tag:theconversation.com,2011:/id/topics/youth-mental-health-5606/articlesYouth mental health – The Conversation2024-03-28T20:41:08Ztag:theconversation.com,2011:article/2258762024-03-28T20:41:08Z2024-03-28T20:41:08ZSpotting the signs of disordered eating in youth: Tips for parents and caregivers<figure><img src="https://images.theconversation.com/files/584906/original/file-20240327-29-jlr0nd.jpg?ixlib=rb-1.1.0&rect=549%2C76%2C2570%2C1739&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Eating disorders are on the rise in youth, with research showing that health-care visits for eating disorders have doubled since before the COVID-19 pandemic.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>In the age of social media, youth are constantly bombarded with viral trends and toxic messages that set unrealistic standards about the ideal body image. This has translated into a far too <a href="https://doi.org/10.1371/journal.pgph.0001091">common expression of body shape dissatisfaction</a> in young people.</p>
<p><a href="https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/eating-disorders">Eating disorders</a>, such as anorexia, bulimia, binge-eating disorder, and avoidant/restrictive food intake disorder are serious mental health conditions that affect approximately <a href="https://nied.ca/about-eating-disorders-in-canada/">one million Canadians</a>. These conditions are also on the rise in youth, with research showing that <a href="https://doi.org/10.1016/j.jaac.2024.02.009">health-care visits for eating disorders doubled</a> during the COVID-19 pandemic, compared to before the pandemic. </p>
<p>This is concerning, since there are already <a href="https://doi.org/10.1016%2Fj.jadohealth.2022.12.008">very long wait times</a> for eating disorder programs. </p>
<h2>Impact of eating disorders</h2>
<p>Individuals with eating disorders experience a problematic relationship with food, often accompanied by significant distress about their weight, shape and size. Many experience body image dissatisfaction and restrictive eating. </p>
<p>Eating disorders do not discriminate. They can occur in people of any race/ethnicity, age, socioeconomic class or gender. Youth who do not “fit” the stereotype of an eating disorder, especially <a href="https://nedic.ca/bipoc/">those from Black, Indigenous and racialized backgrounds, may face delayed recognition and diagnosis</a>.</p>
<p>Eating disorders impact every aspect of an individual’s life and contribute to significant distress for the affected individual and their family, including their siblings. <a href="https://www.nationaleatingdisorders.org/health-consequences/">They can have serious and life-threatening complications</a>, such as bradycardia (heart beating too slowly), osteoporosis (bone weakening) and anemia (low red blood cell count). Eating disorders are also associated with a high rate of premature death.</p>
<p>As clinicians and researchers, we have studied and worked with youth and their families struggling with eating disorders or “disordered eating” (the spectrum of unhealthy eating behaviour and patterns). Below we offer a guide for parents and other supportive adults on recognizing the signs of disordered eating in youth and offer practical resources and tips to support them effectively.</p>
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<img alt="A teen boy sitting at a white table with an empty white plate on it, resting his head on his hand" src="https://images.theconversation.com/files/584907/original/file-20240327-16-158617.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/584907/original/file-20240327-16-158617.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/584907/original/file-20240327-16-158617.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/584907/original/file-20240327-16-158617.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/584907/original/file-20240327-16-158617.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/584907/original/file-20240327-16-158617.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/584907/original/file-20240327-16-158617.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Eating disorders impact every aspect of an individual’s life and contribute to significant distress for the affected individual and their family, including their siblings.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Signs of disordered eating</h2>
<p>Considering the growing concern about the rise in eating disorder behaviour in youth, and the importance of timely recognition and action, the following signs and symptoms of disordered eating are important to look out for:</p>
<p><strong>Behaviours related to disordered eating</strong>:</p>
<ul>
<li><p>Excessive exercise to reduce weight or change body shape</p></li>
<li><p>Going to the bathroom immediately after eating</p></li>
<li><p>Eating in secret</p></li>
<li><p>Restricting foods, such as a specific food group</p></li>
<li><p>A preoccupation with losing weight or maintaining a low body weight</p></li>
<li><p>Frequently weighing themselves because of body image dissatisfaction</p></li>
<li><p>Unusual behaviour around food such as weighing/measuring food or cutting food into tiny pieces, or large consumption of liquids at mealtimes (for calorie dilution and a sensation of fullness)</p></li>
</ul>
<p><strong>Physical signs of disordered eating</strong>:</p>
<ul>
<li><p>Unexplained weight loss or weight fluctuations (up or down)</p></li>
<li><p>Delayed puberty or amenorrhea (missed periods)</p></li>
<li><p>Sensitive or damaged teeth</p></li>
<li><p>Dizziness or fainting</p></li>
<li><p>Feeling cold</p></li>
<li><p>Stomach pain</p></li>
</ul>
<p><strong>Social and psychological signs of disordered eating</strong>:</p>
<ul>
<li><p>Personality changes, such as social withdrawal and increased irritability</p></li>
<li><p>Depression or anxiety</p></li>
<li><p>Fighting with others about food, eating and weight</p></li>
<li><p>Avoidance of food-related social activities like birthdays or sleepovers</p></li>
</ul>
<h2>General recommendations for all parents and caregivers</h2>
<ol>
<li><p>Be on the lookout for sudden or drastic changes in your child’s eating habits, such as extreme dieting, avoiding certain foods, preoccupation with weight, and fears about losing control of overeating. Also, keep an eye out for frequent fluctuations in meal patterns.</p></li>
<li><p>Pay attention to any physical changes you notice in your child, such as unexplained weight loss or gain, persistent fatigue, or changes in mood. These could be signs of underlying issues related to disordered eating.</p></li>
<li><p>Be mindful of withdrawal from social situations that centre on food, such as avoiding gatherings where meals are involved.</p></li>
<li><p>In addition to <a href="https://doi.org/10.1371/journal.pgph.0001091">social media use</a>, parent role modelling <a href="https://doi.org/10.1017/S0007114508892471">can shape children’s attitudes and behaviour toward food and body image</a>. As a result, we recommend that parents ditch the weight-based talk. It is best to avoid commenting on people’s physical appearances, weight, shape and body sizes, including your own and others in your life. Rather, we recommend parents focus on health rather than appearances and empower youth to develop a positive relationship with food and their bodies.</p></li>
</ol>
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<img alt="A mother comforting an upset teen on a sofa" src="https://images.theconversation.com/files/584858/original/file-20240327-28-lk1lch.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/584858/original/file-20240327-28-lk1lch.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/584858/original/file-20240327-28-lk1lch.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/584858/original/file-20240327-28-lk1lch.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/584858/original/file-20240327-28-lk1lch.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/584858/original/file-20240327-28-lk1lch.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/584858/original/file-20240327-28-lk1lch.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">If you notice some of the signs and symptoms of disordered eating, it is essential to talk with your child.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>The importance of early identification and intervention</h2>
<p>If you notice some of the signs and symptoms of disordered eating, it is essential to talk with your child. Invite them to share their experiences and listen without judgement. Express compassion, kindness and concern about their health and well-being.</p>
<p>If you believe your child’s health is at risk, warmly but firmly tell them that you are worried about them and organize contact with a health-care professional. Make an appointment with your primary care provider and <a href="https://nedic.ca/media/uploaded/PARENTS-CARERS_checklist_for_PCP_-_fillable.pdf">come to your appointment prepared</a> to discuss the type of behaviour you have been seeing.</p>
<p>Previous research suggests that <a href="https://doi.org/10.1002/erv.2745">quickly seeking help may support better recovery from an eating disorder</a>. This awareness motivates both providers and family members into action to quickly identify eating disorder behaviour in youth and to advocate for them to receive comprehensive care from a diverse health-care team including psychologists, physicians, dieticians and social workers.</p>
<p>If you experience a long wait for targeted support in your area, consider also exploring <a href="https://nied.ca/wp-content/uploads/2024/02/Caregiver-Well-Being-Resource-Guide-5.pdf">reputable organizations in your geographical location</a>.</p>
<p>It is important for parents and caregivers to recognize that negative body talk does not mean that your child has an eating disorder. It is, however, something to be mindful of, especially when coupled with the signs of eating disorders provided above.</p>
<p>The National Eating Disorders Information Centre helpline and live chat are available seven days a week. For Helpline call 1-866-NEDIC-20 (toll-free) or live chat at <a href="https://nedic.ca/">nedic.ca</a></p><img src="https://counter.theconversation.com/content/225876/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amelia Austin receives funding from the University of Calgary's O’Brien Institute for Public Health and Cumming School of Medicine.</span></em></p><p class="fine-print"><em><span>Gina Dimitropoulos receives funding from the Canadian Institutes of Health Research, the Alberta Children's Hospital Foundation and the UCalgary Research Excellence Chair.</span></em></p><p class="fine-print"><em><span>Sheri Madigan receives funding from the Social Sciences and Humanities Research Council, the Canadian Institutes of Health Research, the Alberta Children's Hospital Foundation, an anonymous donor, and the Canada Research Chairs program.</span></em></p><p class="fine-print"><em><span>Tracy Vaillancourt receives funding from the Canadian Institutes of Health Research, the Social Sciences and Humanities Research Council, and the Canada First Research Excellence Fund. She is the chair of the COVID-19 Task Force for the Royal Society of Canada. </span></em></p>Parents and other supportive adults can learn to recognize young people’s symptoms of disordered eating, which is a spectrum of unhealthy eating patterns and behaviour.Amelia Austin, Postdoctoral Research Fellow, Mathison Centre for Youth Mental Health and Education, University of CalgaryGina Dimitropoulos, Associate professor, Faculty of Social Work, University of CalgarySheri Madigan, Professor, Canada Research Chair in Determinants of Child Development, Owerko Centre at the Alberta Children’s Hospital Research Institute, University of CalgaryTracy Vaillancourt, Tier 1 Canada Research Chair in School-Based Mental Health and Violence Prevention, L’Université d’Ottawa/University of OttawaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2246702024-03-06T17:14:59Z2024-03-06T17:14:59ZWhy do young people have such poor mental health? A psychologist explains<figure><img src="https://images.theconversation.com/files/579608/original/file-20240304-22-i8lpd3.jpg?ixlib=rb-1.1.0&rect=67%2C6%2C4339%2C2978&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sad-man-82004164">spixel/Shutterstock</a></span></figcaption></figure><p>A <a href="https://www.resolutionfoundation.org/publications/weve-only-just-begun/">recent report</a> from think tank the Resolution Foundation has found that 34% of young people aged 18-24 in the UK have symptoms of a common mental disorder – the highest rate of any age group. </p>
<p>Mental health problems among young people are on the rise. An especially stark finding of the report is that 20 years ago, this age group was the least likely to have a common mental disorder.</p>
<p>The big question is why. As a psychologist researching young people’s wellbeing, I believe that young people today face unprecedented pressures to excel academically, professionally and socially. This pressure can manifest in various forms, including academic stress, performance anxiety and fear of failure. </p>
<p>Current societal difficulties, such as the cost of living crisis, will have further exacerbated these issues – as will the lasting impact of isolation and loss of <a href="https://theconversation.com/coming-of-age-in-2020-the-summer-without-exams-or-school-proms-138750">valuable life experiences</a> during the pandemic. </p>
<p>A <a href="https://www.orygen.org.au/About/News-And-Events/2024/Generations-agree-youth-mental-health-is-declining/Youth-mental-health-in-crisis-Public-and-generatio.aspx">new survey</a> from King’s College London and non-profit research group the Orygen Institute shows that a majority of the UK public thinks that young people today have a worse time finding a job and more difficulty affording things than previous generations.</p>
<h2>Markers of success</h2>
<p><a href="https://www.oecd-forum.org/posts/19894-poles-apart-how-technology-globalisation-have-affected-the-global-workforce">Globalisation</a> and <a href="https://www.weforum.org/agenda/2023/05/future-of-jobs-technology-skills-workplace/">technological advancements</a> have transformed the job market, splitting jobs more starkly into high- or low-skilled occupations. This has led to greater emphasis on specialised skills and higher education. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-25-years-of-education-policy-led-us-to-believe-we-can-only-succeed-in-life-with-a-degree-210017">How 25 years of education policy led us to believe we can only succeed in life with a degree</a>
</strong>
</em>
</p>
<hr>
<p>Educational or career success – or failure – is now more visible than ever. The rise of social media has intensified the need to present a perfect image of success.</p>
<p>Logging into a social media account invariably brings an announcement about someone being promoted, starting a new job, or taking up an exciting opportunity. This can potentially trigger negative feelings, particularly if a young person has been struggling to get a job or even an interview. </p>
<p>The King’s College London and Orygen Institute survey found that social media is seen as a <a href="https://www.orygen.org.au/About/News-And-Events/2024/Generations-agree-youth-mental-health-is-declining/Youth-mental-health-in-crisis-Public-and-generatio.aspx">key driver</a> in worsening mental health among the young. </p>
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<img alt="Sad woman looks at phone" src="https://images.theconversation.com/files/579614/original/file-20240304-22-6kgvy4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/579614/original/file-20240304-22-6kgvy4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579614/original/file-20240304-22-6kgvy4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579614/original/file-20240304-22-6kgvy4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579614/original/file-20240304-22-6kgvy4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579614/original/file-20240304-22-6kgvy4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579614/original/file-20240304-22-6kgvy4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A survey shows the UK public believes social media to be a significant factor in poor youth mental health.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/disappointed-black-woman-checking-cell-phone-2415613023">Antonio Guillem/Shutterstock</a></span>
</figcaption>
</figure>
<p>The curated nature of social media feeds can create <a href="https://fherehab.com/learning/beauty-standards-mental-health">unrealistic standards</a> of beauty, success and happiness, leading to feelings of insecurity and low self-esteem. <a href="https://www.tandfonline.com/doi/full/10.1080/1047840X.2020.1820214">Increased time online</a> and the pressure to maintain an online identity may also worsen feelings of inadequacy and isolation. </p>
<p>The <a href="https://www.frontiersin.org/articles/10.3389/fhumd.2021.684137/full">pandemic</a> exacerbated these issues by intensifying feelings of social isolation and uncertainty. Organisational closures and physical distancing requirements reduced social contact and support. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8653204/">Research studies</a> report mental health deterioration among children and teenagers as a result of COVID control measures, especially among those with preexisting vulnerabilities, such as socioeconomic disadvantage, neurodiversity or disability. </p>
<p>A high proportion of young people in the UK believe that many areas are <a href="https://www.orygen.org.au/About/News-And-Events/2024/Generations-agree-youth-mental-health-is-declining/Youth-mental-health-in-crisis-Public-and-generatio.aspx">worse for them</a> compared to when their parents were their age; 78% think they are less able to afford things and 76% think mental health has worsened. This has the potential to lead to a sense of hopelessness.</p>
<p>If young people view their future as <a href="https://link.springer.com/article/10.1007/s41811-023-00165-1">gloomy</a> and feel they can do nothing to change their prospects, they are less likely to engage in tasks and activities that can improve their situation. </p>
<h2>Mental health awareness</h2>
<p>The King’s College and Orygen Institute survey found that 47% of people think mental health problems were <a href="https://www.kcl.ac.uk/policy-institute/assets/youth-mental-health-in-crisis.pdf">just as common</a> among young people in the past; they just weren’t identified as such. </p>
<p>Over the past two decades, there has been a growing awareness and acceptance of mental health issues, leading to greater visibility and discourse. This has helped reduce stigma and improve access to resources. But it has also created new challenges for young people navigating their mental health.</p>
<p><a href="https://www.mind.org.uk/about-us/our-strategy/doing-more-for-young-people/facts-and-figures-about-young-people-and-mental-health/">Increased awareness</a> has empowered young people to seek help and speak out about their struggles. </p>
<p>On the other hand, the way mental health is discussed has created a sense of pressure to find ways to be mentally healthy and resilient, with a person <a href="https://www.bps.org.uk/psychologist/mental-health-awareness-time-re-focus">individually responsible</a> for their own mental wellbeing. This pressure may be particularly challenging for young people who are struggling with difficult circumstances and associated mental health issues, leading to feelings of shame and self-blame.</p>
<p>All these factors are intertwined and difficult to isolate, meaning there is no simple solution. But my advice to everyone, not just young people, is, try to play an active part in each area of your life when you can, push yourself outside of your comfort zone, and make sure you celebrate the small wins.</p><img src="https://counter.theconversation.com/content/224670/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Fiorentina Sterkaj does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>I believe that young people today face unprecedented pressures to excel academically, professionally and socially.Fiorentina Sterkaj, Director of the Department of Psychological Sciences, School of Psychology, University of East LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2170402024-01-17T19:50:11Z2024-01-17T19:50:11ZBig dreams and high demands: The mental health challenges of elite youth athletes<figure><img src="https://images.theconversation.com/files/569667/original/file-20240116-25-tskkz8.jpg?ixlib=rb-1.1.0&rect=215%2C17%2C5775%2C3889&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A recent study found that 41 per cent of Canadian Olympic and Paralympic athletes met the criteria for one or more mental disorders, such as depression, anxiety or eating disorders.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Elite sport poses several unique pressures that can impact athletes’ mental health. </p>
<p>Demanding travel schedules and intense <a href="https://doi.org/10.1080/02640410500131480">competition pressures</a> can lead to negative emotional experiences. Athletes can <a href="http://dx.doi.org/10.1136/bjsports-2016-096731">become injured</a>, or they may be <a href="https://doi.org/10.1016/j.jsams.2017.04.018">uncertain about their future career</a> in sport. </p>
<p>Unfortunately, some athletes may also face <a href="https://doi.org/10.1177/08862605211045096">physical, psychological or sexual abuse</a> in their sport. </p>
<h2>Pressures of elite sport</h2>
<p>Research has shown that elite athletes can experience mental health issues at rates equal to or higher than the general population. A <a href="https://doi.org/10.1016/j.psychsport.2021.102018">recent study</a> found that 41 per cent of Canadian Olympic and Paralympic athletes surveyed met the criteria for one or more mental disorders, such as depression, anxiety or eating disorders. </p>
<p><a href="https://doi.org/10.1007/s40279-020-01266-z">Another study</a> involving Australian elite athletes revealed that they were nearly twice as likely to experience significant psychological distress compared to the broader community.</p>
<p>Even though elite athletes often have many resources to support them, <a href="https://doi.org/10.1037/spy0000319">they may feel it is hard to reach out and ask for help</a>. When left untreated, mental health challenges and performance pressures can lead to athletes feeling burned out or wanting to drop out of their sport, and they may even experience <a href="http://dx.doi.org/10.1136/bjsports-2019-101386">feelings of hopelessness and suicidal thoughts</a>. </p>
<p>Young people engaged in elite sport might be at even greater risk. </p>
<h2>Who are elite youth athletes?</h2>
<p>Reaching the highest levels of performance often requires athletes to <a href="http://dx.doi.org/10.1080/16184742.2017.1324503">specialize</a> in their sport during their teenage years, and <a href="https://olympics.com/en/news/age-number-youngest-olympians-2021-tokyo-2020-athletes">several athletes competing at the Olympic Games are adolescents</a>. There are numerous clubs, leagues and <a href="https://sportpourlavie.ca/wp-content/uploads/2016/12/Sport-Schools-in-Canada.pdf">schools</a> that focus on elite youth sport specialization, and there will be 1,900 athletes taking part in the <a href="https://olympics.com/en/gangwon-2024/">Youth Olympic Games</a> Jan. 19 to Feb. 1, 2024. </p>
<p>Clearly, youth athletes are already competing at elite levels or hope to reach elite levels in their sport.</p>
<p>While the term “elite youth athlete” can be tricky to define, <a href="https://doi.org/10.1177/19417381231219230">we use the term</a> to describe youth athletes who are training in sport settings that have a primary focus on achieving superior performance, with the explicit or implicit goal of moving to adult elite, collegiate or professional sports. </p>
<p>Elite youth sport environments may prioritize spending time on sport activities instead of school or relationships with friends outside of sport. These settings can provide the training and specialized skills needed to become an elite performer, but they may also pose risks to the mental health of young athletes.</p>
<h2>Mental health among elite youth athletes</h2>
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<img alt="A swimmer training alone in a pool" src="https://images.theconversation.com/files/569462/original/file-20240116-19-i1hpc0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/569462/original/file-20240116-19-i1hpc0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=388&fit=crop&dpr=1 600w, https://images.theconversation.com/files/569462/original/file-20240116-19-i1hpc0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=388&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/569462/original/file-20240116-19-i1hpc0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=388&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/569462/original/file-20240116-19-i1hpc0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=487&fit=crop&dpr=1 754w, https://images.theconversation.com/files/569462/original/file-20240116-19-i1hpc0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=487&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/569462/original/file-20240116-19-i1hpc0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=487&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Perfectionism is common among athletes, and strongly linked with poor mental health outcomes.</span>
<span class="attribution"><span class="source">(Unsplash/Jonathan Chng)</span></span>
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<p>Some pressures that are unique to elite youth athletes include early specialization and over-training, having critical or demanding coaches and parents, poor sleep, and trying to balance educational and social needs with increasingly professionalized sporting demands. <a href="https://theconversation.com/5-ways-pressuring-young-athletes-to-perform-well-does-them-harm-186699">These factors can all affect the well-being of youth elite athletes</a>. </p>
<p>Perhaps especially related to elite sport, <a href="https://theconversation.com/how-perfectionism-became-a-hidden-epidemic-among-young-people-89405">young people around the world are reporting unprecedented levels of perfectionism</a>. Perfectionism is common among athletes, and strongly linked with poor mental health outcomes. </p>
<p>Beyond the pressures of elite sport environments, young people experience the heaviest burden of mental ill-health. For young people around the world, <a href="https://doi.org/10.1038/s41380-021-01161-7">the peak age at onset for a mental health disorder is 15, and approximately half of these disorders occur before the age of 18</a>. There are many reasons why young people’s mental health is at such high risk, including increasingly troubling <a href="https://doi.org/10.1007/s00787-023-02300-x">global conflicts and climate change</a>, <a href="https://doi.org/10.1016/j.childyouth.2020.105772">parental unemployment</a>, and <a href="https://doi.org/10.1002/hec.3885">economic prospects</a>. </p>
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Read more:
<a href="https://theconversation.com/climate-change-is-harming-childrens-mental-health-and-this-is-just-the-start-168070">Climate change is harming children’s mental health – and this is just the start</a>
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<p>Compared to the body of research on mental health among <em>adult</em> athletes, there is limited research exploring this issue among elite <em>youth</em> athletes. Currently, we do not have adequate data to reliably report on the prevalence of mental health disorders among elite youth athletes. </p>
<p>One exception is the topic of eating disorders, with a <a href="https://doi.org/10.1016/j.jsampl.2023.100040">recent review</a> suggesting that elite youth athletes may be at increased risk compared to non-elite youth athletes, and compared to young people more broadly. </p>
<p>Considering the unique challenges faced by adolescents in elite sport, <a href="http://dx.doi.org/10.1136/bjsports-2022-106352">there is a pressing need to support the mental health of elite youth athletes</a>.</p>
<h2>Closing the gap: Supporting elite youth athletes</h2>
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<img alt="A skiier in mid-air" src="https://images.theconversation.com/files/569464/original/file-20240116-25-25lkrf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/569464/original/file-20240116-25-25lkrf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=480&fit=crop&dpr=1 600w, https://images.theconversation.com/files/569464/original/file-20240116-25-25lkrf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=480&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/569464/original/file-20240116-25-25lkrf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=480&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/569464/original/file-20240116-25-25lkrf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=603&fit=crop&dpr=1 754w, https://images.theconversation.com/files/569464/original/file-20240116-25-25lkrf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=603&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/569464/original/file-20240116-25-25lkrf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=603&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Some pressures that are unique to elite youth athletes include early specialization and over-training, having critical or demanding coaches and parents, poor sleep, and trying to balance educational and social needs with increasingly professionalized sporting demands.</span>
<span class="attribution"><span class="source">(Unsplash/Sebastian Staines)</span></span>
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<p>A key focus for supporting the mental health of elite youth athletes involves creating youth sport contexts that are protective for mental health. Elite youth sports environments need to be <a href="https://doi.org/10.1007/s40279-023-01912-2">psychologically safe</a> and <a href="https://doi.org/10.3390/socsci9050068">free from abuse and harassment</a>. </p>
<p>A large responsibility sits with parents and coaches, who must avoid overly critical or demanding behaviours and instead engage with young people in supportive ways. Sport organizations should <a href="https://doi.org/10.3389/fpsyg.2022.780359">prioritize well-being and healthy development</a> among youth athletes.</p>
<p><a href="https://doi.org/10.1038/s41380-023-02202-z">Early detection</a> is important to help elite youth athletes get the support they need. Warning signs of mental health concerns can include changes in an athlete’s emotions, mood, behaviours, sleep and appetite. <a href="https://doi.org/10.1016/j.psychsport.2017.11.008">Coaches and parents</a> play important roles in noticing changes in athletes’ mental health, and they can help by opening up conversations about mental health among youth athletes. </p>
<p>Listening without judgment, asking athletes what they think they might need, and offering to help them find places to seek support <a href="https://cmha.ca/brochure/talking-to-teens-about-mental-health/">are all helpful strategies when talking about mental health concerns</a>.</p>
<p>Elite youth athletes and their parents may benefit by seeking support from a psychologist, psychotherapist or psychiatrist who specializes in working with athletes. </p>
<p><a href="https://doi.org/10.1111/jcpp.13889">Much more work is needed</a> to understand the nature of mental health concerns among elite youth athletes. Given the unique demands and pressures of competing in elite sport environments and the challenges that youth face, it is imperative that we pay attention to the mental health needs of these young performers.</p>
<h2>Need support?</h2>
<p><a href="https://cmha.ca/find-help/">Canadian Mental Health Association </a></p>
<p><a href="https://www.ccmhs-ccsms.ca/mental-health-services/referrals">Canadian Center for Mental Health in Sport</a> </p>
<p><a href="https://www.canada.ca/en/public-health/services/mental-health-services/mental-health-get-help.html">Canada Mental Health Support and Resources</a></p><img src="https://counter.theconversation.com/content/217040/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katherine Tamminen is an Associate Professor at the University of Toronto and a Registered Psychotherapist. Her research is supported by the Social Sciences and Humanities Research Council of Canada and Sport Canada, the Tanenbaum Institute for Science in Sport, and the Canadian Foundation for Innovation and the Ontario Research Fund.</span></em></p><p class="fine-print"><em><span>Courtney Walton receives funding through an MSPS Academic Fellowship at the University of Melbourne. He has advised a number of elite sports codes and organisations nationally.</span></em></p><p class="fine-print"><em><span>Jordan Sutcliffe is an Assistant Professor at the Royal Military College of Canada. Some of his past research has been supported by the Social Sciences and Humanities Research Council of Canada, and he is currently involved on a project funded by the Tannenbuam Institute for Science in Sport.</span></em></p>Given the unique demands and pressures of competing in elite sport environments, it is imperative that we pay attention to elite youth athletes’ mental health needs.Katherine Tamminen, Associate Professor, Sport Psychology, University of TorontoCourtney C Walton, Academic Fellow & Psychologist, Melbourne School of Psychological Sciences, The University of MelbourneJordan Sutcliffe, Assistant Professor, Military Psychology and Leadership, Royal Military College of CanadaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2194742024-01-07T12:34:38Z2024-01-07T12:34:38ZNeighbourhood amenities may have helped youth mental health and stress early in the pandemic<figure><img src="https://images.theconversation.com/files/567975/original/file-20240105-25-yskfll.jpg?ixlib=rb-1.1.0&rect=245%2C1003%2C3621%2C1984&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Researchers investigated how the availability of neighbourhood amenities may have contributed to changes in youth mental health and stress levels during the first six months of the pandemic.</span> <span class="attribution"><span class="source">(Unsplash/Paul Hanaoka)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/neighbourhood-amenities-may-have-helped-youth-mental-health-and-stress-early-in-the-pandemic" width="100%" height="400"></iframe>
<p>During the COVID-19 pandemic, youth as a population group <a href="https://www150.statcan.gc.ca/n1/daily-quotidien/210201/dq210201b-eng.htm">reported some of the largest declines in their mental health</a> compared to other age groups in Canada. </p>
<p>Research on youth mental health during the pandemic has focused on <a href="https://www.facetsjournal.com/doi/full/10.1139/facets-2021-0096">poor academic engagement</a>, <a href="https://doi.org/10.1139/facets-2021-0080">loss of peer networks</a>, <a href="https://doi.org/10.1016/S2352-4642(20)30109-7">missed milestone events</a> and <a href="https://doi.org/10.1186/s13034-023-00653-4">challenging summer employment experiences</a>. Yet little is known about how the places where young people lived played a role in changes to their mental health during the pandemic.</p>
<p>From walking in a park to ordering takeout food, there was not much to do out in public during the early months of the pandemic. Youth were attending school remotely and no longer participating in organized sports and indoor recreation. </p>
<p>For many, that meant their daily activities outside the home often consisted of what could be reached within walking distance of where they lived. Parks and food-related retail became the main places for physically distanced social interactions. They became a break in the routines of remote school, activities and virtual social networks available at home.</p>
<h2>Neighbourhood amenities</h2>
<p><a href="https://doi.org/10.1080/23748834.2023.2282850">Our study</a> included Canadian youth between the ages of 13 and 19 in London, Ont. We investigated how the availability of neighbourhood amenities may have contributed to positive or negative changes in mental health — interpreted as their own perception of their mood and outlook on life — and stress levels during the first six months of the pandemic.</p>
<p>Amenities included parks, food outlets and convenience stores in close proximity to home.</p>
<p>We investigated whether these amenities could have protected against declines in mental health and increases in stress levels, and also if youth living in suburban neighbourhoods had different perceptions of mental health and stress levels than those living in urban ones.</p>
<h2>The missing role of parks</h2>
<p>Surprisingly, the availability of parks near the home had no significant impact on mental health and stress levels of youth. This finding runs counter to <a href="https://doi.org/10.1186/s12889-022-13148-2">evidence that suggests these places were crucial to supporting well-being</a> during the pandemic. </p>
<p>Given the pre-pandemic challenges of <a href="https://doi.org/10.24095/hpcdp.40.4.02">engaging young people in using their local parks</a>, these places may have not played as substantial a role in supporting better mental health and lowering stress levels for youth compared to other neighbourhood amenities.</p>
<h2>Youth experiences in urban neighbourhoods</h2>
<p>For youth in urban neighbourhoods, having more fast-food outlets available near young people’s homes resulted in lower levels of stress, but worse declines in mental health. When coupled with the <a href="https://doi.org/10.1080/23748834.2023.2282850">observed decline in eating habits</a>, urban youth were almost seven times more likely to report worse mental health. </p>
<p>While the places near young people’s homes can make a difference to their mental health, we found that the impact is greater on their stress levels. </p>
<p>It may be that food-based amenities in urban neighbourhoods provided places for young people to relieve their stress and try to cope with declines in their mental health by eating fast-food and convenience-store snacks and socializing.</p>
<h2>Youth experiences in suburban neighbourhoods</h2>
<p>Youth in suburban neighbourhoods were more likely to report changes (both improvements and declines) to their mental health and stress levels. They also had a greater availability of food outlets near them compared to urban youth. In particular, having more convenience stores near the home was associated with more drastic changes to mental health and higher stress levels. </p>
<p>In addition, youth residing in suburban neighbourhoods who reported a decline in their physical activity levels were also at nearly three times the risk of having worsened mental health than their peers who reported their physical activity levels had not changed since the pandemic. </p>
<p>Overall, boys were substantially less likely than girls to have improved mental health during the study period, and this was especially true for those residing in suburban areas.</p>
<p>One possible reason for this trend could be that boys are <a href="https://doi.org/10.1016/j.ssresearch.2019.03.015">more likely to play organized sports</a> than girls, which are often delivered by schools as extracurricular activities. In addition, boys tend to have less <a href="https://doi.org/10.1080/14742837.2021.2011189">extensive social networks</a> on digital platforms outside of their school than girls. </p>
<p>The loss of opportunities for physical activity and transition away from in-person social networks at schools may have created feelings of isolation and loneliness for boys.</p>
<h2>The role of neighbourhood amenities</h2>
<p>The first six months of the pandemic revealed the importance of neighbourhood amenities in protecting against declines in mental health and reducing stress levels. </p>
<p>Parks may have been a helpful feature for other population groups, but we found their role was limited for youth in terms of mental health and stress. Planners and landscape architects can reflect on how these places could be changed to be more attractive to youth, thereby ensuring they receive the same benefits from them as younger and older groups. </p>
<p>In addition, it is important to consider that the experiences of youth living in suburban and urban neighbourhoods may differ. This highlights the need to include youth perspectives in the planning of public spaces that contribute to healthy and thriving communities. </p>
<p>The pandemic exposed long-standing issues in how youth can access amenities in their community, and how to best meet their needs in Canadian communities.</p><img src="https://counter.theconversation.com/content/219474/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alexander Wray receives funding from the Social Sciences and Humanities Research Council of Canada and Sport Canada. He is President of the Town and Gown Association of Ontario. </span></em></p><p class="fine-print"><em><span>Kendra Nelson Ferguson was provided with funding through a trainee award from the Children’s Health
Research Institute, funded by the Children’s Health Foundation.</span></em></p><p class="fine-print"><em><span>Gina Martin, Jamie Seabrook, Jason Gilliland, and Stephanie Coen do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Neighbourhood features may have helped youth cope with the mental health impact of pandemic restrictions. Parks didn’t play much of a role but food amenities and the suburbs did.Alexander Wray, PhD Candidate in Geography, Western UniversityGina Martin, Assistant Professor, Faculty of Health Disciplines, Athabasca UniversityJamie Seabrook, Chair and Professor, School of Food and Nutritional Sciences, Brescia University College, Adjunct Research Professor, Paediatrics, Adjunct Professor, Epidemiology & Biostatistics, Western UniversityJason Gilliland, Professor, Director, Urban Development Program, Western UniversityKendra Nelson Ferguson, Postdoctoral Research Associate, Faculty of Social Sciences, Western UniversityStephanie Coen, Associate professor, School of Geography, University of NottinghamLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2171732023-12-18T13:23:10Z2023-12-18T13:23:10ZTeaching positive psychology skills at school may be one way to help student mental health and happiness<figure><img src="https://images.theconversation.com/files/563023/original/file-20231201-23-9z02ez.jpg?ixlib=rb-1.1.0&rect=0%2C14%2C4896%2C3232&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Gratitude, kindness and optimistic thinking can help kids feel a bit better.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/individuality-unique-happy-and-enjoy-stand-out-from-royalty-free-image/1414874178">Wipada Wipawin/iStock via Getty Images Plus</a></span></figcaption></figure><p>Youth mental health has worsened significantly over the past decade, but new interventions that teach positive psychology concepts in school may help.</p>
<p>American young people are reporting <a href="https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBS_Data-Summary-Trends_Report2023_508.pdf">historically high levels</a> of hopelessness, sadness and loneliness. According to the most recent data from the U.S. Centers for Disease Control and Prevention, more than <a href="https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBS_Data-Summary-Trends_Report2023_508.pdf">20% of adolescents</a> have seriously considered suicide – and suicide is the <a href="https://www.cdc.gov/suicide/facts/index.html">second-leading cause of death for children</a> ages 10-14.</p>
<p>Perhaps even more alarming than the prevalence of youth mental health problems is the <a href="https://www.mhanational.org/research-reports/2022-state-mental-health-america-report">inaccessibility of mental health support</a> <a href="https://theconversation.com/as-the-mental-health-crisis-in-children-and-teens-worsens-the-dire-shortage-of-mental-health-providers-is-preventing-young-people-from-getting-the-help-they-need-207476">for the many children who need it</a>. About <a href="https://www.mhanational.org/research-reports/2022-state-mental-health-america-report">60% of depressed adolescents</a> do not receive any treatment – and around <a href="https://www.mhanational.org/research-reports/2022-state-mental-health-america-report">950,000 children do not have health insurance</a> that covers mental health services. </p>
<p>One solution is to provide mental health care in schools, where kids are. This is <a href="https://doi.org/10.1007/s10488-020-01080-9">already happening</a>. School counselors, psychologists and social workers provide support, teach coping strategies and work with caregivers to help students overcome mental health challenges. Such vital care is essential, but clearly more help is needed. </p>
<p>Research shows that students who have a positive outlook regarding their lives <a href="https://doi.org/10.1016/j.jsp.2016.05.003">outperform other students</a> academically and emotionally. You might wonder, can positive thinking be taught?</p>
<p>I study school-based positive psychology interventions. My colleagues have found that students who’ve been <a href="https://doi.org/10.1080/02796015.2017.12087610">introduced to science-based ideas about happiness</a> feel more satisfied with life, experience more positive than negative emotions and have fewer emotional and behavioral problems. </p>
<h2>Science of happiness</h2>
<p>Psychologists began to study the science of happiness <a href="https://doi.org/10.1037/0003-066X.55.1.5">in the late 1990s</a>. Prior to that time, most psychology researchers studied misery. </p>
<p>Psychologist Martin Seligman was such a scientist, having pioneered the concept of “<a href="https://doi.org/10.1146/annurev.me.23.020172.002203">learned helplessness</a>.” But a conversation with his young daughter, in which she demanded to know why he couldn’t “<a href="https://www.verywellmind.com/martin-seligman-biography-2795527">stop being such a grouch</a>,” inspired him to <a href="https://www.pushkin.fm/podcasts/the-happiness-lab-with-dr-laurie-santos/the-man-who-invented-happiness-science-marty-seligman">start studying what makes people happy</a> instead. </p>
<p><a href="https://doi.org/10.1037/0003-066X.55.1.5">Initial studies</a> were conceptual in nature. But before long, researchers started to identify <a href="https://doi.org/10.1037/1089-2680.9.2.111">what makes people happy</a>, the <a href="https://doi.org/10.1037/0033-2909.131.6.803">benefits of happiness</a> and <a href="https://doi.org/10.1080/17439760.2020.1818807">interventions to improve happiness</a>. </p>
<p>Scientists identified three main predictors of happiness – <a href="https://doi.org/10.1037/1089-2680.9.2.111">genetics, life circumstances and purposeful activities</a> – and potentially others, depending on one’s culture. Of the big three, the first two are often out of an individual’s control. But science has shown that <a href="https://doi.org/10.1080/17439760.2019.1689421">people can adopt strategies to feel happier</a>. </p>
<p>Achieving a state of <a href="https://www.simonandschuster.com/books/Flourish/Martin-E-P-Seligman/9781439190760">flourishing</a> – or feeling good and doing good – is the goal of positive psychology interventions. It can evoke positive feelings, increase engagement with life, strengthen positive relationships, move people toward purpose and help people achieve meaningful goals. </p>
<h2>Positive psychology in schools</h2>
<p>Positive psychology is now taught in some <a href="https://doi.org/10.1111/jan.14408">schools around the world</a>, including in the U.S., Australia, Denmark, Israel, New Zealand, China and South Africa. Most interventions educate students about mindfulness and positive psychology concepts such as gratitude, kindness, optimistic thinking, utilizing <a href="https://www.viacharacter.org/character-strengths">character strengths</a> and hope. The idea is not just to teach students about positive psychology as a school subject but help them practice the skills that research suggests will help them flourish.</p>
<p>In typical programs, students first learn positive psychology concepts, then practice using them in real life with the help of trusted adults. For example, students discuss what gratitude means to them, then practice writing down three things they are thankful for every night before bed with the help of their caregivers. After a week, students discuss with adults at school how practicing gratitude affected their level of happiness. </p>
<p>A 2020 review of 57 school-based positive psychology programs showed <a href="https://doi.org/10.1111/jan.14408">more than half resulted in positive outcomes</a>, including less stress, lower depression, less anxiety, fewer behavioral issues, better self-image, higher life satisfaction and stronger social functioning.</p>
<h2>‘Nice inside’</h2>
<p>One intervention currently being studied by the <a href="https://ies.ed.gov/funding/grantsearch/details.asp?ID=4451">U.S. Department of Education</a> is a 10-week, small-group intervention aimed at helping middle schoolers. I coach the mental health providers implementing this program. </p>
<p>Like other programs of its kind, it teaches youth about positive concepts, including gratitude, kindness, character strengths, optimism and hope. Early findings, presented at the 2023 <a href="https://www.nasponline.org/professional-development/nasp-2024-annual-convention/convention-program">National Association of School Psychology</a> conference, show the program is being well received both by students and providers. </p>
<p>We’ve found students tend to favor activities that fit with their culture or values. For example, one student shared that performing acts of kindness was their favorite program-based activity, because it helped them spend more time with family and pets – the two most important things in their life. Another student said being able to share the strategies with their mother helped them both feel happier. This student was also proud to be able to help their family. </p>
<p>We also found that some students believed the program helped them build positive relationships with others. One student shared, “It’s really fun to see how others react when I’m being nice, such as giving a compliment,” and that doing so helped them feel “nice inside.” Another student agreed, saying making others feel good helped them feel happier. </p>
<p>Positive psychology training is only one piece of the solution for improving youth mental health. Children with severe issues need comprehensive treatment, which can include mental health counseling and medication. </p>
<p>Even though many important factors are out of a person’s control, everyone has room for growth in happiness. My colleagues and I hope teaching positive psychology in schools will become a common practice in the future.</p><img src="https://counter.theconversation.com/content/217173/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>I was a post-doctoral research fellow under Dr. Shannon Suldo (author of the Well-Being Promotion Program; WBPP). Currently, I am contracted to coach school mental health providers who are providing the WBPP through an IES-funded grant. </span></em></p>Positive psychology focuses on science-based ideas about how to increase your happiness and live a satisfying life. Studies are following how school-based interventions affect students.Kai Zhuang Shum, Assistant Professor of School Psychology, University of TennesseeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2056522023-12-17T19:17:42Z2023-12-17T19:17:42ZUniversity isn’t right for everyone. Pushing young people to go can have devastating effects<figure><img src="https://images.theconversation.com/files/547106/original/file-20230908-21-vuv5u4.jpg?ixlib=rb-1.1.0&rect=0%2C8%2C6000%2C3979&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Australian school students feel immense pressure to go to university, often at the exclusion of all other pathways, which can lead to devastating mental health effects. </p>
<p>That’s among the headline findings of our decade-long program of research on the aspirations and post-school trajectories of young Australians. </p>
<p>Our <a href="https://www.tandfonline.com/doi/full/10.1080/00131911.2023.2287417">research</a>, published today in the journal <a href="https://www.tandfonline.com/journals/cedr20">Educational Review</a>, reveals the unintended consequences of government higher education policies, inadequate school career advice, and a wider public devaluing of the vocational education and training sector.</p>
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Read more:
<a href="https://theconversation.com/why-would-you-go-to-uni-a-new-study-looks-at-what-young-australians-do-after-school-200073">'Why would you go to uni?' A new study looks at what young Australians do after school</a>
</strong>
</em>
</p>
<hr>
<h2>Our research</h2>
<p>Since 2012, we’ve conducted one of the largest <a href="https://www.aspirations.edu.au/the-research">studies</a> to date on the aspirations of Australian youth, involving more than 10,000 students in Years 3-12.</p>
<p>Recently, we followed up with 50 of these young people <a href="https://www.ncsehe.edu.au/publications/aspirations-equity-higher-education-course-choice/">post-school</a> to see where they ended up in terms of their career and educational pathways.</p>
<p>Our findings reveal some significant and, at times, devastating insights into how young Australians – particularly those from underrepresented backgrounds – have experienced the “push” towards higher education.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/547108/original/file-20230908-19-vuv5u4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A crisp winter light falls upon the University of Sydney." src="https://images.theconversation.com/files/547108/original/file-20230908-19-vuv5u4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/547108/original/file-20230908-19-vuv5u4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/547108/original/file-20230908-19-vuv5u4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/547108/original/file-20230908-19-vuv5u4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/547108/original/file-20230908-19-vuv5u4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/547108/original/file-20230908-19-vuv5u4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/547108/original/file-20230908-19-vuv5u4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Not everyone needs to go to university.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Pressure to attend university and the devaluing of TAFE</h2>
<p>The young people in our research consistently said university was explicitly pushed as the only post-school pathway worth pursuing during their schooling. Other pathways were often deemed to be “not good enough”. One university graduate told us:</p>
<blockquote>
<p>I think there’s quite a lot actually of […] pressure given, not from all teachers, but some teachers, to really go towards higher education […] I’d say I felt pressured as a group, or as like, as a generation […] I just think that was just an overarching expectation.</p>
</blockquote>
<p>This pressure frustrated some students. Angus* fulfilled his dream of becoming a chef by training at TAFE and eventually working in a top restaurant in London. In his first interview in 2014 he described restaurants as a place he “fits in”. </p>
<p>However, he also told us he had been repeatedly told by his teachers that “cheffing’s a horrible job”:</p>
<blockquote>
<p>Almost every teacher at my school wanted to push me into their career path, [and I was told], ‘You’re very smart […] you should go to uni’ [otherwise I] might not become successful […] They always pushed me towards university. Regardless of what my feelings were, to be honest, I never felt truly supported by my career adviser.</p>
</blockquote>
<h2>Limited career education in school</h2>
<p>Young people also overwhelmingly said the career education provided at school was unhelpful, impersonal, and pushed them towards university. </p>
<p>Career guidance was mainly focused on achieving a high ATAR (university entrance rank), with one student describing how her career adviser spent “more time trying to calculate my ATAR than imparting actual advice”.</p>
<p>Alternative entry pathways into university often weren’t openly discussed or fully understood. Such pathways were often devalued in favour of achieving the best ATAR possible. One young person told us:</p>
<blockquote>
<p>I think with the pressure in schools on ATARs and that sort of thing – and they have to put that pressure on because they want you to do well. But it sort of develops a stigma around, well, if I don’t do Year 11 and 12 […], then I can’t get into university, without [young people understanding] there’s actually [alternative] pathways.</p>
</blockquote>
<h2>Stress and poor mental health</h2>
<p>Many young people therefore felt high levels of stress and poor mental health during the final years of high school and the beginning of university, with some “losing the plot” or feeling “burnt out”.</p>
<p>The most extreme mental ill health reported in our interviews was experienced by Dahlia, a young Indigenous woman.</p>
<p>When we first spoke to her in 2016, she was a high achieving Year 11 student with aspirations to become a criminal psychologist. </p>
<p>When we next spoke to her in 2021, she described how the pressure of Year 12 caused her to drop out of school. During this year, Dahlia had severe mental ill health and made an attempt to end her life. </p>
<p>She later completed a traineeship in early childhood and care, before entering university to study a combined degree in primary and early childhood teaching. Dahlia was eager for her experience to be a warning about the pressure and stress of Year 12 exams:</p>
<blockquote>
<p>It was just a burn out, like, I was just so overwhelmed. I felt like I was so pressured to do the best and I felt like I wasn’t the best […] then I’d get anxiety about not being as good as everyone thinks I am […] that’s why I really wanted to do this interview, because I wanted to put it out there that high school is not the be all, end all […] getting that high [Year 12] mark isn’t the be all, end all. </p>
</blockquote>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/547109/original/file-20230908-17-efu6e7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A group of high school students look at a laptop." src="https://images.theconversation.com/files/547109/original/file-20230908-17-efu6e7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/547109/original/file-20230908-17-efu6e7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=384&fit=crop&dpr=1 600w, https://images.theconversation.com/files/547109/original/file-20230908-17-efu6e7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=384&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/547109/original/file-20230908-17-efu6e7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=384&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/547109/original/file-20230908-17-efu6e7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=483&fit=crop&dpr=1 754w, https://images.theconversation.com/files/547109/original/file-20230908-17-efu6e7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=483&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/547109/original/file-20230908-17-efu6e7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=483&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Many young people feel high levels of stress during the final years of high school.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Where to from here?</h2>
<p>The pressure to attend university compounds stress and poor mental health for some young people. This isn’t surprising given the transition to adulthood is the peak period for the <a href="https://onlinelibrary.wiley.com/doi/10.5694/mja2.51327">onset of mental disorders</a>. </p>
<p>We must urgently address the limited career education available to students and the narrow version of success linked to <a href="https://theconversation.com/they-dont-expect-a-lot-of-me-they-just-want-me-to-go-to-uni-first-in-family-students-show-how-we-need-a-broader-definition-of-success-in-year-12-196284">Year 12 exams and the ATAR</a> in schools and society.</p>
<p>This would involve:</p>
<ul>
<li><p>providing adequate training and resources to schools and career advisers</p></li>
<li><p>raising the status of vocational education and careers; and</p></li>
<li><p>valuing alternative pathways to university, such as <a href="https://theconversation.com/what-are-enabling-programs-how-do-they-help-australians-get-to-uni-210269">enabling programs</a>.</p></li>
</ul>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/547107/original/file-20230908-29-c5ry5k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman looks very stressed." src="https://images.theconversation.com/files/547107/original/file-20230908-29-c5ry5k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/547107/original/file-20230908-29-c5ry5k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/547107/original/file-20230908-29-c5ry5k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/547107/original/file-20230908-29-c5ry5k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/547107/original/file-20230908-29-c5ry5k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/547107/original/file-20230908-29-c5ry5k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/547107/original/file-20230908-29-c5ry5k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The pressure to attend university can compound stress.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p><a href="https://www.education.gov.au/australian-universities-accord/resources/accord-interim-report">The Universities Accord</a> (a major federal government-led review that seeks to “reimagine” higher education for the next 30 years) provides an opportunity to change the lives and trajectories of Australian students. Ensuring the higher education sector is fair and equitable is at the heart of this process.</p>
<p>Its <a href="https://www.education.gov.au/australian-universities-accord/resources/accord-interim-report">interim report</a> claims that “too few Australians are going to university.” This is based on estimates that more than 50% of new jobs in the next five years will require a university degree. </p>
<p>However, the skills gap is even greater in technician and trade careers <a href="https://www.nationalskillscommission.gov.au/sites/default/files/2022-10/2022%20SPL%20Key%20Findings%20Report%20-%206%20October%202022_0.pdf">than professional occupations</a>.</p>
<p>This means the spotlight can’t only be on universities; a focus on vocational education and training pathways (such as TAFE) is crucial too.</p>
<p>To confront the challenges of the coming century, we need a broader public conversation about the place of tertiary education – not just university – and the diverse educational and career pathways available.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/they-dont-expect-a-lot-of-me-they-just-want-me-to-go-to-uni-first-in-family-students-show-how-we-need-a-broader-definition-of-success-in-year-12-196284">'They don’t expect a lot of me, they just want me to go to uni': first-in-family students show how we need a broader definition of 'success' in year 12</a>
</strong>
</em>
</p>
<hr>
<p><em>*Names have been changed to protect identities.</em></p><img src="https://counter.theconversation.com/content/205652/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The Aspirations Longitudinal Study and related studies (2010-2021) were funded by the Australian Research Council, the NSW Department of Education, and the National Centre for Student Equity in Higher Education.</span></em></p><p class="fine-print"><em><span>Sally Patfield currently receives funding from the NSW Department of Education, the Commonwealth Department of Education, and the Paul Ramsay Foundation.</span></em></p>We uncovered some significant and often devastating insights into how young Australians – particularly those from disadvantaged backgrounds – have experienced the ‘push’ towards university.Kristina Sincock, Researcher and Project Manager, University of NewcastleFelicia Jaremus, Senior research officer, University of NewcastleSally Patfield, Senior Research Fellow, Teachers and Teaching Research Centre, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2169652023-11-08T22:30:03Z2023-11-08T22:30:03ZHockey organizations need to address the psychological impacts of team trauma, not just the physical ones<iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/hockey-organizations-need-to-address-the-psychological-impacts-of-team-trauma-not-just-the-physical-ones" width="100%" height="400"></iframe>
<p>Hockey player <a href="https://www.cnn.com/2023/10/29/sport/adam-johnson-ice-hockey-death-spt-intl/index.html">Adam Johnson’s death</a> from an on-ice skate blade incident was jarring and tragic. <a href="https://www.theguardian.com/sport/2023/oct/29/nottingham-panthers-ice-hockey-player-adam-johnson-dies-after-freak-injury">Johnson passed away on Oct. 28</a> after being cut in the neck by another player’s skate blade during a professional hockey game in Sheffield, England.</p>
<p>Understandably, a vigorous debate has ensued about whether neck guards should be made mandatory beyond the minor hockey league level. <a href="https://www.cbc.ca/news/canada/calgary/hockey-whl-nhl-adam-johnson-1.7015959">Some leagues quickly responded</a> by implementing neck guard policies and <a href="https://www.espn.com/nhl/story/_/id/38794588/nhl-nhlpa-discuss-safety-player-death-england">others might follow</a> once the issue has been filtered through the proper channels.</p>
<p>Hockey organizations have been <a href="https://cdn.hockeycanada.ca/hockey-canada/Hockey-Programs/Safety/Concussion/Downloads/hockey-canada-concussion-policy-e.pdf">responsive to physical injuries</a> in recent years, and the adoption of life-saving protective equipment is certainly important, but this is not the only conversation we should be having.</p>
<p>Organized hockey at all levels needs a strategy for unseen injuries as well. They’re often the last to heal, <a href="https://theathletic.com/5014881/2023/10/30/clint-malarchuk-adam-johnson-death/">if they do at all</a>. </p>
<h2>Lasting impacts of traumatic events</h2>
<p>Traditionally, hockey culture — the norms and behaviours that guide the sport — has shown a preference for attributes like mental toughness over emotional vulnerability. This practice can damage athletes when they’re confronted with traumatic events, which are more frequent than many realize.</p>
<p>I have spent the last four years exploring team tragedy in the youth hockey context. Alongside research team members Todd Loughead, Owen Bravo, Joe Miller and Shaun Smith, <a href="https://www.uwindsor.ca/dailynews/2020-07-13/swift-current-bus-crash-incident-inform-best-practices-teams-crisis">we have been working to understand why organized youth hockey has mishandled team tragedy</a>, the consequences of untreated trauma and, most importantly, ways to improve support systems for young athletes.</p>
<p>To that end, we conducted almost 30 in-depth interviews, starting with survivors of the Western Hockey League’s <a href="https://www.espn.com/espn/eticket/story?page=swiftcurrent&redirected=true">Swift Current Broncos bus crash</a> that took place in Swift Current, Sask. in 1986. The crash claimed the lives of four players (Trent Kresse, Scott Kruger, Chris Mantyka and Brent Ruff) and the survivors received no formal support from their head coach and general manager, Graham James.</p>
<p>James, in his role as team gatekeeper, employed the time-honoured practice of closing ranks in the face of adversity. Given <a href="https://www.cbc.ca/news/canada/calgary/graham-james-sex-assault-parole-theo-fleury-sheldon-kennedy-1.3762624">James’s later conviction in junior hockey sex assaults against players</a> he coached in the 1990s, this “closing ranks” response seems not only outdated, but profoundly disturbing.</p>
<p>Players, too concerned about appearing weak, didn’t self-advocate for resources. They didn’t want to appear as “damaged goods,” particularly when they were so close to their childhood NHL dreams. Our interviews revealed that some players turned to substances to help cope with their survivor’s guilt and their unresolved mental turmoil. Others struggled because of their close relationships with their fallen teammates or because they had increased responsibilities that resulted from the deaths. </p>
<p>Players that were billeted — a reality of junior hockey — tended to fare worse because they were separated from their families, and their billet families often felt under-resourced to support them. Some players managed to sublimate their mental struggles while their hockey career lasted, but many experienced a significant, if delayed, reckoning in their late 30s.</p>
<h2>Hope on the horizon</h2>
<p>Hockey culture has drawn <a href="https://www.sportsnet.ca/nhl/article/hockey-canada-summit-puts-elite-mens-hockey-culture-under-the-microscope/">increased scrutiny</a> in recent years for failing to modernize and address toxic masculinity in the sport. <a href="https://theconversation.com/hockey-canadas-problems-show-that-the-government-needs-to-regulate-sport-in-canada-192052">Recent troubling incidents involving Hockey Canada</a> prove more can, and must, be done to improve the hockey experience. </p>
<p>Nevertheless, our interviews with youth hockey stakeholders demonstrate there is a clear desire to better support teams struck by tragedy. </p>
<p>A striking example of positive change is evident in the post-tragedy experience shared with us by Tim Barrie, director of hockey operations for the Ayr Centennials. When captain <a href="https://www.cbc.ca/news/canada/kitchener-waterloo/eli-palfreyman-funeral-tuesday-ayr-centennials-1.6571031">Eli Palfreyman</a> collapsed during an intermission and died, the team and league insisted on supporting players with mental-health resources. </p>
<p>The team WhatsApp group chat demonstrated an environment where players and team staff felt safe to express love, sorrow and brotherhood. This stands in stark contrast to the experience of the Broncos, who largely suffered in silence.</p>
<p>The landscape surrounding mental health in youth hockey has changed. Some of this improvement is owing to likes of <a href="https://igotmind.ca/about/">Bob Wilkie</a>, a 1986 Broncos bus crash survivor that saw the system for what it was and knew it could be better. <a href="https://calgarysun.com/sports/hockey/former-nhler-wilkies-i-got-mind-mental-health-tour-helps-parents-athletes">Wilkie founded I Got Mind</a>, a program that helps young athletes and their families deal with mental illness, in 2008.</p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/CwkoCBzr6N0/?utm_source=ig_web_copy_link\u0026igshid=MzRlODBiNWFlZA==","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<p>What remains elusive, however, is an emergency plan that youth hockey organizations can implement once tragedy occurs. </p>
<h2>Supporting player mental health</h2>
<p>At present, responses to tragic events in Canadian hockey have been reactive and improvisational. Representatives from the Ontario Minor Hockey Association and Hockey Canada expressed that <a href="https://cdn.hockeycanada.ca/hockey-canada/Hockey-Programs/Safety/Insurance/Downloads/claim_process_e.pdf">resources are available</a> for member leagues and clubs, but there was some doubt that affected groups would know how to access them. </p>
<p>The money provided by <a href="https://hockeycanada.ca/en-ca/hockey-programs/safety/essentials/insurance">Hockey Canada’s insurance</a> for grief counselling is capped at $1,000 per team, which doesn’t go far in our inflationary times. </p>
<p>To complicate matters, Hockey Canada provides the money but not the expertise, leaving tragedy-stricken teams to search for their own grief counselling providers who can offer timely support. Given <a href="https://www.cbc.ca/radio/checkup/mental-health-service-climbs-waitlists-too-1.6798601">wait times and the scarcity of therapists</a>, particularly in rural areas, this solution seems problematic. </p>
<p>Minor hockey associations that operate in the not-for-profit space and rely heavily on volunteers are particularly shorthanded. They depend on the kindness of the communities they serve to offer resources and expertise to players.</p>
<p>A recent <a href="https://www.cbc.ca/sports/hockey/hockey-canada-elect-new-board-of-directors-1.6689752">change in leadership</a> and direction shows Hockey Canada is serious about <a href="https://www.thestar.com/opinion/editorials/the-funding-is-back-but-can-public-trust-in-hockey-canada-be-restored/article_5b6e5faa-982b-5be0-bc53-71e021c41503.html">winning back the trust</a> of the public. As such, the governing body should embrace this opportunity to properly resource hockey teams in crisis by creating a mental-health unit that can be deployed across the country.</p><img src="https://counter.theconversation.com/content/216965/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Craig Greenham receives funding from the Social Sciences and Humanities Research Council. </span></em></p>Hockey culture’s tendency to prefer attributes like mental toughness over emotional vulnerability can damage athletes when they’re confronted with traumatic events. This needs to change.Craig Greenham, Associate professor, Department of Kinesiology, University of WindsorLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2074762023-08-16T12:28:50Z2023-08-16T12:28:50ZAs the mental health crisis in children and teens worsens, the dire shortage of mental health providers is preventing young people from getting the help they need<figure><img src="https://images.theconversation.com/files/534699/original/file-20230628-23-9wa1lm.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5584%2C3731&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Anxiety, depression and suicide among U.S. teens continue to increase. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/young-girl-in-trouble-feeling-sad-and-depressed-royalty-free-image/1135281941?phrase=distressed+teenager&adppopup=true">Paolo Cordoni/iStock via Getty Images Plus</a></span></figcaption></figure><p>The hospital where I practice recently admitted a 14-year-old girl with <a href="https://www.samhsa.gov/mental-health/post-traumatic-stress-disorder#">post-traumatic stress disorder</a>, or PTSD, to our outpatient program. She was referred to us six months earlier, in October 2022, but at the time we were at capacity. Although we tried to refer her to several other hospitals, they too were full. During that six-month wait, she attempted suicide. </p>
<p>Unfortunately, this is an all-too-common story for young people with mental health issues. A 2021 survey of 88 children’s hospitals reported that they <a href="https://www.cdc.gov/nchs/products/databriefs/db471.htm">admit, on average, four teens per day</a> to inpatient programs. At many of these hospitals, more children await help, but there are simply not enough services or psychiatric beds for them. </p>
<p>So these children languish, sometimes for days or even a week, in hospital emergency departments. This is not a good place for a young person coping with grave mental health issues and perhaps considering suicide. Waiting at home is not a good option either – the family is often unable or unwilling to deal with a child who is distraught or violent. </p>
<p>I am a <a href="https://som.cuanschutz.edu/Profiles/Faculty/Profile/28534">professor of psychiatry and pediatrics</a> at the University of Colorado, where I founded and direct the <a href="https://medschool.cuanschutz.edu/psychiatry/PatientCare/STARTcenter">Stress, Trauma, Adversity Research and Treatment Center</a>. For 30 years, my practice has focused on youth stress and trauma. </p>
<p>Over those years, I have noticed that these young patients have become more aggressive and suicidal. They are sicker when compared to years past. And the <a href="https://blogs.cdc.gov/nchs/2023/06/15/7396/#">data backs up my observation</a>: From 2007 through 2021, suicide rates among young people ages 10 to 24 increased by 62%. From 2014 to 2021, homicide rates rose by 60%. The situation is so grim that in October 2021, health care professionals <a href="https://www.aap.org/en/advocacy/child-and-adolescent-healthy-mental-development/aap-aacap-cha-declaration-of-a-national-emergency-in-child-and-adolescent-mental-health/">declared a national emergency</a> in child mental health. </p>
<p>Since then, the crisis has not abated; it’s only gotten worse.
But there are <a href="https://www.commonwealthfund.org/publications/explainer/2023/may/understanding-us-behavioral-health-workforce-shortage#">not enough mental health professionals</a> to meet the need. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/tuCuFddCaqM?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">How school bullying led to tragedy.</span></figcaption>
</figure>
<h2>The numbers behind the suffering</h2>
<p>The American Academy of Child and Adolescent Psychiatry reported in May 2023 that there is a <a href="https://www.aacap.org/aacap/zLatest_News/Severe_Shortage_Child_Adolescent_Psychiatrists_Illustrated_AACAP_Workforce_Maps.aspx">drastic shortage of child and adolescent psychiatrists</a> across the U.S. </p>
<p>For every 100,000 children in the U.S. – with 1 in 5 of those children having a mental, emotional or behavioral disorder in a given year – there are only 14 child and adolescent psychiatrists available to treat them, <a href="https://www.aacap.org/aacap/Advocacy/Federal_and_State_Initiatives/Workforce_Maps/Home.aspx">according to the American Academy of Child and Adolescent Psychiatry</a>. At least three times as many are needed. </p>
<p>There is also a significant shortage of child therapists – social workers, psychologists, licensed professional counselors – as well. This is particularly the case in <a href="https://doi.org/10.1001/jamapediatrics.2018.5399">rural areas across the country</a>. </p>
<p>Studies show that young people in the U.S. are <a href="https://www.pewresearch.org/social-trends/2019/02/20/most-u-s-teens-see-anxiety-and-depression-as-a-major-problem-among-their-peers/">increasingly stressed and traumatized</a>. The <a href="https://www.mayoclinic.org/healthy-lifestyle/tween-and-teen-health/in-depth/teens-and-social-media-use/art-20474437#">constant barrage of information</a> via social media and the demand to participate in it is complex, and interactions can be harmful to a child’s mental health. </p>
<p>Young people deal with <a href="https://cyberbullying.org/cyberbullying-statistics-age-gender-sexual-orientation-race">cyberbullying</a> and endless exposure to social media content <a href="https://theconversation.com/mounting-research-documents-the-harmful-effects-of-social-media-use-on-mental-health-including-body-image-and-development-of-eating-disorders-206170">focused on body image</a>.</p>
<p>But what children and adolescents see online is not the only problem. Much of life still happens offline, and a lot of it is not good. Millions of young people deal every day with <a href="https://ncsacw.acf.hhs.gov/research/child-welfare-and-treatment-statistics.aspx#">alcoholic, drug-abusing or neglectful parents</a>; peers who <a href="https://drugabusestatistics.org/teen-drug-use/">drink, vape and use drugs</a>; violence at <a href="https://www.cdc.gov/violenceprevention/communityviolence/index.html">their schools or in their streets</a>; and overwhelmed caregivers – whether parents or others – preoccupied with financial or other personal problems. </p>
<p>For an adolescent already struggling to make sense of the world, any one of these issues can be overwhelming. </p>
<h2>Not enough time or money</h2>
<p>The U.S. health care system does very little to support these children or their families. This pattern begins at the moment of birth, and it is baked into the system. </p>
<p>Ideally, prospective parents or those who are pregnant would receive parenting classes that continue through the child’s developmental phases. That generally <a href="https://www.gse.harvard.edu/ideas/ed-magazine/19/08/parent-approved">does not happen</a>. Then, many new parents do not have <a href="https://www.americanprogress.org/article/universal-home-visiting-models-can-support-newborns-families/">nursing and maternal care visits</a> or <a href="https://www.pewresearch.org/short-reads/2019/12/16/u-s-lacks-mandated-paid-parental-leave/">paid parental leave</a>. And for those families struggling financially, there is <a href="https://doi.org/10.1007/s10826-022-02322-0">not an adequate safety net</a>. </p>
<p>Nor can some families afford mental health treatment to support their children’s needs. <a href="https://www.nami.org/Support-Education/Publications-Reports/Public-Policy-Reports/The-Doctor-is-Out/DoctorIsOut">Many mental health providers don’t take insurance</a> and instead opt for out-of-pocket payments from patients. This is due to the low reimbursement rates from most insurers, which makes it very difficult to sustain a practice. Depending on the service, the cost could be anywhere from US$100 to $600 per session. </p>
<p>To see providers that do take insurance, there are usually co-pays – typically between $20 to $50 a week. But it can often be challenging for the insured to find a suitable in-network provider to meet a child’s needs.</p>
<p>The payments add up, particularly when mental health treatment takes many months, and sometimes years, to have an effect. There is a reason why it takes so long. Unlike medical doctors, mental health professionals do not simply make a diagnosis and provide medication or surgery. Instead, for treatments to work and to change the outcome for young people who are struggling, an ongoing – and lengthy – <a href="https://www.apa.org/monitor/2019/11/ce-corner-relationships">relationship between the therapist and the patient is needed</a>. </p>
<p>Treating a child is significantly more difficult than treating an adult. That is, in part, because children are constantly developing and changing. But perhaps the most formidable challenges are the <a href="https://doi.org/10.1186/s40723-021-00094-6">multiple entities</a> a child therapist may have to work with: caregivers, the school system, the courts and child welfare agencies. What’s more, getting a diagnosis, treatment or both often involves working with multiple providers, such as a primary care doctor, individual therapist, family-focused therapist and psychiatrist. </p>
<p>In the institute where I work, the psychiatry department loses money on almost every patient we treat. If it weren’t for fundraising and fostering relationships with donors, the department could only provide care to a select few. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/EHCeodippgo?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Emotional abuse by parents includes threats, bullying, humiliation and insults.</span></figcaption>
</figure>
<h2>Possible solutions</h2>
<p>Struggling children and teens in the U.S. need earlier interventions. Although schools are ideal places to teach social skills, they still do not offer enough activities to help young people <a href="https://raisingchildren.net.au/school-age/behaviour/understanding-behaviour/resilience-how-to-build-it-in-children-3-8-years">develop resilience to cope with adversity</a>. </p>
<p>Sometimes, young patients see primary care doctors who don’t have enough training in this area. Telephone hotline programs, which offer these doctors free consultations from mental health professionals to help assess problems in young patients, should be available throughout the U.S. But right now, <a href="https://www.rand.org/news/press/2019/07/15.html">only 19 states have such programs</a>. One bright spot: The <a href="https://theconversation.com/as-suicides-rise-in-the-us-the-988-hotline-offers-hope-but-most-americans-arent-aware-of-it-210356">988 Suicide and Crisis Lifeline</a>, which launched in July 2022, is available 24/7. </p>
<p>When a young person needs treatment, parents should prioritize finding a mental health provider right away. Asking the child’s primary doctor and school counselors for a reference is a good start. If the child is already on a waiting list, a parent or guardian should call the provider weekly to check in and make sure the child is not forgotten. </p>
<p>The process can be discouraging and daunting, but in our current environment, which provides limited support, that’s the way it is. And without a heavy lift from parents, the child remains at great risk.</p><img src="https://counter.theconversation.com/content/207476/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Steven Berkowitz is affiliated with Sensye, inc. I am a consultant to Senseye, Inc. a startup developing a device to make objective psychiatric diagnoses</span></em></p>Millions of young people in the US are suffering, whether from abuse at home, pressure from social media or exposure to violence. But navigating the mental health care system can be disheartening.Steven Berkowitz, Professor of Psychiatry, University of Colorado Anschutz Medical CampusLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2091322023-07-09T20:05:43Z2023-07-09T20:05:43Z‘I was putting like 20 resumes in a month’: research tracks young Australians’ precarious work and study lives after Year 12<figure><img src="https://images.theconversation.com/files/535699/original/file-20230705-23-uqgch7.jpg?ixlib=rb-1.1.0&rect=0%2C43%2C5734%2C3785&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Alexis Brown/Unsplash</span></span></figcaption></figure><p>New <a href="https://www.thesmithfamily.com.au/media/research/reports/young-people-experiencing-disadvantage-significant-concerns-about-their-future">research released today</a> by The Smith Family shows how leaving school can be a difficult and complex time for young people from disadvantaged backgrounds. It also shows how COVID has made this more difficult and complex. </p>
<p>The new report includes a survey of more than 1,000 young people who were in Year 12 in late 2020 and 33 interviews with some of these survey respondents. The same group was surveyed in 2021.</p>
<p>This research looks at what has happened since the group left school two years ago. It looks at whether they are working or studying, and what is influencing their choices and pathways after school. </p>
<h2>The good news</h2>
<p>The good news is more young people from low income families are working or studying after they have left school, up from 77% in 2021 to 85% in 2022.</p>
<p>Only 3% were not working, studying, doing unpaid work, volunteering or looking for work in 2022, compared to 5% in 2021.</p>
<p>But 10% of the group did not complete year 12 – echoing a <a href="https://www.abc.net.au/radionational/programs/lifematters/why-are-so-many-kids-dropping-out-of-school-/102536810">national decline</a> in the number of young people who are not finishing school.</p>
<p>In recent years, school retention rates have reached <a href="https://www.pc.gov.au/ongoing/report-on-government-services/2023/child-care-education-and-training/school-education#retention">record lows</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/20-of-australian-students-dont-finish-high-school-non-mainstream-schools-have-a-lot-to-teach-us-about-helping-kids-stay-207021">20% of Australian students don't finish high school: non-mainstream schools have a lot to teach us about helping kids stay</a>
</strong>
</em>
</p>
<hr>
<h2>COVID’s impact</h2>
<p>But the study also found some interviewees were pulling out of study and training because they can’t afford it. As Kim* explained: </p>
<blockquote>
<p>You pretty much have assignments back-to-back, and you’ve got placement as well […]. So you’ve got to think, ‘can I go that long without working for an income?’</p>
</blockquote>
<p>This mirrors a wider trend, where students (of all ages) from fields such as teaching, social work and nursing, say <a href="https://www.theguardian.com/australia-news/2023/mar/05/urgent-calls-to-end-compulsory-unpaid-internships-as-students-forced-to-quit-due-to-cost-of-living">they need income support</a> while doing compulsory unpaid work placements.</p>
<p>COVID lockdowns also disrupted young people’s plans and made it difficult for them to restart. One interviewee, Peter, said:</p>
<blockquote>
<p>I needed a specific amount of placement to be able to get my Cert II. And, you know with COVID […] I couldn’t actually get my hours […] And I moved on […] it’s not really a goal anymore.</p>
</blockquote>
<figure class="align-center ">
<img alt="A young man gets a book from a library shelf" src="https://images.theconversation.com/files/535700/original/file-20230705-19-xwsenm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/535700/original/file-20230705-19-xwsenm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=487&fit=crop&dpr=1 600w, https://images.theconversation.com/files/535700/original/file-20230705-19-xwsenm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=487&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/535700/original/file-20230705-19-xwsenm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=487&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/535700/original/file-20230705-19-xwsenm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=611&fit=crop&dpr=1 754w, https://images.theconversation.com/files/535700/original/file-20230705-19-xwsenm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=611&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/535700/original/file-20230705-19-xwsenm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=611&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Unpaid work placements make it very difficult for students to keep earning vital income.</span>
<span class="attribution"><span class="source">Adam Winger/Unsplash</span></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-can-no-longer-justify-unpaid-labour-why-uni-students-need-to-be-paid-for-work-placements-203421">'We can no longer justify unpaid labour': why uni students need to be paid for work placements</a>
</strong>
</em>
</p>
<hr>
<h2>Precarious work</h2>
<p>The study also shows young people from disadvantaged backgrounds working in precarious part-time, low-level jobs (if they can find work at all). As Mercedes told the researchers: </p>
<blockquote>
<p>I wasn’t getting paid properly. I was chasing my pay all the time. </p>
</blockquote>
<p>Peter also spoke of the difficulty of finding work: </p>
<blockquote>
<p>I was putting like 20 resumes in a month. No one answered me […] </p>
</blockquote>
<p>Of those in work, 14% were working two or more jobs, 37% wanted to work more hours, and 34% had looked for a new job in the past four weeks. The most common jobs were in retail and sales, labouring and other construction, transport, distribution and warehouse roles, and hospitality.</p>
<p>A complex web of factors explains these trends.</p>
<figure class="align-center ">
<img alt="A laptop covered in stickers." src="https://images.theconversation.com/files/535720/original/file-20230705-27-xwsenm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/535720/original/file-20230705-27-xwsenm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=361&fit=crop&dpr=1 600w, https://images.theconversation.com/files/535720/original/file-20230705-27-xwsenm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=361&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/535720/original/file-20230705-27-xwsenm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=361&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/535720/original/file-20230705-27-xwsenm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=454&fit=crop&dpr=1 754w, https://images.theconversation.com/files/535720/original/file-20230705-27-xwsenm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=454&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/535720/original/file-20230705-27-xwsenm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=454&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Of those surveyed, about one third of those who were already working had looked for a new job recently.</span>
<span class="attribution"><span class="source">Kenny Eliason/Unsplash</span></span>
</figcaption>
</figure>
<p>More recently, pandemic lockdowns and school closures have affected <a href="https://www.abc.net.au/news/2023-02-07/school-attendance-retention-numbers-fall-across-australia/101935342">the mental health</a> of young Australians, which in turn has seen less school participation and Year 12 completion.</p>
<p>This has made it harder for young people to get and maintain job and follow studies after school. Of those surveyed, 30% said they had poor mental health. Of this group, 46% said it “often” or “always” had an impact on things other young people want to do.</p>
<p>But even before the pandemic, many public schools did not have enough resources to support senior students from disadvantaged backgrounds into employment. This is a missed opportunity and shows how, thanks to funding scarcity, government schools can end up inadvertently reproducing disadvantage.</p>
<p>There have long been calls to <a href="https://www.monash.edu/education/cypep/research/young-women-choosing-careers-who-decides">overhaul careers education</a>. And the need for this has only become more acute, due to the pressures of COVID and declining student mental health. </p>
<p>In the longer-term, the job market has changed and this has disproportionately affected young people. While there is high demand for <a href="https://theconversation.com/yes-we-know-there-is-a-skills-shortage-here-are-3-jobs-summit-ideas-to-start-fixing-it-right-away-188833">retail work</a>, the emphasis is on skilled occupations. </p>
<p>During the past year, <a href="https://www.afr.com/work-and-careers/education/biggest-skill-shortages-in-low-skilled-jobs-that-don-t-need-a-degree-20230305-p5cphf">60% of total employment growth</a> has been in occupations that require a vocational qualification, compared to 36% in professions requiring a university degree. Meanwhile, <a href="https://australiainstitute.org.au/post/new-research-australias-skills-system-continues-to-crumble-after-covid/">vocational education and training</a> continues to be in disarray and in needs of more funds and focus.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/thinking-about-my-future-is-really-scary-school-leavers-are-not-getting-the-careers-support-they-need-190553">'Thinking about my future is really scary' – school leavers are not getting the careers support they need</a>
</strong>
</em>
</p>
<hr>
<h2>Governments have lots of opportunities now to listen</h2>
<p>The Smith Family’s findings come at a time when governments and policy makers are looking closely at how training, employment and education work in Australia. </p>
<p>A federal Parliament <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/House/Employment_Education_and_Training/VETInquiry">inquiry</a> is currently looking the status of vocational education and training, while the Treasury’s <a href="https://treasury.gov.au/review/employment-whitepaper">employment white paper</a>, due in September, is looking at how all Australians can enjoy full employment. </p>
<p>The <a href="https://www.education.gov.au/australian-universities-accord">Universities Accord review</a> is also looking at making higher education more accessible to people from disadvantaged backgrounds. </p>
<p>The Smith Family research shows once again how young people from disadvantaged backgrounds need additional support both at school and once they leave.</p>
<p>The continued impact of the pandemic, together with the rising cost-of-living, show how governments need to be very mindful of how they are supporting a whole generation as they navigate their way into post-school life. </p>
<p><em>*names have been changed.</em></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/these-5-equity-ideas-should-be-at-the-heart-of-the-universities-accord-203418">These 5 equity ideas should be at the heart of the Universities Accord</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/209132/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lucas Walsh currently receives funding from The Paul Ramsay Foundation and the Australian Research Council. He has worked with The Smith Family and sits in a voluntary capacity on the Growing Careers Project External Reference Group. He was not involved in the creation of the report discussed in this article</span></em></p>New research from The Smith Family tracks a group of young people, two years after finishing high school.Lucas Walsh, Professor and Director of the Centre for Youth Policy and Education Practice, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2073932023-06-25T13:34:56Z2023-06-25T13:34:56ZWhat to do if your child is struggling: Steps caregivers can take to help kids and teens with their mental health<figure><img src="https://images.theconversation.com/files/533781/original/file-20230623-21-poqbou.jpg?ixlib=rb-1.1.0&rect=119%2C175%2C5345%2C3723&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Caregivers are encouraged to have conversations about mental health early and often, whether their child or teen is struggling or not.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Emerging research suggests that child and adolescent mental health problems are on the rise. For example, <a href="https://doi.org/10.1001/jamapediatrics.2021.2482">one in four children</a> report that they have experienced clinically elevated rates of depression, and rates of emergency department visits for attempted suicide have <a href="https://doi.org/10.1016/S2215-0366(23)00036-6">increased by 22 per cent</a> in the past few years.</p>
<p>As clinicians and researchers, we have interacted with thousands of caregivers, many of whom have asked us how they can better understand and support their children’s mental health. </p>
<p>Below we offer a step-by-step guide for recognizing the signs of mental distress and responding with support and resources to help foster recovery and resilience in children and adolescents.</p>
<h2>Recognize signs of distress</h2>
<p>Children and adolescents have varying reactions to experiences and events, and signs of mental distress can look different across young people (and can look different compared to adults too).</p>
<figure class="align-center ">
<img alt="A woman with her arm around a teen, sitting on the edge of a bed, seen from behind" src="https://images.theconversation.com/files/533787/original/file-20230623-15-ob8w6d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/533787/original/file-20230623-15-ob8w6d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/533787/original/file-20230623-15-ob8w6d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/533787/original/file-20230623-15-ob8w6d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/533787/original/file-20230623-15-ob8w6d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/533787/original/file-20230623-15-ob8w6d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/533787/original/file-20230623-15-ob8w6d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Talking about mental health helps to normalize the conversation and supports children and adolescents in knowing they can go to you when they are struggling.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Changes are normal in children and adolescents, but <a href="https://ontario.cmha.ca/documents/child-and-youth-mental-health-signs-and-symptoms/">dramatic and sustained changes are not</a>. Typically, caregivers should be on the lookout for a combination of: </p>
<ol>
<li><p>Increased distress, such as more <a href="https://ontario.cmha.ca/documents/children-youth-and-depression/">sadness</a>, irritability, <a href="https://www.anxietycanada.com/articles/abcs-of-anxiety/">worry</a>, or <a href="https://www.camh.ca/-/media/files/guides-and-publications/what-parents-teen-risk-taking-en.pdf">risk-taking</a>.</p></li>
<li><p>Changes in daily functioning, such as changes in sleep, eating, physical activity, energy levels and/or interests, which may be subsequently impacting their peer or family relationships, extracurriculars or academic performance.</p></li>
</ol>
<h2>Talk to your children about mental health</h2>
<p>We encourage caregivers to have conversations about mental health early and often, whether their child or teen is struggling or not. This helps to normalize the conversation and supports children and adolescents in knowing they can go to you when they are struggling.</p>
<p>Conversations are especially important when children or adolescents <a href="https://health.sunnybrook.ca/mental-health/talk-about-mental-illness-conversation-parents/">appear to be struggling</a>. You can start by letting them know you care, and then pointing out what you have observed in terms of changes in their distress and daily functioning, such as “I’ve noticed that you’ve been sleeping a lot more than usual. Have you noticed these changes too?” Then ask if you can talk about this further together to deepen the conversation.</p>
<p>If you feel that strategy won’t work for your child, or if you often get answers of “fine” to “how are you feeling?”, try the third person strategy, which can <a href="https://doi.org/10.3389%2Ffpsyg.2016.01715">reduce distress</a> during tense conversations. </p>
<p>In this scenario, make a statement about children’s mental health generally, such as “I hear there’s a lot of kids and teens struggling with their mental health right now” and then ask open-ended questions, such as: “what do you think about that?” or “what have you noticed about your own mental health lately”? </p>
<figure class="align-center ">
<img alt="A man and a teen outside, having a conversation." src="https://images.theconversation.com/files/533782/original/file-20230623-31-7rmk4f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/533782/original/file-20230623-31-7rmk4f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/533782/original/file-20230623-31-7rmk4f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/533782/original/file-20230623-31-7rmk4f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/533782/original/file-20230623-31-7rmk4f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/533782/original/file-20230623-31-7rmk4f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/533782/original/file-20230623-31-7rmk4f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">If your child finds it hard to have face-to-face conversations about their mental health, ask them to go for a walk and start the conversation then.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>When you have conversations about mental health with your child or adolescent, try to minimize any potential discomfort. It’s best to find a time that works well for your child. For example, when they are rested, fed, and relaxed. </p>
<p>Also, some children find it hard to have face-to-face conversations about their mental health. If this is the case with your child or adolescent, you could ask them to go for a walk and start the conversation then or when you are doing something else, like loading the dishwasher or driving to an extracurricular activity. This can take the pressure off what might be perceived as stressful face-to-face conversations.</p>
<p>When children and adolescents do open up, express empathy for what they are going through, using phrases such as “that sounds really difficult” and/or “I understand how painful that can be.” Often as caregivers, we want to jump into problem-solving mode, but the most effective approach to supporting children and adolescents is often to listen and validate their feelings and/or distress. </p>
<p>Communicating and connecting with children and adolescents, and confirming they have our support, can foster resilience in times of adversity. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/KZBTYViDPlQ?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Express empathy for what children and adolescents are going through. This video discusses empathy and sympathy.</span></figcaption>
</figure>
<h2>Talk with their teacher</h2>
<p>If you remain concerned about your child, and want to gather additional information, you could speak with their teacher or guidance counsellor. Up to <a href="https://doi.org/10.1542/peds.2020-1440">80 per cent of children</a> get their knowledge about mental health from schools. Guidance counsellors are specifically trained to <a href="https://doi.org/10.1080/03069885.2010.531384">address mental health concerns</a> and other school staff are used to having conversations about mental health with students. They typically welcome these conversations with caregivers.</p>
<p>Teachers can also provide a valuable perspective on how a child’s mental health may have changed, and what might be precipitating these changes. For example, children may be experiencing learning struggles or bullying, which they haven’t yet disclosed to you, but is causing them some distress. Guidance counsellors and teachers can also help brainstorm ideas for building up children’s coping strategies and supporting their success at school.</p>
<p>If possible, have your child join these conversations, so they feel involved in discussions about their own mental health and develop agency in addressing it.</p>
<h2>Talk with your health-care provider</h2>
<p>Health-care providers are trained in evaluating mental and physical health problems alike. They can formally <a href="https://cps.ca/en/mental-health-screening-tools">screen and assess for mental health problems</a> by asking the caregiver and child questions about changes in mood, behaviour and functioning and matching symptoms of distress and impairment with “diagnostic criteria” for various mental health disorders. </p>
<figure class="align-center ">
<img alt="A woman with a child on her lap talking to a doctor" src="https://images.theconversation.com/files/533785/original/file-20230623-23-35uieg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/533785/original/file-20230623-23-35uieg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/533785/original/file-20230623-23-35uieg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/533785/original/file-20230623-23-35uieg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/533785/original/file-20230623-23-35uieg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/533785/original/file-20230623-23-35uieg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/533785/original/file-20230623-23-35uieg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Health-care providers can offer strategies and resources to support children and caregivers.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>With this knowledge, health-care providers can offer strategies and resources to support children and caregivers. They will work with caregivers and children directly to decide on the best approaches to addressing the child’s mental health struggles.</p>
<p>It is also important to let children and adolescents know of other services they can access for support, such as <a href="https://kidshelpphone.ca/">Kids Help Phone</a>, which is available via text or phone 24/7.</p>
<h2>Immediately address urgent mental health problems</h2>
<p>The strategies above can occur when children and adolescents are not in immediate danger. But when your child shows warning signs of suicide, or is engaging in self-harm behaviour, <a href="https://www.camh.ca/en/professionals/treating-conditions-and-disorders/suicide-risk/suicide---detecting-and-assessing-suicidality">get them help as soon as possible</a>, including:</p>
<ul>
<li><p>Taking them to the nearest acute care hospital.</p></li>
<li><p>If your child will not go to the hospital or you’re unsure if this is the right thing to do, get help from a health-care provider as quickly as possible. You can call the health-care team or a crisis line.</p></li>
<li><p>If your child is attempting or about to attempt suicide, do not leave them alone, and call 911 immediately.</p></li>
</ul>
<p>Although supportive in nature, taking care of our children’s mental health can also be taxing and/or triggering for many caregivers. To best support children and adolescents, we also need to take care of ourselves. We encourage caregivers to prioritize their own mental health, so that they can feel energized and empowered to attend to their children’s mental health.</p>
<p>If caregivers have concerns about their own mental health, we recommend the following resources:</p>
<ul>
<li><a href="https://www.wellnesstogether.ca/en-CA">Wellness Together Canada</a> is a free and confidential service available to Canadian residents. They can give you information on mental health, offer free confidential sessions with health professionals, and provide peer support services.</li>
<li>Speak to your health-care provider.</li>
<li>If you are in crisis, contact <a href="https://talksuicide.ca/">Talk Suicide Canada</a>.</li>
</ul><img src="https://counter.theconversation.com/content/207393/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sheri Madigan receives funding from the Social Sciences and Humanities Research Council, the Canadian Institutes of Health Research, the Alberta Children's Hospital Foundation, an anonymous donor, and the Canada Research Chairs program.</span></em></p><p class="fine-print"><em><span>Tracy Vaillancourt receives funding from the Canadian Institutes of Health Research, Social Sciences and Humanities Research Council and Canada First Research Excellence Fund. </span></em></p>With child and adolescent mental health problems on the rise, here is a step-by-step guide for caregivers for recognizing signs of mental distress and responding with support and resources.Sheri Madigan, Professor, Canada Research Chair in Determinants of Child Development, Owerko Centre at the Alberta Children’s Hospital Research Institute, University of CalgaryTracy Vaillancourt, Tier 1 Canada Research Chair in School-Based Mental Health and Violence Prevention, L’Université d’Ottawa/University of OttawaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2061702023-06-07T12:25:05Z2023-06-07T12:25:05ZMounting research documents the harmful effects of social media use on mental health, including body image and development of eating disorders<figure><img src="https://images.theconversation.com/files/529888/original/file-20230602-15-ynda6h.jpg?ixlib=rb-1.1.0&rect=8%2C8%2C5742%2C3819&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The hours spent – and the content viewed – by teens on social media can lead to depression, anxiety and body image issues.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/cell-phone-break-up-royalty-free-image/483933372?phrase=upset+teenager+on+phone&adppopup=true">Mixmike/E+via Getty Images</a></span></figcaption></figure><p>Media influences and conventional beauty standards have long plagued society. </p>
<p>This issue took on new urgency in May 2023 when the <a href="https://www.hhs.gov/sites/default/files/sg-youth-mental-health-social-media-advisory.pdf">U.S. surgeon general issued a major public advisory</a> over the <a href="https://www.nytimes.com/2023/05/23/health/surgeon-general-social-media-mental-health.html">links between social media and youth mental health</a>. </p>
<p>Research shows that images of beauty as depicted in movies, television and magazines <a href="https://doi.org/10.1037/0021-843X.103.4.836">can lead to mental illness</a>, issues with disordered eating and <a href="https://doi.org/10.1093%2Fpch%2F8.5.287">body image dissatisfaction</a>. </p>
<p>These trends have been documented <a href="https://doi.org/10.1037/0033-2909.134.3.460">in women</a> <a href="https://doi.org/10.1521/jscp.2008.27.3.279">and men</a>, in the <a href="https://doi.org/10.1016/j.jadohealth.2018.10.096">LGBTQ+ community</a> and in <a href="https://www.hsph.harvard.edu/striped/wp-content/uploads/sites/1267/2022/10/Real-Cost-of-Beauty-Report-10-4-22.pdf">people of different racial</a> and ethnic backgrounds. </p>
<p>Experts have long suspected that social media may be playing a role in the growing <a href="https://www.nytimes.com/2022/04/23/health/mental-health-crisis-teens.html">mental health crisis in young people</a>. However, the surgeon general’s warning is one of the first <a href="https://www.nytimes.com/2023/05/23/health/surgeon-general-social-media-mental-health.html">public warnings supported by robust research</a>.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/yj60GRxHRa8?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The U.S. surgeon general says the youth mental health crisis is the ‘defining public health challenge of our time.’</span></figcaption>
</figure>
<h2>Social media can be toxic</h2>
<p>Body dissatisfaction among children and adolescents is commonplace and <a href="https://doi.org/10.3389%2Ffpsyg.2023.1037932">has been linked to</a> decreased quality of life, worsened mood and unhealthy eating habits. </p>
<p>As an <a href="https://som.cuanschutz.edu/Profiles/Faculty/Profile/29092">eating disorder and anxiety specialist</a>, I regularly work with clients who experience eating disorder symptoms, self-esteem issues and anxiety <a href="https://news.cuanschutz.edu/news-stories/how-does-social-media-affect-our-mental-health">related to social media</a>. </p>
<p>I also <a href="https://doi.org/10.1016/S2215-0366(23)00116-5">have firsthand experience with this topic</a>: I am 15 years post-recovery from an eating disorder, and I grew up when people were beginning to widely use social media. In my view, the impact of social media on diet and exercise patterns needs to be further researched to inform future policy directions, school programming and therapeutic treatment. </p>
<p>The mental health of adolescents and teens has been <a href="https://www.cdc.gov/nchhstp/dear_colleague/2020/dcl-102320-YRBS-2009-2019-report.html">declining for the past decade</a>, and the <a href="https://doi.org/10.1016%2Fj.psychres.2023.115082">COVID-19 pandemic contributed to worsening youth mental health</a> and brought it into the spotlight. As the mental health crisis surges, researchers have been taking a <a href="https://cuanschutz360.buzzsprout.com/1991131/10641970-how-does-social-media-affect-our-mental-health">close look at the role of social media</a> in these increasing mental health concerns.</p>
<h2>The pros and cons of social media</h2>
<p>About 95% of children and adolescents in the U.S. between the ages of 10 and 17 are <a href="https://www.hhs.gov/sites/default/files/sg-youth-mental-health-social-media-advisory.pdf">using social media almost constantly</a>.</p>
<p>Research has shown that <a href="https://www.commonsensemedia.org/sites/default/files/research/report/2021-coping-with-covid19-full-report.pdf">social media can be beneficial</a> for finding <a href="https://doi.org/10.2196/26011">community support</a>. However, studies have also shown that the use of social media contributes to social comparisons, unrealistic expectations and <a href="https://doi.org/10.1001/jamapsychiatry.2019.2325">negative mental health effects</a>. </p>
<p>In addition, those who have <a href="https://www.apa.org/topics/social-media-internet/health-advisory-adolescent-social-media-use.pdf">preexisting mental health conditions</a> tend to spend more time on social media. People in that category are more likely to <a href="https://doi.org/10.1177/1461444817694499">self-objectify</a> and <a href="https://doi.org/10.1016/j.eatbeh.2012.06.003">internalize the thin body ideal</a>. Women and <a href="https://doi.org/10.1371/journal.pgph.0001091">people with preexisting body image concerns</a> are more likely to feel worse about their bodies and themselves after they spend time on social media.</p>
<h2>A breeding ground for eating disorders</h2>
<p>A recent review found that, as with mass media, the use of social media is a risk factor for <a href="https://doi.org/10.1371/journal.pgph.0001091">the development of an eating disorder</a>, body image dissatisfaction and disordered eating. In this review, social media use was shown to contribute to negative self-esteem, social comparisons, decreased emotional regulation and idealized self-presentation that negatively influenced body image.</p>
<p>Another study, called the <a href="https://www.dove.com/us/en/stories/campaigns/social-media-and-body-image.html">Dove Self-Esteem Project</a>, published in April 2023, found that 9 in 10 children and adolescents ages 10 to 17 are exposed to toxic beauty content on social media and 1 in 2 say that this has an impact on their mental health. </p>
<p>Eating disorders are <a href="https://theconversation.com/eating-disorders-among-teens-have-more-than-doubled-during-the-covid-19-pandemic-heres-what-to-watch-for-201067">complex mental illnesses</a> that develop because of biological, social and psychological factors. Eating disorder hospitalizations and the need for treatment have dramatically <a href="https://doi.org/10.1001/jamapediatrics.2022.4346">increased during the pandemic</a>.</p>
<p><a href="https://doi.org/10.1001/jamanetworkopen.2021.34913">Some reasons for this</a> include isolation, food scarcity, boredom and <a href="https://doi.org/10.3389/fpsyg.2023.1139261">social media content</a> related to weight gain, such as the “<a href="https://doi.org/10.1016/j.bodyim.2021.04.002">quarantine15</a>.” That was a reference to the weight gain some people were experiencing at the beginning of the pandemic, similar to the “freshman 15” belief that one will gain 15 pounds in the first year of college. Many teens whose routines were disrupted by the pandemic turned to eating disorder behaviors for <a href="https://doi.org/10.2196/26011">an often-false sense of control</a> or were influenced by family members who held unhealthy beliefs around food and exercise. </p>
<p>Researchers have also found that increased time at home during the pandemic <a href="https://www.luriechildrens.org/en/blog/social-media-parenting-statistics/">led to more social media use by young people</a> and therefore more exposure to toxic body image and dieting social media content. </p>
<p>While social media alone will not cause eating disorders, <a href="https://www.hsph.harvard.edu/striped/wp-content/uploads/sites/1267/2022/10/Real-Cost-of-Beauty-Report-10-4-22.pdf">societal beliefs about beauty</a>, which are amplified by social media, can contribute to the development of eating disorders. </p>
<figure>
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<figcaption><span class="caption">According to a report from the Centers for Disease Control and Prevention, 42% of high school students say they feel ‘persistently sad’ and ‘hopeless.’</span></figcaption>
</figure>
<h2>‘Thinspo’ and ‘fitspo’</h2>
<p>Toxic beauty standards online include the normalization of cosmetic and surgical procedures and pro-eating-disorder content, which promotes and romanticizes eating disorders. For instance, social media sites have promoted trends such as “thinspo,” which is focused on the thin ideal, and “fitspo,” which perpetuates the belief of there being a perfect body that can be achieved with dieting, supplements and excessive exercise.</p>
<p>Research has shown that <a href="https://doi.org/10.1186/s40337-019-0246-2">social media content encouraging “clean eating</a>” or dieting through pseudoscientific claims can lead to obsessive behavior around dietary patterns. These unfounded “wellness” posts <a href="https://doi.org/10.1016/j.childyouth.2020.105659">can lead to weight cycling, yo-yo dieting</a>, chronic stress, body dissatisfaction and higher likelihood of <a href="https://doi.org/10.1177/1461444818821064">muscular and thin-ideal internalization</a>.</p>
<p>Some social media posts feature <a href="https://doi.org/10.3390/ijerph18042186">pro-eating-disorder content</a>, which directly or indirectly encourages disordered eating. Other posts promote deliberate manipulation of one’s body, using harmful quotes such as “nothing tastes as good as thin feels.” These posts provide a false sense of connection, allowing users to bond over a shared goal of losing weight, altering one’s appearance and continuing patterns of disordered eating. </p>
<p>While young people <a href="https://www.dove.com/us/en/stories/campaigns/real-cost-of-beauty/thestats.html">can often recognize and understand</a> toxic beauty advice’s effects on their self-esteem, they may still continue to engage with this content. This is in part because friends, influencers and <a href="https://doi.org/10.1016/j.bodyim.2022.03.007">social media algorithms</a> <a href="https://doi.org/10.1007/s10964-012-9898-9">encourage people</a> to follow certain accounts. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/XvM8hqoHXkI?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Not all teens are on social media.</span></figcaption>
</figure>
<h2>How policy changes could help</h2>
<p><a href="https://scrippsnews.com/stories/legislators-target-social-media-to-combat-eating-disorders/">Legislators across the U.S.</a> are proposing different <a href="https://www.pbs.org/newshour/health/new-state-laws-aim-to-tackle-surge-in-eating-disorders">regulations for social media sites</a>. </p>
<p>Policy recommendations include increased transparency from social media companies, creation of higher standards of <a href="https://www.apa.org/topics/social-media-internet/health-advisory-adolescent-social-media-use?">privacy for children’s data</a> and <a href="https://doi.org/10.1177/0098858819849990">possible tax incentives and social responsibility initiatives</a> that would discourage companies and marketers from using altered photos.</p>
<h2>Phone-free zones</h2>
<p>Small steps at home to cut down on social media consumption can also make a difference. Parents and caregivers can <a href="https://www.luriechildrens.org/en/blog/social-media-parenting-statistics/">create phone-free periods</a> for the family. Examples of this include putting phones away while the family watches a movie together or during mealtimes. </p>
<p>Adults can also help by modeling healthy social media behaviors and encouraging children and adolescents to focus <a href="https://www.dove.com/us/en/dove-self-esteem-project/help-for-parents/social-media/social-media-filters.html">on building connections and engaging in valued activities</a>. </p>
<p>Mindful social media consumption is another helpful approach. This requires recognizing what one is feeling during social media scrolling. If spending time on social media makes you feel worse about yourself or seems to be causing mood changes in your child, it may be time to change how you or your child interact with social media.</p><img src="https://counter.theconversation.com/content/206170/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emily Hemendinger does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Research shows that social media, with it endless promotion of unrealistic standards of beauty, has had a negative impact on millions of young people.Emily Hemendinger, Assistant Professor of Psychiatry, University of Colorado Anschutz Medical CampusLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2051772023-05-22T11:34:49Z2023-05-22T11:34:49ZGirls are in crisis — and their mental health needs to be taken seriously<figure><img src="https://images.theconversation.com/files/526896/original/file-20230517-19889-9mh2pf.jpg?ixlib=rb-1.1.0&rect=0%2C52%2C8688%2C5722&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">If we want to see improvements in the lives of girls in Canada and beyond, we need to first think critically about why we tend to dismiss and invalidate their concerns.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>An article in the <em>Washington Post</em> recently declared “<a href="https://www.washingtonpost.com/education/2023/02/17/teen-girls-mental-health-crisis/">a crisis in American girlhood</a>.” Girls in the United States are experiencing alarmingly higher rates of sexual assault, mental health issues and suicidality than ever before.</p>
<p>Data collected in 2021 by the <a href="https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBS_Data-Summary-Trends_Report2023_508.pdf">Centers for Disease Control</a> (CDC) demonstrates how dire the circumstances of American girlhood are. Fourteen per cent of teenage girls in the United States shared that they had been forced to have sex, and 60 per cent had experienced <a href="https://www.washingtonpost.com/education/2023/02/13/teen-girls-violence-trauma-pandemic-cdc/">extreme feelings of sadness or hopelessness</a>. Nearly a quarter of girls had considered and planned suicide.</p>
<p>While these findings are based on U.S. data, the story is consistent with what girls in Canada have been saying for the past decade. In Canada, <a href="https://www.camh.ca/en/camh-news-and-stories/half-of-female-students-in-ontario-experience-psychological-distress-camh-study-shows">over 50 per cent of female students in Ontario have reported</a> moderate to severe psychological distress. <a href="https://assaultcare.ca/services/sexual-assault-statistics/">One in four girls</a> has been sexually abused by the time they turn 18.</p>
<p>Suicide is the <a href="https://www150.statcan.gc.ca/t1/tbl1/en/cv.action?pid=1310039401">fourth leading cause of death</a> for girls up to 14 years old, an annual statistic that has remained relatively consistent since 2016.</p>
<p>The gendered wage gap in Canada has been found to <a href="https://www.girlguides.ca/WEB/Documents/GGC/media/thought-leadership/girlsonjob/GirlsOnTheJobRealitiesInCanada.pdf">start as early as 12 years old</a>. The situation is worse for girls who are <a href="https://www.girlsactionfoundation.ca/_files/ugd/0512fe_ccc6638a5e3844c8b3dcf4a0e536a9c2.pdf">racialized, living in poverty</a>, <a href="https://dawncanada.net/media/uploads/page_data/page-64/girls_without_barriers.pdf">disabled</a>, or <a href="https://pubmed.ncbi.nlm.nih.gov/28111592/">LGBTQ+</a>.</p>
<p>The dire state of girlhood has historically been attributed to the usual suspects: <a href="https://www.girlguides.ca/WEB/GGC/Parents/Thought_Leadership/IDG_Nationwide_Survey/GGC/Media/Thought_Leadership/IDG_Nationwide_Survey.aspx">unrealistic beauty standards</a>, <a href="https://www.cbc.ca/news/canada/instagram-girls-body-image-1.6200969">pressures of social media</a>, <a href="https://www.berghahnjournals.com/view/journals/girlhood-studies/14/1/ghs140104.xml">living in a rape culture</a>, and more recently, the <a href="https://www.girlguides.ca/WEB/Documents/GGC/Girl_Research/Life_During_COVID19_Report.pdf">COVID-19 pandemic</a>.</p>
<p>In interviews conducted by the <em>Washington Post</em> with girls themselves, however, they point to another, perhaps unsuspected culprit: that when girls do speak up, they aren’t listened to or taken seriously.</p>
<h2>Why don’t we listen to or take girls seriously?</h2>
<p>I am a former community social worker with experience working directly with girls between the ages of 10 and 18 years old. My current doctoral research focuses on girls between the ages of eight and 12 years old who engage in activism, exploring ways that adults can better listen and support them when they tell us what they want for their lives and their worlds. I have heard countless stories from girls themselves about when they had felt dismissed by adults.</p>
<p>This dismissal was often directly tied to their identities as girls, attributed to claims that girls were just going through a phase, not accurately sharing what had happened or that they were being dramatic.</p>
<p>Put simply, when girls tell us what is happening in their lives, we have a tendency not to believe them.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/526901/original/file-20230517-11818-a2ke9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="close up image of two pairs of hands holding each other." src="https://images.theconversation.com/files/526901/original/file-20230517-11818-a2ke9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/526901/original/file-20230517-11818-a2ke9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/526901/original/file-20230517-11818-a2ke9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/526901/original/file-20230517-11818-a2ke9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/526901/original/file-20230517-11818-a2ke9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/526901/original/file-20230517-11818-a2ke9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/526901/original/file-20230517-11818-a2ke9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Adults tend to doubt girls’ credibility as speakers because of prejudices about girls and girlhood.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Dismissing the credibility of an entire group of people because of prejudices that we may have about their identities is what philosopher Miranda Fricker has described as <a href="https://doi.org/10.1093/acprof:oso/9780198237907.001.0001">epistemic injustice</a>.</p>
<p>In this type of epistemic injustice, a speaker’s credibility is dismissed because of prejudices that others have based on the speaker’s identity. This means that the speaker’s testimony is not listened to or taken seriously because of who they are. </p>
<p>Adults tend to doubt girls’ credibility as speakers because of prejudices about girls and girlhood. These prejudices against girls are rooted in the construction of girlhood as a time of frivolity, fun and emotionality.</p>
<h2>Do girls just want to have fun?</h2>
<p>For a long time, girlhood — and specifically <a href="https://nyupress.org/9780814787083/racial-innocence/">white, middle- and upper-class, able-bodied girlhood</a> — has been seen as a time of inherent innocence, <a href="https://www.peterlang.com/document/1109532">frivolity</a> and <a href="https://doi.org/10.1177/1469540518806954">fun</a>.</p>
<p>Constructions of girlhood are linked to expectations we have about girls as children and as gendered subjects. As children, we expect girls to have a sort of <a href="https://doi.org/10.1177/0907568218811484">wide-eyed wonderment</a> about the world around them. As gendered subjects, girls are additionally stereotyped in ways typically associated with womanhood, such as <a href="http://dx.doi.org/10.1037/a0016821">emotionality</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/526897/original/file-20230517-25100-wn41e5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman comforts a teenage girl sitting on a bed." src="https://images.theconversation.com/files/526897/original/file-20230517-25100-wn41e5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/526897/original/file-20230517-25100-wn41e5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/526897/original/file-20230517-25100-wn41e5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/526897/original/file-20230517-25100-wn41e5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/526897/original/file-20230517-25100-wn41e5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/526897/original/file-20230517-25100-wn41e5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/526897/original/file-20230517-25100-wn41e5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">When girls tell us what is happening in their lives, adults must listen and not dismiss them.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>In a world that <a href="https://doi.org/10.1525/collabra.274">dichotomizes rationality and emotionality</a>, with rationality being considered more credible than emotionality, girls are dismissed because of the way girlhood is viewed.</p>
<p>When girls tell us what is happening in their lives, such as when they’ve experienced sexual assault or are feeling suicidal, these views become especially harmful.</p>
<p>If we want to see improvements in the lives of girls in Canada and beyond, we need to first think critically about why we tend to dismiss and invalidate their concerns. Challenging our own prejudices about the credibility of girls is a vital first step in this process.</p>
<p>When considering the crisis in girlhood, girls have been clear about the way forward. In my own community practice work, girls shared that they feel most supported by adults while “<a href="https://www.womenscentrecalgary.org/wp-content/uploads/2020/03/Girls-Lead-YYC-1.pdf">being listened to and feeling like I am being heard</a>.” In the <em>Washington Post</em> article, girls called for adults to “<a href="https://www.washingtonpost.com/education/2023/02/17/teen-girls-mental-health-crisis/">stop dismissing their concerns as drama</a>.”</p>
<p>Girls have never just wanted to have fun. They want — and need to be — listened to and taken seriously.</p><img src="https://counter.theconversation.com/content/205177/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alexe Bernier receives funding from the Social Sciences and Humanities Research Council of Canada (SSHRC) for her doctoral research. </span></em></p>In Canada, over 50 per cent of female students in Ontario have reported moderate to severe psychological distress. One in four girls has been sexually abused by the time they turn 18.Alexe Bernier, PhD Candidate, Department of Social Work, McMaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2033702023-04-25T16:55:05Z2023-04-25T16:55:05ZThe impact of childhood and teenage anxiety disorders on later life – new research<figure><img src="https://images.theconversation.com/files/522092/original/file-20230420-18-y9888z.jpg?ixlib=rb-1.1.0&rect=0%2C7%2C5252%2C3488&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/black-african-mother-embrace-little-preschool-1192766260">fizkes/Shutterstock</a></span></figcaption></figure><p>Anxiety rates <a href="https://digital.nhs.uk/news/2021/rate-of-mental-disorders-among-children-remained-stable-in-2021-after-previous-rise-report-shows">have been rising</a> in recent years among children and young people, with the situation <a href="https://www.who.int/news/item/02-03-2022-covid-19-pandemic-triggers-25-increase-in-prevalence-of-anxiety-and-depression-worldwide">partially exacerbated</a> by the pandemic.</p>
<p>Occasional feelings of anxiety are normal, <a href="https://theconversation.com/we-shouldnt-worry-so-much-about-our-kids-anxiety-its-a-normal-part-of-growing-up-67963">even in childhood</a> – for example, a child may feel anxious about an approaching test at school. But if the anxiety is severe, long-lasting and interferes with a child’s daily life, it is called an anxiety disorder.</p>
<p>Our <a href="https://acamh.onlinelibrary.wiley.com/doi/10.1002/jcv2.12149">new research</a> has found that the consequences of anxiety disorders in young people can include mental health issues in adulthood, lower grades at school and lower earnings. </p>
<p>But <a href="https://link.springer.com/article/10.1007/s00787-019-01388-4">parents</a> and <a href="https://bmjopen.bmj.com/content/9/4/e023876.abstract">doctors</a> can find it difficult to distinguish everyday, age-appropriate fears and worries from anxiety problems that interfere with daily life. </p>
<p>Where families do seek support, they then struggle to access oversubscribed mental health services. Many children with anxiety disorders do not <a href="https://link.springer.com/article/10.1007/s00787-019-01388-4">receive treatment</a>. But our research shows that it is important for children with anxiety problems to receive timely treatment before they develop further. </p>
<h2>Assessing research</h2>
<p>We carried out a systematic review – a research project to identify, evaluate and synthesise all published research studies on a specific area of interest. </p>
<p>By examining the findings of this range of research studies, we found that people suffering from anxiety problems in childhood or as teenagers are more likely to have anxiety disorders in later youth and in adulthood. Numerous studies found a link between teenage anxiety disorders and adult depression. </p>
<p>We also found that teenagers who experience anxiety problems often <a href="https://acamh.onlinelibrary.wiley.com/doi/10.1002/jcv2.12149">miss more days of school</a> and <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2763443">achieve lower grades</a> than those who do not have an anxiety disorder. </p>
<figure class="align-center ">
<img alt="Pensive teenage boy in glasses sat with back to wall" src="https://images.theconversation.com/files/522570/original/file-20230424-28-hqb686.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/522570/original/file-20230424-28-hqb686.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/522570/original/file-20230424-28-hqb686.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/522570/original/file-20230424-28-hqb686.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/522570/original/file-20230424-28-hqb686.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/522570/original/file-20230424-28-hqb686.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/522570/original/file-20230424-28-hqb686.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">An anxiety disorder in childhood can affect grades and future careers.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/intelligent-teen-hispanic-boy-thinking-547979938">cheapbooks/Shutterstock</a></span>
</figcaption>
</figure>
<p>One <a href="https://www.sciencedirect.com/science/article/pii/S0165032713008860?via%3Dihub">research study found</a> that people aged 30 who had suffered anxiety disorders as teenagers were more than twice as likely to have been recently unemployed. They may also encounter difficulties in the workplace. This research shows that adults who had <a href="https://www.sciencedirect.com/science/article/pii/S0165032713008860?via%3Dihub">an anxiety disorder</a> in childhood are more likely to struggle at work and to suffer with stress. </p>
<p>Unsurprisingly, all of this results in a considerable economic cost that affects children with anxiety themselves when they are adults, their families, and wider society. One study found that boys who suffered anxiety problems in childhood experienced <a href="http://eprints.lse.ac.uk/38200/">3% lower earnings</a> from adult employment. </p>
<p><a href="https://link.springer.com/article/10.1007/s10802-007-9194-4">Research in the Netherlands</a> published in 2008 found that parents paid an average of €96 out-of-pocket each year for their child’s treatment (equating to around £111 in the UK in 2023). Having a child with anxiety may also lead to their <a href="https://link.springer.com/article/10.1007/s10802-020-00626-7">parents missing work</a>. A study in the US published in 2020 found that the cost of these missed work days, per child, would cost society US$856 a year (equating to around £685 in the UK in 2023).</p>
<h2>Helping an anxious child</h2>
<p>Children typically rely on parents to seek help for them. Their anxiety may simply be <a href="https://theconversation.com/we-shouldnt-worry-so-much-about-our-kids-anxiety-its-a-normal-part-of-growing-up-67963">part of growing up</a>. However, if you note that the fears and worries of your child persist and start interfering with their daily activities and your family life, then it is wise to seek medical advice. </p>
<p>Our <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(17)30149-9/fulltext">previous collaborative work</a> showed that one way of helping children with anxiety disorders is to teach their parents how to use principles from cognitive behavioural therapy (CBT) when supporting their children. Parents worked through a self-help book and had sessions with a therapist. </p>
<p>We have found that this treatment is both <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(17)30149-9/fulltext">clinically effective and good value for money</a>. This treatment has been <a href="https://www.acamh.org/research-digest/cyp-iapt/">widely adopted by the NHS</a>. Research on its use has also <a href="https://www.cambridge.org/core/services/aop-cambridge-core/content/view/95E025DF1C39213BC65DE31C117DBE55/S1352465822000546a.pdf/parentled_cognitive_behaviour_therapy_for_child_anxiety_problems_overcoming_challenges_to_increase_access_to_effective_treatment.pdf">taken place</a> in countries such as the US and Australia. </p>
<p>There is not much <a href="https://link.springer.com/article/10.1007/s10567-017-0222-9">research evidence</a> on the long-term effects of treatment of childhood anxiety, but the existing evidence suggests that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3881178/">treating childhood anxiety</a> early and effectively could reduce the prevalence of adult mental health disorders. Given the global <a href="https://mental.jmir.org/2020/6/e18472">mental health crisis</a> currently facing <a href="https://www.who.int/news/item/02-03-2022-covid-19-pandemic-triggers-25-increase-in-prevalence-of-anxiety-and-depression-worldwide">many countries</a> – and their <a href="https://www.bmj.com/content/380/bmj.p324">health systems</a> – this possibility should not be ignored.</p><img src="https://counter.theconversation.com/content/203370/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mara Violato receives funding from the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research, Award Number: RP‐PG‐0218‐20010; the NIHR Oxford Health Biomedical Research Centre; and the NIHR Applied Research Collaboration Oxford and Thames Valley. The views expressed are those of the author and not necessarily those of the NHS, NIHR or the Department of Health and Social Care.</span></em></p><p class="fine-print"><em><span>Jack Pollard receives funding from the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research, Award Number: RP‐PG‐0218‐20010. The views expressed are those of the author and not necessarily those of the NHS, NIHR or the Department of Health and Social Care.</span></em></p><p class="fine-print"><em><span>Tessa Reardon receives funding from the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research, Award Number: RP‐PG‐0218‐20010. The views expressed are those of the author and not necessarily those of the NHS, NIHR or the Department of Health and Social Care.</span></em></p>Children with an anxiety disorder are likely to miss more school and get lower grades than those who do not.Mara Violato, Associate Professor, Health Economics, University of OxfordJack Pollard, Researcher in Health Economics, University of OxfordTessa Reardon, Postdoctoral researcher, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2023042023-04-11T16:28:35Z2023-04-11T16:28:35ZWhy children don’t talk to adults about the problems they encounter online<figure><img src="https://images.theconversation.com/files/519833/original/file-20230406-28-gvdbsf.jpg?ixlib=rb-1.1.0&rect=17%2C26%2C5973%2C3961&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cyberbully-mental-health-problems-using-social-2267376741">iSOMBOON/Shutterstock</a></span></figcaption></figure><p>“I don’t listen to adults when it comes to this sort of thing”, a 17-year-old told me.</p>
<p>We were discussing how digital technology affects his life, as part of a <a href="https://www.headstartkernow.org.uk/digital-resilience/">long-term project</a> in the west of England that I carried out with colleagues to explore young people’s mental health – including the impact of digital technology on <a href="https://www.waterstones.com/book/online-resilience-and-wellbeing-in-young-people/andy-phippen/louisa-street/9783030886332">their emotional wellbeing</a>. </p>
<p>There is a widespread perception that being online is bad for <a href="https://www.theguardian.com/media/2018/sep/29/health-chief-set-social-media-time-limits-young-people">young people’s mental health</a>. But when we began the project, we quickly realised that there was very little evidence to back this up. The few <a href="https://www.pnas.org/doi/10.1073/pnas.1902058116">in-depth studies</a> around social media use and children’s mental health state that impacts are small and it is difficult to draw clear conclusions.</p>
<p>We wanted to find out if and how young people’s wellbeing was actually being affected in order to produce resources to help them. We talked to around 1,000 young people as part of our project. What we found was that there was a disconnect between what young people were worried about when it came to their online lives, and the worries their parents and other adults had. </p>
<p>One of the things young people told us was that adults tended to talk down to them about online harms, and had a tendency to “freak out” about these issues. Young people told us that adults’ views about online harms rarely reflected their own. They felt frustrated that they were being told what was harmful, rather than being asked what their experiences were. </p>
<h2>Common concerns</h2>
<p>The concerns the young people told us they had included bullying and other forms of online conflict. They were afraid of missing out on both online group interactions and real-life experiences others were showing in their social media posts. They worried that their posts were not getting as many likes as someone else’s. </p>
<p>But these concerns are rarely reflected in the media presentation of the harsher side of online harms. This <a href="https://www.waterstones.com/book/organisational-responses-to-social-media-storms/andy-phippen/emma-bond/9783030499761">has a tendency</a> to explore the criminal side of online abuse, such as grooming, the prevalence of online pornography. It also tends to describe social media use in similar language to that used to <a href="https://www.bbc.co.uk/news/uk-england-61722070">talk about addiction</a>.</p>
<p>It is no surprise, therefore, that parents might approach conversations with young people with excessive concern and an assumption their children are being approached by predators or are accessing harmful or illegal content. </p>
<figure class="align-center ">
<img alt="Mother trying to talk to her daughter who is on tablet with headphones" src="https://images.theconversation.com/files/519838/original/file-20230406-28-3e5dx0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/519838/original/file-20230406-28-3e5dx0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=447&fit=crop&dpr=1 600w, https://images.theconversation.com/files/519838/original/file-20230406-28-3e5dx0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=447&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/519838/original/file-20230406-28-3e5dx0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=447&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/519838/original/file-20230406-28-3e5dx0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=561&fit=crop&dpr=1 754w, https://images.theconversation.com/files/519838/original/file-20230406-28-3e5dx0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=561&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/519838/original/file-20230406-28-3e5dx0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=561&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Young people and their parents’ concerns about online safety may not match up.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/troubled-teenage-girl-headphones-using-digital-613422185">George Rudy/Shutterstock</a></span>
</figcaption>
</figure>
<p>We have <a href="https://swgfl.org.uk/research/what-causes-upset-online/">run a survey</a> with young people for several years on their online experiences. Our <a href="https://swgfl.org.uk/assets/documents/what-causes-upset-online.pdf">latest analysis</a> was based on 8,223 responses. One of the questions we ask is: “Have you ever been upset by something that has happened online?”. While there are differences between age groups, we found the percentage of those young people who say “yes” is around 30%. Or, to put it another way, more than two-thirds of the young people surveyed had never had an upsetting experience online. </p>
<p>Meanwhile, the online experiences reported by the 30% who reported being upset often didn’t tally with the extreme cases reporting in the media. Our <a href="https://swgfl.org.uk/research/what-causes-upset-online/">analysis of responses</a> showed that this upset is far more likely to come from abusive comments by peers and news stories about current affairs.</p>
<p>This disconnect means that young people are reluctant to talk to adults about their concerns. They are afraid of being told off, that the adult will overreact, or that talking to an adult might make the issue worse. The adults they might turn to need to make it clear this won’t happen and that they can help.</p>
<h2>How to help</h2>
<p>There are three things that young people have consistently told us over the duration of the project, and in our previous work, that adults can <a href="https://www.headstartkernow.org.uk/digital-resilience/parent-digital-offer/">do to help</a>. They are: listen and understand – don’t judge.</p>
<p>Conversations are important, as is showing an interest in young people’s online lives. However, those conversations do not have to be confrontational. If a media story about young people and online harms causes parents concern or alarm, the conversation does not have to start with: “Do you do this?” This can result in a defensive response and the conversation being shut down. It would be far better to introduce the topic with: “Have you seen this story? What do you think of this?” </p>
<p>Working in partnership with others, such as schools, is also important. If a parent has concerns, having a conversation with tutors can be a useful way of supporting the young person. The tutor might also be aware that the young person is not acting like themselves, or might have noticed changes in group dynamics among their peer group. </p>
<p>But, even if they are not aware of anything, raising concerns with them – and discussing from where those concerns arise – will mean both parents and school are focused in the same direction. It is important that young people receive both consistent messages and support. And schools will also be able to link up with other support services if they are needed. </p>
<p>Ultimately, we want young people to feel confident that they can ask for help and receive it. This is particularly important, because if they do not feel they can ask for help, it is far less likely the issue they are facing will be resolved – and there is a chance things might become worse without support.</p><img src="https://counter.theconversation.com/content/202304/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andy Phippen does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Young people told us that adults’ views about online harms rarely reflected their own.Andy Phippen, Professor of IT Ethics and Digital Rights, Bournemouth UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2024812023-04-09T12:07:32Z2023-04-09T12:07:32ZOver-emphasis on safety means kids are becoming more anxious and less resilient<figure><img src="https://images.theconversation.com/files/519676/original/file-20230405-24-iwbwzp.jpg?ixlib=rb-1.1.0&rect=7%2C44%2C4912%2C3230&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Parents being over-protective can deny children the experiences they need to learn and grow.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/over-emphasis-on-safety-means-kids-are-becoming-more-anxious-and-less-resilient" width="100%" height="400"></iframe>
<p>We are facing a mental health crisis. Teenagers and young adults are more <a href="https://doi.org/10.1111/j.1939-0025.2011.01115.x">depressed, suicidal, anxious</a> and <a href="https://doi.org/10.1177/0265407519836170">lonely</a> than ever before. </p>
<p>Depression rates among teens have been increasing since the early 2000s. A 2018 national survey found that <a href="https://www.samhsa.gov/data/report/2017-nsduh-annual-national-report">13.3 per cent of U.S. adolescents experienced a major depressive episode in the last year</a>. </p>
<p>But it’s not just teens — young adults are suffering too. A 2016 international survey of university counselling centres revealed 50 per cent of university students sought help for <a href="https://www.aucccd.org/assets/documents/aucccd%202016%20monograph%20-%20public.pdf">feelings of anxiety and 41 per cent for depression</a>. Suicide rates are also increasing. The <a href="https://wisqars.cdc.gov/reports/?o=MORT&y1=2001&y2=2015&t=0&d=&i=2&m=20810&g=00&me=0&s=2&r=0&e=0&yp=65&a=custom&g1=0&g2=199&a1=15&a2=19&r1=YEAR&r2=NONE&r3=NONE&r4=NONE">number of teenage girls in the U.S. who died by suicide nearly doubled</a> between 2000 and 2015. </p>
<p>The mental health statistics for Canadian youth are similarly grim. In 2003, <a href="https://www150.statcan.gc.ca/n1/pub/42-28-0001/2021001/article/00001-eng.htm">24 per cent of Canadians aged 15-30 self-reported that their mental health was either fair or poor</a> (compared to very good or excellent). <a href="https://www150.statcan.gc.ca/n1/pub/42-28-0001/2021001/article/00001-eng.htm">By 2019, that number had risen to 40 per cent</a>.</p>
<p>The COVID-19 pandemic worsened the mental health of Canadian youths. In 2020, <a href="https://www150.statcan.gc.ca/n1/pub/45-28-0001/2020001/article/00003-eng.htm">58 per cent of Canadians aged 15-24 reported fair or poor mental health</a> and nearly <a href="https://www.cihi.ca/en/children-and-youth-mental-health-in-canada">one in four hospitalizations for children and youth aged 5-24 were due to mental health conditions</a>.</p>
<p>What has changed in the last decade to explain this rise in poor mental health among youth? <a href="http://www.jeantwenge.com/igen-book-by-dr-jean-twenge/">Some psychologists</a> point to the recent <a href="https://www.thecoddling.com/buy">cultural emphasis on safety</a> as a contributor. </p>
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<a href="https://images.theconversation.com/files/519679/original/file-20230405-24-vudswh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A young sad-looking boy leans his head on a wall." src="https://images.theconversation.com/files/519679/original/file-20230405-24-vudswh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/519679/original/file-20230405-24-vudswh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/519679/original/file-20230405-24-vudswh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/519679/original/file-20230405-24-vudswh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/519679/original/file-20230405-24-vudswh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/519679/original/file-20230405-24-vudswh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/519679/original/file-20230405-24-vudswh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Parental overprotection has been shown to foster unhealthy coping mechanisms in children.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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</figure>
<h2>Shift in children’s safety</h2>
<p>In previous decades, American and Canadian children enjoyed more freedom, even though there were rising crime rates. The crime wave in Canada <a href="https://www150.statcan.gc.ca/n1/daily-quotidien/220802/dq220802a-eng.htm">rose steeply from the 60s through the 80s until it peaked in the early 1990s</a>. <a href="https://www.thecanadianencyclopedia.ca/en/article/television">Cable TV became widespread</a> during the same period, meaning that news of crimes spread farther and quicker than ever before. </p>
<p>This surge spurred safety initiatives like sharing pictures of <a href="https://www.theglobeandmail.com/news/world/worldview/who-started-the-milk-carton-campaign-to-find-missing-children/article4101849/">missing children on milk cartons</a> and crime shows like <a href="https://tvtropes.org/pmwiki/pmwiki.php/Series/AmericasMostWanted">America’s Most Wanted</a>. It’s no wonder parents became increasingly fearful and protective.</p>
<p><a href="https://doi.org/10.4000/champpenal.448">Crime rates began to come down in the 1990s</a>, but fear among parents remained. This is where the problem of being over cautious begins. The concept of safety started to extend beyond children’s physical safety to emotional and psychological comfort. This denied children experiences they needed to learn and grow.</p>
<p>Parental overprotection has been shown to <a href="https://doi.org/10.1111/sode.12590">foster unhealthy coping mechanisms in children</a>. Overprotected children are more likely to both internalize problems (as in anxiety and depression) and externalize them (as in delinquency, defiance or substance abuse). </p>
<p>Some psychologists propose that overprotection can morph into what they call <a href="https://www.thecoddling.com/">“safetyism,”</a> which teaches kids negative thought patterns similar to those experienced by the anxious and depressed. Safetyism can over-prioritize a young person’s safety to the exclusion of other practical and moral concerns.</p>
<p>It is natural to want to avoid problems, but <a href="https://doi.org/10.1177/0956797614543022">avoiding things that bring us discomfort can reinforce a belief that we cannot handle certain issues</a> and, over time, make us less capable.</p>
<h2>Unhelpful thought patterns</h2>
<p>Here are three unhealthy thought patterns to monitor in yourself and your children:</p>
<p><strong>Identify negative filtering</strong>. Do not underestimate the positives of experiences like unsupervised play (joy, independence, problem-solving, risk-assessment, resilience) when considering the potential negative consequences.</p>
<p><strong>Be aware of dichotomous thinking</strong>. Do not fall into the good or bad trap. There’s a world of possibility between one or the other. Considering people, ideas, places or situations as either good or evil (but never both or somewhere in between) fosters a polarizing “us vs. them” attitude and eliminates nuance.</p>
<p><strong>Recognize emotional reasoning</strong>. Feeling “unsafe” (uncomfortable or anxious), does not mean you are actually physically unsafe. If you avoid all stress, you will never learn to overcome stressors or understand your full potential. Avoiding hurdles can make us think we are more weak or fragile than we are. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/519678/original/file-20230405-16-1wl7zt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Young people wearing backpacks seen from behind." src="https://images.theconversation.com/files/519678/original/file-20230405-16-1wl7zt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/519678/original/file-20230405-16-1wl7zt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/519678/original/file-20230405-16-1wl7zt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/519678/original/file-20230405-16-1wl7zt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/519678/original/file-20230405-16-1wl7zt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/519678/original/file-20230405-16-1wl7zt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/519678/original/file-20230405-16-1wl7zt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Avoiding things that bring us discomfort can reinforce a belief that we cannot handle certain issues and, over time, make us less capable.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Painting the world as a place with dangers at every turn has created anxious youths who avoid activities they previously would have experimented with. Rising rates of loneliness and anxiety mean some youth are delaying <a href="https://doi.org/10.1111/cdev.12930">getting a job, driving a car, having sex, drinking alcohol and dating</a>. Research supports that <a href="https://doi.org/10.1007/s10826-020-01716-2#Sec16">overprotective parenting</a> (such as “helicopter parenting”) decreases adolescents’ <a href="https://doi.org/10.1007/s10826-013-9716-3">well-being</a>, <a href="https://doi.org/10.1007/s10826-019-01360-5">motivation</a>, <a href="https://doi.org/10.1016/j.adolescence.2012.03.007">independence</a> and <a href="https://doi.org/10.1111/sode.12590">ability to deal with problems in a healthy way</a>. </p>
<p>Generational trends show that across all social and economic demographics, <a href="https://doi.org/10.1353/foc.0.0044">American teens are putting off activities they deem “adult”</a> and don’t crave adult freedom as previous generations did. </p>
<p><a href="https://doi.org/10.1177/0265407519836170">They spend less time unsupervised by parents</a> because they’re worried about what’s out in the world, and they think they can’t handle it. <a href="https://www.cdc.gov/healthyyouth/data/yrbs/yrbs_data_summary_and_trends.htm">They don’t date or have sex</a> because they’re worried about broken hearts, pregnancy and sexually transmitted infections. <a href="https://doi.org/10.1017/S0954579412001228">They don’t drink</a> <a href="https://doi.org/10.1111/dar.12664">alcohol</a> because they’re worried about drunkenly making mistakes and what people will think of them afterwards. <a href="https://doi.org/10.3141/2495-01">They don’t drive</a> because they are happy to rely on their parents for transportation. </p>
<p>While some of these are rational consequences to avoid, they shouldn’t feel so overwhelming as to keep youths from transitioning into adulthood. Broken hearts teach you about what you want in a romantic partner, young people can be taught about safe sex, alcohol can be drunk in moderate amounts and mistakes are healthy, human and normal. Teens shouldn’t be so afraid of life that they no longer feel excited to live it.</p>
<p>Without opportunities to explore and learn their limits, youths risk internalizing a false sense of helplessness and becoming depressed and anxious. </p>
<h2>Helpful thought patterns</h2>
<p>Positive thought patterns must be developed within ourselves. That means giving ourselves, our teens and our children the opportunities needed to become independent, resilient and autonomous. And that means embracing negative experiences like frustration, conflict and boredom.</p>
<p>Here are some words of advice:</p>
<p><strong>Mind your mind.</strong> Your thoughts are powerful. They dictate how you see the world, others and yourself, so foster positive, rational thought patterns.</p>
<p><strong>Raise your voice.</strong> Encourage curiosity and productive disagreement. We will never learn to be open-minded or become well-rounded people if we do not challenge our own beliefs, listen to others’ perspectives and recognize our potential to be wrong. Every aspect of our lives, including our relationships and jobs, depends on our ability to argue in an effective, respectful and productive way without becoming overemotional.</p>
<p><strong>Open your heart.</strong> Try to give others the benefit of the doubt because most people do not intend to do harm. Do not let fear dictate your thoughts and actions.</p>
<p><strong>Trust yourself.</strong> Life will always throw curve balls and there will not always be an authority to defer to. Life is not safe or risk-free. The best protection is the knowledge that you can handle life’s challenges.</p><img src="https://counter.theconversation.com/content/202481/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Simon Sherry receives funding from the Social Sciences and Humanities Research Council of Canada. He also owns CRUX Psychology, a private practice in psychology.</span></em></p>Some psychologists suggest a cultural emphasis on safety is contributing to rising anxiety and depression among teens.Simon Sherry, Clinical Psychologist and Professor in the Department of Psychology and Neuroscience, Dalhousie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2008932023-03-27T12:23:01Z2023-03-27T12:23:01ZExtra food assistance cushioned the early pandemic’s blow on kids’ mental health<figure><img src="https://images.theconversation.com/files/516734/original/file-20230321-20-u5z17m.jpg?ixlib=rb-1.1.0&rect=51%2C25%2C5668%2C3782&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The pandemic-era expansion of SNAP benefits ended in all U.S. states by March 2023.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/asian-woman-wearing-protective-face-mask-hold-paper-royalty-free-image/1253665535?adppopup=true">aogreatkim/iStock/Getty Images Plus via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em></p>
<h2>The big idea</h2>
<p>Despite the <a href="https://theconversation.com/snap-benefits-cost-a-total-of-85-6b-in-the-2020-fiscal-year-amid-heightened-us-poverty-and-unemployment-148077">heightened poverty and unemployment</a> seen when the COVID-19 pandemic got underway, many low-income U.S. children <a href="https://doi.org/10.1016/j.ypmed.2023.107456">did not experience a decline in their emotional and mental health</a>, we found in a new study. </p>
<p>We looked specifically at kids whose families were participating in the <a href="https://theconversation.com/how-snap-can-help-people-during-hard-economic-times-like-these-133664">Supplemental Nutrition Assistance Program</a> – commonly known as SNAP – the government program that helps low-income Americans afford food. </p>
<p>The government began to boost SNAP benefits in early 2020 to help offset pandemic-driven food insecurity for participating families, which now <a href="https://theconversation.com/extra-snap-benefits-are-ending-as-us-lawmakers-resume-battle-over-program-that-helps-low-income-americans-buy-food-199929">number around 41 million</a>.</p>
<p>As a result, <a href="https://www.fns.usda.gov/snap/covid-19-emergency-allotments-guidance">families got an extra US$95</a> or more per month for groceries to <a href="https://www.ers.usda.gov/webdocs/publications/100820/ap-089.pdf?v=5555.5">replace the meals children were missing</a> at schools that had closed. <a href="https://healthyeatingresearch.org/research/snap-waivers-and-adaptations-during-the-covid-19-pandemic-a-survey-of-state-agency-perspectives-in-2020/">Some eligibility rules were loosened</a> to expand the program’s reach, and for the first time, <a href="https://www.usda.gov/media/press-releases/2019/04/18/usda-launches-snap-online-purchasing-pilot">people could buy groceries online</a> with their SNAP benefits.</p>
<p>To learn whether these extra benefits affected children’s mental and emotional health, we analyzed five years of data collected by the <a href="https://www.nschdata.org/">National Survey of Children’s Health</a> on 30,748 low-income families with children aged 6 to 17 years. The data, which included both families who were and were not getting SNAP benefits, covered the four years prior to the pandemic, as well as 2020. </p>
<p><iframe id="d5HZB" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/d5HZB/4/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Among the 8,680 families getting SNAP benefits during this period, 38% had at least one child with problems such as doctor-diagnosed mental, emotional, developmental or behavioral health issues – including anxiety and depression.</p>
<p>To assess whether the temporarily expanded benefits had an impact on these children, we conducted a “<a href="https://www.sciencedirect.com/topics/economics-econometrics-and-finance/difference-in-differences">difference in differences</a>” analysis: We compared data regarding children whose families enrolled in the SNAP program over time with children whose families didn’t get those benefits. In addition, we considered the potential influence of several factors that could play a role, such as parents’ mental health.</p>
<p>We found that children in families getting SNAP benefits in 2020 did not generally experience any change in their mental or emotional health compared to prior years, despite the heavy stress of the pandemic.</p>
<h2>Why it matters</h2>
<p>Typically, <a href="https://www.apa.org/topics/socioeconomic-status/poverty-hunger-homelessness-children">low-income children are more at risk</a> of developing mental health or emotional problems, compared with high-income children. Our study adds to earlier evidence that SNAP benefits can lower that risk by <a href="https://dx.doi.org/10.2105/AJPH.2014.302480">reducing psychological distress and improving food security</a>.</p>
<p>While 2020’s extra SNAP benefits protected children’s mental and emotional health, they did not improve it. This suggests that actually reducing food insecurity for low-income families would have required additional steps. </p>
<p>In March 2023, <a href="https://theconversation.com/extra-snap-benefits-are-ending-as-us-lawmakers-resume-battle-over-program-that-helps-low-income-americans-buy-food-19992">the federal government ended</a> the pandemic-era SNAP expansions in 35 states and territories that hadn’t yet rolled them back. With inflation driving the <a href="https://www.ers.usda.gov/data-products/food-price-outlook/summary-findings/">cost of groceries up 11.4%</a> in 2022, we believe that <a href="https://www.cbpp.org/research/food-assistance/temporary-pandemic-snap-benefits-will-end-in-remaining-35-states-in-march#_ftn2">losing these benefits</a> threatens the well-being of millions of families.</p>
<h2>What’s next</h2>
<p>We are now studying the <a href="https://texaswic.org/">effects of pandemic-related changes</a> to the Special Supplemental Nutrition Program for Women, Infants and Children, better known as WIC. </p>
<p>We are looking at, for example, how expanding WIC benefits to cover canned, frozen and dried fruits and vegetables in addition to fresh produce has affected the low-income families’ purchasing behavior. Our team for this research also includes public health and nutrition scholars <a href="https://scholar.google.com/citations?user=d4_yu0YAAAAJ&hl=en&oi=ao">Alexandra MacMillan Uribe</a> and <a href="https://scholar.google.com/citations?hl=en&user=UKvdw94AAAAJ">Elizabeth Racine</a>, </p>
<h2>What is not known</h2>
<p>When we did our study, data from the years after 2020 wasn’t yet available, so we couldn’t investigate the potential impact of subsequent pandemic-related changes to SNAP benefits. Notably, in 2021, the federal government increased maximum benefit levels by 15% and <a href="https://www.cbpp.org/research/food-assistance/temporary-pandemic-snap-benefits-will-end-in-remaining-35-states-in-march">extended the extra $95 or more</a> in monthly food assistance for the lowest-income households.</p><img src="https://counter.theconversation.com/content/200893/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Grace Melo's research related for this article was supported by funding from the Texas A&M AgriLife Institute for Advancing Health Through Agriculture.</span></em></p><p class="fine-print"><em><span>Pourya Valizadeh receives funding from the U.S. Department of Agriculture's Economic Research Service. </span></em></p><p class="fine-print"><em><span>Rodolfo M. Nayga Jr. receives funding from U.S. Department of Agriculture.</span></em></p>Expanding SNAP helped shield low-income children from some of the harm caused by economic upheaval when the COVID-19 pandemic began.Grace Melo, ACES Faculty Fellow, Texas A&M UniversityPourya Valizadeh, Research Assistant Professor of Agricultural Economics, Texas A&M UniversityRodolfo M. Nayga Jr., Professor of Agricultural Economics, Texas A&M UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2016372023-03-21T12:42:31Z2023-03-21T12:42:31ZA friend who’s more boss than BFF may be harmful for teens’ mental health<figure><img src="https://images.theconversation.com/files/516461/original/file-20230320-16-ty260l.jpg?ixlib=rb-1.1.0&rect=172%2C0%2C4710%2C3325&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">If one friend is always the boss, the other friend may suffer.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/gYdjZzXNWlg">Priscilla Du Preez/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em> </p>
<h2>The big idea</h2>
<p><a href="https://doi.org/10.1007/s10964-023-01763-0">Teens with domineering friends</a> are at heightened risk for mental health problems, according to our new research.</p>
<p>Dominant friends often harness decision-making power – for instance, dictating which classmates their friends should follow on Instagram. They can also exert behavioral control, like by making the subordinate friend go to a party they don’t want to attend.</p>
<p>Friendships are extremely <a href="https://www.guilford.com/books/Friendships-in-Childhood-and-Adolescence/Bagwell-Schmidt/9781462509607">important relationships</a> for teens, but are they always a positive influence? <a href="https://scholar.google.com/citations?user=6Y0_gc8AAAAJ&hl=en&oi=ao">We are</a> <a href="https://scholar.google.com/citations?user=N7WXzdgAAAAJ&hl=en&oi=ao">psychology</a> <a href="https://scholar.google.com/citations?user=1uXnTt4AAAAJ&hl=en&oi=ao">researchers</a> interested in the potential psychological consequences of having dominant friends. We suspected that being part of this kind of friendship with a peer might make adolescents feel worthless or distressed.</p>
<p>To investigate, we surveyed 388 adolescents at U.S. high schools five times across one year. Each time, we asked our teen participants to answer questions about their close friends’ dominating behaviors: Do they make all the decisions? Do they always get their way?</p>
<p>Consistent with our predictions, we found that when adolescents felt powerless in their close friendships – like their friends always “called the shots” – they experienced lower self-esteem and more symptoms of depression or anxiety.</p>
<h2>Why it matters</h2>
<p>Adolescence is a <a href="https://doi.org/10.1038%2Fnrn2513">high-risk time</a> for the onset of psychological disorders; rates of depression and anxiety tend to rise during the teenage years. Supportive and equitable friendships can <a href="https://www.theatlantic.com/family/archive/2020/01/friendship-crucial-adolescent-brain/605638/">positively affect teen mental health</a>, but our new research reveals a potential dark side to some close friendships.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/516463/original/file-20230320-16-56u3zj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="two young men joking with each other" src="https://images.theconversation.com/files/516463/original/file-20230320-16-56u3zj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/516463/original/file-20230320-16-56u3zj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/516463/original/file-20230320-16-56u3zj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/516463/original/file-20230320-16-56u3zj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/516463/original/file-20230320-16-56u3zj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/516463/original/file-20230320-16-56u3zj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/516463/original/file-20230320-16-56u3zj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Teens might need help recognizing the downsides of a lopsided friendship.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/YmPKoZgIVbM">whereslugo/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>Although some teens might be OK going with the flow and letting their friends take the reins, our study found some of the first evidence that this kind of <a href="https://doi.org/10.1007/s10964-023-01763-0">unequal relationship can be psychologically harmful</a>. Healthy friendships should offer both partners opportunities to have a say and make decisions.</p>
<p>Our findings suggest that it’s important to teach teens how to establish healthy, equitable friendships. One friend shouldn’t consistently feel bossed around or powerless. Also, adolescents may benefit from receiving help in developing effective communication tools for asserting their wants and needs to their close friends. </p>
<h2>What still isn’t known</h2>
<p>There is still a lot to learn about how power dynamics in friendships affect teen mental health. For example, is it better to have dominant friends than no friends at all? Does having several supportive friends negate the harm of having one dominant friend? And are there reasons some teens might be more likely than others to end up in these lopsided friendships? For example, it’s possible that personality plays a role, with more introverted teens gravitating toward more assertive peers, and vice versa.</p>
<p>We also need to learn more about the best ways to effectively intervene. Many programs are designed to promote <a href="https://doi.org/10.1016/j.adolescence.2021.08.008">healthy teen romantic relationships</a>, but far fewer address healthy teen friendships. Recognizing that friendships are not unequivocally protective is an important first step in helping teens reap their benefits and avoid their costs.</p><img src="https://counter.theconversation.com/content/201637/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hannah L. Schacter received funding for this work from the Society for Research in Child Development and Wayne State University. She is currently funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). </span></em></p><p class="fine-print"><em><span>Adam Hoffman received funding for this work from the Society for Research in Child Development.</span></em></p><p class="fine-print"><em><span>Alexandra Ehrhardt does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Friendships are important, but are they always healthy? New research finds that teens who feel dominated by their friends experience lower self-esteem and more symptoms of anxiety and depression.Hannah L. Schacter, Assistant Professor of Psychology, Wayne State UniversityAdam Hoffman, Assistant Professor of Psychology, Cornell UniversityAlexandra Ehrhardt, Ph.D. Candidate in Psychology, Wayne State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2002292023-03-09T23:52:16Z2023-03-09T23:52:16ZSuicide attempts rose among children and adolescents during the COVID-19 pandemic, especially for girls<p>Will the kids be alright? There was hope that children and adolescents would “bounce back” as the pandemic progressed, but sadly, the data suggest otherwise. </p>
<p>Twenty-five percent of children and adolescents reported that they have <a href="https://doi.org/10.1001/jamapediatrics.2021.2482">experienced significant depression</a>. The incidence and hospitalization rates for new onset eating disorders <a href="https://doi.org/10.1001/jamanetworkopen.2021.37395">increased by 60</a> per cent during the COVID-19 pandemic.</p>
<p>Precipitants of mental illness have also increased dramatically for children and adolescents in the pandemic. Screen time <a href="https://doi.org/10.1001/jamapediatrics.2022.4116">increased by 50 per cent</a>, physical activity <a href="https://doi.org/10.1001/jamapediatrics.2022.2313">decreased by 20</a> per cent, <a href="https://doi.org/10.3390/children10020279">loneliness increased</a>, family violence <a href="https://doi.org/10.1016/j.eclinm.2022.101634">increased</a>, and parent <a href="https://doi.org/10.1016/S2215-0366(21)00074-2">depression and anxiety doubled</a>. </p>
<p>Many of the experiences and opportunities that help children and teens build identity, friendships, supports and personal growth were also <a href="https://doi.org/10.1001/jamapediatrics.2022.0791">stripped away during the pandemic</a>.</p>
<h2>Child and adolescent suicide attempts</h2>
<p>An unfortunate, but commonly used, indicator of the state of children’s and adolescents’ mental health is suicide attempts. There has been repeated discussion as to whether suicide attempts were within historic trends, or have increased during the pandemic among children and adolescents. </p>
<p>To inform this discussion, our research team conducted a systematic review, published in <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(23)00036-6/fulltext"><em>Lancet Psychiatry</em></a>, of the literature on 11.1 million children’s and adolescents’ emergency department visits in 18 countries.</p>
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<img alt="A teen girl with green hair talking to a school counsellor" src="https://images.theconversation.com/files/514525/original/file-20230309-729-1am03b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/514525/original/file-20230309-729-1am03b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/514525/original/file-20230309-729-1am03b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/514525/original/file-20230309-729-1am03b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/514525/original/file-20230309-729-1am03b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/514525/original/file-20230309-729-1am03b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/514525/original/file-20230309-729-1am03b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Girls may be more comfortable than boys talking with a health-care professional about their feelings.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>In our study, we compared the rate of children’s and adolescents’ emergency department visits for suicide attempts that occurred before the pandemic, to the rate that occurred during the pandemic. In doing so, we provide the most rigorous test to date of whether the number of children and adolescents presenting to the emergency department for suicide attempts has increased, decreased or stayed the same during the pandemic.</p>
<p>We found that the rate of suicide attempts for children and adolescents increased by 22 per cent during the pandemic compared to before the pandemic. Specifically, we found that on average, in any given emergency department setting, there were 102 child and adolescent visits per month for suicide attempts before the pandemic, which increased to 125 during the months of the pandemic.</p>
<p>The pandemic has been difficult for many, and the results of our study highlight just how difficult, and potentially fatal, it has been for children and adolescents.</p>
<h2>Girls attempt suicide more than boys</h2>
<p>When we looked deeper into who was more likely to show increases in suicidal behaviour, we found that the rate of emergency department visits during the pandemic increased by 39 per cent for girls, and by six per cent for boys. </p>
<p>This finding is consistent with previous data on teen suicide, which shows that while girls are more likely to attempt suicide and seek mental health care for their distress, boys are <a href="https://doi.org/10.1001/jamapsychiatry.2020.0596">more likely to die by suicide</a>.</p>
<p>There are several factors that may be contributing to these gender differences. First, girls are more likely than boys to seek <a href="https://doi.org/10.1177/070674371305800504">help when they are distressed</a>, even when that distress is severe and <a href="https://doi.org/10.1177/07067437211058602">potentially life-threatening</a>.</p>
<p>Second, girls are also more likely to have, and sought care for, underlying mental health disorders, such as depression or anxiety, which are more common <a href="https://doi.org/10.1001/jamapsychiatry.2019.3523">among adolescent girls than adolescent boys</a>.</p>
<p>Third, girls may be more comfortable talking with a health-care professional about their feelings. As a society we may also, either intentionally or unintentionally, encourage girls to think and talk about their feelings more than we do for boys. This may lead boys to think or feel that it’s not okay to admit to thoughts of hopelessness, death and suicide, or seek help <a href="https://doi.org/10.1016/j.jadohealth.2017.07.024">when they occur</a>.</p>
<h2>Prevention is key to fostering well-being</h2>
<p>Our research allows us to say more conclusively that the frequent and prolonged exposure to pandemic stressors (such as repeated school closures, social distancing, online learning), combined with limited access to protective supports (for example, extracurriculars, sports, community centres, school counsellors), have likely led to a mental health crisis, the likes of which children and teens have never experienced before. </p>
<figure class="align-center ">
<img alt="A group of boys on a soccer field, talking with their coach" src="https://images.theconversation.com/files/514527/original/file-20230309-24-yxpscj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/514527/original/file-20230309-24-yxpscj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/514527/original/file-20230309-24-yxpscj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/514527/original/file-20230309-24-yxpscj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/514527/original/file-20230309-24-yxpscj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/514527/original/file-20230309-24-yxpscj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/514527/original/file-20230309-24-yxpscj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Pandemic stressors like school closures, social distancing and online learning, combined with limited access to protective supports like sports, extracurriculars, community centres and school counsellors, have likely led to a mental health crisis.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>This crisis requires immediate attention from governments and policymakers. The needs of children and adolescents must be central in health care decision making.</p>
<p>The mental health crisis can be de-escalated through the creation and implementation of prevention strategies and supports. There is very good evidence that it’s better to create <a href="https://cehd.uchicago.edu/?page_id=237">upstream solutions to prevent mental illness</a>, than costly downstream interventions to mitigate mental illness in individuals once it’s established.</p>
<p>Prevention strategies should be implemented early in development, to help children and adolescents gain greater comfort in identifying and expressing their emotions. Mental health care needs to be accessible, convenient and cost effective, spanning “<a href="http://dx.doi.org/10.1139/facets-2021-0078">promotion, prevention, early intervention and treatment</a>.”</p>
<p>Prevention strategies should be mindful of the gender differences in suicidal behaviour among girls and boys, and tailor their initiatives accordingly. Strategies for girls should focus on bolstering supports in health-care settings since girls are likely to engage in help-seeking. Strategies for boys should focus on reducing stigma related to mental distress to increase boys’ comfort in reaching out, and engaging with, adults that they trust and mental health services.</p>
<p>It is important that countries and governments prioritize the mental health of children and adolescents to help reduce the burden of mental illness and improve overall health and well-being. There is no better investment than in the lives of children and adolescents, as they are the next generation of societal contributors and citizens.</p>
<p><em>Information on suicide prevention <a href="https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/suicide">can be found here</a>. Distress lines in Canada are open 24 hours a day. Kids Help Phone: 1-800-668-6868. <a href="https://talksuicide.ca/">Talk Suicide Canada</a>: 1-833-456-4566 or text 45645. Québec residents: 1-866-277-3553. If you live outside of Canada, please look up a suicide help line in your geographical location.</em></p><img src="https://counter.theconversation.com/content/200229/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sheri Madigan receives funding from the Social Sciences and Humanities Research Council, the Canadian Institutes of Health Research, the Alberta Children's Hospital Foundation, an anonymous donor, and the Canada Research Chairs program.</span></em></p><p class="fine-print"><em><span>Daphne Korczak receives funding from Canadian Institutes of Health Research, the SickKids Research Institute, and the SickKids Foundation. Dr. Korczak is the Chair of the Mental Health Task Force of the Canadian Pediatric Society.
</span></em></p><p class="fine-print"><em><span>Jackson Hewitt receives funding from the Social Sciences and Humanities Research Council.</span></em></p><p class="fine-print"><em><span>Nicole Racine receives funding from the Social Science and Humanities Research Council, the Canadian Institues of Health Research, the CHEO foundation, and uOttawa Faculty of Social Sciences. She is affiliated with Strong Minds Strong Kids Psychology Canada. </span></em></p><p class="fine-print"><em><span>Tracy Vaillancourt receives funding from Canadian Institutes of Health Research, the Social Sciences and Humanities Research Council of Canada, and the Canada Research Chairs program. Vaillancourt is the chair of the Royal Society of Canada (RSC) COVID-19 Task-Force and was the chair of the RSC Children and Schools working group.</span></em></p>The rate of suicide attempts in children and adolescents increased by 22 per cent during the pandemic compared to before the pandemic.Sheri Madigan, Professor, Canada Research Chair in Determinants of Child Development, Owerko Centre at the Alberta Children’s Hospital Research Institute, University of CalgaryDaphne Korczak, Child and Adolescent Psychiatrist, SickKids' Chair in Child and Youth Medical Psychiatry, Associate Professor, University of TorontoJackson Hewitt, Graduate Student, Clinical Psychology, University of CalgaryNicole Racine, Assistant professor, School of Psychology, L’Université d’Ottawa/University of OttawaTracy Vaillancourt, Tier 1 Canada Research Chair in School-Based Mental Health and Violence Prevention, L’Université d’Ottawa/University of OttawaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2000522023-02-23T13:17:13Z2023-02-23T13:17:13ZHow to help teen girls’ mental health struggles – 6 research-based strategies for parents, teachers and friends<figure><img src="https://images.theconversation.com/files/511459/original/file-20230221-22-bwnz8d.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6038%2C4019&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Social media can sometimes damage the self-esteem of teen girls.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/bad-news-over-the-phone-royalty-free-image/614833928?phrase=teenage%2Bgirl%2Bdepressed">stock-eye/iStock via Getty Images Plus</a></span></figcaption></figure><p>It’s a well-established fact that children’s and teens’ mental health <a href="https://doi.org/10.1177%2F20503121221086712">took a hit during the pandemic</a>. But new research suggests that teen girls in particular are suffering in unprecedented ways.</p>
<p>A survey by the Centers for Disease Control and Prevention that was published in early February 2023 found that, in 2021, 57% of high school girls reported experiencing “persistent feelings of <a href="https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBS_Data-Summary-Trends_Report2023_508.pdf">sadness or hopelessness in the past year</a>,” <a href="https://www.axios.com/2023/02/13/teen-girls-sadness-violence-cdc-report">up from 36% in 2011</a>. That’s nearly twice as high as the 29% of males who reported having those feelings in 2021.</p>
<p>What’s worse, 30% of the girls surveyed reported seriously considering suicide and 13% attempted suicide one or more times in 2021. That is beyond shocking. It’s appalling.</p>
<p>We are a <a href="https://www.marccenter.org">research team</a> that studies children and their <a href="https://www.marccenter.org/research-resources">social and emotional development</a>, and during the pandemic we’ve been specifically focused on mental health in children and adolescents. Since 2020, we’ve seen more changes in girls, overall, including increases in depression and thoughts of suicide. </p>
<p>In our view, a number of key factors have converged to create this mental health crisis in teen girls.</p>
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<figcaption><span class="caption">The stress experienced by teens is unique and significant.</span></figcaption>
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<h2>A perfect storm of factors</h2>
<p>Previous CDC research has shown that the COVID-19 pandemic <a href="https://www.cdc.gov/nssp/partners/Understanding-the-impact.html">disproportionately affected girls</a>. And in a 2021 study that our team conducted with 240 teens, 70% of girls said that they “very much” <a href="https://doi.org/10.3390/pediatric13030064">missed seeing people</a> during the pandemic, compared with only 28% of boys reporting that sentiment. </p>
<p>A second factor is social media, which can be a <a href="https://www.ingentaconnect.com/content/prin/csj/2018/00000052/00000004/art00009">wonderful source of support</a> but also, at times, a crushing blow to the <a href="https://doi.org/10.1016/j.copsyc.2022.101304">self-esteem and psychological well-being of girls</a>. </p>
<p>Finally, we think that all young people are struggling with issues like climate change and social upheaval. These aren’t just abstractions for many boys and girls: They are their future. Children and teens are usually neither <a href="http://www.ourenergypolicy.org/wp-content/uploads/2013/05/American-Teens-Knowledge-of-Climate-Change.pdf">indifferent to nor unaware of political realities</a>. </p>
<p>So how can parents, teachers and friends help girls through this crisis? </p>
<p>Here are six strategies that research shows can work.</p>
<h2>1. More emphasis on social support</h2>
<p>Social and emotional connectivity between humans is likely one of the most potent weapons we have against significant stress and sadness. Studies have found strong links between a <a href="https://doi.org/10.1016/j.childyouth.2018.03.001">lack of parental and peer support</a> and depression during adolescence. Support from friends can also <a href="https://doi.org/10.1007/s10802-013-9844-7">help mitigate the link</a> between extreme adolescent anxiety and suicidal thoughts. In one study of teens, <a href="https://doi.org/10.1006/jado.2000.0353">social support was linked to greater resilience</a> – such as being better able to withstand certain types of social cruelty like bullying. </p>
<h2>2. Supporting one another instead of competing</h2>
<p>During the 1970s and 1980s, competition between women was seen as something that held women back. Unfortunately, this message seems to have been lost in the <a href="https://online.king.edu/news/social-media-and-body-image/">tsunami of media coverage</a> about bodies, looks and social achievement. Research has found that <a href="https://doi.org/10.1016/j.chb.2015.09.011">social media encourages competition between girls</a>, particularly around their physical appearance. </p>
<p>Teaching girls at young ages to be cheerleaders for one another – and modeling that behavior as grownups – can help ease the sense of competition that today’s teens are facing.</p>
<h2>3. Showcasing achievements</h2>
<p>Thinking about your own appearance is natural and understandable. But an overemphasis on what you look like is clearly not healthy, and it is <a href="https://doi.org/10.1111/j.1471-6402.2006.00265.x">strongly associated with depression and anxiety</a>, especially in women. </p>
<p>Adults can play a key role in encouraging girls to value other qualities, such as their artistic abilities or intelligence. Childhood can be a canvas for children to discover where their talents lie, which can be a source <a href="https://doi.org/10.1002/sce.21066">of great satisfaction in life</a>.</p>
<p>One way that adults can help is simply by acknowledging and celebrating those qualities. For instance, at the <a href="https://www.marccenter.org/">Massachusetts Aggression Reduction Center</a>, an organization we direct and manage that is focused on prevention of bullying and cyberbullying, staff members post female achievements – be they intellectual, artistic, scientific, athletic or literary – on social media channels every Friday, using the hashtag #FridaysForFemales. </p>
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<figcaption><span class="caption">This young woman once felt sad, anxious and trapped.</span></figcaption>
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<h2>4. Empowering women</h2>
<p>Girls look to grown women for examples of how they can behave and what they can do. You may not be the chief executive officer of a huge corporation, but maybe you are a wonderful teacher, or maybe you run a small business that provides an important product or service. Modeling pro-women attitudes means valuing <a href="https://globalvolunteers.org/global-role-of-women/">all of the roles</a> that people play in a society.</p>
<p>In addition, teaching the history behind women’s movements and other important steps toward equality, such as the <a href="https://www.archives.gov/milestone-documents/19th-amendment">women’s right to vote</a>, is key to empowering girls to value themselves and their roles. Women played central roles in <a href="https://www.nationalww2museum.org/students-teachers/student-resources/research-starters/women-wwii">war efforts during World War II</a>. Women have led <a href="https://nmaahc.si.edu/sites/default/files/images/black_women_civil_rights_movement_5.pdf">social movements and fought for people’s rights</a>. And women have been <a href="https://www.nobelprize.org/prizes/physics/1903/marie-curie/biographical/">renowned scientists</a>, <a href="https://oxfordsummercourses.com/articles/famous-female-writers-in-history/">writers</a>, <a href="https://www.harpersbazaar.com/culture/art-books-music/g7916/best-female-artists/">artists</a> and experts in virtually every other profession you can name.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/511780/original/file-20230222-20-xuao0x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Black and white image of Marie Curie sitting in front of a work table watching as her daughter adjusts an instrument." src="https://images.theconversation.com/files/511780/original/file-20230222-20-xuao0x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/511780/original/file-20230222-20-xuao0x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=850&fit=crop&dpr=1 600w, https://images.theconversation.com/files/511780/original/file-20230222-20-xuao0x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=850&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/511780/original/file-20230222-20-xuao0x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=850&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/511780/original/file-20230222-20-xuao0x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1068&fit=crop&dpr=1 754w, https://images.theconversation.com/files/511780/original/file-20230222-20-xuao0x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1068&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/511780/original/file-20230222-20-xuao0x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1068&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Marie Curie, seated, was a Polish-born physicist and pioneer in radioactivity. Together with her husband she won a Nobel Prize for Physics in 1903. Her daughter, Irene, standing in photo, won a joint Nobel Prize for Chemistry in 1935.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/marie-curie-and-her-daughter-irene-1925-mc-polish-born-news-photo/171191031?phrase=marie%20curie&adppopup=true">Culture Club/Hulton Archive via Getty Images</a></span>
</figcaption>
</figure>
<h2>5. An honest look at social media</h2>
<p>Social media represents a unique form of human interaction that has taken on an outsize role in the lives of teens. This is magnified for teenage girls, for whom every social media interaction may feel <a href="http://doi.org/10.1177/2056305119886025">consequential and potentially cataclysmic</a>.</p>
<p>Interacting in a fun and positive way with peers on social media platforms can be a <a href="https://doi.org/10.15804/tner.2016.46.4.01">positive and affirming experience</a>. On the other hand, seeing the things that others post, and comparing it with your own stuff, can make people of any age feel anxious about how they’re appearing, and whether they’re being socially included or excluded. This anxiety applies to both boys and girls, but the potential for emotional distress <a href="https://doi.org/10.1089/cyber.2019.0079">seems to be higher for girls</a>. </p>
<p>Awareness of how social media has the capacity to <a href="https://doi.org/10.1016/j.bodyim.2017.09.001">influence your feelings and mental health</a> seems to help people keep some distance from their interactions on social media. Adults can help girls by discussing with them how social media influences their feelings, their self-perception and even their body image. </p>
<h2>6. Teaching kids to recognize their feelings</h2>
<p>Learning to recognize and label feelings doesn’t come automatically for many people. The good news, though, is that kids can learn ways to help themselves when they’re experiencing <a href="https://doi.org/10.3390/jcm9103064">anxiety or depression</a>. Kids can learn to appreciate how hugging their dog, playing a board game, or talking with their parent(s) can help reduce anxiety, once they understand the feelings.</p>
<p>We think it’s worth noting that everything discussed here can also be helpful for boys, who are by no means <a href="https://www.apa.org/monitor/2022/01/special-childrens-mental-health">immune to mental health problems</a>. Encouraging achievement recognition, understanding how moods can be influenced by social media, and increasing support for both boys and girls is a positive step as we move toward a post-pandemic world.</p>
<p><em>This article has been updated to correct Marie Curie’s place of birth.</em></p><img src="https://counter.theconversation.com/content/200052/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The mental health of teenagers has grown far worse over the last decade. But a new report shows that, compared with boys, teen girls are disproportionately experiencing sadness and hopelessness.Elizabeth Englander, Professor of Psychology, Bridgewater State UniversityMeghan K. McCoy, Adjunct Faculty in Psychology and Childhood Studies, Bridgewater State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1929272022-12-01T13:41:18Z2022-12-01T13:41:18ZHow parents can play a key role in the prevention and treatment of teen mental health problems<figure><img src="https://images.theconversation.com/files/494260/original/file-20221108-24-2nnrfi.jpg?ixlib=rb-1.1.0&rect=6%2C12%2C4015%2C2653&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Early detection is key to treating depression in teenagers.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/sad-young-girl-royalty-free-image/888960804?phrase=teen%2Bdepression">dragana991/iStock via Getty Images Plus</a></span></figcaption></figure><p>More than 44% of teens reported <a href="https://www.cdc.gov/mmwr/volumes/71/su/su7103a3.htm">persistent feelings of sadness and hopelessness</a> in the first half of 2021, according to a report from the Centers for Disease Control and Prevention. The early 2022 report, which was based on an online survey, also found that nearly 20% had seriously considered suicide, and 9% attempted suicide. </p>
<p>The COVID-19 pandemic is a likely contributor to these startling figures, but rates of teen mental illness have been <a href="https://doi.org/10.1016/j.jadohealth.2019.04.033">rising over the past decade</a>. </p>
<p>One crucial factor that has received little attention in supporting teen mental health is the role that parents can play.</p>
<p>This is surprising, since research has clearly established that <a href="https://doi.org/10.1007%2Fs10567-015-0182-x">participation by a caregiver</a> in their child’s mental health treatment is directly related to a successful outcome. A key reason for this is that parents generally interact with their teen on a daily basis and can model and cultivate coping skills. </p>
<p>Yet, for mental health professionals, it can be challenging to integrate parents into teens’ treatment when there are discrepancies between the perspectives, goals and expectations of teens and parents. In addition,
<a href="https://www.guttmacher.org/gpr/2000/08/minors-and-right-consent-health-care">consent and privacy</a> laws sometimes limit providers’ abilities to disclose key details about a teen’s mental health to parents. </p>
<p>As researchers <a href="https://www.solutionsnetwork.psu.edu/t32-grant/fellows">studying childhood trauma</a> <a href="https://scholar.google.com/citations?user=wcuxj5gAAAAJ&hl=en">and adolescent development</a>, we see parents and caregivers as a critical link in addressing the urgent mental health crisis among teens. </p>
<h2>The teenage years can be brutal</h2>
<p>Parents often <a href="https://www.washingtonpost.com/parenting/2022/10/18/teen-years-dread-parenting/">dread the teenage years</a>, anticipating mood swings, risk-taking behaviors and endless arguments. Some of this is developmentally normal: Teens are developing their identities, testing limits and <a href="https://doi.org/10.1111/cdep.12278">asserting their autonomy</a>. These combined factors can lead to hostility and <a href="https://doi.org/10.1111/cdep.12278">a lower-quality</a> parent-teen relationship. </p>
<p>Physically, <a href="https://theconversation.com/school-start-times-and-screen-time-late-in-the-evening-exacerbate-sleep-deprivation-in-us-teenagers-179178">teens are sleep-deprived</a>, in part due to <a href="https://doi.org/10.1542/peds.2014-1697">overly early</a> <a href="https://www.cdc.gov/sleep/features/schools-start-too-early.html">school start times</a> and hormonal changes associated with puberty. As a result, teens can be irritable and sensitive to stressors. They also haven’t developed the <a href="https://doi.org/10.1177/0963721413480170">self-control to manage their reactions</a>. </p>
<p>And it’s important to note that half of all mental illness emerges <a href="https://www.nami.org/about-mental-illness/mental-health-conditions">by age 14 and 75% by age 24</a>, making adolescence a <a href="https://theconversation.com/anxiety-detection-and-treatment-in-early-childhood-can-lower-risk-for-long-term-mental-health-issues-an-expert-panel-now-recommends-screening-starting-at-age-8-192380">highly sensitive period for the prevention</a> and treatment of mental health problems.</p>
<h2>Signs and symptoms of a mental health concern</h2>
<p>Mental health problems in teens can sometimes take unexpected forms. Depression and anxiety can manifest as irritability and noncompliance, which parents may reasonably view as disrespect and laziness. Understanding what is beneath those behaviors is challenging. Teens are quite secretive, so they may not disclose the extent of their struggles. </p>
<p>Traumatic experiences like <a href="https://www.mcleanhospital.org/essential/mental-health-impact-bullying-kids-and-teens">bullying</a>, <a href="https://www.cdc.gov/violenceprevention/intimatepartnerviolence/teendatingviolence/fastfact.html">dating violence</a> and <a href="https://www.nsvrc.org/sites/default/files/publications/2019-02/Teenagers_508.pdf">sexual harassment and assault</a> are unfortunately too common in adolescence and can cause drastic changes in behavior and affect.</p>
<p>Although anxiety is a normal emotional response at any age, about a third of adolescents <a href="https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder#part_155096">have some type of anxiety disorder</a>, and about 10% experience severe impairment as a result. Teens struggling with chronic anxiety may experience agitation or irritability, issues with sleep, perfectionist tendencies, or may try to avoid stressful things altogether. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/wr4N-SdekqY?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Keeping a journal, exercising regularly and maintaining a sleep routine are three ways for teens to cope with stress.</span></figcaption>
</figure>
<p>Among teens, <a href="https://www.nimh.nih.gov/health/statistics/major-depression">17% struggle with depression</a>. Depression generally involves a loss of interest or pleasure in daily activities, but it is more than feeling blue. For teens, symptoms of depression may look like withdrawing from family or social activities, shutting down during conversations or conflict, lethargy, difficulty concentrating, hopelessness about the future or negative feelings of self-worth. </p>
<p>Depression can also be associated with <a href="https://theconversation.com/why-do-teens-engage-in-self-harm-clinical-psychologists-explain-how-to-help-teens-reduce-their-emotional-distress-181419">self-harm</a> and suicide.</p>
<p>In determining whether a teen is experiencing a mental illness, parents should consider how behaviors are affecting their teens’ everyday lives and plans for the future. Those who are falling behind in school, damaging important relationships or engaging in high-risk behaviors may be most likely to be experiencing a mental health issue – as opposed to typical teenage challenges. </p>
<h2>A shortage of mental health care</h2>
<p>Despite the growing need for mental health care, the U.S. has <a href="https://www.aacap.org/AACAP/Press/Press_Releases/2018/Severe_Shortage_of_Child_and_Adolescent_Psychiatrists_Illustrated_in_AAACP_Workforce_maps.aspx">a dire shortage of professionals</a> to meet the demand. Insurance companies create barriers to accessing mental health care by restricting the numbers of <a href="https://www.gao.gov/assets/gao-22-104597.pdf">in-network providers</a> and approved sessions. As a result, many providers prioritize patients who will <a href="https://www.theatlantic.com/health/archive/2016/06/the-struggle-of-seeking-therapy-while-poor/484970/">pay out of pocket</a>. </p>
<p>Parents and teens may wait months for an appointment, and the quality and effectiveness of the services they receive are highly variable. All the while, symptoms may worsen, straining the family and compromising teens’ social and academic opportunities.</p>
<h2>The powerful role parents can play</h2>
<p>This is where parents come in, since they can <a href="https://doi.org/10.1111/j.1467-9507.2007.00389.x">serve as role models</a> for teens’ coping and emotional development. </p>
<p>While good sleep, consistent exercise and quality meals can often be the first line of defense in preventing and managing symptoms of mental health problems, there are several behavioral strategies for parenting struggling teens. Indeed, foster parents care for children with complex histories of trauma, and many of the <a href="https://www.cebc4cw.org/program/together-facing-the-challenge/detailed">behavior management strategies</a> taught to foster parents may be useful for traditional family settings as well. </p>
<p>When teens are unkind or disrespectful, parents may take it personally. But parents who are aware of and able to manage their own triggers can react calmly to challenging behavior, creating opportunities for effective communication with their teen. </p>
<p>Building and maintaining the parent-teen connection, such as by watching a TV show together or other low-pressure opportunities to be together, is key. These experiences <a href="https://doi.org/10.1016/j.pop.2014.05.004">create safe spaces and opportunities for teens</a> to communicate about difficult emotions or situations. Parents who assist teens in recognizing, talking about and dealing with difficult thoughts and feelings help them to understand how their thoughts and feelings can affect their behavior. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/OVE_JmOK4hs?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Set up a behavior contract with your teen.</span></figcaption>
</figure>
<p>Parents can also help their teens manage negative emotions by <a href="https://kidshealth.org/en/teens/self-esteem.html">reinforcing their self-esteem</a> and strengths and encouraging self-efficacy. Parents who offer praise to their teens who are working hard to overcome challenges – as opposed to focusing solely on the outcome – can help teens see their worth beyond their accomplishments. </p>
<p>At the same time, teens require boundaries that allow them to build self-reliance, exercise independence and practice compromise in certain situations. Behavior contracts – in which teens and their parents agree to certain conditions in writing – can provide a structured way to establish shared expectations. </p>
<p>When consequences are necessary, natural consequences allow teens <a href="https://sites.duke.edu/tftc/files/2020/06/March-2020-DB-TH-article.pdf">to learn without parental intervention</a>. For example, if a teen stays up late the night before a big softball game, their coach may bench them for playing poorly. Parents can help teens to connect the frustration and disappointment they experience to their choices regarding sleep, which can be more helpful for their future decision-making than getting into an argument with a parent about their decision or receiving a parent-imposed consequence, such as removing phone privileges. </p>
<p>When natural consequences are not an option, discipline should be specific, time-limited and focused on a specific outcome, such as not allowing preferred activities until homework and chores are complete.</p>
<p>It is also important that parents <a href="https://www.psychologytoday.com/us/blog/promoting-empathy-your-teen/201707/how-avoid-power-struggles-your-teen">avoid power struggles</a> with their teens by modeling respectful communication without trying to manage the teen’s reaction or perspective. Teens are unlikely to admit to being wrong – particularly in a heated moment – and if the point is made, there is rarely a benefit to insisting upon a particular reaction such as a forced apology.</p>
<p>Parents can best support their teens by maintaining connection alongside enforcing structure and discipline. While challenging behaviors can be the status quo of adolescence, parents should be on the lookout for signs that might reflect a pervasive mental health issue, since early detection and treatment is crucial.</p><img src="https://counter.theconversation.com/content/192927/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Nearly 1 in 5 US teenagers battle depression. But parents can help by communicating openly, creating a behavior contract and finding low-pressure opportunities to interact with their teen.Toria Herd, Postdoctoral Researcher in Psychology, Penn StateSarah A. Font, Associate Professor of Sociology and Public Policy, Penn StateLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1945302022-11-29T19:11:01Z2022-11-29T19:11:01ZYou’ve got a friend: young people help each other with their mental health for 3.5 hours every week<figure><img src="https://images.theconversation.com/files/496930/original/file-20221123-26-r5kt5f.jpg?ixlib=rb-1.1.0&rect=0%2C27%2C6134%2C4043&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://images.pexels.com/photos/9807587/pexels-photo-9807587.jpeg?auto=compress&cs=tinysrgb&w=1260&h=750&dpr=2">Pexels/Ron Lach</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Young people experience mental health difficulties at a <a href="https://www.abs.gov.au/statistics/health/mental-health/national-study-mental-health-and-wellbeing/latest-release">higher rate</a> than any other age group.</p>
<p>While there’s ongoing discussion about the <a href="https://www.abc.net.au/news/2022-11-01/new-youth-mental-health-residential-facilities-regional-victoria/101599116">formal supports they need</a>, young people say they’re most likely to speak with <a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1943-278X.2012.00108.x">peers and friends</a> – particularly when mental health care is difficult to access.</p>
<p>In partnership with youth mental health charity <a href="https://www.batyr.com.au/what-is-batyr/">batyr</a> and <a href="https://www.healthdirect.gov.au/australian-health-services/23024853/erin-dolan-and-associates/services/warragul-3820-25-albert-street">clinical expertise</a>, we undertook a <a href="https://www.batyr.com.au/wp-content/uploads/2022/11/Being-there.pdf">national survey and conducted focus groups</a> with young people (aged 16–25 years).</p>
<p>We wanted to understand how young people support each other and what resources they need to keep caring for their friends in safe ways. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/research-suggests-one-way-to-prevent-depression-and-anxiety-is-a-strong-sense-of-connection-at-high-school-193939">Research suggests one way to prevent depression and anxiety is a strong sense of connection at high school</a>
</strong>
</em>
</p>
<hr>
<h2>A critical resource</h2>
<p>Our <a href="https://www.batyr.com.au/wp-content/uploads/2022/11/Being-there.pdf">research</a> included a national survey with 169 young people, as well as focus group discussions with 34 young people from Melbourne and Sydney. We found young people provide on average 3.5 hours per week of support for friends, or about 182 hours each year. </p>
<p>Participants spoke about being there for friends whenever they needed them, and 76% agreed friends provide critical support – often more than mental health professionals and parents or guardians.</p>
<blockquote>
<p>Yeah, I think it’s easier and less confrontational talking to friends rather than family or a professional.</p>
<p>– Mackenzie*</p>
</blockquote>
<p>This support includes assisting during tough times (such as during a relationship or family breakdown) and support due to health or financial difficulties, exam stress, as well as mental health distress. Almost 95% of young people in our study said they had helped a friend through mental ill-health.</p>
<p>Emotional support means “being there” for a friend, but it includes other assistance too, such as financial help, temporary housing, or connecting friends with professional services. </p>
<p>Young people discussed being able to provide immediate support to each other. This support is ongoing and involves more than just one encounter.</p>
<h2>Personalised, dynamic support</h2>
<p>All the young people we spoke to said their support changes depending on the friend, time, place and situation. Malis told us:</p>
<blockquote>
<p>I think it just depends on the person and sort of like their approach to certain things […] it also just depends on the context.</p>
</blockquote>
<p>They emphasised there is not a “one size fits all” approach. As Ari said:</p>
<blockquote>
<p>Giving support, it’s not a formulaic thing.</p>
</blockquote>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/496932/original/file-20221123-24-npaf9z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="group of teen girls sit in skate park" src="https://images.theconversation.com/files/496932/original/file-20221123-24-npaf9z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/496932/original/file-20221123-24-npaf9z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/496932/original/file-20221123-24-npaf9z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/496932/original/file-20221123-24-npaf9z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/496932/original/file-20221123-24-npaf9z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/496932/original/file-20221123-24-npaf9z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/496932/original/file-20221123-24-npaf9z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Young people said they’d ask for professional or adult support if needed.</span>
<span class="attribution"><a class="source" href="https://images.pexels.com/photos/10118237/pexels-photo-10118237.jpeg?auto=compress&cs=tinysrgb&w=1260&h=750&dpr=2">Pexels/Cottonbro Studio</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/mental-distress-is-much-worse-for-people-with-disabilities-and-many-health-professionals-dont-know-how-to-help-187078">Mental distress is much worse for people with disabilities, and many health professionals don't know how to help</a>
</strong>
</em>
</p>
<hr>
<h2>Tailoring an approach to their friends’ needs</h2>
<p>While there is no single approach, there are some common components to how young people support their friends.</p>
<p>A common first step is noticing something is wrong. This might be a mood change observed in person or online.</p>
<blockquote>
<p>You know when they’re just not talking as much or they’re not really, you know, interacting with anyone [then] you kind of say ‘Okay, something’s wrong here’.</p>
<p>– Lara</p>
</blockquote>
<p>They spoke about carefully and strategically starting conversations to make it easier for their friends to talk. Young people say this requires more than asking “Are you OK?”. Ash told us it was about “being a lot more specific and directing questions with a bit more intent”. </p>
<p>Sometimes friends approach them, and they spoke about being ready for them when and where they were needed; being on “standby”, as Malis put it. </p>
<p>Support takes place in-person and online, and sometimes moves between the two settings. Omar said a friend might start chatting on a train “and then they go online and start talking”.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/locking-up-kids-has-serious-mental-health-impacts-and-contributes-to-further-reoffending-194657">Locking up kids has serious mental health impacts and contributes to further reoffending</a>
</strong>
</em>
</p>
<hr>
<h2>Providing the right support 5 ways</h2>
<p>Young people say providing the right support and response means working out what their friend needs, whether they want advice (or not), and taking into account their cultural background.</p>
<p>They spoke about taking the following actions:</p>
<ul>
<li><p>sharing their <a href="https://link.springer.com/article/10.1007/s10597-021-00786-w">own lived experiences</a> and what worked for them</p></li>
<li><p>finding <a href="https://www.batyr.com.au/resource-hub/">online resources</a> about the issue a friend was going through and forwarding details to them</p></li>
<li><p>finding lists of accessible professionals and supports</p></li>
<li><p>taking a friend along to a mental health professional, or organising their visit with a mental health professional</p></li>
<li><p>talking to someone in their immediate family or network to get their friend the support they needed, though this was often considered a last resort.</p></li>
</ul>
<p>The young people we spoke to said they avoided unnecessary engagements with adults. They felt they’d been entrusted with their friend’s concerns and needs. Adults were frequently seen as not understanding issues around mental health more generally. </p>
<p>However, if they thought a problem was beyond their control or expertise, then they would seek outside help. As Shalani said:</p>
<blockquote>
<p>If I feel like it’s out of my area of expertise or something, I would probably think it’s better for them to like go elsewhere.</p>
</blockquote>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/496936/original/file-20221123-12-r0mtn8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="two pairs to feet in sneakers against graffitied wall" src="https://images.theconversation.com/files/496936/original/file-20221123-12-r0mtn8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/496936/original/file-20221123-12-r0mtn8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/496936/original/file-20221123-12-r0mtn8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/496936/original/file-20221123-12-r0mtn8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/496936/original/file-20221123-12-r0mtn8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/496936/original/file-20221123-12-r0mtn8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/496936/original/file-20221123-12-r0mtn8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Adults were frequently viewed as not having a good understanding of mental health issues.</span>
<span class="attribution"><a class="source" href="https://images.unsplash.com/photo-1622253543934-c3cb280f8323?ixlib=rb-4.0.3&ixid=MnwxMjA3fDB8MHxwaG90by1wYWdlfHx8fGVufDB8fHx8&auto=format&fit=crop&w=1740&q=80">Unsplash/Aedrian</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/research-suggests-one-way-to-prevent-depression-and-anxiety-is-a-strong-sense-of-connection-at-high-school-193939">Research suggests one way to prevent depression and anxiety is a strong sense of connection at high school</a>
</strong>
</em>
</p>
<hr>
<h2>Helping themselves too</h2>
<p>Young people can sometimes <a href="https://minerva-access.unimelb.edu.au/items/50c94e9e-c749-5338-ba92-c2f530677615">take on too much responsibility</a> for their friends. Young people in the study spoke about how they look after themselves to create healthy boundaries. Celine had learnt this the hard way and said:</p>
<blockquote>
<p>Ultimately you can help your friend, but then you’ve got to make sure that you’re okay first to do that.</p>
</blockquote>
<p>However, sometimes the lines between being a good friend and supporter and maintaining self-care were difficult. As Sam said:</p>
<blockquote>
<p>I have found it difficult when I was having a hard day and had to be their support person for the whole day. It’s also difficult when you are out of the house (with family or other friends) and can tell they need you at that moment but you don’t really have the time, but you make time anyway.</p>
</blockquote>
<p>Some young people didn’t provide help to a friend because they were worried about saying the wrong thing or putting the friendship at risk by expressing concern. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/its-ruok-day-but-how-can-i-help-might-be-a-better-question-to-ask-190064">It's RUOK Day – but 'how can I help?' might be a better question to ask</a>
</strong>
</em>
</p>
<hr>
<h2>Helping them help each other</h2>
<p>This study shows the critical work young people are doing to informally support each other. </p>
<p>We need to recognise the expertise of these young people, particularly when there are difficulties accessing formal mental health support.</p>
<p>We need to think about how we best resource young people in acceptable ways, so they have the tools to continue to support friends and manage feelings of responsibility.</p>
<p>We need to develop services and responses that include friends, and we need to create and foster public and online spaces where young people feel comfortable supporting each other, including on social media.</p>
<p>And ultimately, we need to address many of the underlying fundamental issues that result in tough times for young people – poverty, uncertainty, exclusion and discrimination – the social drivers that lead to and exacerbate tough times.</p>
<p><em>*Names have been changed to protect participants’ privacy.</em></p>
<hr>
<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call <a href="https://www.lifeline.org.au/">Lifeline</a> on 13 11 14.</em></p><img src="https://counter.theconversation.com/content/194530/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This project was supported by funding from batyr as well as financial support from the Western Sydney University’s Vice-Chancellor’s Research Fellowship program.</span></em></p><p class="fine-print"><em><span>Amelia Henry, Erin Dolan, and Jasbeer Musthafa Mamalipurath do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Young people provide timely and personalised mental health support to friends – but sometimes find looking after their own needs difficult in the process.Benjamin Hanckel, Senior research fellow, Western Sydney UniversityAmelia Henry, Research Assistant, Western Sydney UniversityErin Dolan, Honorary Fellow / Clinical Psychologist, The University of MelbourneJasbeer Musthafa Mamalipurath, Research officer, Institute for Culture and Society, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1904872022-11-28T15:11:08Z2022-11-28T15:11:08ZPerfectionist teens reported more depression and stress during COVID-19<figure><img src="https://images.theconversation.com/files/495949/original/file-20221117-21-fofm3w.jpg?ixlib=rb-1.1.0&rect=0%2C165%2C6500%2C3757&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Perfectionists tend to be unable to or at least reluctant to adapt to changing situations.</span> <span class="attribution"><span class="source">(Pexels /Julia M Cameron)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/perfectionist-teens-reported-more-depression-and-stress-during-covid-19" width="100%" height="400"></iframe>
<p>Perfectionists are sometimes <a href="https://pubmed.ncbi.nlm.nih.gov/21087903/">thought of as superheroes</a>: people who are high achievers and seem to always <a href="https://www.wellandgood.com/imposter-syndrome-perfectionism/">have it all together</a>.</p>
<p>Perfectionism is different from simply trying to do a good job or even seeking <a href="https://pubmed.ncbi.nlm.nih.gov/35201817/">excellence</a>. Rather, perfectionism refers to rigidly requiring nothing short of absolute perfection and being highly self-critical.</p>
<p><a href="https://doi.org/10.1111/cdev.13855">Our recent study</a>, published in the journal <em>Child Development</em>, examined how perfectionism is affecting teens’ mental health and stress levels during the COVID-19 pandemic. </p>
<h2>Exacting standards</h2>
<p>While <a href="https://doi.org/10.1007/s10648-019-09484-2">research shows</a> some forms of perfectionism are related to small achievement gains, it also reveals perfectionism is commonly associated with experiencing more <a href="https://doi.org/10.1016/j.jrp.2005.04.002">health problems</a> along with <a href="https://doi.org/10.1016/j.paid.2012.02.009">relationship difficulties</a>. </p>
<p>People higher in perfectionism even show <a href="https://doi.org/10.1016/j.bbih.2021.100211">dysregulated immune system functioning</a>. </p>
<p>Perfectionists do not fare any better with respect to their mental health: <a href="https://doi.org/10.1002/jclp.22435">research</a> indicates perfectionistic individuals report higher levels of depressive symptoms, stress, disordered eating and anxiety compared to their less perfectionistic peers. </p>
<p>Perfectionistic people are particularly susceptible to experiencing these adverse consequences when they <a href="https://doi.org/10.1007/BF02686885">are stressed</a> or faced with difficult and uncertain situations, because they tend to be unable to or at least reluctant to adapt to changing situations. </p>
<p>Thus, there is good reason to be highly concerned about perfectionists during the continually <a href="https://theconversation.com/covid-19-and-mental-health-feeling-anguish-is-normal-and-is-not-a-disorder-153784">evolving pandemic that has been exceptionally stressful for</a> most people.</p>
<figure class="align-center ">
<img alt="A girl in a sweatshirt that says 'always cute, always cool, always positive." src="https://images.theconversation.com/files/495919/original/file-20221117-19-fioa9t.jpg?ixlib=rb-1.1.0&rect=0%2C15%2C5136%2C3165&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/495919/original/file-20221117-19-fioa9t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495919/original/file-20221117-19-fioa9t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495919/original/file-20221117-19-fioa9t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495919/original/file-20221117-19-fioa9t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495919/original/file-20221117-19-fioa9t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495919/original/file-20221117-19-fioa9t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There is good reason to be concerned about teen perfectionists in the pandemic.</span>
<span class="attribution"><span class="source">(Zen Chung/Pexels)</span></span>
</figcaption>
</figure>
<h2>Perfectionism as personality trait</h2>
<p>When measuring perfectionism as a personality trait, psychology researchers identify different “flavours” of <a href="https://doi.org/10.1177/0734282916651381">perfectionism</a>. </p>
<p>Self-oriented perfectionism refers to requiring perfection from oneself. People high in self-oriented perfectionism demand perfection from themselves and are incredibly hard on themselves when they do not meet those demands. </p>
<p>Socially prescribed perfectionism refers to the belief or perception that others require perfection. Individuals who are high in socially prescribed perfectionism think others demand perfection from them, are critical of them and believe that they will never measure up to others’ expectations. </p>
<p>These forms of perfectionism are commonly observed in teens, a group that experiences relatively high levels of perfectionism. <a href="https://doi.org/10.1002/pits.21792">Research shows</a> that approximately one in four youth are highly perfectionistic.</p>
<h2>Lack of closure, opportunities</h2>
<p>It is important to focus on how young people are doing during these difficult times. Unlike adults who have already gained their sense of independence, the pandemic and its accompanying restrictions have held teens back in a state of suspended reality. </p>
<p>For example, many teens have completely missed out on significant developmental <a href="https://theconversation.com/how-to-help-high-school-seniors-cope-with-milestones-missed-due-to-coronavirus-139147">milestones such as graduations and proms</a>, leaving them feeling lost due to a lack of closure on important chapters of their lives. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/students-returning-to-campus-want-the-university-experience-missed-during-covid-19-186507">Students returning to campus want the 'university experience' missed during COVID-19</a>
</strong>
</em>
</p>
<hr>
<p>Government-mandated lockdowns <a href="https://www.cbc.ca/news/politics/federal-modelling-covid-19-case-count-1.5999634">that were put in place to slow the spread of COVID-19</a> forced young people into isolation where they were often separated from friends and family for extended periods of time. School closures also led to substantial interruptions to young people’s schooling, which is associated with gaps in <a href="https://covid19-sciencetable.ca/wp-content/uploads/2022/01/Ontario-Returns-to-School-An-Overview-of-the-Science_20220112-1.pdf">in educational achievement</a>.</p>
<p>It is not hard to imagine how difficult gaps would be for young perfectionists who often define themselves by their ability to achieve.</p>
<figure class="align-center ">
<img alt="A mother next to a teen looking at homework." src="https://images.theconversation.com/files/495930/original/file-20221117-27-73djg1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/495930/original/file-20221117-27-73djg1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495930/original/file-20221117-27-73djg1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495930/original/file-20221117-27-73djg1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495930/original/file-20221117-27-73djg1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495930/original/file-20221117-27-73djg1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495930/original/file-20221117-27-73djg1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A lack of closure on important chapters of their lives has been a stressor on youth.</span>
<span class="attribution"><span class="source">(Pexels/Andrea Piacquadio)</span></span>
</figcaption>
</figure>
<h2>Effects of lockdowns</h2>
<p>Our study shows the significant effects lockdowns have had on the self-reported mental health of teens. </p>
<p>We assessed 187 adolescents’ levels of perfectionism, anxiety symptoms, stress and depressive symptoms before the pandemic began and then again during the first and <a href="https://news.ontario.ca/en/release/59922/ontario-declares-second-provincial-emergency-to-address-covid-19-crisis-and-save-lives">second government-mandated lockdowns</a> that took place in Ontario, Canada.</p>
<p>Results showed an interesting pattern of change with respect to depressive symptoms and stress levels. Depressive symptoms and stress decreased slightly from before the pandemic began to the first lockdown and then increased dramatically from the first to second lockdown. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/quebec-tried-to-keep-schools-open-during-the-pandemic-heres-what-high-school-students-experienced-169119">Québec tried to keep schools open during the pandemic. Here’s what high school students experienced</a>
</strong>
</em>
</p>
<hr>
<p>Although we cannot be sure, one possible explanation for these findings is that teens were able to take a much-needed break from their busy and possibly overscheduled lives during the first lockdown, which resulted in some relief of depressive symptoms and stress. </p>
<p>However, by the time the second lockdown occurred, teens may have been feeling demoralized and hopeless as the pandemic continued to take its toll on everyone, resulting in higher levels of stress and depressive symptoms.</p>
<h2>How perfectionists fared</h2>
<p>A key finding is that teen perfectionists are not faring as well during the pandemic compared to their non-perfectionistic peers. Teens who demanded perfection from themselves (self-oriented perfectionists) were more depressed, anxious and stressed than those who did not tend to demand perfection from themselves over the course of the pandemic. </p>
<p>Results also showed that when teens experienced higher than their typical levels of self-oriented perfectionism, they were also more anxious, but not more depressed or stressed. </p>
<p>Teenagers who believed that others demanded perfection from them were more depressed and stressed than those who did not have such beliefs during the pandemic. </p>
<p>We also found that when teens experienced more of these beliefs than usual, they were more depressed, but not more anxious or stressed.</p>
<h2>Struggles behind the mask</h2>
<figure class="align-left ">
<img alt="A teen in a superhero mask." src="https://images.theconversation.com/files/495915/original/file-20221117-13-ed8a7o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/495915/original/file-20221117-13-ed8a7o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495915/original/file-20221117-13-ed8a7o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495915/original/file-20221117-13-ed8a7o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495915/original/file-20221117-13-ed8a7o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495915/original/file-20221117-13-ed8a7o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495915/original/file-20221117-13-ed8a7o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Perfectionist teens aren’t superheroes who are impervious to hardships.</span>
<span class="attribution"><span class="source">(Pexels/Cottonbro Studio)</span></span>
</figcaption>
</figure>
<p>Taken together, these findings support the idea that perfectionistic teens are more vulnerable to mental health problems and greater stress compared to their non-perfectionistic peers during the pandemic. </p>
<p>It is important to recognize that although teen perfectionists <a href="https://doi.org/10.1177/0829573512468845">often appear to be doing well on the surface</a>, they are not superheroes who are impervious to hardships.</p>
<p>Instead, they are young people who are often in distress and struggling behind their mask of perfection and in need of support during these difficult times.</p><img src="https://counter.theconversation.com/content/190487/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Danielle S. Molnar receives funding from the Canada Research Chairs Program, the Social Sciences and Humanities Research Council, and an Early Research Award from the Ministry of Research and Innovation, Government of Ontario. </span></em></p><p class="fine-print"><em><span>Dawn Zinga receives funding from the Social Sciences and Humanities Research Council of Canada. </span></em></p><p class="fine-print"><em><span>Melissa Blackburn does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Although teen perfectionists often appear to be doing well on the surface, they are not impervious to hardships. They are young people who are often in need of support.Danielle S. Molnar, Associate Professor of Child and Youth Studies; Canada Research Chair (Tier II) Adjustment and Well-Being in Children and Youth, Brock UniversityDawn Zinga, Professor of Child and Youth Studies; Associate Dean, Graduate Studies and Research, Faculty of Social Sciences, Brock UniversityMelissa Blackburn, PhD Candidate, Child and Youth Studies, Brock UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1939392022-11-27T19:04:08Z2022-11-27T19:04:08ZResearch suggests one way to prevent depression and anxiety is a strong sense of connection at high school<figure><img src="https://images.theconversation.com/files/497163/original/file-20221124-26-y5tul.jpg?ixlib=rb-1.1.0&rect=58%2C33%2C5483%2C3580&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Aedrian/Unsplash</span></span></figcaption></figure><p>About one in five <a href="https://www.aihw.gov.au/reports/mental-health-services/mental-health">young Australians</a> will experience a mental health problem like depression or anxiety each year. The COVID pandemic has only <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2782796">intensified mental health concerns</a> in young people. </p>
<p>In Australia, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5269479/">decades of investment</a> in early intervention and treatment services have not decreased rates of depression and anxiety. This has sparked more interest in what we can do to <a href="https://theconversation.com/more-australians-are-diagnosed-with-depression-and-anxiety-but-it-doesnt-mean-mental-illness-is-rising-120824">prevent</a> mental health problems.
Schools are ideal settings for prevention because you can reach large numbers of students, help build healthy skills and habits, and capitalise on schools being both learning and social environments. </p>
<p>Our <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-14364-6">new research</a> suggests, one promising way to prevent depression and anxiety is by ensuring students feel a strong sense of belonging and connection to their high school.</p>
<h2>What is ‘school connectedness’?</h2>
<p>“<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6133283/">School connectedness</a>” is about the quality of engagement students have with their peers, teachers, and learning in the school environment. </p>
<p>It can include things such as, knowing teachers support them, having a friend to talk to about their problems, feeling like they can be themselves at school and like school is an enjoyable place to be, and actively participating in school activities. </p>
<figure class="align-center ">
<img alt="Students sitting at desks, listening" src="https://images.theconversation.com/files/497164/original/file-20221124-18-j9c3vl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/497164/original/file-20221124-18-j9c3vl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=411&fit=crop&dpr=1 600w, https://images.theconversation.com/files/497164/original/file-20221124-18-j9c3vl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=411&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/497164/original/file-20221124-18-j9c3vl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=411&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/497164/original/file-20221124-18-j9c3vl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=516&fit=crop&dpr=1 754w, https://images.theconversation.com/files/497164/original/file-20221124-18-j9c3vl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=516&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/497164/original/file-20221124-18-j9c3vl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=516&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Up to one in four young Australians experience a mental health issue each year.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>School connectedness has been linked to <a href="https://link.springer.com/article/10.1007/s10648-015-9319-1">better academic achievement and wellbeing</a>. But it is now attracting attention as a possible way to protect against depression and anxiety.</p>
<p>However, existing research reviews have tended to look at cross-sectional studies (data collected at one point in time) rather than longitudinal studies (data collected over time). And they haven’t considered anxiety and depression specifically, making it difficult to determine if there is a preventative effect. </p>
<h2>Our research</h2>
<p>In a <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-14364-6">new study</a>, we investigated whether school connectedness prevents the onset of later depression and anxiety in 14 to 24 year-olds. We did this with funding from the UK charity, the <a href="https://wellcome.org/what-we-do/mental-health/projects/anxiety-depression-young-people-finding-next-generation-treatments">Wellcome Trust</a> as part of its push to identify innovative <a href="https://zenodo.org/record/7327296#.Y4AMSfdByUl">interventions</a> for anxiety and depression.</p>
<p>We systematically reviewed ten years of evidence examining relationships between school connectedness and depression and anxiety. After screening 3,552 potential articles, we found 34 longitudinal and two intervention studies which met our <a href="https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=270967">inclusion criteria</a>. The intervention studies measured the change in participants’ depressive symptoms before and after a program, compared to participants who did not receive the program.</p>
<p>We then summarised the findings from the included articles.</p>
<p>To ensure young people’s perspectives informed our review, we also partnered with five youth advisers aged 16 to 21 with lived experience of mental health problems and/or the schooling system in Australia, Indonesia, and the Philippines.</p>
<h2>Our findings</h2>
<p>Most studies found higher levels of school connectedness predicted lower levels of depression and anxiety later. Most studies examined depression. </p>
<p>For example, United States <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/jora.12275">one study</a> of nearly 10,000 students found higher levels of self-reported school connectedness (questions included, “you feel like you are part of your school”, “the teachers at school treat you fairly”) led to reductions in self-reported depressive symptoms in the past week. This effect occurred both later in secondary school and persisted into early adulthood, even when accounting for previous depressive symptoms. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/self-compassion-is-the-superpower-year-12-students-need-for-exams-and-life-beyond-school-192086">Self-compassion is the superpower year 12 students need for exams ... and life beyond school</a>
</strong>
</em>
</p>
<hr>
<p>Another <a href="https://www.sciencedirect.com/science/article/abs/pii/S1054139X20305838">study</a> investigated the effect of a <a href="https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(21)00190-5/fulltext">whole-school</a> health promotion program in over 5,000 secondary school students in India. </p>
<p>The program encouraged supportive relationships between members of the school community, promoted school belonging, increased participation in school activities, and promoted social skills among students. The study found this led to a reduction in depressive symptoms 17 months later. </p>
<h2>Reflections from youth advisers</h2>
<p>Our findings resonated with the experience of our youth advisers. For example, one 18-year-old adviser from Australia reflected, </p>
<blockquote>
<p>I’ve had mental health issues my whole life […] I noticed the second that I moved schools to a more healthy environment, the rapid improvement of my mental health.</p>
</blockquote>
<p>Another 18-year-old adviser from Indonesia explained, </p>
<blockquote>
<p>Knowing your school is there for you really calms you down, takes one more thought out of your head, and more weight off your shoulders.</p>
</blockquote>
<p>Most of the studies were from high-income countries, primarily the US, yet our advisers stressed the importance of cultural context. One 16-year-old youth adviser explained the importance of religion. </p>
<blockquote>
<p>In Indonesia you can’t really dismiss religion. You can’t ignore it because it’s so deeply rooted in our society and that in turn reflects (on) other things like our mental health and even school connectedness.</p>
</blockquote>
<p>Interestingly, we found one study reported higher levels of school connectedness led to higher levels of internal distress. Our youth advisers noted that sometimes feeling more connected to school can come with increased expectations from teachers and pressure to perform, which might increase anxiety in some students. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-missing-middle-puberty-is-a-critical-time-at-school-so-why-arent-we-investing-in-it-more-150071">The missing middle: puberty is a critical time at school, so why aren’t we investing in it more?</a>
</strong>
</em>
</p>
<hr>
<h2>What does this mean for schools?</h2>
<p>Our findings show how schools matter for mental health and that fostering school connectedness might be a way to prevent depression and anxiety. </p>
<p><a href="https://www.education.vic.gov.au/documents/about/department/resiliencelitreview.pdf">Existing research</a> shows there are a lot of “<a href="https://www.researchgate.net/publication/233430604_Teacher-student_relationships_which_promote_resilience_at_school_A_micro-level_analysis_of_students'_views">little things</a>” teachers can do throughout the day in their <a href="https://link.springer.com/article/10.1007/s10648-021-09621-w">ordinary interactions</a> with students to foster school connectedness. </p>
<p>This includes, actively listening to students, being available and accessible, advocating for students, encouraging students in their school work even if they are struggling, having empathy for students’ difficulties, and treating students like “humans”. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/teachers-play-a-key-role-in-helping-students-feel-they-belong-at-school-99641">Teachers play a key role in helping students feel they 'belong' at school</a>
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</em>
</p>
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<p>Students are also <a href="https://catalogue.nla.gov.au/Record/3724275">more likely</a> to ask for help with their learning when teachers say hello, talk to them and take an interest in what they are doing, and show they are proud of them. </p>
<p>Our youth advisers reinforced the importance of feeling acknowledged by teachers and peers and that students need to be able to safely express their identity.
One 16-year-old youth adviser from Australia explained that feeling connected to school has many parts.</p>
<blockquote>
<p>You’ve got that social aspect, but you’ve also got extra-curricular activities, how you’re going through your studies, your classes […] it’s the positive emotions, it’s the relationships, it’s the meaning, it’s engagement, the accomplishment, it’s all of that. Once you feel supported in all these areas is when you feel connected.</p>
</blockquote>
<p>Across the pandemic, school closures and remote learning have shaped a different appreciation of the significance of schools for mental health and wellbeing. The question now is how governments, schools and communities act on this information.</p>
<hr>
<p><em>If this article has raised issues for you or your child, you can call <a href="https://www.lifeline.org.au">Lifeline</a> on 13 11 14 or <a href="https://kidshelpline.com.au">Kids Helpline</a> on 1800 55 1800.</em></p><img src="https://counter.theconversation.com/content/193939/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Monika Raniti works for the Centre of Research Excellence in Driving Global Investment in Adolescent Health (NHMRC Australia GNT 1171981) and The ALIVE National Centre for Mental Health Research Translation (NHMRC Australia Grant GNT 2002047). She has received funding from the Wellcome Trust, WHO, UNESCO, UNICEF and the Commonwealth Government of Australia for projects related to health promoting schools. She is a member of The Australasian School Based Health Alliance.</span></em></p><p class="fine-print"><em><span>Susan M Sawyer is co-director of a WHO Collaborating Centre for Adolescent Health and in this role, regularly engages with UN agencies. Most recently, she lead a body of work for WHO and UNESCO that informed the development of the first global standards on Health-promoting Schools. She is currently leading a series of topic briefs for WHO UNICEF and UNESCO on Health-promoting Schools. She is also a current grantholder with the Commonwealth Government of Australia for a training program on whole-school approaches to health. She was previously a member of an External Advisory Committee for a new clinical guideline from the World Health Organization on School-Based Health Services. </span></em></p><p class="fine-print"><em><span>Divyangana Rakesh does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A new study investigated whether ‘school connectedness’ prevents the onset of depression and anxiety in 14 to 24 year-olds.Monika Raniti, Research Fellow, Murdoch Children's Research InstituteDivyangana Rakesh, Postdoctoral research fellow, Harvard UniversitySusan M Sawyer, Professor of Adolescent Health The University of Melbourne; Director, Royal Children's Hospital Centre for Adolescent Health, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1944962022-11-17T21:33:18Z2022-11-17T21:33:18ZOn World Children’s Day, let’s recognize that children’s rights include mental health<figure><img src="https://images.theconversation.com/files/495964/original/file-20221117-15-9tnmd.jpg?ixlib=rb-1.1.0&rect=490%2C36%2C7591%2C4880&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In a Spring 2022 survey of parents with kids between ages six and 17 years, more than 50 per cent perceived that their child had needed help regarding their emotional or behavioural problems in the past six months.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p><a href="https://www.unicef.org/world-childrens-day">World Children’s Day</a> is Nov. 20, when we celebrate the importance of children’s rights and of safeguarding adequate physical, mental, spiritual and social development for every child around the world. </p>
<p>These rights, laid out in the <a href="https://www.ohchr.org/en/instruments-mechanisms/instruments/convention-rights-child">UN Convention on the Rights of the Child</a>, should be universally accepted and supported, but this is often not the case for many children around the globe, even in wealthy nations such as Canada. In fact, Canada continues to fall behind regarding the mental health and well-being of children, ranking 30th out of 38 wealthy nations in <a href="https://www.unicef.ca/en/unicef-report-card-16">UNICEF’s 2020 report card</a> on the state of children and youth worldwide. </p>
<p>The poor standing of mental health and well-being of children and youth in Canada highlights the need to invest and prioritize mental health supports and services for children and their families, a call that <a href="https://doi.org/10.1177/0706743719830033">pre-dates the pandemic</a>. The best time to act was then; the second-best time is now.</p>
<h2>Children’s mental health challenges in Canada</h2>
<p>Children’s mental health challenges have been exacerbated during the COVID-19 pandemic. Evidence shows that <a href="https://doi.org/10.1037/cbs0000305">substance use</a>, <a href="https://doi.org/10.1016/j.jadohealth.2021.09.025">eating disorders</a>, and <a href="https://doi.org/10.1007/s00787-021-01744-3">anxiety and mood difficulties</a> have increased. Pediatric hospitals in Canada saw an increase in the number of cases presenting to <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2793932">emergency departments</a> <a href="https://annals-general-psychiatry.biomedcentral.com/articles/10.1186/s12991-022-00398-y">for mental health concerns</a>.</p>
<p>Canadian studies show that <a href="http://dx.doi.org/10.1136/bmjopen-2020-042871">nearly 25 per cent</a> of parents report that their children’s mental health has decreased during the COVID-19 pandemic. With an increase in mental health needs, it follows that the need for services and supports has also increased.</p>
<h2>A crisis in child mental health care access</h2>
<figure class="align-center ">
<img alt="Two teen boys listening to an adult; all three are sitting in chairs facing each other," src="https://images.theconversation.com/files/495966/original/file-20221117-20809-6elxpb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/495966/original/file-20221117-20809-6elxpb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495966/original/file-20221117-20809-6elxpb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495966/original/file-20221117-20809-6elxpb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495966/original/file-20221117-20809-6elxpb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495966/original/file-20221117-20809-6elxpb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495966/original/file-20221117-20809-6elxpb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Prior to the pandemic, there were more than 28,000 children on waitlists for mental health treatment in Ontario, with wait times exceeding 2.5 years to receive service.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Children’s Mental Health Ontario and the <a href="https://cmho.org/kids-cant-wait/#:%7E:text=Kids%20Can't%20Wait,and%20where%20it%20is%20needed.">#KidsCantWait campaign</a> demonstrated that prior to the pandemic, there were more than 28,000 children on waitlists for mental health services, sometimes waiting up to 2.5 years. Last summer, a survey revealed that <a href="https://www.ctvnews.ca/health/coronavirus/more-than-half-of-canadians-say-the-pandemic-negatively-impacted-their-children-report-1.6030067">more than 50 per cent of parents</a> say their children are still experiencing negative impacts of the pandemic. </p>
<p>In Spring 2022, we found similar results in Québec based on a sample of 2,500 parents surveyed by our research group at Université Laval. Indeed, more than 50 per cent of the parents of children and adolescents between ages six and 17 years perceived that their child had needed help with emotional or behavioural problems in the past six months. These results are striking when compared to a 2014 study in Ontario, when <a href="https://doi.org/10.1177/0706743719830035">18.9 per cent of parents perceived mental health needs for their child</a>. </p>
<p>Not surprisingly, children’s mental health service providers across the country have reported <a href="https://cmho.org/skyrocketing-demands-for-kids-mental-health-services/">extensive increases</a> in mental health service demand, including a doubling of calls for services and wait times. In addition to the consequences for children and adolescents, increases in perceived unmet needs during the pandemic was shown to lead to <a href="https://doi.org/10.3389/fpsyg.2022.884591">increases in parental depression and anxiety</a>. </p>
<p>This pandemic has been described as a <a href="https://www.un.org/sites/un2.un.org/files/sg_policy_brief_covid-19_and_education_august_2020.pdf">generational catastrophe</a>, particularly for children and youth from <a href="https://childrenfirstcanada.org/wp-content/uploads/2022/09/RC2022_CFC_RC-Report_09-02.pdf">equity-deserving groups</a>, including First Nations, Métis, and Inuit children, children from racialized communities, gender and sexually diverse youth, and young people with disabilities. Every child, regardless of background, social status, or location, should have access to high quality mental health assessment and support.</p>
<h2>Call to action</h2>
<p><strong>1. Preventing mental health challenges: Earlier is better</strong></p>
<p>The best way to address increases in mental health needs is to implement services and policies that prevent their development. Targeting the early years of life makes sense because most mental health difficulties in early adulthood have their <a href="https://doi.org/10.1001/archpsyc.62.6.593">origin in childhood</a>. As such, improved access to early childhood services, awareness of early childhood mental health, support and education for caregivers and community providers, as well as community-based early mental health promotion, <a href="https://mentalhealthcommission.ca/wp-content/uploads/2021/06/early_childhood_one_pager_eng.pdf">are critical</a>.</p>
<figure class="align-center ">
<img alt="Closeup faces of happy children embracing each other and smiling, photographed from below" src="https://images.theconversation.com/files/495968/original/file-20221117-22-etb122.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/495968/original/file-20221117-22-etb122.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495968/original/file-20221117-22-etb122.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495968/original/file-20221117-22-etb122.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495968/original/file-20221117-22-etb122.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495968/original/file-20221117-22-etb122.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495968/original/file-20221117-22-etb122.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The most consistent assets of resilient children and adolescents are caring families, healthy schools and good peer relationships.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p><strong>2. Supporting children and adolescents by supporting adults</strong></p>
<p>The most consistent assets of resilient children and adolescents are caring families, healthy schools and good peer relationships. Prevention efforts must therefore not only address children, but also the environments in which they grow. The <a href="https://www.theglobeandmail.com/canada/article-stop-assuming-most-kids-will-be-resilient-in-the-face-of-covid-19-when/?utm_medium=Referrer:+Social+Network+/+Media&utm_campaign=Shared+Web+Article+Links">adults in children’s lives must be healthy</a> and supported for children and adolescents to flourish. Resiliency is not ingrained; it is fostered by strengthening <a href="https://www.camh.ca/en/health-info/guides-and-publications/growing-up-resilient">individuals, families and environments</a>. If it takes a village to raise a child, we need to build and maintain a village that promotes resiliency.</p>
<p><strong>3. Increasing funding for child and family mental health services</strong></p>
<p>The <a href="https://cmha.ca/joint-statement-from-members-of-the-child-and-youth-mental-health-sector-and-its-stakeholders/">Canadian Mental Health Association</a> and other allied organizations have put forward a call for increased funding for child and youth mental health services to address service gaps. In addition to the benefits for individuals, results show that the <a href="http://dx.doi.org/10.1136/bmjgh-2021-007759">return on investment</a> for every dollar spent on preventing and treating mental health difficulties in youth is $23.60. These investments not only lead to increases in well-being but are also good economic policy.</p>
<p><strong>4. Improving service access</strong></p>
<p>Access to mental health services needs to improve across the country. For most children, mental health services are obtained <a href="https://doi.org/10.1177/0706743719830024">through schools</a>. With increased funding and support, mental health promotion and intervention in schools can provide increased access for children and adolescents. Alternatively, <a href="https://rsc-src.ca/sites/default/files/C%26S%20PB_EN_0.pdf">ongoing access to virtual approaches</a> to mental health services can provide accessible and efficient options to mental health supports with a high potential for broadened reach across the country.</p>
<h2>National Child Day in Canada</h2>
<p>In addition to World Children’s Day, in Canada <a href="https://nationalchildday.org/">National Child Day</a> is also celebrated on Nov. 20 to recognize our country’s commitment to uphold children’s rights. This day is also a good opportunity to take a moment to look back on the commitments, initiatives and policies that have actually been implemented, as well as look forward to those that should be put in place. Now is not the time to wait. Our children’s future starts today.</p><img src="https://counter.theconversation.com/content/194496/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>André Plamondon receives funding from the Social Sciences and Humanities Research Council and the Canadian Institutes of Health Research</span></em></p><p class="fine-print"><em><span>Nicole Racine receives funding from the Social Sciences and Humanities Research Council and the Canadian Institutes of Health Research. She sits on the Board of Trustees of Strong Minds, Strong Kids, Psychology Foundation of Canada.</span></em></p><p class="fine-print"><em><span>Tracy Vaillancourt receives funding from the Canadian Institutes of Health Research, the Social Sciences and Humanities Research Council of Canada.</span></em></p>Canada ranks 30th out of 38 wealthy nations in supporting the mental health and well-being of children. The need to invest in and prioritize mental health for children and young people is urgent.André Plamondon, Full Professor, Faculty of Educational Sciences, Université LavalNicole Racine, Assistant professor, School of Psychology, L’Université d’Ottawa/University of OttawaTracy Vaillancourt, Tier 1 Canada Research Chair in School-Based Mental Health and Violence Prevention, L’Université d’Ottawa/University of OttawaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1923802022-10-17T12:30:31Z2022-10-17T12:30:31ZAnxiety detection and treatment in early childhood can lower risk for long-term mental health issues – an expert panel now recommends screening starting at age 8<figure><img src="https://images.theconversation.com/files/489609/original/file-20221013-13-iqoxtv.jpg?ixlib=rb-1.1.0&rect=372%2C40%2C6337%2C4406&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People who experience anxiety in childhood are more likely to deal with it in adulthood too.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/worried-mom-comforting-depressed-teen-daughter-royalty-free-image/1221847312?phrase=anxiety%20kids&adppopup=true">fizkes/iStock via Getty Images Plus</a></span></figcaption></figure><p><em>The U.S. Preventive Services Task Force, an independent panel of experts in primary care and prevention, issued a final recommendation on Oct. 11, 2022, <a href="https://doi.org/10.1001/jama.2022.16936">published in the journal JAMA</a>, stating that all children and adolescents between the ages of 8 and 18 should be screened for anxiety, regardless of whether they have symptoms. The recommendation follows a systematic review that evaluated the potential harms and benefits of screening.</em> </p>
<p><em>The Conversation asked Elana Bernstein, a school psychologist who researches child and adolescent anxiety, to explain the task force’s recommendations and what they might mean for kids, parents and providers.</em></p>
<h2>1. Why is the task force recommending young kids be screened?</h2>
<p>Nearly 80% of chronic mental health conditions <a href="https://doi.org/10.1097/YCO.0b013e32816ebc8c">emerge in childhood</a>, and when help is eventually sought, it is often years after the problem’s onset. In general, recommendations to screen for mental health disorders are based on research demonstrating that youths do not typically seek help independently, and <a href="https://doi.org/10.1097/CHI.0b013e318160e3a0">that parents</a> and <a href="https://doi.org/10.1007/s12310-014-9125-9">teachers</a> are not always skilled at correctly identifying problems or knowing how to respond.</p>
<p>Anxiety is the <a href="https://dx.doi.org/10.1176%2Fappi.focus.20150029">most common</a> mental health problem affecting children and adolescents. Epidemiological studies indicate that <a href="https://doi.org/10.1016/j.jpeds.2018.09.021">7.1% of children are diagnosed with anxiety disorders</a>. However, studies also estimate that upwards of 10% to 21% of children and adolescents struggle with an anxiety disorder and as many as <a href="https://childmind.org/wp-content/uploads/2021/09/CMI_2018CMHR.pdf">30% of children</a> experience moderate anxiety that interferes with their daily functioning at some time in their life.</p>
<p>This tells us that many kids experience anxiety at a level that interferes with their daily functioning, even if they are never formally diagnosed. Additionally, there is a <a href="https://doi.org/10.1080/15374416.2015.1046177">well-established evidence base</a> for treating childhood anxiety. </p>
<p>The task force evaluated the best available research and concluded that, while there are gaps in the evidence base, the benefits of screening are clear. Untreated anxiety disorders in children <a href="https://doi.org/10.1007/s10802-007-9194-4">result in added burdens</a> to the public health system. So from a cost-benefit perspective, the cost-effectiveness of screening for anxiety and providing preventive treatment is favorable, while, as the task force pointed out, the harms are negligible. </p>
<p>The task force recommendation to screen kids as young as age 8 is driven by the research literature. Anxiety disorders are most likely to first show up during the elementary school years. And the typical age of onset for <a href="https://doi.org/10.1016/j.jaac.2010.05.017">anxiety is among the earliest</a> of all childhood mental health diagnoses. The panel also pointed to a lack of accurate screening instruments available to detect anxiety among younger children; as a result, it concluded that there is not sufficient evidence to recommend screening children age 7 or younger. </p>
<p>Anxiety disorders can persist into adulthood, particularly those disorders with early onsets and those that are left untreated. Individuals who experience anxiety in childhood are more likely to deal with it in adulthood, too, along with other mental health disorders <a href="https://doi.org/10.1111/j.1469-7610.2007.01812.x">like depression</a> and an overall diminished quality of life. The task force considered these long-term impacts in making its recommendations, noting that screening in children as young as 8 may alleviate a preventable burden for families.</p>
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<figcaption><span class="caption">The US task force’s recommendations include screening for all children beginning at age 8, regardless of whether they show symptoms of anxiety.</span></figcaption>
</figure>
<h2>2. How can care providers identify anxiety in young kids?</h2>
<p>In general, it is easier to accurately identify anxiety when the child’s symptoms are behavioral in nature, such as refusing to go to school or avoiding social situations. While the task force recommended that screening take place in primary care settings – such as a pediatrician’s office – the research literature also supports <a href="https://doi.org/10.1177/10598405211056647">in-school screening for mental health problems</a>, including anxiety. </p>
<p>Fortunately, in the past three decades, considerable advances have been made in mental health screening tools, including for anxiety. The evidence-based strategies for identifying anxiety in children and adolescents are centered on collecting observations from multiple perspectives, including the child, parent and teacher, to provide a complete picture of the child’s functioning in school, at home and in the community. </p>
<p>Anxiety is what’s called an internalizing trait, meaning that the symptoms may not be observable to those around the person. This makes accurate identification more challenging, though certainly possible. Therefore, psychologists recommend including the child in the screening process to the degree possible based on age and development.</p>
<p>Among the youths who are actually treated for mental health problems, nearly two-thirds <a href="https://www.nasponline.org/resources-and-publications/resources-and-podcasts/mental-health/school-psychology-and-mental-health/comprehensive-school-based-mental-and-behavioral-health-services-and-school-psychologists">receive those services at school</a>, making school-based screening a logical practice. </p>
<h2>3. How would the screening be carried out?</h2>
<p>Universal screening for all children, including those with no symptoms or diagnoses, is a preventive approach to identifying youths who are at risk. This includes those who may need further diagnostic evaluation or those would benefit from early intervention. </p>
<p>In both cases, the aim is to reduce symptoms and to prevent lifelong chronic mental health problems. But it is important to note that a screening does not equate to a diagnosis, something that the task force highlighted in its recommendation statement. </p>
<p>Diagnostic assessment is more in-depth and costs more, while screening is intended to be brief, efficient and cost-effective. Screening for anxiety in a primary-care setting may involve completion of short questionnaires by the child and/or parent, similar to how <a href="https://doi.org/10.1542/peds.2011-2654">pediatricians frequently screen kids</a> for <a href="https://theconversation.com/what-causes-adhd-and-can-it-be-cured-170179">attention-deficit/hyperactivity disorder, or ADHD</a>. </p>
<p>The task force did not recommend a single method or tool, nor a particular time interval, for screening. Instead, care providers were advised to consider the evidence in the task force’s recommendation and apply it to the particular child or situation. The task force did point to multiple available screening tools such as the <a href="https://www.pediatricbipolar.pitt.edu/resources/instruments">Screen for Child Anxiety Related Emotional Disorders</a> and the <a href="https://www.phqscreeners.com/select-screener">Patient Health Questionnaire Screeners</a> for generalized anxiety disorder, which accurately identify anxiety. These assess general emotional and behavioral health, including questions specific to anxiety. Both are available at no cost. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/WAg8keGdbQk?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A discussion of the differences between normal worry and anxiety.</span></figcaption>
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<h2>4. What are care providers looking for when screening for anxiety?</h2>
<p>A child’s symptoms can vary depending on the type of anxiety they have. For instance, social anxiety disorder involves fear and anxiety in social situations, while specific phobias involve fear of a particular stimulus, such as vomiting or thunderstorms. However, many anxiety disorders share symptoms, and children typically do not fit neatly into one category. </p>
<p>But psychologists typically observe some common patterns when it comes to anxiety. These include negative self-talk such as “I’m going to fail my math test” or “Everyone will laugh at me,” and emotion regulation difficulties, like increased tantrums, anger or sensitivity to criticism. Other typical patterns include behavioral avoidance, such as reluctance or refusal to participate in activities or interact with others.</p>
<p>Anxiety can also show up as physical symptoms that lack a root physiological cause. For example, a child may complain of stomachaches or headaches or general malaise. In fact, studies suggest that spotting youths with anxiety in pediatric settings may simply occur through <a href="https://doi.org/10.1016/j.cbpra.2007.08.003">identification of children with medically unexplained physical symptoms</a>.</p>
<p>The distinction we are aiming for in screening is identifying the magnitude of symptoms and their impact. In other words, how much do the symptoms interfere with the child’s daily functioning? Some anxiety is normal and, in fact, necessary and helpful. </p>
<h2>5. What are the recommendations for supporting kids with anxiety?</h2>
<p>The key to an effective screening process is that it be connected to evidence-based care. </p>
<p>The good news is that we now have decades of high-quality research demonstrating how to effectively intervene to reduce symptoms and to help anxious youth cope and function better. These include both medications or therapeutic approaches like cognitive behavioral therapy, which <a href="https://doi.org/10.1016/j.jaac.2020.05.005">studies show to be safe and effective</a>.</p>
<p><em>This is an updated version of an <a href="https://theconversation.com/why-a-us-task-force-is-recommending-anxiety-screening-in-kids-8-and-older-181562">article originally published on May 13, 2022</a>.</em></p><img src="https://counter.theconversation.com/content/192380/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elana Bernstein has received funding from her organization to examine school-based practices for youth with anxiety. She is currently working collaboratively on a federally funded (HRSA) grant aimed at improving behavioral health workforce education and training. Additionally, as part of a national research team focused on improving mental health screening practices, she is collaborating to develop a screening tool for emotional well-being in teens. This project was recently funded through the Institute for Collaboration on Health, Intervention, and Policy at the University of Connecticut via their Mechanisms Underlying Mind-Body Interventions & Measurement of Emotional Well-Being (M3EWB) Network, which is funded through the NIH (Grant #: NIH U24AT011281).</span></em></p>Anxiety is the most common mental health issue facing children and adolescents. But research shows that early screening – including in school settings – can identify children who are at risk.Elana Bernstein, Assistant Professor of School Psychology, University of DaytonLicensed as Creative Commons – attribution, no derivatives.