Worried Sick

Sophie Araque-Liu knows what it feels like to struggle. Like many teens, the 17-year-old from Stuart, Florida, attended school remotely during the pandemic and was unable to see her friends in person. Talking to people made her really nervous, and she was constantly stressed about grades and trying to be perfect. She felt isolated and alone.

“I was kind of embarrassed to reach out and tell people what I was going through,” she recalls.

Sophie’s story isn’t unusual. The number of kids and teens struggling with anxiety, depression, and other mental health issues has spiked in recent years. Last year, U.S. Surgeon General Vivek Murthy warned of a “devastating” mental health crisis among adolescents.

“The future well-being of our country depends on how we support and invest in the next generation,” he says.

American adolescence is undergoing a drastic change. Three decades ago, the gravest public health threats to teenagers in the United States came from binge drinking, drunk driving, teen pregnancy, and smoking. These have fallen sharply, replaced by a new public health concern: soaring rates of mental health disorders.

Sophie Araque-Liu knows what it feels like to struggle. Like many teens, the 17-year-old from Stuart, Florida, attended school remotely during the pandemic and was unable to see her friends in person. Talking to people made her really nervous. She also was constantly stressed about grades and trying to be perfect. She felt isolated and alone.

“I was kind of embarrassed to reach out and tell people what I was going through,” she recalls.

Sophie’s story isn’t unusual. The number of kids and teens struggling with anxiety, depression, and other mental health issues has spiked in recent years. Last year, U.S. Surgeon General Vivek Murthy warned of a “devastating” mental health crisis among American youth.

“The future well-being of our country depends on how we support and invest in the next generation,” he says.

American adolescence is undergoing a huge shift. Three decades ago, the most pressing public health threats to teenagers in the United States came from binge drinking, drunk driving, teen pregnancy, and smoking. These have fallen sharply. Instead, they’ve been replaced by a new public health concern: soaring rates of mental health disorders.

In 2019, 13 percent of adolescents reported having a major depressive episode, a 60 percent increase from 2007. Emergency room visits by children and adolescents in that period also rose sharply for anxiety, mood disorders, and self-harm. And for people ages 10 to 24, suicide rates, which were stable from 2000 to 2007, leaped nearly 60 percent by 2018, according to the Centers for Disease Control and Prevention.

The Covid pandemic intensified the decline in mental health among teenagers but the trend was already underway, spanning racial and ethnic groups, urban and rural areas, and the socioeconomic divide. Medical groups have called it a national emergency, citing a severe shortage of therapists and treatment options, and insufficient research to explain the trend.

“Young people are more educated; less likely to get pregnant, use drugs; less likely to die of accident or injury,” says Candice Odgers, a psychologist at the University of California, Irvine. “By many markers, kids are doing fantastic and thriving. But there are these really important trends in anxiety, depression, and suicide that stop us in our tracks.”

“We need to figure it out,” she adds. “Because it’s life or death for these kids.”

In 2019, 13 percent of adolescents reported having a major depressive episode, a 60 percent increase from 2007. Emergency room visits by children and adolescents in that period also rose sharply for anxiety, mood disorders, and self-harm. And for people ages 10 to 24, suicide rates, which were stable from 2000 to 2007, leaped nearly 60 percent by 2018, according to the Centers for Disease Control and Prevention.

The Covid pandemic worsened the decline in mental health among teens, but the trend was already underway. The issue spans racial and ethnic groups, urban and rural areas, and the socioeconomic divide. Medical groups have called it a national emergency. They’ve cited a severe shortage of therapists and treatment options as well as limited research to explain the trend.

“Young people are more educated; less likely to get pregnant, use drugs; less likely to die of accident or injury,” says Candice Odgers, a psychologist at the University of California, Irvine. “By many markers, kids are doing fantastic and thriving. But there are these really important trends in anxiety, depression, and suicide that stop us in our tracks.”

“We need to figure it out,” she adds. “Because it’s life or death for these kids.”

M, a 15-year-old in suburban Minneapolis, is one of those kids. (To protect their privacy in sharing their stories in depth, some young people are being identified only by an initial.)

M’s first hint of trouble came in sixth grade, with challenges focusing in class. By seventh grade, M began to struggle socially too. A close friend got popular, while M often came home from school and got into bed.

“I felt like a plus-one,” M says. “I just wanted to be unconscious.” Other times, “I just sat in my room and cried.”

In the spring of 2020, with the pandemic in full swing, M lied about participating in online classes, felt guilty, and watched YouTube instead. One night after dinner, M went upstairs and used scissors to cut both ankles.

“I was mad at myself for not doing homework,” M says. “I was kind of thinking, ‘Oh, the pain feels good,’ like it was better than being stressed.”

M, a 15-year-old in suburban Minneapolis, is one of those kids. (To protect their privacy in sharing their stories in depth, some young people are being identified only by an initial.)

M’s first hint of trouble came in sixth grade, with challenges focusing in class. By seventh grade, M began to struggle socially too. A close friend got popular, while M often came home from school and got into bed.

“I felt like a plus-one,” M says. “I just wanted to be unconscious.” Other times, “I just sat in my room and cried.”

In the spring of 2020, with the pandemic in full swing, M lied about participating in online classes, felt guilty, and watched YouTube instead. One night after dinner, M went upstairs and used scissors to cut both ankles.

“I was mad at myself for not doing homework,” M says. “I was kind of thinking, ‘Oh, the pain feels good,’ like it was better than being stressed.”

In the autumn of 2020, M’s mom found an online therapist, and the following February, M entered full-day group therapy, eventually getting discharged with a diagnosis of depression and a prescription for antidepressants. From 2015 to 2019, prescriptions for antidepressants rose 38 percent for teenagers compared with 15 percent for adults, according to Express Scripts, a major mail order pharmacy.

In March 2021, M visited the mental health counselor in middle school for the first time. On a scale of 0 to 10, M ranked hopelessness and anxiety at 9, expressing terror at returning to school, a fear of falling behind, and suicidal thoughts.

But M’s mood soon improved; the school counselor attributed the improvement to family support and getting back to school. He cautioned the parents, though, that the pendulum could swing back.

The teen mental health crisis is often attributed to the rise of social media, but solid data on the issue is limited, the findings are nuanced and often contradictory, and some adolescents appear to be more vulnerable than others to the effects of screen time. But many studies have found that adolescents who spend more time online are less happy.

In the autumn of 2020, M’s mom found an online therapist. The following February, M entered full-day group therapy. M was eventually discharged with a diagnosis of depression and a prescription for antidepressants. From 2015 to 2019, prescriptions for antidepressants rose 38 percent for teenagers compared with 15 percent for adults, according to Express Scripts, a major mail-order pharmacy.

In March 2021, M visited the mental health counselor in middle school for the first time. On a scale of 0 to 10, M ranked hopelessness and anxiety at 9. M also expressed terror at going back to school, a fear of falling behind, and suicidal thoughts.

But M’s mood soon improved. The school counselor connected the shift to family support and getting back to school. But he cautioned the parents that things could go backward.

The teen mental health crisis is often linked to the rise of social media. But solid data on the issue is limited, and the findings are often inconsistent. Some youth also appear to be more vulnerable than others to the effects of screen time. But many studies have found that adolescents who spend more time online are less happy.

“I don’t want to blame the internet, but I do want to blame the internet,” says C, a 22-year-old in Salt Lake City who struggled with depression throughout adolescence. “I feel like if I was born in 2000 B.C. in the Alps, I’d still be depressive, but I think it’s wildly exacerbated by the climate we live in.”

The ability of youth to cope has been further eroded by declines in sleep, exercise, and in-person connection, which all have fallen as screen time has gone up.

And it’s not just social media. Justin, 24, says he would often spend six hours at a time playing video games when he was in middle and high school, partly to numb his emotions. Consequently, he wasn’t getting much sleep.

“The darkest period of my life in regards to mental health was definitely freshman year of college—can’t get out of bed, stomach hurts,” Justin recalls. “I could not process in a way that made me feel like anything was worth anything, that anything mattered.”

“I don’t want to blame the internet, but I do want to blame the internet,” says C, a 22-year-old in Salt Lake City who struggled with depression throughout adolescence. “I feel like if I was born in 2000 B.C. in the Alps, I’d still be depressive, but I think it’s wildly exacerbated by the climate we live in.”

The ability of youth to cope has been further challenged by declines in sleep, exercise, and in-person connection. All of these have fallen as screen time has gone up.

And it’s not just social media. Justin, 24, says he would often spend six hours at a time playing video games when he was in middle and high school. He did so in part to numb his emotions. As a result, he wasn’t getting much sleep.

“The darkest period of my life in regards to mental health was definitely freshman year of college—can’t get out of bed, stomach hurts,” Justin recalls. “I could not process in a way that made me feel like anything was worth anything, that anything mattered.”

Biology may also be playing a role. Over the past century, the age of puberty onset has dropped markedly for girls, to 12 years old today from 14 in 1990; the age of onset for boys has followed a similar path.

When puberty hits, the brain becomes hypersensitive to social and hierarchical information, even as media flood it with opportunities to explore one’s identity and gauge self-worth.

Laurence Steinberg, a psychologist at Temple University, says the ability to maturely grapple with the resulting questions—Who am I? Who are my friends? Where do I fit in?—typically lags behind.

Biology may also be playing a role. Over the past century, the age of puberty onset has dropped markedly for girls, to 12 years old today from 14 in 1990. The age of onset for boys has followed a similar path.

When puberty hits, the brain becomes hypersensitive to social information. At the same time, media flood the brain with chances to explore one’s identity and measure self-worth.

Laurence Steinberg, a psychologist at Temple University, says the ability to maturely grapple with the resulting questions—Who am I? Who are my friends? Where do I fit in?—typically lags behind.

The falling age of puberty, he says, has created a “widening gap” between stimulation and what the young brain can process: “They’re being exposed to this deluge at a much earlier age.”

The combination of early puberty and information overload from the internet presents “a double whammy” that can lead to “anxiety and depression when people feel a lack of control,” says Andrew Meltzoff, co-director of the University of Washington Institute for Learning and Brain Sciences.

He says that the falling age of puberty has created a “widening gap” between stimulation and what the young brain can process: “They’re being exposed to this deluge at a much earlier age.”

The combination of early puberty and information overload from the internet presents “a double whammy” that can lead to “anxiety and depression when people feel a lack of control,” says Andrew Meltzoff, co-director of the University of Washington Institute for Learning and Brain Sciences.

The pandemic brought economic hardships, disrupted learning, and resulted in less in-person time with teachers, family, and friends. Many teens, like Sophie, the Florida 17-year-old, lost direct connections during a critical period in their lives and still haven’t fully recovered, says Stacy McAllister, an adolescent psychiatrist at Children’s Hospital of Philadelphia.

“Teens are supposed to be out exploring the world, testing their abilities, building relationships, figuring out who they are and who they want to become,” explains McAllister. “Even though we are ‘back to normal,’ many teens are trying to figure out how to feel normal after missing out on so much for so long.”

Health experts note one positive: The crisis at least is unfolding in a more accepting environment. Mental health issues have shed much of the stigma they carried decades ago, and parents and adolescents are more at ease discussing the subject and seeking help (see box, below).

The pandemic brought economic hardships and disrupted learning. It also resulted in less in-person time with teachers, family, and friends. Many teens, like Sophie, the Florida 17-year-old, lost direct connections during a key period in their lives and still haven’t fully recovered, says Stacy McAllister, an adolescent psychiatrist at Children’s Hospital of Philadelphia.

“Teens are supposed to be out exploring the world, testing their abilities, building relationships, figuring out who they are and who they want to become,” explains McAllister. “Even though we are ‘back to normal,’ many teens are trying to figure out how to feel normal after missing out on so much for so long.”

Health experts note one positive: The crisis at least is unfolding in a more accepting environment. Mental health issues have shed much of the stigma they carried decades ago. Parents and youth also are more at ease discussing the subject and seeking help (see box, below).

For Sophie, opening up to her parents about her feelings was the first step. Their support helped her cope and inspired her to enter a mental health-focused Doodle for Google contest last summer. The theme was “I care for myself by . . .” Sophie’s winning artwork, which she titled “Not Alone,” shows her hugging her mom.

Sophie hopes her story reminds others that they don’t have to tackle everything on their own.

“There is always someone out there for you,” she says. “Even if it feels like you might be alone, you’re not alone.”

For Sophie, opening up to her parents about her feelings was the first step. Their support helped her cope and inspired her to enter a mental health-focused Doodle for Google contest last summer. The theme was “I care for myself by . . .” Sophie’s winning artwork, which she titled “Not Alone,” shows her hugging her mom.

Sophie hopes her story reminds others that they don’t have to tackle everything on their own.

“There is always someone out there for you,” she says. “Even if it feels like you might be alone, you’re not alone.”