Depression

Teen Girls' Risk for Depression During the COVID-19 Crisis

Does your daughter seem depressed lately? Try these strategies to help her cope.

Posted May 23, 2020

 MissMayoi/Flickr
Source: MissMayoi/Flickr

While it is too early to determine the full impact of current events on kids around the globe, I would like to highlight concerns about a population we know is already vulnerable to depression: adolescent girls. According to the most recent national Youth Risk Behavior Survey, 20% of all teen girls experienced an episode of Major Depressive Disorder, and 22% said they had seriously considered attempting suicide (compared to only 11% for boys)[2]. Girls’ tendency to become depressed in response to all of the changes of adolescence is already high, and we should be concerned about how the pandemic will likely exacerbate these risks. What are some risks parents should look for?

Girls Are At Risk for Depression When They:

Are Faced With Multiple Stressors All at Once

During puberty, girls’ bodies are changing dramatically, their hormones are surging, and they often feel bewildered by what is happening to them. Imagine this stress paired with all of the other typical changes of adolescence—facing unrealistic cultural pressures regarding appearance, living up to perfectionistic standards on social media, establishing a sense of identity, managing friends and romantic relationships, and figuring out academic and extracurricular expectations—while also going through puberty at the same time! On top of all of that, they are now faced with many additional, unprecedented stressors associated with the current pandemic. Their sense of security has been shaken (“Will we be OK? Will we get sick?”), their families are stressed (“Will my parents keep their jobs?” “Will we be able to pay the bills?”), and they don’t know what the future will hold (“Will we ever go back to school? Will I ever be able to go to a school dance again? Attend a football game? Play my sport? Have a graduation ceremony?”). They have moved their entire academic and social lives online and are spending inordinate amounts of time in their rooms alone, trying to figure all of this out. Overall, girls are now hit with multiple stressors, but don’t necessarily have the skills to cope with so many staggeringly complex changes all at once.

Base Self-Esteem on Their Relationships

Girls are heavily socialized to base their self-esteem and worth on the success of their relationships. In other words, how they feel about themselves in any given moment is based on how well their relationships are going or how others are treating them at the time. When this reliance on relationship success is out of balance, she can become overly focused on people-pleasing, keeping everyone happy with her, acquiescing to others’ needs and opinions, and becoming exquisitely sensitive to any perceived rejection by others. Feeling like everyone needs to like her and approve of her at all times, that she is not OK if any of her relationships are not OK, can leave a girl prone to depression.

When her sense of self is overly based on others’ approval of her, she can be especially influenced by what happens (or doesn’t happen) in her social media life. Instead of being secure in herself, she can fall prey to measuring her worth by the number of friends, followers, views, and likes she has accumulated on social media. She is especially vulnerable to this now that she is not able to see anyone in-person and all interactions are occurring online. When scrolling through her feeds, it is very difficult for any girl to resist the pull to compare herself to others, and most of the time this comparison results in a feeling of inadequacy, worrying that “I can never measure up.” She may ruminate about questions such as: “Why can’t I look like her?” “Why didn’t I get invited to that party?” “Why does she have more followers than me?” “Why does her selfie have more ‘Likes’ than mine?” Even in a time of quarantine, she can view pictures of other girls hanging out, seemingly carefree and having a great life from which she is excluded. Because she only sees these “highlight reels,” these comparisons can lead to a dangerous trap resulting in feelings of envy, rejection, invisibility, and isolation, resulting in depression. 

Neglect Wellness Basics

When so many girls suddenly lost their weekday routines dictated by school hours and activities, many are now sleeping late into the day and staying up into the early hours of the morning. One of the symptoms of depression is having trouble falling or staying asleep, or sleeping noticeably more than usual. When teens have no routine to their days during quarantine, it is difficult for parents to determine whether sleeping more or less than usual is just typical teen behavior or a sign for concern. It is helpful to watch for her mood and whether she wants to get out of bed and engage with the day when she does wake up. Further, girls’ usual eating patterns have also been disrupted, with many girls reporting trouble with eating more than usual or with skipping meals (or both). These can also be signs of depression. When not sleeping or eating well, they are less motivated to get out of bed or to leave their rooms. They might have days where they do not go outside for fresh air or do not feel energized enough to exercise. A vicious cycle can emerge: Lack of sleep, proper nourishment, and adequate exercise all can contribute to negative mood, and negative mood contributes to poor sleep, eating, and motivation to move.

Engage in Rumination and Worry

Girls are more likely than boys to use a thinking style that increases their vulnerability to depression. Rumination is our tendency to go over past events or conversations repeatedly in our minds in order to question what we should have said or done differently, berating ourselves for perceived mistakes or flaws in our words and actions (“Why did I post that picture? What did my friend think when I made that comment?”). While rumination involves traveling back to the past, worry is what happens when we time travel to the future. We imagine future scenarios and usually envision the worst possible outcomes (“Will I ever see my friends again? Will my parents ever let me leave the house? Will I ever be able to go to college like I planned?”). When a girl ruminates about the past or worries about the future, these thinking patterns keep her stuck in a cycle of depression, anxiety, and fear.

If you are concerned about your daughter’s mental health and are wondering how to help, here are four basic depression prevention strategies to consider:

What parents can do to help daughters cope

1. Recognize signs and symptoms of depression in teen girls

All of us experience sad moods and can feel down sometimes. This is normal and expected during the current crisis. In contrast, depression is a constellation of symptoms that can include prolonged sadness, being overly anxious, having trouble concentrating, eating and sleeping problems, decreased energy, or excessive feelings of guilt or worthlessness. See the American Counseling Association’s resources on depression for more information. When several of these symptoms are present for more than a few days, it's time for a parent to take action by initiating a conversation with her about their concerns. It is also important to consider seeking out counseling services for her with a licensed mental health professional.

2. Promote wellness

Wellness begins with essential health basics...adequate sleep, nutrition, and physical activity. Girls will benefit from having some structure to their days, even if it is minimal, especially as schools are finishing up for the year (e.g., same wakeup/sleep times, routine meal times, and some time for physical movement each day). Eating regular meals is important to help her avoid undereating as well as to prevent overeating (which is more likely to occur when she goes too long without food). Physical movement can help increase positive mood, help to clear her ruminative/worried mind, and give her more energy. If at all possible, encourage her to spend some time outside each day in fresh air. Spending time outdoors is proven to boost mood and can provide her with an enhanced perspective. Finally, encourage her to have some unplugged time each day, whether it is taking a short walk without her phone, reflecting on her feelings in a journal, or taking a few moments to meditate or pray.

3. Help her develop relational resilience

First, we know that positive social support such as hanging out with friends and spending quality time with supportive people is essential for mental health. Conversely, social isolation is a risk factor for depression. We also know that social media use does not provide the same mood-enhancing benefits as in-person interactions, as it does not allow for the same sense of social reward and attunement that comes from face-to-face conversations. However, in our current environment, social media is your daughter’s primary lifeline to her social world. She has had to keep her complex social connections going through multiple platforms (e.g., Snapchat, Instagram, texting) and it has likely been quite an exhausting, unsatisfying experience for her. So as the situation changes, be watchful for opportunities to encourage her to begin to plan in-person opportunities to hang out (and that can occur in a safe, socially responsible way). At the same time, help her balance "in real life" (IRL) with her social media life, encouraging breaks throughout the day so she can take time to remember who she is apart from what she thinks other people expect of her. Help her evaluate her friendships: Are her friends people who value her thoughts and opinions? Who respect her and remain loyal to her, even when they disagree? Can she be her real self without a threat to the relationship? Help her to learn to stay confident in herself without the pressure to acquiesce to what she thinks is expected of her online.

4. Listen with intent and help her cope

Especially in this time of fear and massive uncertainty, girls need adults to help provide them with a sense of safety, security, and unconditional acceptance. Teen girls often seem to distance themselves from caring adults in their lives even while they actually want their support and guidance. When your daughter does make an effort to talk to you, treat this request with respect. Turn off your devices, make eye contact, and give her your undivided attention. Listen first without interruption and allow her the space to verbalize how she is feeling. When she seems to be ruminating about the past, help her refocus on the present and what she can do now. When she is worried about the future, validate her concerns and let her know that it is hard for all of us to have so many things operating outside of our control right now. Help her stay grounded in the present and to focus on those things she can actually control. Above all, help reassure her that while you don’t have all of the answers, you will be there as a secure base to support her as we all navigate our way together through these unprecedented and uncertain times.

For more information, see my recent books Depression in Girls and Women Across the Lifespan: Treatment Essentials for Mental Health Professionals, and Swimming Upstream: Parenting Girls for Resilience in a Toxic Culture.

References

1. Kaiser Family Foundation Poll: https://www.kff.org/report-section/kff-health-tracking-poll-late-april-2020-economic-and-mental-health-impacts-of-coronavirus/

2. Centers for Disease Control and Prevention (2018). Youth risk behavior survey trends report. Retrieved from www.cdc.gov/healthyyouth/data/yrbs/pdf/trendsreport.pdf.