t the same as loneliness, and loneliness isn’t the same as depression. But more aloneness and more loneliness may have combined to push up sadness among teenagers who need sociality to protect themselves from the pressures of a stressful world” (3). We know that the isolation that occurred during the pandemic exacerbated teens' mental health symptoms. The ways in which Covid worsened mental health, “offers clues about what’s really driving the rise in sadness.” (3). Isolation increases rates of feeling sad and lonely because we are inherently social beings who thrive and find meaning in our interpersonal relationships.

The lack of in-person schooling and other social outlets also meant that teens could not use those relationships for coping, emotional regulation, and meaning-making in the same way they had prior to Covid. Teens who were stressed out prior to the pandemic lost a key element in their lives for feeling seen and heard by their peers in a way that is central to identity development, rupture/repair, self-confidence, and healing from upsetting and confusing events.

Another clue to teens' suffering may be found in social media and its usage. I caution that social media analysis is not "one size fits all". We need to allow for nuance and multiple truths regarding social media use.

“If we just talk about social media, we’re combining all kinds of different sorts of experiences into one homogenous catch-all that makes it so it loses any kind of meaning,” said David Bickham, a research scientist at Boston Children’s Hospital’s Digital Wellness Lab, who studies children and media. “Is going on TikTok and watching videos the same as direct messaging a friend to ask for help with something? Those are very different experiences.” (4).

This is often something my teens and I talk about, especially during the early pandemic days, when in-person school, extra-curriculars, and activities were all virtual. Instagram, TikTok, and Snapchat, etc. all felt like outlets to stay connected, as was playing various video games online with friends. As we continue to learn more about the impact of social media on adolescent mental health outcomes, Bickham says it is possible we find out that only some subgroups of youth may be vulnerable to certain impacts of social media. My questions for my teenage clients are, “How is this specific social media interaction or app making you feel when using it/after using it?” Do they feel connected and supported? Riddled with anxiety, comparison, or stress? How much time spent on their socials feels “healthy” or even helpful, and can they recognize when they may need a break, or need to set certain limits?

Another clue to teens’ mental health may be the concept of internalizing and externalizing behaviors. “Girls, more than boys, are socialized to internalize distress, meaning that they tend to collapse in on themselves by becoming depressed or anxious” (1). Teens exhibiting externalization of their emotions are more likely to be flagged by teachers, parents, and peers as someone needing support, while the collapse that occurs for internalizers is often difficult to see right away, as these teens are often quite good at “appearing to be okay.” The internalizing of emotions typically correlates to certain mental health disorders, including depression and anxiety, more somatic complaints than typical, and higher rates of teenage suicide. Often, teenagers who internalize their emotions will show up to therapy struggling with depression, anxiety, self-harming tendencies, eating disorders, and can struggle with asking others for help and support.

Isolation due to Covid or other reasons, a difficult relationship with social media participation, and internalizing tendencies—these things may seem very different on the surface, however, they may have one important thing in common. They may be leaving teens feeling disconnected and misunderstood when they want to be connected and heard. Perhaps, then, one of the most important things we can do for our teens is listen to their ideas, goals, and questions, without our own criticism or judgment. Beneath the TikTok dances, the likes, and facades of academic and social competency are the central questions of love, approval and belonging:

• Who am I?
• Where do I fit in? How do I fit in? Do I want to fit in?
• Who are my friends?
• What is important to me? What do I value?
• Who do I want to be?
• How do I feel about myself and the world around me?

Source: Scott Webb, Unsplash

That said, teens often turn to their friends before parents or other trusted adults. Parents often feel at a loss about how to speak to their teens about difficult topics. Using resources from trusted sources (school, mental health orgs, etc.) can be helpful for parents or other trusted adults who feel stuck.

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The Jed Foundation, a non-profit organization working to protect emotional health and prevent suicide in our nation’s teens and young adults, has an extensive conversation guide (6) for adults in a young person’s life who may be concerned about their teen but are not sure where to start in talking with them, or how to assess warning signs that someone may be struggling.

Some of the key takeaways are to notice changes in your child as they relate to basic self-care (eating, sleeping, socializing, changes in/increased use of substances) and changes in mood (irritability, impulsivity, more fearful than normal).

Ways I often frame talking to adolescents about difficult topics with parents are bringing things up “organically”, remaining open, and focusing on support and understanding. This looks like checking in on your teen and finding a pocket of time within a calm and regulated conversation that is occurring to do so. It involves keeping adult emotions, opinions, and perspectives in check as your child shares thoughts and feelings with you, and validating those feelings (different from behaviors). The goal of the conversation should be centered around collaborating with your teen to find ways to feel safer and more supported.

The difficulties of adolescence and the changes with which young people interface are not going to go away, especially in the midst of the pandemic and all of the social, cultural, and political stressors occurring.

“If we try to shield our children from pain or sadness, we run the risk of diminishing their emotional depths. The truth is that even if we wanted to shield them, we could not. Life will bring its share of pain,” according to the Center for Parent & Teen Communication (7).

There are various ways of helping young people learn to “create containers” (7) to hold their (often conflicted or difficult) feelings, and support them in gaining strategies to identify and process these emotions. In the realm of therapy, this could look like outpatient individual therapy, groups specifically for adolescents struggling with a variety of issues, or more creative outlets such as art and dance-based therapies and psychodrama groups. Community of any kind is especially important in the process of identity exploration for adolescents. Not feeling alone in the liminal space of getting to know who you are can make a world of difference.

The more we can encourage and create these supportive and non-judgmental spaces for adolescents to express their emotions in healthier ways, the more we can combat some of the “aloneness/loneliness.” The most important thing we can do as adults in young people’s lives is to create a consistent and trusting space for them to process their experiences and emotions, and to aid in counteracting the internalization of anxiety and depression that can lead to a decline in emotional wellness.