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’t 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’d 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, “I would go back into that really worried ... kind of state where I couldn’t sit still, and just feeling really overwhelmed,” said Wang, now 17 and a senior at Mission San Jose High School in Fremont, Calif. “It definitely felt difficult to navigate all of those things.”
Whether it’s from stress, anxiety, depression, or thoughts of suicide, the mental health of America’s 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 reported feeling so sad or hopeless 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. Thoughts of suicide, suicide attempts, and actual suicides among young people have also risen in that period, with Black children nearly two times more likely than their white peers to die by suicide, according to the U.S. Centers for Disease Control and Prevention’s biennial Youth Risk Behavior Survey and CDC statistics. Depression and anxiety among young people, by some measures, doubled as the COVID-19 pandemic dragged on.
More and more, schools have stepped up their array of mental health services in recent years—though shortages of mental health professionals and inconsistent funding have presented barriers. In fact, the CDC credited one recent small sign of improvement in adolescents’ mental health—a decline in mental health-related emergency room visits among teens between the fall of 2021 and fall 2022—in part to schools’ expansion of mental health services.
Solving the problem of American adolescents’ declining mental health will take more than schools, but schools no doubt are a big part of the solution, according to experts. They’re in a key position to address students’ existing mental health problems by bringing treatment to young people who might otherwise have trouble accessing it. And they’re in a position to help prevent some of these problems from developing unchecked and later becoming diagnosable conditions—through a variety of strategies including mental health screenings, and education that helps students recognize and manage their emotions.
“Young 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’re learning emotional skills that will help them to develop and thrive as adults,” 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’ mental health and suicide prevention.
Many mental health problems emerge in adolescence
Ninety-three percent of school health workers say they’ve seen an increase in students with anxiety since 2019, and 42 percent say they’ve 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’ mental health problems was already underway before pandemic shutdowns.
“Globally, 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,” Erickson-Schroth said.
Why?
To begin with, adolescence—which starts with puberty and can stretch to age 20 or later—is 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’t 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’s 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.
“Kids 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’t before,” she said.
Such “thought loops” that emphasize the negative are a common characteristic of depression, Erickson-Schroth said.
“These thought loops can really become entrenched patterns over time and can be really hard to break down,” she said. “The younger these thought loops start and the longer they last, the harder they are to change.”
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’re doing all of that without adult problem-solving skills, Erickson-Schroth said.
Different parts of the brain are developing at different speeds, and there’s a biological mismatch between how the human body matures in adolescence and the society for which it’s 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.
“The 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,” he said. “There 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.”
Mental health problems can also have genetic roots. Additionally, they can stem from childhood trauma—adverse childhood experiences, or ACEs—such 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’s 2021 advisory on youth mental health.
Why is adolescent mental health getting worse?
Those factors have long existed in young people’s lives, however, so why has adolescents’ mental health worsened so much in the past decade-plus? There’s 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. “And that trickles down to kids,” 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’s 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 “impending doom about our future,” 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 has also coincided with growing mental health problems. Eighth and 10th graders in 2021 spent an average of 3½ hours daily on social media platforms, according to a survey of tens of thousands of students conducted by University of Michigan researchers. Thirty-five percent of teens last year said they used social media “almost constantly,” according to the Pew Research Center.
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 study of 12- to 15-year-olds 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 found improvements in their mental health when they limited social media use to 30 minutes a day or less. And a 2019 study of 14-year-olds in the United Kingdom 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.
“Adolescents naturally compare themselves to other people and often find themselves lacking, but when you’re comparing yourself to a curated profile, it’s easier to get FOMO [fear of missing out],” Offner said. “It’s easier to feel inadequate.”
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’t get enough of it, according to the CDC.
Wang said she also sees cyberbullying through social media taking a toll.
“If someone doesn’t leave a very nice message, that could be harmful to how we see ourselves and our mental health,” 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 has been particularly pronounced among 15- to 24-year-olds.
“We’re really social creatures,” Erickson-Schroth said. “Research 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.”
At the same time, social media offers young people some chances for connection they wouldn’t 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’ mental health? There’s some evidence that teens slept more during pandemic shutdowns.
What will improve adolescents’ mental health?
To Prinstein, of the American Psychological Association, there’s little surprise that America has gotten to this point.
“I think the primary issue is that we’ve been ignoring mental health for decades, and we’re now seeing the effects of that catch up with us,” he said.
The last major federal investment in a national mental health care system came just after World War II, he said: The National Mental Health Act of 1946, which established the National Institute of Mental Health, a key to boosting the country’s capacity to research, diagnose, and treat psychiatric disorders.
But the improvements were aimed at adults—at the time, veterans returning from war. “We’ve never made a similar investment in youth mental health care,” 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—and staff such as school psychologists—but 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’t 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.
“We need this holistic emphasis on social-emotional, behavioral functioning and mental health,” he said. “We know that when students are doing well in those realms that they tend to do better in the academic realm.”
One preventative measure is universal mental health screenings in schools, which can alert educators to students who might be having problems—early signs of depression or anxiety, for example—and need help. But only 20 percent of schools perform such screenings, according to one 2020 study. And although there’s been some momentum to screen more, there’s also been resistance from parents’ rights advocates who claim that such screenings infringe on their rights and their children’s privacy.
Another prevention strategy is to teach children strategies to identify, regulate, and manage their emotions—which is happening more and more as schools invest in social-emotional learning—akin to teaching them about physical health and nutrition, Prinstein said.
“We clearly think that it’s important enough to do that when it comes to issues related to our physical health,” he said. “I’m not sure why we don’t provide just as much investment in our emotional and psychological health.”
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.
“If 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,” she said. “Anybody 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.”
Some of Weist’s recent research has involved integrating mental health professionals and supports with schools’ 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—not just those with the most severe mental health and behavior problems—working 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’s first step to seek help for her mental health challenges was seeing her school counselor, who’s charged with 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’s 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—meditating, 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’t want to see.
This year, Wang was one of The Jed Foundation’s Student Voice of Mental Health award winners. She hopes to study cognitive science in college. Ultimately, she’d like school to be a place where students find the mental health support they need.
“Hopefully, the mental health stigma would definitely be reduced, and we would be more open to talking about struggles and what we’re dealing with,” she said.
