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March 24, 2022

What's driving the 'mental-health crisis' among young Americans?

Daily Briefing

    Writing for the New York Times Magazine, Kim Tingley explains how researchers and public health experts are thinking about—and responding to—the rise of the "mental-health crisis" among young people in the United States.

    Radio Advisory episode: Seattle Children's approach to behavioral health

    The rise of mental health struggles among young people in the United States

    In December 2021, Surgeon General Vivek Murthy highlighted a "mental-health crisis" among children and teens in the United States—a problem he said began before the Covid-19 pandemic disrupted everyday life. 

    For instance, according to CDC, between 2013 and 2019, ADHD and anxiety were the most common mental health conditions affecting young people ages three to 17, which each disorder affecting roughly one in 11 children. In addition, more than one in five 12- to 17-year-olds reported having a major depressive episode.

    However, in 2019, CDC said fewer than 15% of children between the ages of five and 17 had received some form of mental health treatment.

    And while experts agree that the Covid-19 pandemic has exacerbated this mental health crisis among young people, they do not believe it is the root cause, Tingley reports.

    "Pre-Covid we had a mental-health crisis," said John Walkup, chair of the psychiatry and behavioral-health department at Lurie Children's Hospital of Chicago. "The biggest misconception is that Covid makes people mentally ill. From my point of view, Covid unmasked people who have underlying vulnerabilities."

    Covid-19: A new stressor

    Last month, CDC reported a marked increase in cases of tics among adolescent girls based on ED data—a trend initially observed in six case studies published in June 2021 focusing on girls who presented with tics after watching TikTok videos of tics. As of January 2022, the number of ED visits for tics almost tripled during the pandemic among girls ages 12 to 17. In addition, visits for eating disorders doubled, and visits related to anxiety, stress, trauma, and obsessive-compulsive disorders increased as well.

    If these tics are—as many experts believe—the result of mirroring behavior observed online, they could be an unintentional way of trying to connect during what for many has been a period of loneliness amid the pandemic and associated periods of social isolation, Tingley writes.

    "With the social isolation and lack of social connection, I think [the pandemic] hit girls harder than boys," said John Piacentini, an expert in tic disorders and director of the Child Anxiety Resilience Education Support Center at the University of California, Los Angeles. "Girls tend to socialize in different ways."

    "I think it's a little beyond their control," Piacentini adds. "I don't think most kids are doing this for attention."

    But adolescent girls are not the only young people affected by the pandemic, Tingley writes. According to Lakshmi Radhakrishnan, a health scientist at CDC and author of the agency's mental health study, "equally striking" as the rise in mental health visits among young girls is the clear—but less widely discussed—decline in mental health visits among young boys.

    However, unfortunately, the surveys that track mental health in children cannot capture swift changes, making it difficult to determine the answers to questions like, "Why do girls appear to be struggling? Are boys faring better? Or are their problems more likely to be overlooked?" Tingley writes. 

    And what mental health surveys have been conducted have predominately focused on how adults have fared amid the pandemic. "A lot of times kids aren't the first in line," said Daniel Dickstein, the associate chief and director of research at McLean Hospital's child and adolescent psychiatry division.

    How to move forward

    According to Dickstein, if more children were able to receive adequate mental health care early on, fewer would end up in the ED. And according to Radhakrishnan, the CDC insights pulled from ED data may help raise awareness about these mental health issues among young people—prompting earlier action down the line.

    But experts also cautioned that because this mental health crisis predates Covid-19, people should not expect that the trend will reverse once schools reopen, mask mandates fall away, and things go back to "'normal,'" Tingley writes. In fact, Lisa Fortuna, the UCSF chief of psychiatry at Zuckerberg San Francisco General Hospital, said these changes may actually exacerbate mental health issues among young people—particularly for young people who lost a parent or guardian amid the pandemic. 

    To reach out to young people proactively, Anita Everett, director of the Center for Mental Health Services at the Substance Abuse and Mental Health Services Administration, said she would "encourage parents to talk to kids and ask them" about their mental health, including whether they feel sad or are experiencing suicidal ideation.

    Ultimately, Tingley writes, "[o]pening a dialogue with children about how they are feeling and listening without judgment are critical"—and no one should assume that simply ignoring the issue will make it go away.

    "Some sort of path forward is important," Everett added. (Tingley, New York Times Magazine, 3/23)

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