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A closer look at the declining mental health of kids

SARAH MCCAMMON, HOST:

If you're a parent or a caregiver or someone with kids in your life, you've probably been hearing some concerning news about the state of young people today. And a warning for our listeners - this conversation includes a discussion of serious mental health issues.

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UNIDENTIFIED NEWSCASTER #1: The U.S. surgeon general has called it an urgent public health crisis, a devastating decline in the mental health of kids across the country.

MCCAMMON: Kids and adolescents are struggling with depression and anxiety.

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UNIDENTIFIED NEWSCASTER #1: According to the CDC, the rates of suicide, self-harm, anxiety and depression are up among adolescents.

MCCAMMON: With their schoolwork.

UNIDENTIFIED NEWSCASTER #2: Report cards are in, and they show student test scores dropped to alarmingly low levels.

MCCAMMON: With social connections.

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UNIDENTIFIED NEWSCASTER #3: Tonight's health watch - when it comes to socializing, many children are having a hard time.

MCCAMMON: And with loneliness. A new advisory out this week from the U.S. Surgeon General, Dr. Vivek Murthy, has deemed loneliness a public health challenge that needs immediate attention. And it may surprise some to learn that loneliness is a big problem with young people. He spoke with NPR.

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VIVEK MURTHY: It turns out that 1 in 2 adults report measurable levels of loneliness, and the group that's actually most lonely in our population are actually young people, despite how connected they may be by technology. And I'm worried about this from a public health perspective because it turns out that being socially disconnected has real consequences for our health. It increases our risk of depression, anxiety and suicide, but it also increases the risk of cardiovascular disease, of dementia, stroke and premature death.

MCCAMMON: Study after study has raised alarms about the many ways kids have been affected by the COVID-19 pandemic, from loneliness to depression and anxiety to faltering grades. And those who track the well-being of young people say problems were emerging long before the pandemic. We've known for a while now that the kids are not all right. The information is troubling, and lately, there's been a lot of information.

In a recent episode of our podcast Consider This, we spoke to an expert about why it is an especially difficult time to be a kid right now. Lisa Damour is a psychologist and the author of the book "The Emotional Lives Of Teenagers: Raising Connected, Capable And Compassionate Adolescents." We asked her to help us understand the big picture, and she started on a positive note.

LISA DAMOUR: What I can tell you is that a lot of kids are functioning really well. They look like teenagers before the pandemic. They are thriving. They are living their lives in healthy and forward-looking ways. We are also seeing teenagers who are still suffering as a result of the pandemic or suffering as a result of things subsequent to the pandemic, or they were struggling before the pandemic, and the pandemic made it worse. The other thing we are seeing now is a much higher rate of teenagers who don't go to school on a regular basis. Across the board, we are hearing from schools that - you know, they call it a lot of different things - truancy or school absenteeism or school avoidance - that those rates are higher than anyone remembers historically.

MCCAMMON: And do researchers - do you think that that is a pandemic effect, or is there something more going on?

DAMOUR: I think our sense is that's a result of the pandemic, that one of the things we know to be true is that avoidance feeds anxiety. And kids were out of school for a long time. And so a lot of them became anxious about returning to school. And when kids don't go routinely, they fall out of the loop socially. They fall out of the loop academically, and it makes it that much harder to go back to school.

MCCAMMON: And you said initially some kids are doing OK. Some seem almost like the pandemic never happened. Others are struggling more. I mean, what makes the difference? Who's the most affected by all this?

DAMOUR: Well, when we look at the data, we do know, unsurprisingly, but very upsetting, that teenagers who were suffering or marginalized prior to the pandemic definitely bore the brunt of the negative emotional impact of the pandemic. So minoritized groups, young people who were already having emotional difficulties were not in any way helped by the pandemic and, in fact, we seem to think quite a bit more harmed by the pandemic. In terms of the young people we see who seem to be on normal developmental trajectories, thriving, you know, they had some combination of maybe good luck in terms of what their schools could provide, you know, good fortune in terms of the kind of supports that they were able to enjoy during the pandemic. They may be, you know, kids who enjoyed quite a bit of privilege that protected them from the worst of the pandemic. But we're seeing it all. And I think it's important that we get used to the idea that this is going to be a complex story, that some kids continue to suffer quite a bit and other kids are thriving.

MCCAMMON: And in terms of really trying to understand what's going on, you know, one thing that stuck out to me is we're seeing these declines across several measures of wellbeing. We're talking about mental health, social connections, also school performance. Are there connections here between these different data points? I mean, is academic decline related to mental health and vice versa?

DAMOUR: We can definitely see those two traveling together. That part of what helps kids to feel good is feeling like they're succeeding. And so then if they're not succeeding, they're going to feel worse. And then, of course, the worse kids feel, the less likely they are to perform well academically or to feel like they have the energy that they need to do the kind of schoolwork they want to do. So it's not altogether surprising that we're going to see all of these things impacted at once. It's also the fact that there can be other factors that impact those same measures. So, for example, sleep - teenagers don't sleep nearly as much as they need to. Teenagers generally require about nine hours of sleep a night, very few are getting that. And reduced sleep time is, unsurprisingly, associated with worsened mental health, worsened academic performance. So we have to be really open minded when we're looking for causal explanations and open to the idea that there are things that we can do that really do help teenagers, and certainly whatever else is going on, protecting their sleep and making sure they're getting enough will almost always help. And it certainly never hurts.

MCCAMMON: When you talk about teens not getting enough sleep, you know, I'm a mom. I'm thinking about my kids on their phones, that constant battle for so many parents. Is that the reason or is something else happening there?

DAMOUR: I think for a lot of kids, that's a reason. And I think that's one of the more negotiable things we can use here to impact how much sleep kids are getting is making sure that technology is not interfering with their sleep. But there are some kids who aren't sleeping enough because they have incredibly heavy academic demands that take up a lot of time. And there are some kids who aren't sleeping enough because they're working two jobs to try to support their family while also trying to go to school. So sleep is an interesting indicator because there's so many different things that can inform it. But it's also, I always think, a very good place to start, you know, to look at the question of what is interfering with a young person's sleep and then to look at what can be done to change that.

MCCAMMON: You talked to a lot of children for your work. What kinds of things are they saying about what they're feeling right now?

DAMOUR: You know, you hear a wide range of things. I will tell you something that is coming up more and more in my conversations is, you know, concerns about gun violence, kids talking about it, parents asking my advice about how to help their young person who's feeling very anxious about their safety in school settings or, you know, out in public and their worries about guns. So we know that these things weigh heavily on teenagers' minds. Climate change weighs heavily on their minds. So there's big social factors that kids are thinking about. They are very aware of political polarization. And they are very aware of very, you know, fraught discourse that goes on around them. And yet also - and this is why teenagers are so wonderful - they're worried about how they're going to make friends in college and, you know, if they're going to be able to find a date to the dance. You know, the same things that have always made adolescence complex, those are there too alongside bigger, very powerful and often negative factors that surround our teenagers.

MCCAMMON: You know, we heard from Dr. Vivek Murthy, and a lot of people might be surprised when he talks about how even though teens seem very connected online, there is a big problem with teen loneliness, a lot of those concerns you just mentioned about making friends. Social media is often kind of a boogeyman when it comes to what's harming kids these days. But where do you fall on that? What's behind the loneliness that kids are feeling?

DAMOUR: Well, social media may be a factor. And one of the things that we are getting a clearer picture on is that social media tends to amplify whatever that young person is experiencing in real life. So for teenagers who have good, rich friendships, those often carry over to how they are interacting on social media, and they're enhancing those relationships. For teenagers who feel isolated, their interactions on social media can make them feel worse. They can scroll and scroll and feel left out, or they might engage in, you know, conflict online. But, you know, Dr. Murthy did such - you know, an incredible service to call our attention to loneliness and social isolation. And in the excellent new advisory that came out, one of the things that's pointed out is that the starkest decline of in-person activity was actually for people ages 15 to 24. He reports a 70% drop over two decades in terms of in-person time spent by, you know, teenagers and young adults.

MCCAMMON: And what about these other trends, the academic declines we're seeing? How do we - what are some solutions for that?

DAMOUR: Well, I think we shouldn't be shocked that having school be massively disrupted by a global pandemic is going to have an impact on academic functioning. So I think it's to be expected. I think what's key is to focus on talking about it in terms of delay as opposed to loss. And I think sometimes the loss narrative can be pretty grim, hard for kids to hear, and leave adults feeling helpless. Whereas if we talk about it in terms of delay and trying to shore up delays, I think that creates an opening for thinking about how we get kids back on track.

MCCAMMON: Now, we think and talk so much about the impact of the pandemic for, you know, obvious reasons. But I wonder, you know, have these declines - are these really new? What's been going on with kids for the past 5 or 10 years, if you look back further?

DAMOUR: Yeah, they're not new, actually. The CDC has been tracking adolescent mental health for decades. And starting in about 2010, we were seeing rising rates of depression and anxiety. Now, unsurprisingly, that was accelerated by the pandemic, but it's not the case that these are all new findings or all new concerns. We've been worrying about teenagers for a while now.

MCCAMMON: You know, we're seeing this data about young people experiencing spikes in anxiety and depression. And I can't help but wonder, is - are those problems getting worse? Or are we just better at talking about them? Or is it some combination?

DAMOUR: We do try, in the methodologies, to account for, you know, how comfortable any given group of young people is with reporting how they're feeling. And - because people do ask that question. Is it just that kids talk about depression and anxiety more and so we're hearing about it more? And the methodologies we have really do try to control for that, which is to say, no, we really think it's worse. It's not just that kids are talking about it more. We do think that we're seeing higher rates of depression and anxiety. And we have things we can point to, pre-pandemic.

In 2018, the American Psychological Association put out a report on stress in America. And what they found was that Generation Z - so 15- to 21-year-olds, roughly, that they were looking at - reported that they, far more than older people, worry about things like climate change and gun violence and political polarization. So young people do have things that weigh on them that are new and also that weigh on them more, it seems, than they do on adults.

MCCAMMON: As you look at the research such as it exists, has this happened before? Have there been other tough periods in history, farther back, when American children and teens were especially struggling?

DAMOUR: I don't know that we have apples-to-apples data that we can look at to answer that question. But it certainly - of course, we can say historically, I mean, teenagers have been through world wars. They've been through the Cold War. I think the thing that is different that we need to take seriously is that those of us who grew up in the Cold War, if we thought about it and were paying very close attention to the news as much, as we could think about it would be the morning paper in the evening news, if we were even plugged into those. And I do think it is different, for all of us and especially teenagers, that there is a 24-hour ticker of bad news about what is happening in the world to which we all have constant access.

MCCAMMON: Right.

DAMOUR: And so I think it's very hard to tease apart, is it that things are so much worse? Or is it that it's impossible not to think about or know about what isn't working well in our society right now?

MCCAMMON: What is at stake here for the long term?

DAMOUR: Well, what's at stake is that people are suffering, and human suffering, under any condition, is something that we should work to prevent and ease. But also, what's at stake is that we want young people to thrive, and we want them to thrive both for themselves and also because they are the ones who are moving up into the workplace. They are moving up into adult roles in society. And so it really matters that we take seriously adolescent mental health - their need for connection, their need for meaning, their need to feel purposeful - because that both will help them to thrive in the short term, and it also helps to create the kind of adults that we want in our society.

MCCAMMON: I know we've talked a lot about the concerns here. And I know, as parents, we all want to address the concerns head-on to help our kids. But I wonder, are there things, when you talk to kids today, that - things that you look out, sort of over the landscape - are there things that give you hope?

DAMOUR: Well, yeah. I mean, I think teenagers are fascinating because they are just so vibrant, and they're so growth-oriented. And I think that's as true of teenagers today as it ever was. Another thing that gives me hope, though, just besides the nature of adolescents themselves, is that we have studied adolescent mental health for decades. And what we know is that the single most powerful force for adolescent mental health is strong relationships with caring adults. And I think we need to really lean into that, that we need to make sure that every teenager is connected to an adult who has their back, and that that teenager feels really gets and cares for them. And so this is something we can all do. You don't have to be the parent. You can be the boss or the mentor or the neighbor or the uncle who is making sure that they have created a working and powerful connection with a teenager in your life. And I think that we can find our way through.

MCCAMMON: Lisa Damour is a clinical psychologist and the author of "The Emotional Lives of Teenagers: Raising Connected, Capable, And Compassionate Adolescents." Thank you so much for your time.

DAMOUR: You're welcome.

MCCAMMON: If you or someone you know may be considering suicide or is in crisis, please call or text 988 to reach the Suicide & Crisis Lifeline. Transcript provided by NPR, Copyright NPR.