Mental Health in Teens
It’s typical for teenagers to experience hormonal, peer and academic pressures. But when is it more than that?
As a high school art teacher who had been noticing, anecdotally but with alarm, increased instances of teen anxiety and depression, I conducted some of my own research and then sought out Anne Russell, a licensed clinical social worker and mental health program lead at CHKD, and Dr. Charles Parker of Parker, Schlichter & Associates and CoreBrain Journal, to get their take.
You’ve seen memes similar to this, yes?: “Welcome to being a parent of a teenager. Prepare for a large amount of eye rolling, emotional outbursts and thoughts of running away. And that’s just the parents.”
In all seriousness, everyone knows that teens can be moody and that situational anxiety is part of being a teenager with all of the typical hormonal, peer and academic pressures. But when is it more than that? When are signs of teen depression and anxiety legitimate, serious and potentially life-threatening healthcare concerns that merit treatment?
According to Anne Russell, LCSW, it can be challenging to sort out what is developmentally normal. “Life happens, and stress happens,” and teens will experience occasional anxiety. But when dark moods and anxiety “persist and worsen,” it is time for an intervention. Though we should never ignore symptoms such as emotional and behavioral changes, diagnosis is not based on symptoms alone but on symptoms in conjunction with impairments in the teen’s ability to function. When their symptoms “impact their day-to-day life,” treatment is warranted. “We can’t afford to ignore it,” asserts Russell. “We must be advocates.”
Psychiatrist Charles Parker adds that parents and caregivers should inquire about self-harm more often, prefacing their question with a phrase like, “Even though you wouldn’t do it ...” He feels such an inquiry is a parental responsibility when a teen shows symptoms of depression. But he cautions that thinking about it and thinking about actually doing something harmful to oneself are distinct, though both indicate the need for a professional mental health evaluation.
As a starting point in accessing appropriate treatment, Russell recommends an appointment with the teen’s pediatrician or primary care provider to first rule out medical issues. And she stresses that pursuit of mental wellness is nothing to be embarrassed about for the child or for the parent/caregiver, no more than a flu or a fever. Mental illness is not caused by character flaws or personal weakness. In fact, she insists that when parents pursue an appropriate path to mental health for their children, “they are modeling something healthy.”
With a diagnosis in hand, Russell emphasizes the importance of “evidence-based, research-supported treatment” and “best practice care,” which is an umbrella term for proven-superior activities, disciplines and methods for improving effectiveness and efficiency in healthcare. This may mean a variety of therapies. Cognitive Behavioral Therapy (CBT) seeks to challenge negative thought patterns that result in unwanted behaviors, while trauma-focused treatments address disorders arising from abuse, violence or grief. Family-based therapy, especially for anorexia, views family members as helpful and even necessary tools for recovery. Likely, teens with mental health diagnoses will require a team of collaborative supporters and trained professionals, including psychiatrists, psychologists and social workers, to help them maintain wellness.
Parker stresses that the mind is a complex system and that the best diagnoses and treatments take into account that biomedical and neurophysiological complexity to include counseling, medication, nutrition and exercise. “Treatment,” he asserts, should embrace the complexity “through multiple levels of therapy.”
Regarding anxiety, Parker cautions that there are two forms: cognitive and emotional or affective, though most attention is paid to the latter. The former is “in your head,” the latter “in the stomach and the chest,” to use layman’s terms. Cognitive anxiety deals with thinking, analyzing and executive function and can lead to affective anxiety. We, as humans, he explains, prefer our lives to be organized and sequential so we need to learn how to “reduce the abundant additional variables” in our lives and teach our kids the same. We tend to become overwhelmed by today’s many demands.
He underscores the importance of “limiting and focusing,” i.e. of helping teens—and ourselves—"seek improved organization by better self-management.” When a person is cognitively overwhelmed, “depression and anxiety intersect in the cognitive realm.”
CHKD is seeing increases in children and families seeking treatment for acute needs in the ER. Overall the number of males and females is evenly distributed across disorders, says Russell, except in the case of depression for which there is a higher number of females. This is possibly due, in part, to hormonal and biological causes. In general, though, it is difficult to suss out precise causes for depression and anxiety, though a combination of factors is likely to blame: biological, hormonal imbalances, environmental, cultural, societal—including social media—and psychological, such as abuse, neglect or the death of a caregiver.
Russell believes it is possible to prevent some instances of anxiety and depression. Within families, she stresses the importance of parents connecting with their children through “face-to-face quality time.” Teaching resiliency, self-control and more through positive parenting is another piece of the puzzle. Essentially, positive parenting is a relationship-based perspective that emphasizes empathy, respect and strong communication between parent and child.
She sees managing social media, which has become a large part of many teens’ social interaction as well as a significant part of family life, as part of that process. As with anything else, a healthy balance is key, e.g. limiting screen time, setting up “text-free zones” and teaching safe use of the internet. Social media can erode teens’ self-esteem, whether it be through comparison with others or even cyberbullying. Russell recommends teaching teens to use social media to learn healthy coping strategies, noting the availability of mindfulness apps as just one tool.
Not surprisingly, adverse childhood experiences, such as abuse or the incarceration of a caregiver, can lead to negative health outcomes. It could be argued that, as a community, we have a responsibility to do more in the area of prevention by way of high-quality parent training, domestic violence prevention and, overall, more social supports for parents.
The bottom line is that “there is hope and help available.” If cost is a factor, Russell insists that it is “always OK to ask for help” in the navigation of uncompensated care, Medicaid and access to resources. Nothing should prevent teens from sharing their concerns and adults from aggressively pursuing a diagnosis and appropriate treatment. People of any age with mental illness cannot simply “snap out of it.”
Recommended Online Resources
Conceptual rendering of planned mental health facility at CHKD
CHKD's growing Mental Health Program was established to bring excellence, innovation, accessibility and hope to mental health care and to empower every member of our community to assist our children with overcoming today's unprecedented mental health crisis. This website shares programs, services, information, links, resources and more offered by CHKD at its hospitals and many practice locations throughout Coastal Virginia.
Anne Russell’s bio outlines her immersion in mental healthcare for children and training for adults, beginning with undergraduate and graduate degrees from VCU. Her dominant clinical interests include trauma, parent training, child maltreatment and post-traumatic stress disorder.
An award-winning author, Dr. Parker has spent his 45-year career in psychiatry and psychopharmacology. In addition, his broad range of clinical experience includes psychoanalysis, substance abuse, SPECT neuroimaging and experience with systems/functional medicine and advanced biomedical assessments
This comprehensive site offers help through a wide range of articles, reports, resources, information and strategies. Media use has become a component of public health. This article offers families tips for healthy, safe and productive digital activity and even provides a template for creating a Family Media Plan that can be tailored to a family’s needs.
With the mission to reduce the impact of substance abuse and mental illness on America's communities, the Substance Abuse and Mental Health Services Administration website is broad-reaching. By typing in the search tab “mental illness in teens,” “depression in teens,” or whatever your topic of interest, you will find a range of reports, resources, information, strategies, webinars, podcasts and more.