In the United States, we face a widely recognized youth mental health crisis. The 2022-2023 NGA Chair’s Initiative on Strengthening Youth Mental Health hosted four roundtable discussions that brought state leaders together with community leaders, academic experts and representatives of partner organizations and funders.
Empower young people and their families to recognize and manage difficult emotions.
Adolescence
During adolescence, teens have an egocentric perspective, which leads them to focus on themselves and believe that everyone else is focused on them, too. Mild anxiety and stress are normal during this time, but serious mental health conditions can emerge, too.
Experts are working to address these challenges. Psychologists have a critical role to play in helping families, schools, and communities address youth mental health issues. They’re researching and disseminating solutions at the clinical, community, and policy levels, including new recommendations from the U.S. Preventive Services Task Force for regular anxiety screenings for youth ages 8 to 18.
Pediatricians are another group that can help by educating families about warning signs and providing young people with ongoing, problem-focused support. They’re also able to build long-term relationships with young people over many years through well-child visits, and can help destigmatize the idea of seeking mental health care. This is why the Strengthening Youth Mental Health Initiative brings together Governors and their First Spouses to advance best practices and implementable, impactful solutions for states.
Puberty
Puberty is a time of massive hormonal, physical, social and cognitive change. It’s a time of uncertainty, risk and responsibility that can cause a lot of stress. This level of stress can lead to anxiety, depression and other internalizing disorders. Moreover, it can also impact moods and lead to feelings of shame and low self-esteem.
Despite the prevalence of these mental health problems, researchers have not been able to establish causative relationships between pubertal timing and psychopathology. Nonetheless, studies involving large nationally representative samples have shown that pubertal timing is associated with psychological symptoms in early adolescence.
Moreover, the research has also found that adolescents who enter puberty earlier than their peers may experience a number of challenges, including bullying and sexual harassment. Children experiencing precocious puberty are also at greater risk of abusing drugs and engaging in early sexual activity, as well as of suffering from eating disorders. Neuroimaging has also demonstrated that the advancement of puberty is associated with increased activation in the ventral striatum during social self-evaluations (which involve mentalizing).(71) However, further longitudinal work is needed to establish causal links.
Adolescent Suicide
Adolescents who attempt suicide often show warning signs such as a depressed mood most of the time, a loss of interest in family, friends or activities, a change in sleep or eating patterns, restlessness and psychomotor slowing, a preoccupation with death or dying, a history of previous suicide attempts and access to lethal substances. The most common suicide means are firearms, poisoning and hanging and asphyxiation. Rates of suicide are higher for female adolescents than male adolescents. The risk of suicide is also increased in those who are from fixed demographic groups such as American Indian and Alaska Native youth or who are LGBTQ.
It is important for healthcare providers to be able to recognize warning signs of suicidal behavior and to be able to offer referrals to mental health professionals for evaluation and treatment. Patients who present with a traumatic injury should be routinely screened for depression and suicidal thoughts at level I and II trauma centers, as well as referred for psychiatric evaluation.
Adolescent Depression
A depressed teen may withdraw from friends and activities that normally bring them joy. Isolation makes depression worse, so it’s important for teens to stay connected with a trusted third party: family, friends, school counselor or mental health professional.
If you notice a change in your teen, it’s important to listen to their concerns and show unconditional support. Attempting to talk them out of their feelings or telling them that they’re overreacting can make them feel like you don’t take their feelings seriously.
Adolescents who screen positive for depression should receive an assessment, including a suicide risk evaluation. The assessment should include a physical exam, lab tests (such as a complete blood count or thyroid function test) and a psychological evaluation. The latter may include a questionnaire and interviews with the teen and their caregivers. During the psychotherapy portion of treatment, the therapist may use cognitive behavioral therapy or interpersonal therapy. The duration of therapy varies depending on depression severity and the rate at which symptoms improve.