May 7, 2024 – Teen mental health problems have hit a new peak in the U.S., and the gap between the number of teenagers who report conditions like anxiety, depression, and hopelessness and the number of those who receive treatment is increasing.
That’s according to a new report from the United Hospital Fund, an independent nonprofit group that aims to improve health care for New Yorkers. The report rounds up the latest statistics on adolescent mental health, both in New York and across the country. While these numbers date from 2022, at the height of the pandemic, the report shows clearly that the sharp drop in youth mental health began 10 years earlier, long before COVID-19 hit our shores.
In 2022, 6.7 million U.S. adolescents had one or more behavioral health conditions, and the the total number of them with those conditions skyrocketed from 2011 to 2021. During that decade, for example, the number of adolescents per 100,000 who had a major depressive episode, or MDE, soared from 8,063 in 2011 to 19,863 in 2021 – an increase of nearly 150%. While the growth in clinically diagnosed depression was smaller, it rose by 7% per year, on average, from 2016 to 2022.
The increase in persistent sadness and hopelessness among high schoolers is just as alarming. From 2011 to 2021, the rate of this condition per 100,000 teens leaped from 28,459 to 42,347. That is a 49% increase, or an average of 4% per year.
The data shows that the decline in teen mental health predated the pandemic. The rate of adolescents with clinically diagnosed anxiety, for instance, jumped from 10,427 in 2016 to 13,808 in 2019 – a surge of 32% in just 3 years.
“The pandemic exacerbated these trends, but this issue has been growing year over year for the past decade,” said Oxiris Barbot, MD, president and CEO of the United Hospital Fund. “And there hasn’t been anything earth-shattering on either the local or the national level to give us any indication that things are turning the corner.”
Risky Behaviors
Youths who feel sad and hopeless are more likely to engage in risky behaviors than are those who have a more positive outlook, the report notes. They are three times more likely to use illicit drugs, 2.3 times more likely to engage in binge drinking, 1.5 times more likely to drink and drive, and 1.3 times more likely to have sex without using any method of contraception.
As the mental health crisis among them has worsened, the number of teens who have contemplated or attempted suicide has risen, and racial differences are evident. The rate of White high school students who considered suicide rose by 4% per year from 2011 to 2021; in contrast, the rate increased 5% year over year for Black students and 3% for Hispanic students, while dropping slightly for Asian students. High school girls were much more likely than boys to consider suicide or have a major depressive episode in 2021.
Another group that had worse mental health than their peers was LGBTQ youth. For example, 6% of heterosexual high schoolers attempted suicide in 2021, compared to 24% of lesbian, gay, and bisexual students, and 18% of kids in the “other/questioning” category.
Social Media and Other Sources of Stress
You've likely heard it before: Social media is taking a toll on the mental health of today's teens. Since the early 2010s, teenagers and preteens have become obsessed with social media on their smartphones – at least one factor that has worsened the issue, as cited by U.S. Surgeon General Vivek Murthy as well as sociologist Jonathan Haidt in his new bestselling book The Anxious Generation. Social media use has reportedly depressed many teens and/or made them anxious because it has partly displaced in-person relationships and has led to an explosion of cyberbullying and social competitiveness online.
“While social media may offer some benefits, there are ample indicators that social media can also pose a risk of harm to the mental health and well-being of children and adolescents. Social media use by young people is nearly universal, with up to 95% of young people ages 13 [to] 17 reporting using a social media platform and more than a third saying they use social media ‘almost constantly,’” the Surgeon General said in a statement released in May 2023.
Experts interviewed by WebMD agreed that social media is a big part of what is ailing American adolescents, but it’s not the whole story.
“The world is being perceived as more dangerous than it was before,” said John Piacentini, PhD, a pediatric psychologist and a professor of psychiatry and biobehavioral sciences at UCLA. “The American Psychological Association does a Stress in America survey every few years. And in the 2018 report, they found that Gen Z kids worry at significantly higher rates than the general population about mass shootings and about school shootings, because that’s what’s going on for them. Climate change and global warming are also issues for them.”
Robin Gurwitch, PhD, a psychologist and a professor at Duke University School of Medicine, agreed.
“Climate change is a huge worry and concern for adolescents today, and so are school shootings,” she noted. “We also know that social media is adding to anxiety and depression among adolescents, and both of those are getting worse.”
In Haidt’s book, he points to another factor that predated social media. This is the trend that started in the 1990s of many parents restricting the freedom of their children out of concern for their safety. Haidt argues that by not allowing their kids to go out and play with their friends, and even engage in some kinds of unsupervised, risky play, these parents have inhibited normal social development, which can lead to depression and anxiety.
“The lack of free time and play for kids and the reduction in child independence are very important,” Piacentini said. “The things that our generation did as kids are incorrectly perceived as unsafe. The child whose feet never touch the ground never learns how to walk. So I agree with Haidt, and he’s saying what a lot of other people are thinking and researching.”
Why are girls affected so much more than boys? Gurwitch noted that there has always been a gender difference in mental health challenges. Not only do girls tend to internalize feelings of depression and anxiety more than boys do, she said, but boys are less likely to express their feelings.
“For decades, it’s been less permissible for boys to admit they don’t feel good and are under stress. It’s more acceptable for girls to acknowledge behavioral health problems.” That said, Gurwitch believes that girls are particularly vulnerable to social media.
“Pre-pandemic, we saw an increase in online bullying. And, as kids became more addicted to their phones, anxiety increased, especially among girls. They’re not sleeping well because they’re so worried they might miss a text or a message, or what somebody is saying," she said. "They’re not as rested and not doing as well in school.”
Why Teens Aren't Getting Help
One of the most stunning findings in the United Hospital Fund report is the gulf between the number of teens with behavioral health problems and the number who are receiving professional help. For every 20 adolescents reporting symptoms of depression in 2022, for instance, only 10 were clinically diagnosed with depression; for every 20 adolescents reporting symptoms of anxiety, only nine were clinically diagnosed with the condition.
Treatment is less common than diagnosis, and it’s getting scarcer. In 2010, for example, 5,182 adolescents in 100,000 had a major depressive episode but didn’t get any treatment; 2,880 other youths with MDEs did receive care. In 2021, 12,042 adolescents in 100,000 had MDEs without treatment and 7,822 with MDEs received care. That means only 39% of those in need of care for an MDE were able to access it in 2021.
The biggest reason for this discrepancy, experts say, is the inadequate number of health care professionals available to help troubled adolescents. The shortage of licensed therapists and psychiatrists in the U.S. is a problem for adults and is even worse for teenagers, who may not be able to seek help on their own.
Schools should be a natural place for adolescents to get treatment, and a recent report on child and adolescent mental health notes that students are more likely to complete mental health treatment in schools than in other settings. But the report noted that 80% of the school-age children with a mental health diagnosis did not receive care. One reason, it said, is the shortage of mental health support and professionals in the schools. Another report pointed out that only about half of schools screen students for behavioral health conditions, and fewer offer treatment services.
In addition, said United Hospital Fund CEO Barbot, the resources we have now are “fragmented and disjointed.” Children may be touched by several systems that influence health – including the educational system, the child protective system, and juvenile services – but they aren’t necessarily communicating with each other.
Integrated Pediatric Practices
The American Academy of Pediatrics, which declared a national state of emergency in children’s mental health in 2021, has called for more mental health care in schools and more pediatric practices that use behavioral health providers. But to date, not many practices have gone in that direction.
“With regard to the workforce issue, we need to be realistic about the fact that we won’t be able to put out enough clinicians in a short amount of time to address the issues that adolescents are experiencing now,” Barbot said. “So we need to focus on how to expand that continuum of care so that not every child who is experiencing these symptoms has to see a child psychiatrist or a social worker. We have to focus more on how we tap into peers and train more peers to be resources for their fellow adolescents.”
She cited the Ballmer Institute for Children’s Behavioral Health at the University of Oregon. This program offers an undergraduate degree in child behavioral health. Students are trained in early identification, behavioral health promotion, and supervised practice in schools and community settings, allowing them to counsel adolescents in schools and other settings without going through the long training cycle for licensed therapists.