Many healthcare leaders have characterized the youth mental health crisis as an epidemic noting that growing numbers of American children are experiencing depression, anxiety, and other mental health disorders. The crisis was brewing for about a decade before 2020, but the epidemic further exacerbated existing problems while at the same time creating new ones.
The Societal Context of Youth Depression
There is a strong genetic/biological component to depression, and it does tend to run in families. But depression in teens and children is not an isolated phenomenon – it is also a reflection of broader societal dynamics. The interplay between individual experiences and societal trends is intricate, influencing the mental health of young people in profound ways. The rise in youth depression can be attributed to multiple factors, including rapid technological advancements, societal expectations, and evolving family structures.
The digital age has indelibly transformed the landscape for young people, offering unprecedented connectivity while simultaneously posing unique challenges. The omnipresence of social media and digital communication has been linked to increased rates of anxiety and depression among adolescents. The pressure to create and maintain a perfect online persona can lead to feelings of inadequacy and self-doubt and can contribute to the onset of depressive symptoms.
Moreover, the constant exposure to idealized images and lifestyles can exacerbate feelings of isolation and loneliness, as youth may perceive a disparity between their own lives and the seemingly flawless lives presented online. It has been 17 years since the iPhone was introduced in 2007 but educators, health professionals, and policy makers are only beginning to address the need to teach students media literacy and to promote healthy digital habits.
Some experts also point to the evolution of over-protective parenting styles as part of the problem. Increasingly many parents attempt to clear all potential obstacles in their children’s paths to protect them in an uncertain world. While these behaviors are well-intentioned, taken to an extreme they can interfere with a child’s ability to learn problem solving skills, to tolerate distress, frustration, and failure, and to persistently work toward goals. In other words, modern parenting styles can negatively impact a child’s ability to develop certain skills and a sense of self-efficacy.
Finally, youth who have been exposed to trauma or other adverse childhood experiences (ACEs) are at risk for depression as well as other mental health diagnoses. The myriad stressors related to the pandemic cannot be ignored, of course, but children are growing up in a world that overall feels less safe and predictable. Gun violence, climate disasters, economic distress, racial strife, political divisiveness all impact the health and well-being of children, parents, and other caregivers.
The Prevalence of Depression and Related Conditions
The U. S. Surgeon General’s office and many major health organizations have released statistics about the youth mental health crisis and have issued calls to action. The CDC’s Youth Risk Behavior Surveillance Survey for 2009-2019 revealed that 1 in 3 high school students had experienced persistent feelings of sadness or hopelessness in 2019, a 40% increase since 2009. The survey results also indicated that in 2019 approximately 1 in 6 youth had reported making a suicide plan in the past year, a 44% increase since 2009. By 2018, suicide rates for young people ages 10-24 jumped by approximately 60% after having been stable from 2000 to 2007. In 2019, about 19% of high school students reported having seriously considered attempting suicide.
In March 2022, two full years after the COVID-19 pandemic caused widespread school closures, the CDC reported that in 2021 more than 4 in 10 American teens reported feeling “persistently sad or hopeless”. This increase in depression and suicidality cuts across all demographics, but some students are more at risk than others. For example, a 2021 government survey of almost 8,000 high school students found that the rate of major depressive episodes was higher for adolescent girls (25.2 percent) compared with boys (9.2 percent).
Renee Goodwin, a professor at the City University of New York’s Graduate School of Public Health and Health Policy, has noted that “depression is extremely common in the U.S. and has reached epidemic levels.” The 2015-2020 National Survey on Drug Use and Health reported that since 2015 depression rose fastest among teens and young adults ages 12 and older, while remaining unchanged for individuals who are 35 and older. Of the 3 child/adolescent age ranges reported on by the CDC (ages 3-5, 6-11, 12-17), depression is consistently found to be most common in the 12-17 age bracket.
Recognizing the Symptoms of Youth Depression
Identifying depression in youth requires a keen awareness of symptomatic manifestations that may differ from those seen in adults. When they are depressed adolescents often exhibit irritability and mood swings and withdraw from previously enjoyed activities. These behavioral changes are frequently accompanied by academic decline, sleep disturbances, and alterations in appetite. Early recognition of these symptoms can help parents, educators, and mental health professionals provide necessary support and intervention before symptoms become more severe.
Occasional feelings of sadness or hopelessness are part of every child’s life. It is the persistence of these feelings that should raise a red flag for parents, educators, and pediatricians, signaling the need to assess a child for possible depression. Unlike anxiety, except in its more extreme and unrelenting forms, depression is not a normal part of life.
As described by the National Institute of Mental Health (NIMH), depression should be suspected if symptoms persist for at least two weeks, and are present mostly every day, for most of the day. Depression can be expressed in different ways, but some common signs include:
- Persistent feelings of sadness, hopelessness, pessimism, guilt, worthlessness, and/or helplessness
- A loss of interest in activities the child previously enjoyed
- Academic decline or a loss of interest in schoolwork
- Increased irritability, frustration, restlessness, and/or mood swings
- New risky or dangerous behaviors
- Decreased energy, fatigue
- Changes in eating or sleeping habits, including weight loss or gain, and sleeping more or sleeping less
- Difficulty concentrating, remembering things, or making decisions
- Spending more time alone than usual
- Withdrawing from activities that the child once loved
- More frequent medical complaints – aches or pains, headaches, cramps, or digestive problems without a clear physical cause and that do not ease after treatment
- Thoughts/verbalizations about death or suicide, or suicidal behaviors
Depression is a common but serious mood disorder that can affect how a person feels, thinks, and handles daily activities. In its most severe form, an individual might not be able to get out of bed or complete even the most basic self-care activities. But it is important to remember that even youngsters who push through all their academic, social, and extra-curricular activities might still be struggling with depression.
Therapeutic Interventions and Treatment Modalities
The treatment of depression in youth necessitates a multifaceted approach that is both evidence-based and tailored to the individual needs of the adolescent. A combination of psychotherapy, pharmacotherapy, and therapeutic activities can yield the most efficacious outcomes. Monitoring young people for signs of depression can help them access effective treatments that can decrease unnecessary suffering and prevent the tragic loss of a young person to suicide.
Psychotherapy options include Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), trauma focused therapies, family therapy, and group therapy to help students build skills, improve self-esteem, and heal from trauma. Depression is highly treatable but only if we help students and their families access available help.
Cognitive Behavioral Therapy (CBT) is a widely endorsed therapeutic modality that has demonstrated efficacy in the treatment of youth depression. CBT focuses on identifying and challenging self-defeating thought patterns, promoting healthier cognitive processes that can mitigate depressive symptoms. It also includes efforts to plan and participate in activities that create positive emotions. The structured nature of CBT provides adolescents with practical skills to navigate their emotions and develop resilience.
DBT combines CBT techniques with acceptance-based and mindfulness practices to help adolescents focus on the present moment, without judgment, which has been shown to reduce anxiety and depression by promoting emotional regulation and awareness. Involving family members in therapy can improve communication, address dynamics that may contribute to the youth’s depression, and foster a supportive environment. Play Therapy is often used with younger children and allows children to express their feelings and experiences through play, facilitating emotional exploration in a safe space. Participation in group therapy can help adolescents feel less isolated and learn new coping strategies as connection with peers has proven to be an extremely effective way to impact the well-being of young people.
Pharmacotherapy may be indicated in some cases, particularly for moderate to severe depression and prescribers have many more medication options than in the past. Selective Serotonin Reuptake Inhibitors (SSRIs) are commonly prescribed, though their use in adolescents necessitates careful monitoring due to potential side effects. It is helpful for pharmacotherapy to be administered in conjunction with psychotherapy to ensure a holistic approach to treatment.
In addition to formal therapeutic interventions, engaging youth in therapeutic activities can play a pivotal role in alleviating depressive symptoms. Physical activities, such as sports and outdoor excursions, have been shown to enhance mood and promote psychological well-being. These activities not only provide an outlet for emotional expression but also foster a sense of community and belonging.
Furthermore, mindfulness practices and creative outlets, such as art and music therapy, can serve as powerful tools for emotional regulation and self-discovery. Encouraging adolescents to explore these avenues can enhance their coping mechanisms and contribute to their overall mental health.
The Role of Educational Institutions in Addressing Youth Depression
Educational institutions are uniquely positioned to play a proactive role in addressing youth depression by fostering an environment that prioritizes mental health and reduces stigma while collaborating with both school-based and community mental health providers. School-based programs should encompass regular mental health screenings, counseling services, and workshops that educate staff, students, and parents about mental health and coping strategies.
Understanding and addressing youth depression requires a concerted effort from all sectors of society. By acknowledging the complex interplay between societal trends and an individual’s biology and personal environment, we can develop more effective strategies to support the mental health of young individuals. Through data-driven insights, comprehensive education, and compassionate intervention, we can foster a future where youth are equipped to thrive despite the challenges they face.
