With teen mental health deteriorating over five years, there’s a likely culprit

pimchawee

Around 2012, something started going wrong in the lives of teens.

In just the five years between 2010 and 2015, the number of U.S. teens who felt useless and joyless – classic symptoms of depression – surged 33 percent in large national surveys. Teen suicide attempts increased 23 percent. Even more troubling, the number of 13- to 18-year-olds who committed suicide jumped 31 percent.

In a new paper published in Clinical Psychological Science, my colleagues and I found that the increases in depression, suicide attempts and suicide appeared among teens from every background – more privileged and less privileged, across all races and ethnicities and in every region of the country. All told, our analysis found that the generation of teens I call “iGen” – those born after 1995 – is much more likely to experience mental health issues than their millennial predecessors.

What happened so that so many more teens, in such a short period of time, would feel depressed, attempt suicide and commit suicide? After scouring several large surveys of teens for clues, I found that all of the possibilities traced back to a major change in teens’ lives: the sudden ascendance of the smartphone.

All signs point to the screen

Because the years between 2010 to 2015 were a period of steady economic growth and falling unemployment, it’s unlikely that economic malaise was a factor. Income inequality was (and still is) an issue, but it didn’t suddenly appear in the early 2010s: This gap between the rich and poor had been widening for decades. We found that the time teens spent on homework barely budged between 2010 and 2015, effectively ruling out academic pressure as a cause.

However, according to the Pew Research Center, smartphone ownership crossed the 50 percent threshold in late 2012 – right when teen depression and suicide began to increase. By 2015, 73 percent of teens had access to a smartphone.

Not only did smartphone use and depression increase in tandem, but time spent online was linked to mental health issues across two different data sets. We found that teens who spent five or more hours a day online were 71 percent more likely than those who spent less than an hour a day to have at least one suicide risk factor (depression, thinking about suicide, making a suicide plan or attempting suicide). Overall, suicide risk factors rose significantly after two or more hours a day of time online.

Of course, it’s possible that instead of time online causing depression, depression causes more time online. But three other studies show that is unlikely (at least, when viewed through social media use).

Two followed people over time, with both studies finding that spending more time on social media led to unhappiness, while unhappiness did not lead to more social media use. A third randomly assigned participants to give up Facebook for a week versus continuing their usual use. Those who avoided Facebook reported feeling less depressed at the end of the week.

The argument that depression might cause people to spend more time online doesn’t also explain why depression increased so suddenly after 2012. Under that scenario, more teens became depressed for an unknown reason and then started buying smartphones, which doesn’t seem too logical.

What’s lost when we’re plugged in

Even if online time doesn’t directly harm mental health, it could still adversely affect it in indirect ways, especially if time online crowds out time for other activities.

For example, while conducting research for my book on iGen, I found that teens now spend much less time interacting with their friends in person. Interacting with people face to face is one of the deepest wellsprings of human happiness; without it, our moods start to suffer and depression often follows. Feeling socially isolated is also one of the major risk factors for suicide. We found that teens who spent more time than average online and less time than average with friends in person were the most likely to be depressed. Since 2012, that’s what has occurred en masse: Teens have spent less time on activities known to benefit mental health (in-person social interaction) and more time on activities that may harm it (time online).

Teens are also sleeping less, and teens who spend more time on their phones are more likely to not be getting enough sleep. Not sleeping enough is a major risk factor for depression, so if smartphones are causing less sleep, that alone could explain why depression and suicide increased so suddenly.

Depression and suicide have many causes: Genetic predisposition, family environments, bullying and trauma can all play a role. Some teens would experience mental health problems no matter what era they lived in.

But some vulnerable teens who would otherwise not have had mental health issues may have slipped into depression due to too much screen time, not enough face-to-face social interaction, inadequate sleep or a combination of all three.

It might be argued that it’s too soon to recommend less screen time, given that the research isn’t completely definitive. However, the downside to limiting screen time – say, to two hours a day or less – is minimal. In contrast, the downside to doing nothing – given the possible consequences of depression and suicide – seems, to me, quite high.

It’s not too early to think about limiting screen time; let’s hope it’s not too late.

For Teens Knee-Deep In Negativity, Reframing Thoughts Can Help

NPR

Teen Negativity art

Jenn Liv for NPR

“Why didn’t she text me back yet? She doesn’t like me anymore!”

“There’s no way I’m trying out for the team. I suck at basketball”

“It’s not fair that I have a curfew!”

Sound familiar? Parents of tweens and teens often shrug off such anxious and gloomy thinking as normal irritability and moodiness — because it is. Still, the beginning of a new school year, with all of the required adjustments, is a good time to consider just how closely the habit of negative, exaggerated “self-talk” can affect academic and social success, self-esteem and happiness.

Psychological research shows that what we think can have a powerful influence on how we feel emotionally and physically, and on how we behave. Research also shows that our harmful thinking patterns can be changed.

You may not be of much help when it comes to sharpening your son’s calculus skills. But during my 35-plus years of clinical practice it’s become clear to me that parents can play a huge role in helping their children to develop a critical life skill: the ability to take notice of their thoughts, to step back and view the bigger picture, and to decide how to act based on that more realistic perspective.

Taking heed of an alarmist or pessimistic inner voice is a universal experience. It has survival value; it often protects people from danger. And it’s often true that a worrying thought can act as a motivating force – to study, for example.

Still, the insecurities that adolescents feel as they undergo the multiple transitions necessary in growing up make them especially vulnerable to believing the worst. This tendency can lead to chronic anxiety, depression and anger, and can interfere with relationships and success in school.

Helping children grasp the importance of thinking more realistically may help protect them later when they make the huge transition to college. A 2016 survey by the American College Health Association of undergraduates at over 50 colleges and universities found that about 38 percent had felt so depressed at some time during the previous year that it was tough to function. Some 60 percent had experienced an episode of debilitating anxiety.

The power of thoughts to affect feelings and behavior is a foundational principle of cognitive behavioral therapy, which is the form of therapy that I practice. CBT teaches people how to recognize faulty negative self-talk, to notice how it makes them feel and act, and to challenge it. Parents can practice this skill themselves, and act as models as they guide their kids to question a thought by looking at the evidence for and against it.

If your child often seems withdrawn, sad or angry, you may be able to identify a problematic thinking pattern by listening closely. Here are four key styles of negative self-talk to listen for:

Catastrophizing. One common thought habit is the tendency to jump to the worst-case scenario (“What if I fail the test? I’m never going to get into college!”) Scanning constantly for disaster ahead acts as a huge contributor to anxiety. And catastrophizing often leads teens to avoid people or become reluctant to try new things.

Zooming in on the negative. Ruminating on a disappointment without taking into account the many positive and neutral aspects of one’s experience is often associated with sadness and depression. A missed soccer goal might overshadow everything else that happens one day – the lunch with friends, the good grade on a test, the hilarious TV show – and consume your high-schooler for days.

It’s not fair! Interpreting every letdown as a grave injustice – the “it’s not fair!” habit – often underlies teens’ anger and can harm friendships and family relationships.

I can’t! Reacting habitually to difficult situations or to new opportunities with “I can’t,” rather than “I can try,” leads to helplessness. Changing the thought to “I can try!” encourages problem-solving and a willingness to be proactive, to take positive action — both keys to being successful and resilient.

For parents, the idea is not to squelch the negative thought. Research has found that attempted “thought stopping” can actually make the idea stickier. Rather, you want your child to face the thought, thoroughly examine it and replace it with a more realistic and helpful perspective.

Questions that you might pose to carefully weigh the evidence include: “You had a group of friends at your old school and at camp – realistically, what are the chances you can’t make friends now? What actions can you take to reach out? What would you say to somebody else who worries about this?”

A helpful replacement thought might be: “It probably will take a few weeks to get to know people, but I’ve made friends before and there are things I can try. I can sign up for the photography or robotics club and meet people that way.”

More realistic and balanced thinking leads to positive action, which, in turn, tends to bolster confidence, enhance self-esteem and result in greater happiness.

Mary K. Alvord, Ph.D., is a psychologist and director of Alvord, Baker & Associates, LLC, in Rockville, Md. She is the co-author of Conquer Negative Thinking for Teens: A Workbook to Break the Nine Thought Habits That Are Holding You Back, as well as the audio recording Relaxation and Self-Regulation Techniques for Children and Teens.

Depression Strikes Today’s Teen Girls Especially Hard

NPR

A new study suggests that teen girls experience more bouts of depression than teen boys.

Nicole Xu for NPR

It’s tough to be a teenager. Hormones kick in, peer pressures escalate and academic expectations loom large. Kids become more aware of their environment in the teen years — down the block and online. The whole mix of changes can increase stress, anxiety and the risk of depression among all teens, research has long shown.

But a recent study published in the journal Pediatrics suggests many more teenage girls in the U.S. may be experiencing major depressive episodes at this age than boys. And the numbers of teens affected took a particularly big jump after 2011, the scientists note, suggesting that the increasing dependence on social media by this age group may be exacerbating the problem.

Psychiatrist Ramin Mojtabai and colleagues at Johns Hopkins University Bloomberg School of Public Health wanted to know whether rates of depression among teens had increased over the past decade. They analyzed federal data from interviews with more than 172,000 adolescents. Between 2005 and 2014, the scientists found, rates of depression went up significantly — if extrapolated to all U.S. teens it would work out to about a half million more depressed teens. What’s more, three-fourths of those depressed teens in the study were girls.

The findings are just the latest in a steady stream of research showing that women of all ages experience higher rates of depression compared to men, says psychologist and author Catherine Steiner-Adair. And no wonder, she says — despite gains in employment, education and salary, women and girls are still “continually bombarded by media messages, dominant culture, humor and even political figures about how they look — no matter how smart, gifted, or passionate they are.”

Today’s constant online connections — via texting, Facebook, Instagram and Snapchat, — can exacerbate that harsh focus on looks and other judgments from peers, she says. The uptick in teen depression Mojtabai found after 2011 could be evidence of that.

Mojtabai says girls, in particular, “are more likely to use these new means of communication, so may be exposed to more cyberbullying or other negative effects of this latest social media.”

The effects can feel devastating, says Steiner-Adair.

“We know girls are very vulnerable to defining themselves in comparison to others,” she says. Her young female patients often tell her they get their “entire identity” from their phone, she says, constantly checking the number of “tags, likes, Instagram photos and Snapchat stories.”

Steiner-Adair urges schools to be proactive in trying to reduce teens’ feelings of being “left out” or judged. One tool, she says, might be a course in mindfulness — a form of meditation that has been shown to offer measurable health benefits and can help reduce anxiety and depression.

Such training can help teach kids that their brain “on tech” actually needs a rest, Steiner-Adair says. Mindfulness training teaches the value of solitude and can help practitioners calm the urge to constantly check the phone — a useful skill for people of all ages and gender.

Meanwhile, Mojtabai says, parents and family doctors, as well as teachers and school counselors, should be on the lookout for any behavioral changes in the teens they live and work with that might be signs of depression. Symptoms can include changes in sleep patterns, appetite or energy, or a growing inability to pay attention and concentrate.

Even just one counseling session to evaluate such symptoms, Mojtabai says, can help get teens back on the right track.