Courtney: Welcome to Health Matters. Your weekly dose of the latest in health and wellness from NewYork-Presbyterian. I’m Courtney Allison.

How can we better understand the range of issues that youth face today and the impact those challenges have on their mental health? 

This week, I’m joined by Dr. Shannon Bennett, a psychologist and the clinical director of the Center for Youth Mental Health at NewYork-Presbyterian.

She helps explain how the global pandemic, social media, and pressing issues such as climate change have contributed to the youth mental health crisis — and what we can all do to support youth today.  

Courtney: Hi Dr. Bennett. Thanks for joining us.

Dr. Bennett: Hi Courtney. Thank you so much for having me today. 

Courtney: So I want to start by getting an understanding of the youth mental health crisis. According to the CDC, in 2021, 42% of high school students reported experiencing persistent feelings of sadness and hopelessness – which feels like a big number.

Recent studies have shown over the last decade, the number of teens and young adults with depression has more than doubled. Can you describe what is happening and what you’re seeing?

Dr. Bennett: We’ve seen a steep increase in youth reporting fear, anxiety, and depression, or some issues with their mood, right? There’s different ways that we understand a clinical major depressive disorder. And certainly the rates of major depressive disorder and clinical anxiety disorders have truly increased in youth, in children, adolescents, and young adults over the last 10 to 15 years.

COVID has accelerated this. The isolation, the loneliness for many youth. The changes in schooling and in parental expectations, the time that families spent all together with not a lot of relief was problematic for many people.

The financial strain that this has caused for many families, healthcare concerns, certainly the grief and the loss and other societal stressors that we’ve all been going through over the last five to 10 years.

Youth are much more aware. Not only are they feeling this emotionally and psychologically, they have much more access to news and what’s going on in the world, and there’s some really scary things that are going on, and so they recognize this. I think many are feeling sort of hopeless or demoralized about what is this gonna mean for me and my future?

Courtney: Could you share some common signs and symptoms of mental health issues in young people? Or just a sign that someone’s struggling?

Dr. Bennett: When we think about anxiety and depression, one hallmark behavior of both is to avoid or withdraw. So when you see a change in what a child, a teen, or a young adult is doing and how they’re spending their time, if they start avoiding things that they used to enjoy doing or they’re withdrawing from peers or withdrawing from the family, that’s something to pay attention to.

We avoid things that we feel anxious about, right? Because we perceive them as threatening. So it feels adaptive to then avoid that thing that could be threatening or we perceive as dangerous, even if it isn’t like school or a party. And when we feel depressed, that often changes our energy levels, our motivation, and we withdraw.

With kids, you can also see irritability. Attempts to control their environment. Sometimes behavioral outbursts, temper tantrums. Lashing out verbally or physically can also be attempts to control one’s environment or to change a situation that is creating some anxiety or mood problems.

Courtney: If you see a child avoiding something, what should you do?

Dr. Bennett: As parents our instinct is to protect our kids from any potential threat, even if it’s something that when we perceive our kids as experiencing fear, we go into protective mode most of the time. 

So I think the first step is to understand if the child can articulate perhaps at a later time when they’re feeling more calm, what it is that drove them to avoid. Was there something that felt threatening about that situation? So to have a conversation about it. And then usually, in most behavioral treatments, like exposure therapy or cognitive behavioral therapy, if we need to, we can break things down into smaller steps, teach kids ways to cope and understand what those feelings are.

Anxiety and depression can be a really physical experience, so that can be another sign or symptom of anxiety is a lot of physical complaints; stomach aches, headaches, difficulty sleeping.

Giving kids strategies to cope and understand what it is that they’re feeling, often breaking it down into manageable steps or just supporting them as they kind of reenter these settings that they want or need to be a part of.

Courtney: Do you think there’s still a stigma around mental health?

Dr. Bennett: I think it is improving and I’m so impressed with young people today, many of whom are very open, and I think COVID also broke this open in a way that was important, right? It was easier for us to talk about how we were struggling because most people were also struggling. But the stigma absolutely remains and it is more powerful or potent in some cultures or some communities than others.

And we need to really continue to push the message, that’s very true, that mental health is public health and it is healthcare and it’s really important and we need to treat it just like we would a strep throat or a broken leg.

The rates of anxiety disorders in youth, in adolescents and in adults are really high. When I’m meeting young people for the first time in my practice, I’ll talk to them about these statistics and just kind of crunch the numbers and think about how many people in your school or in your class, in your community – certainly no one’s experiencing exactly what it is you’re experiencing because we all experience our feelings in different ways – but you’re not alone in this experience. 

Courtney: It does feel like so many adolescents have faced some kind of mental health struggle. And that is often linked to social media, which is such a presence in children’s lives. Can you share a bit about social media’s role and its impact?

Dr. Bennett: There is research support that demonstrates the connection between social media use and anxiety and depression in youth.

There’s no time to disconnect from the things that make us feel anxious. So whether that’s things that are going on in the world, things we see on the news, social pressures, body image and self-esteem.

Feeling left out of social groups, even academic pressures, seeing college acceptances on social media or people signing to sports teams. Like, whatever it is that’s important to you, you’re gonna see other people doing it better or different than you. And so if we never turn that off, we never get a chance to just recalibrate internally, physically, and psychologically to get some separation from those things that make us feel bad or make us feel anxious or down. 

So it’s important that we allow ourselves to have a break, particularly in the evening because we know social media and screens also impact sleep. So young people are staying on their devices, you know, well after the time that they should be sleeping. And when we’re not getting enough sleep, that leaves us more vulnerable to worsening anxiety and depression. 

Some of the research is suggesting that how we use social media may be correlated with how it influences us. If we’re using social media as a tool intermittently to connect with groups that we actually then interact with also in person, that can be really helpful and help us to feel more connected. 

It’s really a lot of that passive scrolling that we can do, which can also be a tool for avoiding other things that we should be doing, whether that’s homework or housework or sleeping, right?

Courtney: Yeah.

Dr. Bennett: That passive scrolling and the social comparison is more indicative of anxiety and depression.

Courtney: Any other positive ways to draw boundaries?

Dr. Bennett: Yeah, I think it’s really important for parents from a really young age with their kids to be talking about digital citizenship, and how we interact online, how we represent ourselves, how we present ourselves, that we shouldn’t say things online that we wouldn’t say to someone’s face.

Cyber bullying is another huge problem that’s really impacting youth. It’s impacting everyone, not just youth, but, there’s a lot of youth victims of cyber bullying. So thinking about the things that we say, the pictures that we post, the information that we share, that these things don’t go away, right?

It isn’t something that kids are often aware of or thinking about the consequences of what they say or do or post online.

It’s important for parents to be monitoring social media use and the sites that your kids are on as much as possible to be talking about what kids are seeing and experiencing online.

If you find out that your child has been a victim of bullying, whether that’s in person or online, to speak to some authority, to address that because as we know, the impacts can be so severe and very serious, particularly for those youth who are more vulnerable and, don’t feel like they have a voice to speak up for themselves.

Courtney: How do you see climate change affecting children’s mental health? Does it come up a lot?

Dr. Bennett: It does. And I think more and more young people, particularly adolescents and young adults, but even really young kids, are understanding that our planet is in peril and that the changes that we all need to make and the legislation that needs to be passed worldwide is not happening, right? So it leaves this feeling of helplessness and hopelessness that are also symptoms of depression and can lead to depression, right?

Particularly for those youth, when we start to see these numbers coming out, from major reports, whether from the UN or climate scientists, it’s our youth who are gonna have to live in this world during this time when we really can’t predict what the earth is gonna be like for them.

For kids who are prone to anxiety or obsessional thinking, right? To worrying. That’s a pretty big, scary thing that can really consume their mind and leave them feeling scared, threatened, and again, helpless and hopeless, which isn’t good for our mental or physical wellbeing.

There’s so much bad news in the world that we can all find ourselves feeling helpless and hopeless. And  an important intervention is to figure out some way that feels meaningful and doable to you to try to be involved.

And we can’t take on every single world issue, all on ourselves, right? That’s not gonna be healthy either. But to pick the causes that are most important to you and when we take action, it actually helps to improve our mood and our feelings of optimism. 

Courtney: So for this next topic, I want to be sensitive about how we talk bout it, but in terms of the youth mental health crisis and kids really struggling – If we’re concerned someone may be involved in self-harm or thinking about suicide – how do we talk about that with kids if we’re worried about it?

Dr. Bennett: As soon as possible we wanna try to address that with our kids to really understand and to bring up, do you ever feel like you just don’t wanna live? Can we talk more about that and come up with a safety plan? 

If your child is endorsing self-harm, if you’re seeing that they may be injuring themselves in some way, cutting or things of that nature, then talking to a mental health professional is extremely important.

If you’re worried about your child’s safety, going to the emergency room or treating this as the emergency that it may be is also very important. So there’s immediate steps that could be taken if you feel like there is an imminent threat. But importantly, if you’re worried about anxiety or depression, changes in behavior, substance use, other impulsive behaviors. Kids may do something that they don’t imagine could actually be lethal if they’re more engaged in risky or impulsive behaviors.

Part of what can be scary about starting these conversations is a fear that we won’t know the right thing to say, or that we might say something that would make someone feel worse. So just being there listening, you can even articulate, you know, “I don’t know the right thing to say here, but I just want you to know that I love you and I’m here for you.” 

Courtney: Switching gears a bit, I’d love to talk a little bit about emerging adulthood, that period in your late teens, early twenties, you know, you’re trying to kinda figure out your life–That also seems to be a time of stress. So, could you talk about why this period might be hard for young people and how can an adult who maybe doesn’t completely understand what they’re going through or why they’re having such a hard time, how can you help them through that time?

Dr. Bennett: Absolutely. The Center for Youth Mental Health was created for this specific purpose of serving those youth in this period of emerging adulthood from around age 16 to around age 28. 

But in adolescence and emerging adulthood, youth are vulnerable biologically, they’re vulnerable because of this push towards independence where they’re still understandably developing the skills that they need to be responsible when they are given independence.

But all of a sudden the expectations become completely unclear. And even the path of what should I do next is suddenly up to you in many cases. Or there’s this pressure to find a job so that you can have some like financial responsibility for yourself, but there’s not necessarily a handbook to show you how to do that.

There’s a lot of national research that’s been done. Young adults reported having an average of seven jobs in their twenties, moving on average once a year in your twenties. Starting romantic relationships, ending romantic relationships, moving in with your family, moving out from your family. Any one of these is tremendously stressful all by itself, and all of this happening all in this time of life when you’re just trying to figure out who you are and who you wanna be and what you wanna do, it’s a really exciting and kids do report high levels of optimism, but a really high levels of stress and fear.

The Center for Youth Mental Health in large part, we have designed our clinical services and our research and our education and outreach to not just teach people about anxiety and depression and related syndromes, but also to understand why adolescents and emerging adulthood are so complicated all on their own. Right? 

And when you’re suffering from anxiety or depression on top of everything else that comes along with being a teenager and a young adult, you need to learn these skills and have the medicine or the the therapy that will help you with anxiety and mood problems, but also learn the life skills that will then help you navigate. Right? 

It’s not just enough to manage your symptoms. We have to help kids get back to their life and, and help them figure out, you know, how they wanna live it.

Courtney: Yeah. What are any other resources or support systems that may be available?

Dr. Bennett: We are always curating and creating a resource library on our website, and many of our clinicians and researchers are giving talks and webinars and podcasts like this. 

This is an opportunity for me to plug the Center for Youth Mental Health and our resource library. It’s a place where you can find connection to other resources that we have vetted, whether these are are national hotlines or national groups that we are a part of, or leaders of. The Association for Behavioral and Cognitive Therapies.

There’s ways that we can help you find access to mental healthcare via in person or telemedicine in a region where you live.

Courtney: Dr. Bennett, thank you so much for your time. This has been so helpful.

Dr. Bennett: It’s such an important topic and it was really nice to be here talking with you today.

Our many thanks to Dr. Shannon Bennett.

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