Youth and the Pandemic: A Mental Health Crisis

Our youth are struggling. The public health advisory issued recently by the U.S. Surgeon General sounds the alarm that we are in the midst of a youth mental health crisis that may rival the COVID-19 pandemic in its scope and long-term impact. The advisory confirms a trend we’ve been seeing at Caron: The pandemic created a “super storm” of teens and young adults experiencing anxiety and depression, combined with drugs, alcohol, and other risky behaviors, such as vaping.

In some ways, this shouldn’t be surprising. Not only have teens experienced the same pandemic-related stresses as everyone else, but as they are still in the process of forming core parts of their identities, the isolation and disruption of the pandemic affected teens and young adults in significant ways.

In fact, according to the advisory, the impact on youth has been profound. The incidence of depression and anxiety have doubled during the pandemic, with 25% of youth experiencing depressive symptoms and 20% experiencing anxiety. Even more troubling, there has been a noticeable increase in suicide and self-injury among adolescents and young adults. Since the beginning of the pandemic, there has been a significant increase in emergency room visits related to suicide attempts, some of which were impulsive and some of which were planned out.

More young males are also now self-harming. Where once they might have punched a wall or increased their risk-taking behaviors, they are now engaging in cutting or burning, behavior more commonly associated with females. At Caron, we’ve also noticed an increase in disordered eating patterns and body image concerns among males, as well as females. Young men, particularly, are engaging in extreme dieting or excessive exercise to manage the chaos in their world.

Driven by a need for control and stability

All this signals that youth are struggling with their sense of control. Part of the adolescent identity formation process is developing that sense of control, of both themselves and their environment. However, the pandemic has taught us how little control we truly have over many aspects of our lives. To put it plainly, the pandemic has taken away many aspects of life that helped teens feel normal.

If teens can’t have control over their larger circumstances, then what better way to assert themselves than by controlling how they meet their basic needs: Diet, sleep, and exercise?

Unfortunately, what might begin as an adaptive process – as they try to get back control – can turn into a maladaptive one. For example, they might use isolation to decrease their sense of anxiety. Over time, though, this may backfire by eroding the connection that they have with other people and increasing unhealthy coping behaviors.

Digital well-being

Parents are often concerned about their teen’s use of social media and electronic devices. Indeed, the increase seen in body image concerns, suicide, self injury, anxiety and depression almost mirrors the rise in use of social media. But there are a dozen other factors also at play, so it’s hard to place the blame entirely on social media.

This is a generation that has grown up digitally connected. They're one of the first generations to view virtual relationships in the same way as in-person relationships. One of the downsides to the pandemic, though, is that those virtual relationships were nearly all the social contact available to them for a significant period. When it came time to develop healthy, in-person relationships, they were lost. The isolation of the lockdown hit many of them hard.

We all need time away from our families to engage in the larger community. The interrelationship between the community, the individual and the family can be likened to a three-legged stool. If you remove one of the legs, the stool will no longer support you.

Young people get their primary means of socialization through school. And as stressful as school can be, it provides a sense of normalcy and a way to break away from the stress of being at home. During the height of the pandemic, it was unsafe for teens and even young adults to grow outside of the structure of the family. We need to teach kids to relate, play and communicate off-line so they can develop a healthy balance.

Teens, marijuana, and avoidance

Marijuana also continues to be an issue for teens and young adults.

Tragically, the use of marijuana among young people has grown exponentially as the perception of harm continues to decrease and the misperception that it possesses far-ranging medicinal properties has increased. In fact, it’s the leading drug of choice for our adolescent and young adults seeking treatment at Caron.

The THC content in marijuana today is 30 to 100 times more powerful than it was in the 1970s, which has made it more dangerous than ever. Psychosis and early onset mental health disorders are now a common consequence of marijuana use among our adolescent and young adult patients. The reality is the brain is not fully developed until around age 25, and heavy use of marijuana often causes permanent changes in the developing brain.

From a physical perspective, marijuana interferes with some important biological processes as well. Marijuana can cause dysregulation in sleep, appetite, emotional support, and stability. It interferes particularly with the maintenance of appropriate emotional responses. Given that adolescence and young adulthood are times when people should be developing their emotional connections to others at an adult level, this is very concerning.

Tips for Parents

We need to help empower our children to take control of their mental health and well-being. Page 14 of the Surgeon General’s advisory outlines ways that young people can take charge of their mental health and well-being. I suggest bringing this to the attention of your children, perhaps even sit with them and discuss their thoughts on what is being suggested. There are also similar suggestions for parents and caregivers on page 16.

Being a parent of a teenager is not easy. It is an age when the brain begins to reorganize, resulting in behaviors that often seem irrational. They are almost driven in their desire to break away from parental influences, yet they also crave the stability of a well-structured home life.

Teens need a place of safety that allows them to grow, usually by rebelling against that very sense of safety. It can be maddening. My advice to parents is to remember their ABCs:

A. Ask questions. Ask open-ended questions, including questions where you're asking them to reflect. A question parents will commonly ask is, “Did you like school today?” It's a closed-ended question, and the answer is likely to be, "No."

Instead, ask them specific, open-ended questions about something that you know they are interested in. For example, one of my one of my sons really enjoys science videos on YouTube. My question was, “What's a video that you've watched recently that you're really into?” The result was a 10-minute description of a five-minute video he had watched. It was something he really enjoyed, he knew that I was interested, and my question reinforced that those were the videos we wanted him to watch.

Such questions may also give you a sense of their struggles. They may come right out with it, or it may be something hinted at only indirectly. But it’s okay for you to ask direct questions as a follow up.

You may not get an answer right away, but it can show you are paying attention and that you are there. Reinforce that you were their age one time, and while some things have changed, you understand how stressful things can be. Again, ask open-ended questions like, “How can I support you?” or “How can I help you?” These questions emphasize that they are not alone and they have someone checking in on them.

B. Boundaries. Maintain appropriate boundaries. Teens don't have to be fully aware of the struggles the family faces, especially in the early stages of a problem where it's still ambiguous and lacking a clear solution. Youths want something concrete, so they feel their world's not going to be thrown upside down. When we thrust adult problems on them, when we don't have the answers yet, they're going to struggle with it as well. By maintaining appropriate boundaries, it reduces their worry about things that are outside of their control. It also gives us the space to be an adult and them to be kids.

Of course, the uncertainty abroad in the world is bound to prompt questions from your teen about how this affects the family. Questions are good, and it’s appropriate to say that you don’t have all the answers, that there are things outside of our control. What tends to stress kids out more is when their concerns are invalidated. A common strategy we use as parents is to say, “You don't have to worry about it. We adults will take care of it.” But they're asking because it is a concern. A better approach is to validate their concern, saying, “I understand this is a concern for you right now, and we're trying to figure things out. We don't have an answer yet, but we'll let you know as we learn more.”

Asking their perspective helps, too, because then you can also hear where their concerns are. While you may not have all the answers yet, you know enough to be able to answer their concerns. Gaining their perspective may offer a glimpse into how they perceive the problem. This can spur additional conversations If you just brush off their concerns, you miss that opportunity.

C. Consistency is key. This means not only being consistent with providing support but also with one of the hardest parts of parenting: Discipline. Your Nos must be Nos and your Yesses, Yesses.

There will be times where you will need have to operate in a gray area, which is fine. Communicate to them to why this is a gray area. If you know what was previously a Yes needs to be changed to a No, explain that to them. Be consistent with your messaging and your actions, both in your support and your discipline.

Family life should be as consistent as possible, and structuring time for family activities is a practical way to do so. This could be as simple as a regular family mealtime. This gives teens a sense of structure, and it also sets a time that adults know they need to reserve for their kids. Follow-through is important. If you establish that this Friday is going to be family movie night, or game night, then stick to it, unless there are unusual extenuating circumstances outside of your control. If you must reschedule, explain the reason, and set a new date. Be mindful that you are also in essence saying that you have more important priorities than being with them. Breaking a family date should be the rare exception, not the rule.

How to recognize your child needs help

One of the quicker ways to recognize a child needs help is when they say they so. Many children will verbalize that they just don't feel right. They may not have the experience or perspective to understand the problem fully, but they know something is wrong. Listening to these concerns and talking through them like a friend might give you a sense that there is a deeper problem going on.

Unfortunately, teens might not verbalize that they are having problems. Some other signs that a child needs help is if you notice there's something off about their behavior – they're not sleeping, their appetite has changed, their performance at school has declined, their emotions seem unstable, or they say concerning things about what's going on in their world.

Once you know the issue is something that's outside of your power as a parent, it is important to seek professional help because these types of problems tend to get worse over time. Admitting that you need help doesn’t make you a bad parent. Quite the opposite – it means you are aware of your limitations and know how to seek assistance.

As for finding the right guidance, your pediatrician, the school psychologist, and local healthcare facilities can provide recommendations. A behavioral health professional will be able to validate the concern if necessary and work with you and your child to determine how to best address the issues. We are still living through extremely challenging times, but it’s important to remember that you are not alone, and resources are available to support you and your family on this critical wellness journey.