U.S. Surgeon General Vivek Murthy has issued an advisory calling for swift action to respond to a growing mental health crisis among youth that has worsened due to stressors related to the COVID-19 pandemic.
The advisory notes that national surveys have shown major increases in certain mental health symptoms, including depressive symptoms and suicidal ideation. Early estimates from the National Center for Health Statistics suggest there were tragically more than 6,600 deaths by suicide among the 10-24 age group in 2020.
Since the pandemic began, rates of psychological distress among young people, including symptoms of anxiety, depression, and other mental health disorders, have increased. Recent research covering 80,000 youth globally found that depressive and anxiety symptoms doubled during the pandemic, with 25 percent of youth experiencing depressive symptoms and 20 percent experiencing anxiety symptoms. Negative emotions or behaviors such as impulsivity and irritability—associated with conditions such as ADHD—appear to have moderately increased. Early clinical data are also concerning: In early 2021, emergency department visits in the United States for suspected suicide attempts were 51 percent higher for adolescent girls and 4 percent higher for adolescent boys compared to the same time period in early 2019.
The prevalence of mental health challenges varies across subpopulations. For instance, girls are much more likely to be diagnosed with anxiety, depression, or an eating disorder, while boys are more likely to die by suicide or be diagnosed with a behavior disorder, such as attention deficit hyperactivity disorder (ADHD). In recent years, suicide rates among Black children (below age 13) have been increasing rapidly, with Black children nearly twice as likely to die by suicide than White children. Moreover, socioeconomically disadvantaged children and adolescents—for instance, those growing up in poverty—are two to three times more likely to develop mental health conditions than peers with higher socioeconomic status.
Risk Factors and Groups at Higher Risk Highlighted
The Advisory identifies risk factors contributing to youth mental health symptoms during the pandemic, as well as groups at higher risk of mental challenges during the pandemic.
Youth with intellectual and developmental disabilities (IDDs), who found it especially difficult to manage disruptions to school and services such as special education, counseling, occupational, and speech therapies are at higher risk, as well as youth with multiple risk factors. For example, children with IDDs who lost a parent to COVID-19.
Advisory Recommendations
The Surgeon General’s Advisory suggests supporting the mental health of children and youth will require a whole-of-society effort to address longstanding challenges, strengthen the resilience of young people, support their families and communities, and mitigate the pandemic’s mental health impacts. Among the recommendations:
- Recognize that mental health is an essential part of overall health.
- Empower youth and their families to recognize, manage, and learn from difficult emotions.
- Ensure that every child has access to high-quality, affordable, and culturally competent mental health care.
- Support the mental health of children and youth in educational, community, and childcare settings.
- Address the economic and social barriers that contribute to poor mental health for young people, families, and caregivers.
- Increase timely data collection and research to identify and respond to youth mental health needs more rapidly.
The Advisory suggests ways in which educators, school staff and school districts can help. Among the recommendations are:
- Create positive, safe, and affirming school environments.
- Expand social and emotional learning programs and other evidence-based approaches that promote healthy development.
- Learn how to recognize signs of changes in mental and physical health among students, including trauma and behavior changes. Take appropriate action when needed.
- Provide a continuum of supports to meet student mental health needs, including evidence-based prevention practices and trauma-informed mental health care.
- Expand the school-based mental health workforce.
- Support the mental health of all school personnel.
- Promote enrolling and retaining eligible children in Medicaid, CHIP, or a Marketplace plan, so that children have health coverage that includes behavioral health services.
- Protect and prioritize students with higher needs and those at higher risk of mental health challenges.
The Advisory suggests important steps children and young people themselves can take to protect, improve, and advocate for their mental health and that of their family, friends, and neighbors:
- Remember that mental health challenges are real, common, and treatable.
- Ask for help.
- Invest in healthy relationships.
- Find ways to serve.
- Learn and practice techniques to manage stress and other difficult emotions.
- Take care of your body and mind.
- Be intentional about your use of social media, video games, and other technologies.
- Be a source of support for others.
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