Gabrielle Carlson was ready to pull the fire alarm. It was October 2021, and Carlson, then president of the American Academy of Child and Adolescent Psychiatry, saw a world of kids in crisis: Soaring rates of depression and anxiety. Families under siege by pandemic-fueled disruptions. Dramatic increases in emergency room visits for childhood psychiatric crises.
And then there were the suicides.
Nearly 1 in 10 high school students admitted they had tried to take their own life in the previous 12 months, according to a survey published by the Centers for Disease Control and Prevention, and 1 in 5 had seriously considered it.
Suicide rates among adolescents had risen nearly 53 percent between 2010 and 2020; it was now the second-leading cause of death for people ages 10 to 18. Then came the pandemic, and the lockdowns, and the isolation, and the increased reliance on virtual schooling and socializing. And everything got worse.
“I said to my executive committee, ‘We need to do something,’ ” recalls Carlson, a professor of psychiatry and pediatrics at Stony Brook University’s Renaissance School of Medicine. “ ‘We need to declare a national emergency.’ ”
Today, organizations from the CDC to the American Academy of Pediatrics and the U.S. Surgeon General’s office agree: We’re in the throes of a mental health crisis for young people ages 10 and up.
More than ever, the nation’s children are at risk.
More than ever, we seem powerless to help.
To really understand the crisis facing today’s teens and tweens, start with this one fact: They have superpowers that most older adults can only begin to understand. Superpowers granted to them by an array of social media apps on their smartphones.
Snapchat gives them the power to see where their friends are, to see who is hanging out with whom, and to know if and when they’ve been excluded. Instagram gives them the power to compare their lives with those of others who post filtered, idealized portraits of themselves. TikTok allows them to scroll endlessly through posts that cater to their current obsessions, no matter how dark or damaging those interests may be. All of these smartphone apps and more give them the power to communicate with others anywhere, at any hour of the day, anonymously if they’d like — and often against the wishes of adults.
But as social media allows kids to reach out, it also allows others to reach them. Bullies, once limited to playgrounds and schoolyards, can now harass vulnerable children anywhere, at any time. Algorithms dictate what kids see on social media, feeding them a daily diet of content about their deepest passions, fears and insecurities. Scammers and sexual predators find it easy to access children: The National Center for Missing & Exploited Children (NCMEC) reported a 97.5 percent increase in “online enticement”— essentially adults trying to lure children into sexual acts from 2019 to 2020.
“A lot of parents still think: Not my kid, not in my house, not in my neighborhood,” says Titania Jordan, chief parenting officer at Bark Technologies, which makes digital monitoring systems for parents to track their kids’ online activities. But Jordan recently demonstrated how, using a widely available photo filter, “I was able, at 41, to make myself look like a fifth grade girl and post images online. Within moments there were predators trying to message me on Instagram,” she says.
As adults, we already know that technology makes this generation of kids uniquely vulnerable, even to their own missteps. “Think about what it was like when we were young,” says Lauren Coffren, executive director of NCMEC’s exploited children division. “There was spin the bottle, there was streaking. Except that we don’t have videos of these acts following us around for the rest of our lives.”
Mental health crisis
Jonathan Haidt is one of several researchers who draw a direct line between social media and the increase in mood disorders in children and teens. “When you compare rates in 2009 — before most teens were daily users of social media — to 2019 — the last full year before COVID-19 made things even worse — the increases are generally between 50 percent and 150 percent,” Haidt wrote in testimony before the Senate Judiciary Committee in May. Self-harm among young teen girls, in particular, is up about 180 percent, says Haidt, a professor of ethical leadership at New York University. Boys and girls both have higher rates of anxiety and depression, but girls have suffered the greater impact.
When kids have access to social media one to two hours per day, there is often no correlated increase in poor mental health, Haidt wrote. But as daily usage increases to three or more hours, increases in mental illness “often become quite sharp.”
“I do not believe that social media is the only cause of the crisis,” he wrote to the committee. “But there is no alternative hypothesis that can explain the suddenness, enormity and international similarity” of the spike in mental health disorders.
Clinicians treating kids on the ground report the same thing: young people exhibiting exploding rates of depression, anxiety and self-harm, right about the time that digital media became a daily part of their lives.
“What I’ve seen clinically matches with what the literature is saying — that somewhere around 2010 is that inflection point, where you really start to see diagnoses going up, you start to see hospitalizations going up,” says Megan Moreno, M.D., professor of pediatrics at the University of Wisconsin–Madison and principal investigator with the university’s social media and adolescent health research team. “The question is, ‘What caused the numbers to go from that to this?’
“And you want me to answer: [smartphones]. That’s the easy answer that people reach for,” Moreno continues. “It’s the question of the day: Have we essentially given every kid a self-destruct-o device?”
The answer is, of course, more complicated.
“Between about 2008 and 2011, there was an incredibly rapid uptake of electronic medical records for huge institutions across the country,” Moreno says. And electronic medical records prompt physicians to screen routinely for mental health issues. “We started asking everybody—not just kids who looked sad or who had purple hair.” As a result, teens who seemed to be functioning quite well started testing positive for anxiety and depression.
But while that might have played a role in the timing of the spike, the reality of the crisis is undeniable.
“There are so many things that are weakening support systems for kids,” says Amanda Lenhart, a researcher at the Data & Society Research Institute in New York City who studies how adolescents and families use technology. “If you just focused on cellphones, you would be missing part of the story.” Teacher burnout and overcrowding in schools mean less support for kids who are vulnerable. Meanwhile, the country feels just a little less safe. Fistfights on airplanes. Political rallies that turn violent. Volatile confrontations over race. America is filled with angry adults. And angry adults lead to skittish children.
Another factor that weighs on children’s minds: mass shootings.
The active-shooter drills that today’s students practice resemble the “duck and cover” procedures of boomer childhoods. But there’s a difference: While prepping for nuclear war was scary, “how many times was the mainland United States attacked by a bomb?” asks Nusheen Ameenuddin, M.D., chair of the American Academy of Pediatrics Council on Communications and Media. “It’s a different story for kids. There are shootings at theaters, shootings at events, shootings at school; there really isn’t a place where they feel safe.”
Social media amplifies all of these anxieties. Moreno, for one, sees a near normalization of suicide on social media that may be playing a role in what’s happening in real life. “There’s a contagion effect. If someone in their very remote social network attempted suicide, that information is going to feed back and show that youth that there’s tons of people out there doing this,” she says. “It presents suicide as an option, and that’s the unique power that social media has that other types of media have not had before.”
Yet, at the same time, social media also offers young people an outlet for their emotional challenges. In a 2020 study, 43 percent of people ages 14 to 22 said that when they felt depressed, stressed or anxious, using social media usually made them feel better, compared with just 17 percent who said it made them feel worse. Young people with moderate to severe depressive symptoms are nearly twice as likely as those without depression to say they use social media “almost constantly.”
“Much to many people’s surprise, social media became a very OK place to talk about mental health,” Moreno says. “I think it’s had a huge impact on stigma. It’s more acceptable. It’s OK to ask for help.”
But asking for help and getting it are two different things.