Rise of mental health issues in children

In October 2021, health groups including the American Academy of Pediatrics (AAP) declared a national emergency in children's mental health. And a new study published by the AAP shows antidepressant use is on the rise in young people. Any parent hearing about the mental health crisis may wonder the best way to support their child. It's normal for everyone to feel sad or anxious once in a while. But when children and teens seem depressed or anxious for weeks, it may be time to seek professional help.

Before COVID‑19, mental health disorders in children and teens were already on the rise, and the pandemic added to pre-existing challenges that youth faced. According to the Department of Health & Human Services, high school students who reported persistent feelings of sadness or hopelessness increased by 40% between 2009 and 2019, to more than 1 in 3 students. A Centers for Disease Control and Prevention (CDC) survey of more than 7,000 teens in 2021 found 4 in 10 felt "persistently sad or hopeless," while 1 in 5 had contemplated suicide. Additionally, results from the CDC's 2021 Youth Risk Behavior Survey recently revealed more girls are experiencing unprecedented levels of hopelessness and suicidal thoughts.

While the statistics can feel disheartening, James Norcross, M.D., Division Director for Psychiatry Services at Children's Health℠ and Professor and Chief of Child and Adolescent Psychiatry at UT Southwestern, says we can consider the increased awareness of mental health in children as a step in the right direction.

"For a long time, the thought was only adults get depressed or anxious," says Dr. Norcross. "Now we know better. Kids can get anxious. Kids can get depressed. And I think we understand now that we need to pay attention to children's mental health in the same way we pay attention to their physical health."

Why are youth mental health disorders on the rise?

While it's hard to pinpoint one exact cause behind the pre-pandemic rise in mental health disorders in children and teens, several different factors may contribute, such as:

• Perceived pressure to excel at school, extracurricular activities and other responsibilities
• Stress of increasingly busy schedules
• Overuse of social media and/or negative impacts of social media apps or certain online sites
• Mental health stigma that prevents people from getting help
• Bullying or cyberbullying, which can be worse for certain groups of youth such as members of the LGBTQ community.

Over the past few years, the mental health effects of the COVID-19 pandemic added to these factors.

"The pandemic certainly added to the usual stressors kids already would have had," Dr. Norcross says. "Teenagers and kids were initially worried about getting sick with the virus – or that their parents or grandparents would get sick – which was anxiety-provoking. Teens lost the social support they had with their peers that they would have had at school. Doing classes online was more stressful without the support of a teacher nearby. All those factors added up to make the pandemic a particularly challenging time for children and teens."

What are warning signs of a mental health disorder?

It's normal for everyone to feel sad or anxious from time to time. But when children and teens seem depressed or anxious for weeks at a time, it may be time to seek professional help. "A major depressive episode includes sadness or loss of interest in activities for a period of at least two weeks," explains Dr. Norcross.

To identify depression or anxiety in children and teens, parents should look for warning signs, including the following:

• Changes in normal appetite patterns
• Changes in sleep routines
• Crying spells
• Loss of concentration
• Low energy
• Suicidal thinking or suicide attempts

If your child shares thoughts of suicide or makes a suicide attempt, seek emergency help right away. Use the other warning signs as a signal to talk with your children and teens about how they're feeling emotionally – and see if they'd like to talk with a professional counselor or therapist for additional help.

"The most important thing is just to ask your children, 'How are you doing?'" Dr. Norcross suggests. "You want to check in on them regularly. Let them know you love them and keep an open line of communication and solid support system in place."

What can parents do to help support their children's mental health?

Dr. Norcross encourages parents to support their children's mental health by incorporating these habits into their family's routine:

• Prioritize your own mental health as a parent. First, parents should make sure they take care of themselves – including carving out time for exercise or quiet time for recharging. "A parent that's functioning better will be able to provide better support for their kids," Dr. Norcross says.
• Establish and keep a normal routine. To help alleviate feelings of anxiety that can come with uncertainty, parents should also work to maintain a normal routine within the home. Keeping a consistent bedtime, dinnertime and homework window helps kids and teens feel more settled and in control of their daily schedules.
  
  "If the normal routine falls apart, it can send a message to kids that things are really out of control," Dr. Norcross says.
• Encourage open communication. Check in with your child regularly. It's also essential the lines of communication flow both ways. Parents should be open with their children and teens about their own feelings of worry or anxiety – to a point. "You want to do it in a way that's developmentally appropriate for the child," Dr. Norcross says. "You don't want to do it in a way that the parent comes across as hopeless or helpless. But it's important to be honest," he adds.
• Model healthy coping skills. When parents talk openly about their own feelings and the coping strategies they use to deal with them, children and teens learn it's normal to sometimes feel worried, angry or sad – and that they can take steps to work through those emotions.
  
  For example, parents can model positive coping strategies for dealing with feelings of anxiety or depression and include their children in these activities. This might include:
  • Setting up social meeting times with friends
  • Making time for exercise
  • Spending time in self-care activities such as a soothing bath, a favorite hobby or reading
  • Journaling
  • Getting outdoors
  • Talking with a mental health professional
  "Modeling positive coping behaviors can be a very powerful thing," Dr. Norcross says. "It helps signal to your children that you're available to help them figure out how to manage their feelings together."
• Notice and encourage healthy habits. Finally, when you see your child or teen making a positive choice to support their own mental health, praise them. "When you do that, they will feel a sense of confidence and competence that will help reinforce their use of those coping skills in the future," Dr. Norcross says.

Additionally, when needed, do not hesitate to seek professional mental health support. Just like you would see a doctor for any physical concern, it's important to normalize seeking emotional support when needed.

See more mental health resources

Find out more about Children's Health's mental health services and resources for children and teens and discover additional ways to support kids' mental and emotional well-being in our mental health library.