On a special episode of the 5 Things podcast: The teen mental health crisis is now urgent. The US Surgeon General recently called kids’ declining mental health the “defining public health crisis of our time.” As another school year gets underway, we ask, how do we protect our kids? Dr. Lisa Damour, host of the popular “Ask Lisa” podcast which gives guidance to parents raising teens, joins us to discuss the alarming increase in rates of anxiety and depression among youth and adolescents across the country.

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Dana Taylor:

Hello and welcome to 5 Things. I'm Dana Taylor. Today is Thursday, September 14th, 2023, and this is a special episode of 5 Things.

Every generation of teens grapples with its own set of unique issues, but today's young people have been dealt a triple whammy. School shootings continue to skyrocket, bullying on social media has exploded and then there were all of the challenges that came with the pandemic. Rates of anxiety and depression among young people and adolescents have reached record highs across the country. It's so bad the Surgeon General recently called, "Kids' declining mental health the defining public health crisis of our time." As another school year gets underway, we ask, "How do we protect our kids?"

Our guest, Dr. Lisa Damour, is the host of the popular Ask Lisa podcast, which gives guidance to parents raising teenagers. She's also the author of three New York Times bestsellers, including her latest, The Emotional Lives of Teenagers. Thank you for joining us, Dr. Damour.

Dr. Lisa Damour:

Thank you for having me. I'm honored to be with you.

Dana Taylor:

The Surgeon General's quote from this past June, calling kids' mental health, "The defining public health crisis of our time," is a shocking one. Do you agree with him?

Dr. Lisa Damour:

Well, given that it is what I care about more than anything in the world, which is the mental health of young people. I'm sad to agree with him, but very glad that it's on the table.

Dana Taylor:

Earlier this year the CDC published a survey that found that in the aftermath of the pandemic in 2021, 57% of high school girls reported persistent feelings of sadness or hopelessness in the past year, up more than 20% from 10 years earlier. It's nearly twice as high as males. They also found that roughly one in three high school girls in the US have seriously considered suicide. Are girls and young women more in danger? And if so, why?

Dr. Lisa Damour:

That is such an interesting set of results that came from the CDC that were released in February of this year. And as you mentioned, they were data collected in 2021, which puts us right in the middle of the pandemic for teenagers. And interestingly, the way the questions were posed, they asked about mood over the previous year. So, I was distressed, but not altogether surprised, to see that teenagers in great number, especially girls, were reporting feeling very, very distressed in the prior year. Girls reported higher rates of anxiety and depression.

This fits with what we've long observed in terms of gendered patterns of distress, that girls are more likely to suffer from what we call internalizing disorders, anxiety and depression, and other ways that they collapse in on themselves, whereas boys, when they're in distress are more likely to suffer from what we call externalizing disorders, being hard on the people around them, getting in trouble, acting out. Interestingly, those were self-report survey data. I think they gave us a very helpful, if alarming, picture of what was happening for girls. Self-report data don't tend to ask about externalizing disorders or externalizing symptoms.

If they were to ask, it would be questions like, "Is everybody annoying you?" Or, "Have you gotten in trouble a lot lately?" So, you can see why they don't necessarily lend themselves to the kinds of surveys we have right now. Those data are concerning. I would say, I'm not sure that self-report data are the best way for us yet to get a sense of what's happening for boys. And then as for the suicide question, obviously, that kind of huge numbers for suicidal ideation is very, very alarming. Very, very distressing.

And again, in the way these questions were asked, girls are out pacing boys quite significantly in suicidality. I worry terribly about the girls. I also worry about the boys, because when we actually look at suicide rates, boys outpace girls in suicide rates. So, girls may talk and think about suicide more, but we also know that boys, we use a terrible term, complete suicide more. So, this is to say we have a lot of alarming data and we may be better at detecting early signs of distress in girls than in boys. We want to make sure we're taking a good look at all teenagers and keeping a close eye on everyone.

Dana Taylor:

Well, sticking with data, also this year, the National Institutes of Health released a study. It showed that teen brains aged prematurely during the COVID-19 pandemic. On average, the brains of teens who went through 10 months of pandemic shutdowns aged three years. So, what impact did this premature aging have on their mental health?

Dr. Lisa Damour:

This is fascinating research and I'm so grateful for the team who collected these data. And what they found, in very specific terms, is a thickening in the amygdala and the hippocampus, which are parts of the brain associated with stress response and a thinning in the prefrontal cortex, which helps maintain perspective and helps to sort of govern the brain's reactivity. This is what we see under stress conditions when the brain is bathed in stress hormones. This is the kind of neurological changes we see in response to trauma or chronic stress. The pandemic was chronically stressful for teenagers. There's just no getting around that.

What I will say, thank goodness, is that one thing that's true about brains, and especially teenage brains, is that they are highly plastic, is the term we use, which is meaning they change and they keep changing. And so I don't want people to feel like the pandemic broke teenagers or even a teenager who really suffered from the pandemic and maybe even had neurological changes, that those are then now a factory setting, that nothing can be done about that. We know that with loving relationships and the opportunity to spread their wings and the possibility of making meaningful contributions to their community, teenagers grow and change even in the wake of very, very hard things.

Dana Taylor:

Guns have been the leading cause of death for kids 18 and younger two years in a row now. How can we help our teens process school shootings?

Dr. Lisa Damour:

I think we have to take seriously the mental health wear and tear of the ongoing possibility of a school shooting, much less actually experiencing one. In my clinical practice, I hear from teenagers all the time about this being an ongoing worry. It's something they think about every day or at least several times a week. And of course if they weren't thinking about it, then if there's a lockdown drill, they're thinking about it. And it also affects the adults around them. Teachers in school are thinking about the possibility of a school shooting. They are more anxious. They are feeling like they're supposed to be there to focus on learning and growth and actually delighting in the young people in their presence and instead, they often find their attention pulled away towards questions of, what would happen if someone came in the room right now with a gun?

Dana Taylor:

So what kind of destructive coping behaviors are we seeing in teens?

Dr. Lisa Damour:

Coping is really the thing we want to focus on. I always like to say, "The definition of mental health is not feeling good. It's having feelings that fit the situation and then handling them well." And what we want to see is healthy coping and what we don't want to see is unhealthy coping. So, to your question of what is the unhealthy coping we want to watch out for: we want to watch out for things like substance misuse, as a way to manage feelings. It works. If you feel really lousy and you get drunk, you will feel better. But over time it causes trouble. We want to watch out for problematic cell phone use, being up on a phone all night, having it intrude upon relationships or other things we're supposed to be doing. We want to watch out for teenagers who are hard on everybody around them or unduly hard on themselves. Those are the flags we want to watch for.

In terms of healthy coping, here's the kind of things you see in teenagers. They will sometimes want to talk about their feelings, but sometimes they'll want to watch a show they've seen before just to distract themselves for a little while. That's fine too. They may want to go for a run if they've had a really hard day and that's how they're going to cope. That's great. Crying is actually something psychologists really respect and find to be important. It relieves the central nervous system. It brings a sense of calm.

Dana Taylor:

What can you do if your child isn’t comfortable discussing their thoughts and feelings with you? How do you maintain a positive and open line of communication? 

That's the challenge, right? I think we love our teenagers so much. We know them. We can see sometimes that there's a whole universe of emotion happening within them, and then we say, "How are you? What's going on?" And we get, "Fine. Nothing's going on." And it's so painful as a parent or caregiver, but there's a few ways to think about this. One is, teenagers don't always want to have the conversation when we want to have the conversation. In fact, they usually don't want to have it when we want to have it, but they do often want to talk to us. So, I think a key thing for adults around teenagers is noticing their overtures, being available when they're in the mood to talk, even if it's late at night or by text. If they want to talk, we want to listen. We also have to respect that talking about feelings is just one way to get relief. It's one form of healthy coping. It's not going to be what every kid wants to do, or certainly all the time.

And so, standing back and admiring that a kid who's had a really, really hard day and who comes home and cuddles with the dog on the floor as a way to process that very hard day, is using a highly adaptive, no downside coping strategy that doesn't happen to involve telling us what went wrong that day.

Dana Taylor:

What can you do if your child isn’t comfortable discussing their thoughts and feelings with you? How do you maintain a positive and open line of communication? 

Dr. Lisa Damour:I think what we have to recognize is that it's always been hard to be a teenager. So, the first thing I would say to parents is, try to remember how intense this time felt when we were teenagers and then layer on top of that what it means to be a teenager today. What with alarming headlines and certainly a lot of concerns about gun violence, but also the wonders and the not so wonderful aspects of having constant access to everyone you know by way of the thing in your hand.

Here's the good news. We have studied adolescent mental health for decades, and what we know is that there's one thing that makes an enormous difference in terms of protecting teen mental health and its strong relationships with caring adults. So, we don't have to prevent all these stressors. We couldn't if we tried. Our job is to do our part to make sure that every teenager, whether it's your kid, someone else's kid, has a really caring adult in their life who wants to know how things are going for that teen, cares about where that kid is headed and is available as a resource to them.

Dana Taylor:

Let’s talk about bullying. According to the Boys and Girls Club of America, bullying has soared past pre-pandemic levels. In 20019 about a quarter of all kids experienced bullying. This year, it’s about 40%. Why has bullying gotten so bad and what can parents do about it? 

Dr. Lisa Damour:

It is worse, and I can tell you I'm seeing this clinically as well. So first, let's just make a distinction between conflict between kids and bullying, because they are very different and I think it's important for us to make sure we disentangle the two. So, conflict is just kids not getting along and there's always going to be conflict between kids. Bullying, which is on the rise, is when a young person is subject to mistreatment by another kid or a group of other kids and is unable to protect themselves. That's the key, that there's a power differential. So, we are seeing more of that. Now, why, we don't exactly know. But here's what I think: kids' social skills either didn't develop or became incredibly rusty in the pandemic, which is not too surprising, right? They were out of practice for a very long time.

And so they have come back together, having missed a lot of learning about how to handle disagreements, having missed a lot of learning about how to handle when somebody's rubbing you the wrong way, which of course if you put a whole bunch of kids in a building all day, every day, for a year, they're going to rub each other the wrong way. That's not something we can get around. And so, we have to do much more direct teaching with kids about how to handle conflict well, that they are allowed to dislike their peers, they're allowed to find other kids annoying, that's going to happen. But they can't be cruel, they can't be mean. If they need to say something, it has to be done with respect. We can hold them to those standards and teach that to them. The other thing, of course, is they're watching the adults. And if you look at the landscape around us in terms of how people are handling themselves sometime in the news, I can't say that adults are always offering the best example of what civil and respectful disagreement looks like.

Dana Taylor:

How does a teen's physical health contribute to their mental well-being?

Dr. Lisa Damour:

It's huge. In fact, the connection between disrupted sleep and mental health concerns in teens is extremely strong. And again, they can kind of feed each other. If a teenager becomes distressed, they may have more trouble sleeping, which can then exacerbate their distress. So, I would say, as the adults who are around teenagers, if we can prioritize sleep, there's no downside. It's all upside. It's not a substitute for therapy. But things like making sure that teen's getting enough sleep, making sure they're eating well and moving their bodies, giving them ways to make meaningful contributions, getting them signed up for activities that they care about. Those things actually go surprisingly far either in protecting mental health for teenagers or helping to shore it up when it is shaky.

Dana Taylor:

And finally, as you mentioned, teens weren’t the only ones who experienced depression and anxiety during the pandemic. How can a parent's mental wellbeing impact their child's mental health and what’s some advice you would offer? 

Dr. Lisa Damour:

So, what I would say to parents and caregivers who are listening, is that you should take good care of yourself. I want you to take good care of yourself. And you taking good care of yourself, whether that means getting enough sleep or asking for more help is not you being selfish, it's good for you and it's also good for your kid.

Dana Taylor:Thanks for your time, Dr. Damour.

Dr. Lisa Damour:

Thank you so much for having me.

Dana Taylor:

Thanks to Cherie Saunders for her production assistance. Our senior producer is Shannon Rae Green, and our executive producer is Laura Beatty. Let us know what you think of this episode by sending a note to [email protected]. Thanks for listening. I'm Dana Taylor. Taylor Wilson Will be back tomorrow morning with another episode of 5 Things.