According to a recently released report in the Journal of the American Medical Association (JAMA), U.S. suicide rates have been climbing, with a 30% increase from 2000 to 2016 for all age groups. In this report, researchers expressed particular concern for adolescents due to increases in their social media use, anxiety, depression, and self-inflicted injuries. In a sense, it might not be so surprising. To have even a passing awareness of the modern day news cycle is to have been met with a barrage of fears about the future—whether it be about economic inequality and hardship, climate change, the rise of authoritarianism, or the way technology is isolating today’s youth. A 2019 Gallup poll found that sadness, anger, and fear have risen for the second consecutive year around the world.
However, it is also true that we’ve experienced a burgeoning of resources, the highest education rates ever in the country’s history, and an overall decreasing violent crime rate. The same innovations that are said to be isolating also allow us to express ourselves, connect with others around the world, and stay informed. Steven Pinker, a professor of psychology at Harvard University, showed that despite the bleak worldview of the 24/7 news cycle, many metrics reveal that we are living in the most peaceful time in human history.
Thus, there are two contrasting narratives. We are battling increasing loneliness, despair, and addiction, in a world that is more interconnected and prosperous than ever before. From my conversations with educators and parents all throughout the country, youth mental health is becoming one of the top pressing issues. How are we to understand this discrepancy—shouldn’t mental health rise with other indicators of well-being?
When we look at the latest youth mental health research, we see some concerning trends. The most recent report from the CDC noted a 76% increase in the suicide rate between youth 15–19 between 2007 to 2017. In addition, the rates of major depressive episodes in youth aged 12–17 increased 52% from 2005–2017. There is also an increases of young people using psychotropic medications such as antidepressants and antipsychotic drugs, as well as psychotherapy. Additionally, 46% of Americans report sometimes or always feeling alone, with younger generations, particularly Gen Z and Millennials, more likely to feel lonely than older ones. Other researchers raise concern about the near-constant amount of time youth spend online and the connections they have found between high amounts of screen time and depression, lower psychological well-being, and even increased youth suicide rates.
I believe that there are explanations behind the surface of these surprising numbers. The first is the reduction of social stigma in reporting mental health challenges. Though we have much work to do to continue the de-stigmatization of mental illness, discussions of mental illnesses in the public sphere have become more educational and informative, which can combat misinformation and fear. More people than ever are eager to recommend seeking help from mental health professionals than in the previous quarter century. In this same vein, families and doctors may now be more willing to label death by suicide, instead of providing a different reason for death to shield the family’s privacy.
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Secondly, inclusion criteria of different disorders have expanded, possibly leading to increased diagnoses. For example, the controversial removal of a “bereavement exclusion” in the DSM-5 worried me and others in the field, with the concern that people experiencing loss would become more likely to be diagnosed with major depressive disorder instead of viewing their condition as a normal and often lengthy process of mourning. Finally, both increases in the availability of drugs for depression, anxiety, and ADHD, and diagnoses of conditions like autism or bipolar disorder, also contribute to these increases in young people. Whenever treatments become available, mental health professionals also are more likely to diagnose accordingly. That is not an indicator of increased numbers of people suffering from a given disorder compared to the past, but rather a sign of more people receiving the label and the related medications or treatments.
From my perspective, the increases of disorders could also stem from a “societal cleansing” process, in which people open their closets to share their pain. Moreover, I believe that the medicalization of human suffering has considerably increased the numbers of mental health disorders. For example, what used to be under the purview of the church—the experience of grief, guilt, and existential anxiety—has been secularized in a mental health field that is entirely overwhelmed by the influx of potential patients and clients.
But are the factors I’ve just outlined enough to account for the reported increases in despair, depression, anxiety, and suicidality in youth? Unfortunately, I believe that we are witnessing real increases, though most likely not as dramatic as reported in the media. Much of the compelling evidence comes from the study of different age groups over time, known as time-lag cohort studies. For example, a study could compare the outcomes of 13–14-year-olds surveyed between 2000–2004 with youth who were 13–14-years-old between 2005–2009.
One particular annual study of U.S. adolescents found that all suicide-related outcomes in 13–18-year-olds increased by 12% between 2009 and 2015, and deaths by suicide in particular rose by 31% in that time frame. Depressive symptoms also increased by 33% from the 2009 adolescent group to the 2015 one. Another recent study by the same researchers using a similar methodology found that the completed suicide rates of all ages increased from 2008 to 2017, with the largest percentage differences observed in 18–19-year-olds and 20–21-year-olds with increases by 56% and 35%, respectively.
It is true that we cannot control for all the possible explanations mentioned before. But whatever the reasons are, the objective numbers and the fact that many studies are finding the same trends using very different measures (self-report, structured clinical interviews, mortality files, and more) gives us some sense that the mental health rates are in fact going up. This is extremely concerning, as serious mental health issues in youth—particularly suicide—create large cascading effects of trauma and despair within the communities that they affect.
Despite these daunting statistics, I share a certain optimism with Steven Pinker. Even within these unsettling numbers, the population at large is more aware of the obstacles to thriving and well-being. The suffering is real, and if large numbers of a population are chronically struggling with depressive and anxious feelings and disorders we cannot say that “things are better” now than they were before. Instead, we have to understand the causes of the misery, whether they are related to technological transformations, social isolation, financial insecurities, social fragmentation, availability of drugs, or a general sense of dystopia.
We need a collective response to the avalanche of psychological symptoms and syndromes, to the pain and suffering. I will address this question in a follow up blog.