Corrected: This article has been updated to correct the age of students who learn about warning signs of suicide in the Torrance school district. The lessons start with students in the sixth grade.
This article has been updated to correct the name of the principal of Sarah Pyle Academy. It is Kristina MacBury.
Rates of mental-health incidents among teens and young adults have arced upward over the last decade while they’ve remained relatively unchanged for older adults, a new analysis finds.
The findings confirm what many educators say has long been evident in their classrooms. Teachers and principals must be more versed in the warning signs of serious issues like mood disorders, anxiety, and suicidal thoughts so that they can better serve students in crisis, they say.
As psychologists explore causes behind trends in mental illness—probing issues like an increase in smartphone use, economic trends, and social isolation for clues—more schools are engaging students themselves to seek solutions.
They’re teaching teens to build healthy habits, enacting programs designed to strengthen relationships, and bringing suicide prevention work to students as young as elementary school.
“It’s very unusual to see changes this large happen in such a short period of time,” said Jean Twenge, a psychology professor at San Diego State University who studies generational trends.
Depression in Teens
Twenge co-authored the new analysis, published in the Journal of Abnormal Psychology Thursday, that relied on data from the National Survey of Drug Use and Health, an annual, nationally representative survey of Americans 12 and older.
Between 2005 and 2017, the proportion of teens 12-17 who reported the symptoms of a major depressive episode within the last year rose from 8.7 percent to 13.2 percent, the data showed. Adults ages 18-25 showed similar trends, while rates remained relatively stable for older generations.
A respondent was deemed to have had a major depressive episode if they confirmed they had experienced at least 5 of 9 criteria defined by the American Psychiatric Association, including a “depressed mood” or “loss of interest or pleasure in daily activities.” The survey uses slightly different criteria for teens than for adults.
The findings build on other data that show a recent uptick in rates of teens who have attempted or considered suicide, the second leading cause of death for adolescents.
The data show a “cohort effect,” Twenge said, suggesting a systemic cause.
She pointed to an increase in social media and smartphone use as a possible cause. Heavy use of such technology may contribute to less sleep and more social isolation among teens and young adults, she said, noting that recent upward trends in psychological issues correlate with a growth in popularity of devices like iPhones.
“We can’t change a lot of the causes of mental-health issues,” Twenge said. “We can’t change genetics, we can’t change childhood trauma…But we can help them use their leisure time in a healthier way.”
Healthy Habits
But competing research contends that screen time has a minimal psychological effect on adolescents, and some researchers have speculated that the use of social media has actually helped children forge social bonds, especially when kid-safe public spaces are limited.
Kristina Macbury, the principal of Sarah Pyle Academy in Wilmington, Del., says that with smartphone use, as with so many other things, moderation is key.
“If you already have the propensity to have mental illness and depression, then it sometimes gives you that crutch to continue to self isolate,” she said.
Macbury’s school enrolls about 175 students ages 16-21 who have struggled in a traditional high school.
Professional counselors visit the school twice a week to meet one-on-one with students, support groups help them address specific challenges, and teachers are certified in a program developed by the National Alliance on Mental Illness to recognize and respond to mental health concerns.
Macbury says it’s important for schools to promote well-being for all students, in addition to seeking the intensive supports for those with diagnosable mental illnesses.
For example, teachers require students to track and reflect daily habits—like sleep, phone use, and water intake—using apps or worksheets to determine how they are linked to things like anxiety or engagement in class.
The exercise is an “intentional and strategic” way to help students see the effects of the choices they make everyday and to develop a values system they can apply to other areas, Macbury said.
In the Torrance, Calif., school district near Los Angeles, school counselors work to hold parents events to help promote student well-being, discussing issues like physical activity, screen time, and how to recognize depression in their children and their children’s friends.
The district has also adopted a social-emotional learning strategy to help students recognize and manage their emotions, said Antoinette Laiolo, the coordinator of psychology and counseling programs.
And it’s teaching children as young as 6th grade to spot signs of suicidal thoughts in their peers.
“It’s life or death,” Laiolo said.
Many states and districts have adopted requirements to train staff or students on issues related to suicide in recent years.
And New York and Virginia lawmakers have mandated that public schools develop curricula to teach students about mental health.
“Sometimes we just insult those people who struggle,” Virginia state Sen. Creigh Deeds, who sponsored his state’s legislation, told NPR in 2018. “Mental health issues need to be given the same dignity as physical-health issues.”
In 2013, Deeds’ 24-year-old son attacked and stabbed his father before killing himself. Earlier that day, Gus Deeds had sought to admit himself to a psychiatric hospital, and he was denied because of a lack of beds.
Resources for Mental Health Are Skimpy
A lack of resources to address mental illness is a concern for schools as well.
Just three states meet the recommended ratio of at least one school counselor for every 250 students, said a recent ACLU analysis of the most recent federal data, collected by the U.S. Department of Education in 2015-16. And just three states met the recommended ratio of at least one psychologist for every 750 students, the analysis said.
Those data come as policymakers call for increased student supports in broader safety debates following two large school shootings in 2018.
Despite such calls, included in a report by the Federal School Safety Commission assembled by President Donald Trump and in the findings of state-level task forces, schools still scramble for funds to hire counselors, social workers, and support personnel.
And it takes resources to help students with mental illness, said Desiré DeSoto, a school counselor at Wai’anae High School in Honolulu.
The school has an on-site clinic that accepts Medicaid and offers physical and mental health care to students.
Educators employ a trauma-informed approach, recognizing the out-of-school factors that may have caused students emotional and psychological harm. And 13 counselors support the school’s students, 60 percent of whom are Native Hawaiian.
“Now, kids are more internalizing their anxiety and depression, whereas in the past they would have acted it out behaviorally,” DeSoto said.
Counselors identify destructive behaviors like cutting, and they do cognitive behavioral therapy, which helps them develop healthy ways to respond to thoughts and experiences that trigger anxiety.
The school has also worked with sociologists to develop approaches to group therapy that are responsive to native students’ cultural backgrounds. That means putting more of a focus on communities than just individuals, and helping students to consider their role within their families as they process their experiences, DeSoto said.
“We have to change the way we think because society is changing and needs are changing,” she said. “You can’t move forward on Maslow’s hierarchy of needs until you start at the bottom.”
