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57% of teen females are clinically depressed, 30% seriously considered suicide.

Pretty sad! Locking down kids during the pandemic has taken a huge toll on mental health. I also think social media and the college arms race places a ridiculous amount of pressure on kids. Both of these systems are seriously broken and could use an overhaul.


The price kids are paying is going to manifest itself for decades unless we wake up?


Teens’ Mental-Health Distress Could Be Worse Than CDC Data Suggest

Youth Risk Behavior survey takes place in school, potentially skewing the self-reported results


Teenagers are reporting record levels of distress, according to the CDC.


Josh Zumbrun hedcut, WSJ

Feb. 17, 2023 5:30 am ET


America’s teenagers are distressed coming out of the pandemic, reporting record levels of sadness and suicide risk, according to a report released this week by the Centers for Disease Control and Prevention.


A closer look at how these numbers come together suggests that the data might be a little bit off: If anything, teens’ distress levels could be higher than reported.


“The problem is as bad as what is suggested by the survey, if not worse,” said Bonnie Halpern-Felsher, a professor of pediatrics at Stanford University who has authored research on the strengths and weaknesses of the CDC’s youth survey. She thinks the CDC might be underestimating the extent of some of the most alarming numbers in its report, but “the point is it’s high, whatever the numbers are, it’s high,” she said.


Some of the CDC’s latest statistics, which are drawn from its biennial Youth Risk Behavior Survey, are staggering: 57% of high-school females reported experiencing persistent feelings of sadness or hopelessness, up from 36% a decade ago. For males that age, feelings of hopelessness rose to 29% from 21%.


For females, 30% said they had seriously considered suicide, up from 19%. These figures are also high for students who don’t identify as heterosexual, 69% of whom felt hopeless and 45% of whom considered committing suicide.



Part of this is the timing of the survey, fielded in the fall of 2021 as many students were just returning to school after pandemic-driven closures and disruptions.


But Dr. Kathleen Ethier, director of the CDC’s Division of Adolescent and School Health, noted that “while much attention has been given to the youth mental-health crisis during the Covid-19 pandemic,” the CDC’s data “have shown that many measures were moving in the wrong direction before the pandemic.”


The CDC began conducting the Youth Risk Behavior Survey in 1991. A total of 17,508 students completed the 99-question survey for 2021. The data is a go-to source for the prevalence of drug and alcohol use, teen sex behavior, bullying and other things identified over the years as health-risk factors.


The first reason for some caution in interpreting the results is that the survey is administered in school.


I remember taking a survey with a very similar set of questions in high school. The administrators informed us that the answers would be confidential, but as someone who doesn’t automatically trust authority figures, I wasn’t 100% confident of that. I wasn’t about to admit to anything illegal on a survey being distributed in homeroom. (Though, at that point in my life, I had done very little interesting or risky.)


But hesitation to admit behaviors in a classroom survey means those behaviors would be more common than the survey captures.


Surveyors have tried other ways to tell whether students tell the truth. A number of studies over the years have attempted to suss out whether you can poll adolescents about drug use by asking if they had ever taken fictitious drugs—such as zetacyllin (invented by Norwegian researchers only for the purpose of seeing who is bluffing about drug use in surveys). Such studies have typically shown only about 1% or fewer of respondents claiming to have used nonexistent drugs.


Researchers have tested for the presence of cotinine, a compound metabolized from nicotine. One study found 3% of adolescents said they were nonsmokers, but testing showed they smoked. Researchers attributed the finding to “social stigma or fear that their parents would find out about their survey responses.”


Another limitation of the CDC data—highlighted in a 2020 paper on the strengths and weaknesses of the Youth Risk Behavior Survey, of which Dr. Halpern-Felsher was a co-author—is that although the survey is conducted at schools, roughly 5% of those ages 14 to 17 aren’t in school. Reasons for being out of school can vary, but overall, 16-year-olds not in school have an elevated chance of exposure to exactly the sort of risks the CDC is attempting to measure.


“The reasons they are not in school may actually be related to these risk behaviors,” the researchers note. “For example, pregnant or parenting teens are more likely to drop out of school, and substance use or violence in or around school can lead to suspension, expulsion, and/or involvement with the juvenile justice system.”


If they were included, the risk factors would almost certainly be higher.


But even if the true prevalence of some behaviors is slightly lower or slightly higher than the CDC finds, many of the trends are unmistakable. This is especially the case for the mental-health data.


“The actual point estimates are less important than the trends. They’re going up, and they’re going up very high, and young people are very stressed,” Dr. Halpern-Felsher said.


The CDC has acknowledged the limitations of self-reported data, and of missing those students who are out of school. (Another limitation officials have noted is that parental permission procedures aren’t consistent across different locations. The CDC tested, but discarded, the idea of having the questionnaire administered at home instead of the classroom but found that whatever reluctance students have to answer honestly at school is magnified under their parents’ roof.)


Not everything that the CDC tracks as a risk factor has increased. Teenage alcohol use and drug use, for example, have both declined over the past decade. Thinking about suicide is of course a warning sign, but the link between thinking about it and following through isn’t as clear as one might imagine. Despite high rates of young females thinking about suicide, the rates of suicide are significantly higher among young males.


Though the data is alarming, the situation isn’t hopeless, said Scottye Cash, a professor at Ohio State University who studies which methods work for children and adolescents at risk of poor mental-health outcomes, and who has studied the epidemiology of suicide.


Resources are available, she said, including 988, the new national suicide and crisis lifeline, (formerly known as the National Suicide Prevention Lifeline) and the Crisis Text Line, which can be reached by texting HOME to 741741.


It would be nice—but alas wishful thinking—if the numbers were wrong and it meant we didn’t have to worry. The teenage years are never easy, but many of the things that make those years stressful are especially acute right now.


“The more we normalize what adolescents are going through—this is hard and there’s nothing wrong with them—then we can talk about it and we can start getting help for it,” Dr. Cash said.


Write to Josh Zumbrun at josh.zumbrun@wsj.com



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