Young people in the United States are more depressed than ever before. The latest national estimates indicate that this mental health scourge has been increasing among young people since 2015, and that in 2020, before the pandemic, Nearly one in five young people between the ages of 12 and 17 have experienced depression in the past year. By comparison, the overall national estimate was nearly 10%, indicating that for the first time in recorded history, children’s mental health is a raging public health problem that has outpaced adult depression.
By any conceivable scale, these trends actually worsened before the pandemic disrupted school, friendships, and family life.
Twenty years ago, depression among children was considered extremely rare, if present at all – and it was generally thought of as a disorder that did not affect young people until the late teens at the earliest. As a result, this was a problem in the field of child psychiatry – which is a small, specialized field – rather than in the field of public health.
Combined with media reports documenting a lack of all-case mental health care among young adults across the United States, these latest numbers document an unprecedented level of untreated depression among young adults. However, the pediatric mental health epidemic still needs a priority comprehensive public health response. This failure has tragic consequences.
Compare and contrast. It’s flu season in New York, and public service announcements provide everywhere reminders for kids and adults to get their flu shots.
If a child has flu symptoms, even if they are mild, they are usually quickly noticed by gatekeepers (parents, caregivers, teachers), who prompt them to do something (eg, see a medical professional for evaluation). Even the only symptom–fever alone–spurs adult interest and action and, depending on symptoms and resources, results in prompt treatment, care instructions, and follow-up.
In contrast, with depression, seeking treatment can be seen as something that should be delayed and avoided at almost all costs. Studies have shown that the gap of several years between the onset of depression and receiving treatment is the norm. As a result, it is common for treatment not to be sought until depression is severe, and only then, some professional help may be seen as necessary. Early intervention and prevention, the cornerstones of public health, are still not widely used for pediatric mental health because despite all this research, a mental health epidemic is not generating a public health response, while an infectious disease epidemic is occurring. Even when the risks to children are diminished.
With influenza, we have invested heavily in surveillance systems and built sophisticated digital influenza dashboards at the local and national levels. They are used by epidemiologists and are available to the public. There are extensive weekly reports on the number of cases, service usage and other metrics, geocoded across the state to identify hot spots where more services should be deployed each week. The State Department of Health and the Federal Centers for Disease Control recognize that life is at risk and act accordingly.
In contrast, there is no comparable statewide monitoring of depression in New York or nationwide. In particular, there is no data on the percentage of cases treated or hospitalized, because depression is not a condition that should be reported to the Department of Health or the CDC. Despite the fact that this mental health crisis was evident before the pandemic and is expected to worsen thereafter, there are no dashboards on hot spots on which we can direct services. There is still more concerted public health interest devoted to monkeypox than mental health.
Because of a comprehensive public health approach to infectious diseases, in 2021 there were fewer than 200 pediatric deaths from childhood influenza; Influenza/pneumonia is the eighth leading cause of death between ages 10-24 nationwide.
In contrast, in 2021, there were more than 6,500 deaths by suicide among young people aged 10 to 24, making suicide the second largest cause of death among young people nationally.
Everyone knows what a fever is. Symptoms of depression vary, and are often subdued, but not always. Sometimes there is irritation and anger rather than sadness. This can be met with punishment, not mercy, if one is unaware of the potential presentations.
What we need is early education for young people about what depression is, how to recognize it, and what to do if you need help. In addition, we need to teach early that regular use of common substances such as cannabis is particularly harmful to mental health – it will increase depression and anxiety, and may lead to the onset of depression and anxiety, research has shown.
This is especially important in a city where cannabis is now sold illegally in convenience stores across the street from schools, completely unregulated with not even the most basic of laws enforced aimed at protecting children from increased exposure. New York State laws on cannabis make California look strict, as here, unless the municipality chooses not to engage in recreational sales altogether, local leaders are prohibited from enacting ordinances that put in place additional protection measures to avoid increased intentional or accidental use and passive exposure among young people are More stringent than dictated by state law.
It is a critical moment when the mental health of young people, who are already struggling, can only get worse. With the cannabis industry offering the drug as a “cure” for depression and anxiety, and a lack of information to the contrary, young people’s perception of the risks associated with cannabis use has declined in recent years, and depressed young adults More likely to use cannabis than those who do not have.
Young people should be informed, contrary to industry claims, that cannabis use will not be a solution (quick or otherwise), and may in fact exacerbate depression and impede recovery from depression. Not only that, but we must bear in mind that depression can actually reduce young people’s ability to accurately perceive risks and act accordingly – creating a kind of vicious cycle where young people who are depressed are more likely to pick up marijuana and therefore less likely to do so. . Develop effective coping skills including, but not limited to, seeking actual professional help.
Unlike influenza, the mental health of young people is inextricably intertwined with the health of their parents, who are also portals to treatment in general. Adults in New York City have now experienced two mass traumas (9/11 and the pandemic) in the past 25 years. Exposure to trauma is a strong risk factor for depression.
Adults also struggle, making it difficult to mobilize children’s needs and respond to them through action – seeking childcare – and it is among the toughest parenting challenges of the best of times. To this end, the public health approach includes supportive programs and policies to facilitate access to treatments (eg, by placing them on street corners) that a purely clinical response does not.
Along with direct education for young people, we need to teach gatekeepers—parents, teachers, coaches, and more—about how to recognize depression and other common mental health conditions. We need to train gatekeepers on the need to urgently refer children who may need help and give them the information and tools to do so. We must err on the side of caution. Depression in its early or mild stages can be treated much more easily than severe and complex cases, which strengthens the case for early intervention.
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This can be helped by a large-scale public awareness campaign to educate the public about how depression manifests itself; how the symptoms may not be the same in different people, and that the only distinguishing feature is not limited to “a person who cannot get out of bed all day”; And that alcohol, nicotine and cannabis will make it worse, not better. Although all of these substances may make a person feel better temporarily, they will eventually make recovering from depression more difficult.
While we do all this, we must understand that stigma is still a huge barrier. Seeking help, especially in the form of mental health care, remains fraught with both real and imagined obstacles.
There are national PSAs from the Surgeon General in the United States about the availability of low-cost treatments. That may be the case, but we don’t see it in New York.
In New York City, there is much more demand than availability among those who seek treatment on their own or are advised to seek an evaluation by the school. For example, there is a waiting list of at least six to nine months for a neuropsychological evaluation here, although in some cases, the child may barely be able to learn, benefit and/or go to school while waiting. This process alone – waiting and not being able to learn and grow – can contribute to a young person’s depression, depending on the circumstances. For instances where such treatment is recommended, we urgently need advocates to help parents and children deal with the very complex process of obtaining mental health services.
Prevention in the United States has little support. Expect to accept that “there is no money for prevention”. We hope we can make an exception for children’s mental health when it reaches epidemic levels because we have a responsibility to stand up for those we have a responsibility to care for and protect.
Children need to feel safe. And if they are struggling, they need hope. As a society, we have a duty to provide a safe environment in any way possible. If you are in a position to listen and sit with someone and stay there in a time of darkness and need, do it. The hope and feeling that you are being heard, that one is not alone at a given moment may mean more than you will ever know.
Goodwin is professor of epidemiology at the City University of New York, adjunct professor at Columbia University’s Mailman School of Public Health and a licensed clinical psychologist. Call 988 Suicide and Crisis Lifeline if you are experiencing mental health distress or are concerned about a loved one who may need support in a crisis.