As the world faces a global youth mental health crisis, it is important to look at a variety of factors that contribute to this. These include increasing trends in instability and identity explorations during adolescence and emerging adulthood, economic precarity and food insecurity, as well as the use of various social media and cyberbullying modalities.
Social determinants of mental health
A variety of factors impact youth mental health. These include social determinants, which are the structural conditions that influence individuals’ chances of experiencing mental health challenges or disorders and contribute to disparities in these outcomes between groups. These determinants include income, employment, access to education, food security, housing, neighborhood quality, social support, childhood adversity, discrimination, and exposure to violence.
Many of these determinants are modifiable, but they require comprehensive, integrated interventions that address the full range of youth needs. This includes addressing trauma, supporting recovery, providing supports that promote resilience, and improving opportunities for positive relationships. Adolescence and young adulthood are important times for developing these skills, but they also offer unique obstacles. Moreover, scholars should examine whether there are time sensitive periods when particular social determinants—and, therefore, associated interventions—have larger effects. This could help determine the best strategies to target specific populations, such as girls, youth of color, or LGBTQ+ youth, who may face more barriers to receiving services than others.
Adolescence
Adolescence is a unique period of human development that spans the years from 10 to 19. A healthy adolescence requires a supportive environment that can bolster opportunities for youth to thrive.
A teen’s social relationships, family environments and school experiences can impact their mental health. For example, adolescent exposure to risk factors such as poverty, harsh or neglectful parenting, lack of access to mental health care and peer support, and racial and gender disparities in schools can be significant contributors to negative outcomes.
Symptoms of mental disorders are often difficult to distinguish from normal adolescent behaviors and may be exacerbated by stress. Mental health problems tend to emerge early in adolescence and progress over time, escalating in frequency, severity, and duration. These problems can impact a teenager’s ability to learn, work and function in their daily lives. Teens may experience distress in different ways, depending on the individual: for example, female students and LGBTQ+ students are more likely to report symptoms of distress than their cisgender and heterosexual peers.
Depression
Recent school shootings have led to a rise in youth mental health problems, including anxiety and depression. In fact, adolescent depression is linked to substance use and suicide. Furthermore, adolescent anxiety and depression may also contribute to poor school performance and other negative outcomes. Economic trends, including the lack of employment, have also been linked to adolescent depression and low wellbeing. In particular, adolescent worry and depression has increased during periods of high unemployment in Sweden and Australia.
The National Governors Association’s Youth Mental Health Playbook identifies strategies that state leaders are taking to support youth mental health and well-being. These include identifying and addressing mental health needs, increasing access to care and reducing the social, self and structural stigma of mental illness. In addition, states are addressing structural factors such as poverty, food insecurity and homelessness that can lead to stress-response patterns that are associated with mental health challenges. They are also promoting trauma-informed and culturally relevant care and services to improve long-term mental health and resilience.
Suicide
Suicide is a growing concern for many young people, particularly teens. The CDC report on youth suicide in 2021 found that nearly 40% of high school students felt persistently sad or hopeless, and more than 20% of girls and 50% of LGBTQ+ youth considered trying to kill themselves.
Health care professionals should ask every patient who screens positive for depression about suicidal thoughts and feelings, preferably using an expanded version of the PHQ-9 modified for adolescents that includes question 9 (“In the past two weeks have you had thoughts that you would be better off dead or of hurting yourself in some way?”). The AAP Blueprint for Youth Suicide Prevention recommends referral to a mental health specialist for those who screen positive on a suicide risk assessment (BSSA) and subsequent safety planning and referrals as needed.
Teens who have suicidal thoughts or attempts often feel isolated, so it is important to reassure them that they are not alone and that depression and suicidal feelings can be treated with medication and therapy. It is also essential to ensure that they do not have access to lethal means, including firearms and medications, with counseling on safe storage.