Understanding The Reasons For The Mental Health Crisis In Youth

IRA FLATOW: You’ve probably read the headlines about a spike in youth suicide rates, or maybe about how social media and screen time are exacerbating teen anxiety and depression. Or maybe you read about the shortage of services for kids who need help, long wait times in emergency rooms waiting for inpatient beds to open up. And of course, there’s the pandemic, which left kids already struggling without the support of friends and teachers in their school communities.

I wanted to take a closer look at what’s driving these trends, get past the headlines, talk with doctors who are working directly with young people and their families to get the care they need.

To help make sense of the crisis and advise us what we can do to help are my guests, Dr. Patricia Ibeziako, Associate Chief for Clinical Services, Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, and Associate Professor of Psychiatry at Harvard Med School, Dr. Tammy Benton, Psychiatrist in Chief in the Department of Child and Adolescent Psychiatry and Behavioral Sciences– that’s at Children’s Hospital of Philadelphia. Dr. Benton is also a professor of psychiatry at the University of Pennsylvania’s Perelman School of Medicine.

Welcome both of you to Science Friday.

PATRICIA IBEZIAKO: Thank you. Thanks so much for having us.

TAMMY BENTON: Thank you.

IRA FLATOW: You’re welcome. I want to alert the audience that we will be talking about some sensitive topics. And if you need to, make sure you take care while listening.

OK, let’s just jump in here. Let me ask both of you first. Let me start with the big question. What role has the pandemic played in the rising rates of mental health issues among teens? Dr. Benton, why don’t you try it first?

TAMMY BENTON: So I think the pandemic had exacerbated a pre-existing challenge. So prior to the pandemic, we were seeing increasing rates of suicide among young people, increasing rates of depression and anxiety, longer wait times for mental health services, and significant barriers to access to care prior to the pandemic.

And the pandemic actually just made everything worse. The pandemic, in the short term, immediately interrupted access to care, because services were closed. And then we transitioned pretty rapidly to more telehealth services.

Schools closed, where many young people received their mental health treatment. And so those resources were no longer available to children and their families. And it actually took a while before we were able to reopen some of those services using telehealth.

But in the meantime, there were some populations who did not even have access to those services through telehealth. And then there were other people just waiting until they could have access to services. So a lot of those young people really just started to do worse.

In addition to that, a lot of young people experienced the adversities that were brought by the pandemic. So there was financial challenges for children whose parents lost jobs. There were deaths in families. There were lots of environmental turmoil and anxiety that really exacerbated the preexisting concerns. So the pandemic made things a lot worse for young people.

IRA FLATOW: Yeah. Dr. Ibeziako, could you actually see numbers associated with the reporting of this additional stress?

PATRICIA IBEZIAKO: Yeah, so when we looked at trends of children presenting to our hospital over a two year period, like the 12 months before and then the 12 months after the start of the pandemic, we saw striking increases of adolescents with anxiety, depression, suicide attempts, eating disorders, and substance abuse.

And the sad part is, when we looked at the trends of kids presenting with suicidal ideation and behaviors, there was actually no difference in the trends between both years, meaning that even without the pandemic, suicidal ideation and attempts were on track to continue to increase.

Our hospital was one of only two US hospitals that collaborated on a study of 62 emergency rooms in 25 countries. And there was a significant increase in kids presenting with self-harm in 2021, compared to 2020 and 2019.

IRA FLATOW: As you say, these kids were already presenting. The rates were rising before the pandemic. We are now three years into the pandemic. How have the types of issues that kids are presenting with, Dr. Ibeziako, changed over time?

PATRICIA IBEZIAKO: So there are three main domains where the most common complaints of kids we see fall into. And that’s school stress, peer related stress, family stress. Those have been the immediate concerns of kids for years, and they have remained the same.

The quality and the nature of the complaints and the stress in those domains altered during the pandemic. For example, anxiety about school was about remote school. Well now, kids are now back in school in person.

There were concerns about falling behind academically, in the context of doing remote school, which they already had when they were in school in person. During the pandemic, there was sadness about not being able to see friends, concerns about family members being ill.

But now that the immediate crisis of the pandemic is over, those domains haven’t changed. They’re just no longer tinged with COVID related issues.

IRA FLATOW: Dr. Benton, were you surprised to see this rise continue through the pandemic? And how do you see it progressing now?

TAMMY BENTON: I actually was surprised on some level, although at the start of the pandemic, most studies predicted we would see about a doubling of the rates of depression that we were seeing, and that we would see about a 30% increase in the number of cases worldwide, with kids reporting anxiety symptoms that require clinical intervention.

I did assume that some of that would get better as the crisis and as the threat of COVID subsided. But that’s not what we’re seeing.

And what we’re seeing is that young people are facing other stressors. So there was, in addition to COVID, there were a lot of social stressors, including the death of Mr. Floyd and other things. A lot of televised school shootings, all those things contribute to the anxiety that kids are experiencing.

But we’re starting to see the suicide attempts increasing for a younger group of kids than we had been seeing prior to the pandemic. So we’re seeing more kids under 12, more minoritized youth, particularly Black youth. And those are trends we’re following very closely.

IRA FLATOW: And what do you think is driving this?

TAMMY BENTON: All of the factors that we’ve been referencing, in addition to, I believe, an increase in exposure to violence and the shootings that we see televised on a regular basis. So a lot of the younger kids are talking about hearing gunshots at night, and how frightening and disturbing that is.

And for young people, they’re really not mature enough to necessarily respond to reassurance, or even to express their levels of trauma and fear around those experiences.

IRA FLATOW: Yeah, through that lens, it’s very easy to understand that. Dr. Ibeziako, are there gender disparities too in who is being affected and who is seeking care?

PATRICIA IBEZIAKO: Oh, there definitely is. And there’s always been, even before the pandemic.

I would say that the CDC, in 2019, reported that one in three high school students endorsed feelings of sadness and hopelessness. And females had a higher prevalence rate.

In 2021, that percentage of high school students was 44% who reported feeling so sad and hopeless. And almost 60% of female students experienced feelings of sadness and hopelessness during the past year. And 25% had made a suicide plan.

So there’s definitely a difference in terms of gender, and also other disparities. Close to 70% of LGBTQ plus students experienced feelings of sadness and hopelessness during the past year. And more than 50% had poor mental health during the previous 30 days.

And that’s just depression. Anxiety disorders are even more common than depression and can also affect functioning.

IRA FLATOW: I want to go back to the gender disparities for a moment. Because I was reading a recent cover story in the respected magazine Science News. And let me read you the headline.

On the cover, it says, The Unseen Suffering of Boys. Mental health surveys may miss depression in young males. And it goes on to say that depression looks different in boys and girls. So teenagers’ age and gender both potentially influence how they express depression.

Could we be missing how it’s affecting– you pointed out how much higher it is in females?

PATRICIA IBEZIAKO: We absolutely can. And I think it’s important to say that there are vulnerabilities in all groups. And just some groups are more vulnerable than others.

But the danger of always emphasizing one group is that then, you de-emphasize the other. And as you mentioned, boys are also struggling. And their struggle may look different. They may express distress and disorder in different ways.

And so it’s really important to have a greater understanding of how that looks in different people, and not just gender based, but also across socioeconomic status and racial and ethnicity lines as well.

IRA FLATOW: Well, now that we have outlined a depressing depressing situation, let’s talk about anything hopeful. Are there resources available? Will kids respond to treatment? Dr. Ibeziako, give me an idea of what the future might look like in a better world.

PATRICIA IBEZIAKO: Wow. I know you want us to start by being positive. But this crisis was several decades in the making. And there’s a lot that needs to be done to improve the mental health care of kids in America.

And we need to, in a better world, we would invest in research and quality improvement initiatives to better understand mental health diagnosis, to better predict models for illness and resilience, to have more cost effective treatments, and to have a cure.

We need a full spectrum of care, with outpatient and community supports. We need school based programs and early intervention for prevention. We need acute care and intensive programs, because kids are getting sicker.

The one positive that has come, if any, is that adolescents have become the greatest mental health advocates of any generation. The role of stigma has been significant in mental health, and many people, there’s a lot of shame and guilt and talking about illness.

And adolescents do that freely, and with each other and with adults, and publicly, in a way that generations before them didn’t. So it’s important.

IRA FLATOW: Dr. Benton, let me get your opinion. What do we need to do better to help kids struggling with anxiety and depression?

TAMMY BENTON: I’m somewhat more optimistic. So I think this pandemic really allowed the organizations that care for children to come together. So with the Declaration of the National Mental Health Emergency Crisis for Young People, we were able to garner a lot of federal and state level support and attention for the issues that are impacting the mental health of young people.

And to Dr. Ibeziako’s point, young people, adolescents, have been very active voices in addressing those things. So we’ve made some success in bringing government attention to children’s mental health.

And we’ve had some successes, such as the Children’s Coping Act with Mental Health, which has been approved.

The other thing is that we have hundreds of interventions that work for young people. And the challenge is connecting young people to those interventions. We have hundreds of evidence based interventions to target depression and anxiety. And the opportunities that are developing and the funding that’s actually been more focused on supporting mental health in schools and in primary care settings, partnering with other providers who are not primary mental health providers, but people who can participate in care, like pediatricians, school counselors, and think the level of national attention, has allowed us to start focusing on other ways that we can do more prevention.

So I actually think that we’re in a better place than we have ever been in the history of children’s mental health, from the perspective of attention to addressing some of the crisis that exists.

IRA FLATOW: This is Science Friday from WNYC Studios. Let’s talk about, in the short time I have left, I’m sure that there are parents who are listening at home. They’re worried about their kids. Any advice you can give them to get help for their kids if they suspect they are struggling? I mean, parents are on the front lines, are they not, Dr. Benton?

TAMMY BENTON: Yes they are. For parents, one of the biggest questions is, when does my child’s behavior or mental health become a problem? And we do make a distinction between times that kids are struggling and times when kids need to seek care.

We typically identify impairment as children not being able to function in their normal setting. So a child can feel somewhat sad at times, and parents should inquire and ask questions. But when they notice that their child’s not meeting their usual responsibilities and duties, they’re not engaging in their normal social activities, that they’re saying that they’re not being successful in areas where they were previously successful, those are really times that families should start to talk with the professionals they’re associated with, like their pediatricians.

They can talk with their school counselors. But I typically recommend to families, if they’re concerned at all, they should talk to their primary care providers first. Most people never see a mental health professional. But almost everybody sees their primary care providers.

And then there’s the 988 line. And so if, in fact, you’re concerned that your child may be experiencing some suicidality, you’re not sure, you can call the 988 text line or text them. And you can talk with someone who can help actually guide you through some of those questions you might have about whether you need more support.

IRA FLATOW: Dr. Ibeziako, any final thoughts you’d like to add to that?

PATRICIA IBEZIAKO: Yes, I would say that parents are struggling, too. A study was just released that shows one in three teenagers have a parent who’s suffering from anxiety and depression, and 2/5 of teens voiced concern about their own parents’ mental health.

So parents are struggling at the same rate as their kids. And talking with their children about their own emotional struggles can help normalize the experience and open the door for more transparent discussions, so that the child doesn’t feel alone.

And parents have a tendency to blame themselves when a child is not doing well. And children have a tendency to blame themselves when they perceive that something is going on in the family. So speaking openly about this is really important.

And I’ll also say that adolescents themselves can play a role in making things better. The see something, say something also applies when it happens, when it comes to mental health.

I can’t tell you the number of lives that have been saved because a teenager received a text from one of their friends and saw something on social media, and they alerted a parent or a school teacher. So there’s lots of things that people who are not health professionals can do to improve the situation.

IRA FLATOW: Very, very helpful, I think, to all of us. And thank you both for the work that you do, and for taking time to be with us today.

PATRICIA IBEZIAKO: Thanks for having us.

TAMMY BENTON: And Thank you for paying attention to this really, really important subject. The media are key partners in getting the message out. So thank you.

IRA FLATOW: Well, thank you. Dr. Patricia Ibeziako, Associate Chief for Clinical Services, Boston Children’s Hospital, Associate Professor of Psychiatry at Harvard Med School, Dr. Tammy Benton, Psychiatrist in Chief in the Department of Child and Adolescent Psychiatry and Behavioral Sciences at the Children’s Hospital of Philadelphia and Professor of Psychiatry at the University of Pennsylvania’s Perelman School of Medicine.

Copyright © 2023 Science Friday Initiative. All rights reserved. Science Friday transcripts are produced on a tight deadline by 3Play Media. Fidelity to the original aired/published audio or video file might vary, and text might be updated or amended in the future. For the authoritative record of Science Friday’s programming, please visit the original aired/published recording. For terms of use and more information, visit our policies pages at http://www.sciencefriday.com/about/policies/