M E N TA L H E A LT H

Teens are talking about mental health

High schoolers’ stories give a glimpse into the national crisis

T
he prevalence of mental health issues is hard to
measure, but federal data show how widespread According to the Centers for Disease
the challenges are. The Centers for Disease Control and Prevention, in 2021:
Control and Prevention (CDC) said we need to address ɠ 36% of high school students perceived or experienced
threats to mental health in young people—especially racism before or during the pandemic
adolescents. • Asian (non-Hispanic): 64%
More than one third (37%) of high schoolers in the • Black (non-Hispanic): 55%
United States reported experiencing poor mental health
• Multiracial (non-Hispanic): 55%
during the COVID-19 pandemic, according to a 2021
• Hispanic or Latino: 42%
CDC study. Almost half (44%) of high schoolers reported
• American Indian/Alaska Native (non-Hispanic): 27%
feeling persistently sad or hopeless in the last year. Some
of these feelings were also linked to experiences of • Native Hawaiian/Pacific Islander (non-Hispanic): 55%
racism, social stigma around gender and sexual identity, • White (non-Hispanic): 23%
and sexual violence. ɠ 18% of female high schoolers and 5% of male high
Studies like these can help shed light on issues schoolers experienced sexual violence
that teens may be hesitant or unable to discuss with • Up from 15% and 4%, respectively, in 2017
parents, doctors, and school staff.
ɠ 57% of female high schoolers and 29% of male high
Stigma and a lack of information or access to care also
schoolers had persistent feelings of sadness or
keep many teens from getting help. But sharing personal
hopelessness
stories about mental health can offer encouragement
and connection. This can help teens feel like they are • Up from 41% and 21%, respectively, in 2017
not alone. That’s why NIH asked high schoolers to ɠ 69% of lesbian, gay, bisexual, and questioning (LGBQ+)
describe these challenges in their own words for the high schoolers* and 35% of heterosexual students had
2022 Speaking Up About Mental Health! essay contest. persistent feelings of sadness or hopelessness
• 14% of LGBQ+ high schoolers and 7% of heterosexual
students did not go to school because of safety
FAST FACT concerns

In 2018–2019, among adolescents in the

*Although this data set did not account for gender identity, previous research
has shown that transgender youth experience more stigma and are more

United States ages 12 to 17, 15.1% had likely to have more suicidal thoughts or behaviors compared to their peers.
IMAG E CREDITS: G ET T Y IMAGES

a major depressive episode.

SOURCES: Centers for Disease Control and Prevention; Morbidity and
Mortality Weekly Report Supplement, Vol. 71, No. 3; CDC report shows
concerning increases in sadness and exposure to violence among teen girls
SOURCE: CENTERS FOR DISEASE CONTROL AND PREVENTION and LGBQ+ youth; LGBQ+ Teens

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“I was also having issues “That young, fragile boy

with my friendships at seemed so mentally
school and an increased strong. He knew how to
level of stress when it came get out, how to solve
time for tests, projects, problems … I now realize
and other assessments … that a teenager’s plights
the feeling of isolation, lack and a child’s plights are
of appetite, and absolute usually very different.”
hatred of school were
not normal.” — Melvin, Massachusetts

— Morgan, New Jersey

The contest was sponsored by the National Institute of “Young people who are feeling overwhelmed or are not
Mental Health (NIMH), the National Institute on Minority sure how to cope with emotions may be more likely to
Health and Health Disparities (NIMHD), and the Eunice use substances to kind of help with that,” Dr. Mendelson
Kennedy Shriver National Institute of Child Health and said. Such substances could include alcohol, tobacco, or
Human Development (NICHD). They wanted to start prescription or illicit drugs.
conversations around youth mental health and highlight Puberty is also when many young people become more
different aspects of this national health crisis. aware of their sexual orientations and gender identities.
In their essays, many students talked about feeling lost, For some, this can lead to being unaccepted or bullied.
embarrassed, or frustrated by their mental health struggles. Rates of substance use and misuse also tend to increase
Others wrote about going from being confident in early during puberty.
childhood to feeling alone or unseen in adolescence. In addition to navigating the typical stressors that
NIH-funded researcher Tamar Mendelson, M.A., Ph.D., teens face, they've recently had to cope with the
Bloomberg Professor of American Health and Director for COVID-19 pandemic and related family losses or
the Center for Adolescent Health at the Johns Hopkins financial struggles. They’ve experienced or witnessed
Bloomberg School of Public Health, says that’s not racial- and identity-based discrimination, gun violence,
surprising. Depression rates tend to increase around puberty, political unrest, natural disasters, and climate change.
especially among girls but also in boys. Dr. Mendelson said These challenges, coupled with other risk factors,
this can be caused by a combination of hormonal changes, including some parenting styles, can lead to mental
new social relationships, and new pressures from academic, health issues such as anxiety and depression.
athletic, and other activities.
IMAG E CREDITS: NATI ON AL I NSTI TUTE ON MI NORI T Y HEALTH AND HEALTH D ISPA RITIES

“Since I started high “For many Asian American

school in an LGBTQ- youths, getting help for mental
accepting school where health can be hindered by
LGBTQ issues are stereotypes. Asian American
discussed and anti- boys, in particular, may not seek
discrimination measures therapy since their cultures
are taken, my depression expect them to be more resilient
has decreased than girls. After all, as the older
significantly.” brother, how can I let my little
sister know when I am not
— Leila, Ohio feeling well emotionally?”

— Evan, Texas

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“By changing the way “After [my cousin’s]

eating disorders are diagnosis, he was
taught in all school subjected to ever-changing
levels, it is possible to medications until they
change the false found one that numbed his
assumptions the emotions while still
public often has allowing him to function.
about individuals Finding the right therapist
who struggle with required being put on
eating disorders.” multiple waitlists, and
several therapists didn’t
— Evelyn, Virginia accept insurance.”

— Rohan, California

Even though environmental triggers have changed But digital tools can connect youth to information about
over time, adolescent anxiety was rising even before their mental health. For example, Dr. Ybarra said, the
the pandemic. rise of telehealth and teletherapy since the pandemic has
Michele Ybarra, Ph.D., an adjunct professor of mental helped increase access for some.
health at the Johns Hopkins Bloomberg School of Public Dr. Ybarra said that while technology (including social
Health as well as an NIH-supported researcher, said that media) can have both positive and negative effects on
not long ago, it was widely believed that youth could mental health, it can also be a force for good. The nature
not have depression because people thought, “What do of relationships has changed in the internet age, and
[they] have to be depressed about?” connecting online is natural for adolescents. Options like
But in the last several decades, Dr. Ybarra said, mental crisis lines or online therapy can get help to teens quickly.
health professionals have realized that depression can Multiple students said when they could not find
happen to anyone at any age. resources from their schools or communities, they
Several students wrote about schools with limited, started their own. Some also said their experiences have
outdated, or no education on the topic. Some said they inspired them to study mental health and treatments
could not speak to a therapist or school counselor when after high school.
they needed to. One student said they began volunteering for a teen
The issue is worse for students in rural areas, in crisis hotline after a relative used the same service for help.
schools with limited financial resources, or who need The student also joined a youth advisory group for their
culturally appropriate care such as bilingual mental state governor’s office and offered help as a peer-to-peer
health information. counselor at their school.

IMAG E CREDITS: NATI ON AL I NSTI TUTE ON MI NORI T Y HEALTH AND HEALTH D ISPA RITIES
“Why was I so desperate for an “Schools are places where
escape that I was considering students should feel safe
ending my own life? I messaged and comfortable enough to
some friends on Discord* about ask for help. By using
what was going on, and they simple technology and
immediately directed me to the dedicating time toward
suicide hotline. Finally, I talked impactful mental health
with someone on the phone for a screening, schools can truly
solid 40 minutes, coming up with serve students and assist
a plan on what to do and services them in living happier,
that could help.” healthier lives.”

— Sydney, Minnesota — Huda, North Carolina

*Discord is a digital chat platform where friends and community groups with shared interests can communicate on private or public channels via text, video, or voice call.

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NIH-SUPPORTED RESEARCH ON
If you think a teen is experiencing a mental health ADOLESCENT MENTAL HEALTH
crisis, the 988 Suicide & Crisis Lifeline Greater Engagement in Gender-Sexuality
Alliances (GSAs) and GSA Characteristics
is a national, 24/7 hotline that can connect Predict Youth Empowerment and Reduced
you with a trained crisis counselor by phone Mental Health Concerns

or online chat. TTY users can contact the This study, supported by NIMHD, focused on
the connections between sexual and gender
Lifeline via their preferred relay service minority youth’s involvement in extracurricular
or by dialing 711, then 988. activities and their mental health. Researchers
focused on gender-sexuality alliances (also
sometimes called gay-straight alliances), which
are school-based clubs to bring young people
“My passion towards becoming a researcher on
together to discuss shared issues or interests.
psychiatric disorders is stronger than ever,” they wrote.
Learn more about this study.
The way people talk about mental illness could also
be better, one student wrote. They preferred the phrase Understanding Bystanders for Self-Directed
“living” with a mental illness rather than “suffering” from Violence Prevention: A Prospective National
one. This small change in language signals it’s possible for Study Highlighting Marginalized Youth and
Young Adults
people with such conditions to live happy and fulfilling
lives. This student also said their own school began Self-directed violence refers to anything a person
marking mental health-related absences as excused does intentionally that can cause injury or death
to themselves. This study will examine the
and holding an annual mental health week to encourage
effectiveness of programs that train youth to be
open conversation.
“active bystanders” and help those in danger of
It’s too early to tell what the long-term effects of the past self-directed violence. Researchers will survey
few years will have on youth mental health. But Dr. Ybarra approximately 5,000 participants ages 13 to 22,
said some teens have become more resilient since the recruited via social media, about the impacts of
pandemic began. these bystander training programs in real-world
“I don’t think this generation is doomed in any way,” situations. Read more about this study.
she said. “Several kids have said [the pandemic] really
Strategic Framework for Addressing Youth
gave them the time to better understand themselves, Mental Health Disparities
they better understand their sexuality … Other kids took
This plan outlines research studies and other
on new hobbies, and they learned how to do new things.
activities by NIMH, NICHD, and NIMHD to
Maybe they gave themselves permission to not talk to that reduce mental health disparities among
toxic person in their lives.” While there’s no denying the underserved and underrepresented youth by
pandemic has been a stressful experience, Dr. Ybarra’s 2031. Some of the plan’s goals are to develop
impression is that most teens have come out on the culturally appropriate mental health interventions
other side with a new perspective and ability to thrive. for youth and parents and to research co-occurring
“This is good news. It also means that we need to be mental illness among young people in groups
diligent about identifying teens who continue to struggle that have been marginalized. Read more about
IMAG E CREDITS: G ET T Y IMAGES

and connect them to services,” she said. T the framework.

Volume 18, Issue 2 magazine.medlineplus. gov 35