A guide to teen mental health for parents and caregivers

Teen mental health statistics | Mental health and COVID | Symptoms | Teen mental health resources

As many as 1 in 5 teens are affected by a mental health disorder. The goal of World Teen Mental Wellness Day, observed on March 2, is to bolster awareness of and remove stigmas around adolescent mental health issues.

Adolescents can be particularly vulnerable to social exclusion, discrimination, stigma, or educational difficulties—many of which have been heightened during the pandemic. Undetected or untreated, mental health conditions in teens can limit future opportunities to lead fulfilling lives as adults, says Jon Stevens, MD, MPH, the chief of outpatient services at Menninger Clinic in Houston, Texas. But knowing the potential warning signs of a mental health problem as well as some treatment options can help prevent issues from lingering into adulthood.

Teen mental health statistics

Even prior to the COVID-19 pandemic, instances of teen mental health issues have been on the rise. Most alarmingly, suicidal thoughts or attempts among teens rose 63.3% between 2005 and 2018. Dr. Stevens notes that this unacceptably high rate of teen suicide, depending on the year, varies between the second and third leading cause of death in 15- to 19-year-olds. “Clinical or major depression is one of the main risk factors for suicide and affects approximately 10% of teens in a given year,” he adds.

Anxiety in adolescent girls tends to be more common than in adolescent boys, with 38% of adolescent females experiencing an anxiety disorder compared with 26% of adolescent males. As with anxiety, the prevalence of teen depression is higher among girls (20%) compared to boys (6.8%). However, anxiety and depression are not the only clinical diagnoses associated with suicide. It also occurs with people experiencing symptoms associated with psychotic disorders, other mood disorders like bipolar disorder or other personality disorders.

Oftentimes, people experience more than one mental or mood disorder at a time. For example, people with attention-deficit hyperactivity disorder (ADHD) are more likely to also have an anxiety disorder. Additionally, the majority of people hospitalized for an eating disorder, like anorexia or bulimia, have comorbidities like depression, anxiety, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).

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COVID-19 and mental health in teens

While many Americans’ emotional health has been affected by the COVID-19 pandemic, the most concerning increase in risk is among young adults. “While 11% of respondents to the Centers for Disease Control and Prevention (CDC) survey had “seriously considered” suicide in the past month, that same figure jumps to 25% for people aged 18-24, which is deeply concerning,” says Dian Grier, LCSW, clinical therapist with Choosing Therapy.

One of the reasons for this increase may be social distancing. “Teenagers and young adults are social by nature and learning to find their own identity within their peer group, which offers development skills that cannot be found in isolation,” says Grier. She adds that no amount of screen-time can make up for these desperately needed face-to-face human interactions.

Further, we’re facing a never-ending stream of coverage on pandemic statistics, government responses, political quarrels, and volatility in the financial markets—all of which can induce stress. “We rarely include our teenage population and how they are coping with numerous disruptions to their lives, including abrupt school closures, movement to remote learning, restrictions on leaving their homes and the inability to physically gather with friends into the discussion,” Dr. Stevens says.

Traditional sources of support, including peers, teachers, and counselors, may not be as available to identify signs of anxiety and depression in others while remote, hybrid, or wearing masks at school. That means expressions of distress could potentially go unattended. Inequities often widen as a result of disasters such as the pandemic. “Minority youth already have less access to mental health care when compared to their white counterparts,” says Justine Larson, MD, medical director of schools and residential treatment at Sheppard Pratt in Maryland. “And LBGTQ youth—who are already at higher risk for depression and anxiety—may feel even more isolated during the pandemic.”

Often, the challenges created by the pandemic don’t align with the developmental needs of teenagers, says Stevens. Some of those instances that can lead to mental disorders in teens include:

• Feeling emotionally distant from friends: Adolescents are more sensitive to social acceptance from friends, but are now more limited in how they can connect with their friends. Despite electronic means of communication, many teens not only feel physically distant, but emotionally detached from their friends, even worrying that they could lose their friendships. 
• Feeling overwhelmed by family: Adolescents need growing degrees of independence within their families. Many teens complain that spending so much time with their families without a break becomes overwhelming. They also become irritated by a perceived lack of boundaries and privacy. Notably, instances of domestic violence have also skyrocketed during the pandemic.
• Restlessness from not getting out: Hobbies and extracurricular activities play an important role in helping adolescents discover their personal interests and talents, and they ultimately form their emerging sense of identity. Teens often voice frustrations about not being able to get out of the house to participate in activities that are important to them.
• Fears about the pandemic: Many teens are worried about the pandemic itself and are fearful about spreading the virus to older and more vulnerable family members—even after vaccines and boosters became available.
• Grieving missed life moments and losses: Many high school and college students are dealing with loss due to canceled graduations, not playing sports or missing out on the dorm experience, contributing to poor mental health in teens. Additionally, many people have lost family members to the pandemic and are mourning them.

Symptoms of mental illness in teenagers

“The important thing that parents and caregivers can do is communicate with their teen about how he or she is doing,” says Larson. Beyond these check-ins, there are some important symptoms to be on the lookout for, especially as teens navigate a global pandemic. 

Anxiety, depression, and symptoms of other disorders in teens can even present itself in surprising ways—different from the way they affect adults—such as headaches, stomachaches, oppositional behavior, aggression, irritability, trouble concentrating and social withdrawal, according to Dr. Larson. Additionally, teens may exhibit the following symptoms:

• Feeling disconnected from reality
• Feeling nervous or having frequent worries
• Illogical thinking or a decrease in functioning
• Changes in sleep pattern
• Changes in eating habits resulting in weight gain or loss
• Increased social withdrawal
• General apathy or lack of interest in previously enjoyed activities
• Difficulty concentrating
• Rapid mood changes
• Increased sensitivity to light and sounds
• Increased somatic symptoms, such as aches and pains
• Statements about life not being worth living or thoughts about wanting to die

If your teen is experiencing one or more of these symptoms, it may be a good idea to schedule a check-in with a mental healthcare provider. 

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How to help a teenager with mental health issues

Although it might not be easy to broach the subject, ignoring mental health issues can lead to severe consequences for the teen and for the family as a whole. “Teens with depression, anxiety, or other mental health disorders often face stigma and internalize feelings of inadequacy, so it’s important that you honor your teen’s feelings and acknowledge that their symptoms are real,” says Grier. In fact, being attentive, acknowledging your teen, and helping them take action if necessary may deepen your connection with them at a time when it is needed most.

If you’re concerned about your teen’s mental health, there are a number of resources and support groups where you can seek professional help:

• Pediatricians commonly treat and refer teens for mental health problems, and they should be familiar with available resources. The American Academy of Pediatrics has extensive behavioral health resources.
• Many schools have mental health professionals and counselors who are aware of community resources.
• The Substance Abuse and Mental Health Services Administration (SAMHSA) hotline 1-800-662-HELP is a 24/7 referral service for individuals and family members impacted by mental illness. SAMHSA also has an online treatment locator.
• Support groups and family organizations such as The National Alliance on Mental Health (NAMI) provide support to family members through a network of regional organizations.
• The American Association for Child and Adolescent Psychiatry has online resources and tip sheets for families.
• The Child Mind Institute has excellent mental health information about various mental health conditions, including bipolar disorder, major depressive disorders, eating disorders, drug use, and substance use disorders.
• The National Institute of Mental Health has many educational resources available as well as a list of treatment options.

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If your teen is experiencing suicidal thoughts or self-harm, call the National Suicide Prevention Lifeline at 1-800-273-8255 or visit the nearest emergency room.