(Originally published June 2022)
In December 2021, the US Surgeon General’s Advisory called attention to the deterioration of children’s mental health during the pandemic, and reminded readers that recent increases in depression, anxiety, suicidal ideation, suicide attempts and suicides among children and youth followed almost two decades of deterioration in US children’s mental health. According to the Surgeon’s General’s Advisory:
From 2000 to 2019:
The proportion of US students reporting feelings of sadness and hopelessness increased by 40%
The share seriously considering suicide increased by 36%
The share creating a suicide plan rose by 44%
Between 2011-15 youth psychiatric visits to emergency departments for depression and anxiety and behavior challenges increased by 26%.
Between 2009-18 suicide rates among youth ages 10-24 increased by 57%.
And in 2020 alone there were 6,600 suicides among 10-24-year-olds in 2020.
These distressing statistics are only the tip of the iceberg. One recent study found that drug overdose deaths among adolescents in the US doubled during the past decade, in part due to increased use of fentanyl, (Freidman, et al, 2022) and another study re all-cause mortality for all age groups estimated that more than 400,000 US deaths per year were due to childhood adversities.
The pandemic has made many of these trends worse. There has been a sharp increase in the rate of pre-adolescent suicide of children,10-13. (Liu, 2022) A recent CBS News story reported that in Wisconsin, a state with the fifth highest rate of adolescent self-harm and attempted suicide in the country, there has been a near doubling of adolescent self-harm rates since 2019. Furthermore, this increase has affected all social classes and races/ethnicities in Wisconsin and around the country. Nevertheless, in some urban area’s low income racial/ ethnic minority children have especially affected by a significant increase in depression and anxiety. (Spenser, et al, 2021) Among these children, there has also been an increase in rates of childhood diseases such as asthma commonly believed to have an emotional component.
The pandemic’s effect on children’s mental health has not been limited to the US. According to the Surgeon’s General advisory “Recent research covering 80,000 children globally found that depression and anxiety symptoms doubled during the pandemic, with 25% of youth experiencing depressive symptoms and 20% anxiety symptoms.” Even before the pandemic, almost one in five children in the US had a reported mental, emotional, behavioral, or developmental disorder according to research cited by the Surgeon General’s Advisory. It is obvious that the social isolation resulting from lockdowns and school closures during 2020-2021 exacerbated the trend toward social disconnection resulting (in part) from the introduction of smart phones in 2007. However, this new technology would not have had disastrous effects on children’s mental health in a country that was not already actively engaged in social distancing and fragmentation, and already experiencing a weakening of community bonds.
Smart phones and social disconnection
One dimension of social disconnection is loneliness, a common experience in all age groups in the U.S. well before smart phones and increased use of social media. However, the dramatic effect of smart phones on the social interaction of US children and youth became apparent within a decade. In 2017, Jean Twenge, a sociology professor at San Diego State, published iGen: Why Today’s Super-Connected Kids Are Growing Up Less Rebellious, More Tolerant, Less Happy - and Completely Unprepared for Adulthood, which discusses differences between the iGen generation born between 1995-2012 and Boomers, Generation X and Millennials. iGen’s:
Grow up more slowly based on common indicators of independent functioning such as engaging in activities outside the home without adult supervision
Less likely to ‘hang out’ with friends outside the home
Less likely to date
Less likely to have sex by the 12th grade
Less likely to drive in high school
Less likely to go to a movie theatre
Spend less time on homework, volunteering, and extracurricular activities
Less likely to use or misuse alcohol, including engaging in binge drinking, but smoke more marijuana
Twenge states: “The entire developmental trajectory from childhood to adolescence has slowed … Adolescence is now an extension of childhood rather than the beginning of adulthood.” Twenge believes these changes have occurred because the iGen generation and their parents place a huge emphasis on safety first, including emotional safety, and because more parents are attempting to create the conditions of perfect childhood in which all their children’s needs are met within the family, and because ofrecent technology: the smartphone.
“The average teen checks her phone eighty times a day and spends six hours a day on the phone outside of school, texting, on social media or watching TV shows and movies,” Twenge asserts.
The bizarre (to me) use of smartphones is so common- place among Americans of all ages it is difficult to caricature. I once observed a gorgeous young couple in an expensive restaurant dressed in prom clothes (tux, gown) attend to their phones for 45 minutes without speaking a word or even glancing at one another. It’s possible that the couple were texting one another rather than engaging in conversation, or they may have been texting friends at adjoining tables who were also engrossed with their phones. From the perspective of some young people, one of the problems with in-person dating is the pressure to be unfaithful to one’s phone! Still, even in the bedroom a couple could agree to text in lieu of foreplay.
Twenge maintains that many teens sleep with their phones, and that their cell phone is the last thing they check before falling asleep and the first thing they check in the morning. Twenge comments: “Some saw their phones as a lifeline or as an extension of their bodies, like a lover.”
Some readers may ask the question, “so what if adolescents have found a different way of socializing than their parents or other generations?” Twenge’s 2017 comment was prophetic:
“iGen is on the verge of the most severe mental health crisis for children in decades” and …“From the1980s to the 2000s progressively more teens said they were satisfied (with their lives). Then when the first iGener’s became high school seniors in 2011-2013, satisfaction plummeted, reaching an all-time low in 2015.”
Twenge argues that obsessive use of smartphones and increase in screen time has led to increased loneliness, increased online bullying, especially among adolescent girls, an increase in feelings of social exclusion and large increases in anxiety, depression, and suicide among American youth. A just published study in JAMA Network Open (Arnon, et al, 2022) confirmed that “in this large cross-sectional study of US adolescents, cyberbullying experiences were relatively prevalent(9.0% of the cohort)and were associated with suicidality(ideation or attempts) over and above multiple confounders … our findings point to cyberbullying experiences as an independent risk factor for youth suicidality.” Other studies have pointed to a recent increase in suicidality and suicide among children, 10-13, with the largest increase among young girls.
Twenge maintains that the relationship between the increase in time adolescents spend on smart phones, less in-person contact with friends and rates of depression is causal, not merely a strong association. She writes: “… 56% more teens experienced a major depressive episode in 2015 than in 2010 …” and “the increase in major depressive episodes is much greater among girls … three times as many 12-14-year-olds killed themselves in 2015 than in 2007.” Twenge wrote these words before the substantial increase in depression, anxiety, suicidality, and suicide among youth during and since the first year of the pandemic. The US Surgeon General’s Advisory reference to a children’s mental health crisis may be an understatement: what is occurring among American children is closer to a national emergency.
Some of the most surprising information in iGen concerns indicators of emotional fragility among youth and the consequences of that fragility, regarding which Twenge’s young informants were acutely aware.
Compared with previous generations, iGen’s are cautious and wary of romantic intimacy during high school and college. Intimate relationships were often described as “smothering” and a source of unwelcome stress. Guidelines for avoiding intimacy after sex included “don’t cuddle,” “do not go in for hugs and snuggles,” and “create a barrier of pillows between you and your sexual partner.” “Desperate times call for desperate measures,” one young person said to Twenge.
iGen’s definition of emotional safety includes protection from exposure to opinions one finds hurtful or repugnant. Twenge’s student sample expected college administrators to afford them this protection.
A common view Twenge heard from her sample is that “the world is an inherently dangerous place because every social interaction carries the risk of being hurt.”
Twenge found that iGen’s were individualistic, socially tolerant, with libertarian attitudes toward abortion, sexual identity and gun rights. They favored collective solutions toward issues that affected them (such as student debt), but not necessarily other liberal causes, except for racial justice. According to Twenge, these students could not fathom or stomach racist attitudes that have shaped
American society forever. Twenge also found that her informants were materialistic and expected to become affluent, but not necessarily to like or devote themselves to their jobs.
Another pathway to social disconnection
One pathway taken by children and youth to mental health problems resulting from social disconnection is through interpersonal fragility, loneliness, experiences of ostracism and bullying, and through feelings of hopelessness regarding one’s ability to change these conditions. This is the pathway of painful experiences in peer groups and in conflicts with romantic partners or family members.
There is another pathway to behavioral and emotional problems resulting from a youth’s despair regarding her/his prospects for a fulfilling life that offers a decent income, opportunities for promotion, the respect of family and community members and self-respect. Deaths of despair occur among young people as well as middle aged Americans.
The report, Pain in the Nation: The Epidemic of Alcohol, Drug and Suicide Deaths2022 from the Trust for America’s Health asserts that “Between 2019 and 2020, these deaths increased a stunning 20 percent… Increases were particularly large among communities of color and young adults.” Even more shocking is the information that between 2015 and 2020 drug induced deaths increased from 55,000 (17.2 per 100,000) to more than 96,000(28.4 per 100,00), an increase of more than 70% in 5 years!
In their ground-breaking book, Deaths of Despair (2020), Anne Case and Angus Deacon present evidence that rates of deaths of despair and other indicators of poor health and mental health among middle aged Americans are strongly associated with educational attainment, i.e., having or not having a BA degree. They report that the risk of severe mental distress for middle aged adults with a BA degree is “a quarter of that faced by those without a bachelor’s degree.” The increase in deaths of despair in the US that was initially most evident among middle aged Americans without a BA degree has spread to younger populations. Why has this happened?
For the past 50 years, the US has steadily evolved into a country of “haves” and “have nots” characterized by extreme income inequality and by a “winners and losers” social ethos justifying this state of affairs. In this social milieu, no level of compensation is too great for top talent in any socially valued profession, while “have nots” often blame themselves for a loss in income, poverty and/or a lack of social recognition and regard. One of the best discussions of “have nots” with substance abuse problems is contained in Nichols Kristof’s and Sheryl Wu Dunn’s book, Tightrope, which tells the stories of Kristof’s high school friends, several whom had already died from drug overdoses or suicide after stints in prison. Kristof’s friends with drug/alcohol problems viewed themselves and others in their condition with loathing and had little or no compassion for their suffering. Not surprisingly, most viewed Trump favorably.
American adolescents and high school students and their parents are clear eyed regarding the “haves” and “have nots” world that awaits them. The world of “haves” has 3 main entrances: a) through the educational meritocracy of four-year colleges, an avenue in which young women are faring much better than same age males, and in which whites and Asian Americans have large advantages, and/ or b) through exceptional athletic talent or creative talent in the arts, computers, cooking, gardening, animal husbandry, etc. or, c) through successful entrepreneurship.
Currently, approximately one-third of American adults have college degrees, and a much smaller percentage of young people have exceptional talents that give them access to the income, status and privileges monopolized by “haves”. Higher income is only one of the advantages of inclusion among “haves;” social recognition and status is not readily available to “have nots” even when they have average to above average incomes. In the world view of highly educated Americans, the only achievement more admired than professional success is extraordinary creative or athletic talent, or the ability to invent or market lucrative products outside of corporate America.
Many adolescents in low-income families and from families of oppressed minorities are headed for low-income, dead-end jobs and are likely to end up serving the wants and needs of affluent “haves” in “Superstar” cities such as Seattle where they may not be able to afford rent. In 2020, more than 50% of US households had annual incomes less than $50,000, while in nine states, including Washington, 10-14% of households had incomes greater than $200,000 per year.
Twenge asserts that many adolescents from affluent families who compete for entry to elite colleges and universities have deep anxiety regarding the possibility of doing poorly in college and dropping off the economic cliff into the world of “have nots.” The division of American families into “haves” and “have nots” is a stark divide that engenders both anxiety and despair, and sometimes rage, among young people in all social classes.
When young people cannot imagine a future in which they can earn a decent living, develop their talents, gain the respect of family and community members, and maintain self-respect, and when they feel hopeless/helpless to improve their prospects, they may become enraged, anti-social or depressed, engage in drug/alcohol abuse; and some may consider suicide, or develop a suicide plan, which gives them a sense of control over their life. Weirdly, self-harm among the young can be an antidote to despair.
What can be done?
It is common for advocates and scholarly experts who write about the country’s child mental health crisis to quickly survey a wide range of plausible causes, and then focus on possible programmatic solutions, along with the need for more and better mental health services, and enhanced access to services. This is a superficial approach to deep seated cultural issues that must be confronted to prevent a further deterioration in children’s mental health. The increased use of antidepressants in recent decades has not reduced rates of depression among children or adults; if anything, the opposite has occurred. Anti-depressants may have benefits for many people, but their widespread use does not address the social causes of depression. The same is true of CBT or any other depression treatment.
It is past time for all concerned to reflect on toxic cultural influences which are doing emotional harm to both children and adults. The social life of all Americans older than ten has been affected by smart phones and social media, and Americans in every social class have been influenced by a diminished (but powerful) cultural story of winners and losers and by the social policies this world view has engendered.
Next month, I will discuss cultural changes, empowerment practices and community initiatives with the potential of combating hopeless/helpless feelings and attitudes and of reducing loneliness among American children and youth.
Alfonsi, S. “U.S. kids grappling with mental health crisis made worse by pandemic, CBS News, May 8,2022.
Arnon, A., Klomek, A. & Visoki, E., “Association of Cyberbullying “Experiences and Perpetration with Suicidality in Early Adolescence,” (2022) JAMA NetW, 5(6), published online June 27,2022.
Case, A. & Deacon, A., Deaths of Despair and the Future of Capitalism (2020), Princeton University Press, Princeton, NJ.
Freidman, J., Godvin, M., Shover, C., Gone, J., Hansen, H. & Schriger, D., “Trends in Drug Overdose Deaths Among US Adolescents,” (April 12, 2022), JAMA, Volume 327, No. 14.
Kristof, N. & Wu Dunn, S., Tightrope: Americans Reaching for Hope (2020), Alfred A. Knopf, New York City.
Leonhardt, D., “The pandemic has created a crisis for American children,” (January 4, 2022) The New York Times, The Morning.
Liu, R., Walsh, R., Sheehan, A., Cheek, S. & Sanzari, L., “Prevalence and Correlates of Suicide and Non-suicidal Self-injury in Children,” JAMA Psychiatry, published online, May 25,2022.
Malleske, D, Bryant- Stephens, T. & Montoya- Williams, D., “Childhood Asthma Disparities – Race, Place, or Not Keeping Pace?” (May 23,2022, online), JAMA Pediatrics.
Pain in the Nation: The Epidemics of Alcohol, Drug, and Suicide Deaths, Trust for America’s Health, available online.
Protecting Youth Mental Health” The US Surgeon General’s Advisory, December 2021, available online.
Spenser, A., Oblath, R., Dayal, R., Loubeau, J., Lejeune, J, Sikov, J., Savage, M., Posse, C., Jain, S., Zolli, N., Baul, T., Ladino, V., Ji, C., Kabrt, J., Mlousda, L, Rabin, M, Murphy, J., Garg, A. (2021) “Changes in psychosocial functioning among urban, school-age children during the COVID-19 pandemic,” Child and AdolescentPsychiatry and Mental Health, 15:73.
Twenge, J., iGen: Why Today’s Super- Connected Kids Are Growing Up Less Rebellious, More Tolerant, Less Happy – and Completely Unprepared forAdulthood (2017), Atria paperback, Simon and Schuster, New York City.