essay on youth mental health

• Open access
• Published: 14 September 2023

Children and youth’s perceptions of mental health—a scoping review of qualitative studies

• Linda Beckman 1 , 2 ,
• Sven Hassler 1 &
• Lisa Hellström 3  

BMC Psychiatry volume  23 , Article number:  669 ( 2023 ) Cite this article

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Recent research indicates that understanding how children and youth perceive mental health, how it is manifests, and where the line between mental health issues and everyday challenges should be drawn, is complex and varied. Consequently, it is important to investigate how children and youth perceive and communicate about mental health. With this in mind, our goal is to synthesize the literature on how children and youth (ages 10—25) perceive and conceptualize mental health.

We conducted a preliminary search to identify the keywords, employing a search strategy across electronic databases including Medline, Scopus, CINAHL, PsychInfo, Sociological abstracts and Google Scholar. The search encompassed the period from September 20, 2021, to September 30, 2021. This effort yielded 11 eligible studies. Our scoping review was conducted in accordance with the PRISMA-ScR Checklist.

As various aspects of uncertainty in understanding of mental health have emerged, the results indicate the importance of establishing a shared language concerning mental health. This is essential for clarifying the distinctions between everyday challenges and issues that require treatment.

We require a language that can direct children, parents, school personnel and professionals toward appropriate support and aid in formulating health interventions. Additionally, it holds significance to promote an understanding of the positive aspects of mental health. This emphasis should extend to the competence development of school personnel, enabling them to integrate insights about mental well-being into routine interactions with young individuals. This approach could empower children and youth to acquire the understanding that mental health is not a static condition but rather something that can be enhanced or, at the very least, maintained.

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Introduction

In Western society, the prevalence of mental health issues, such as depression and anxiety [ 1 ], as well as recurring psychosomatic health complaints [ 2 ], has increased from the 1980s and 2000s. However, whether these changes in adolescent mental health are actual trends or influenced by alterations in how adolescents perceive, talk about, and report their mental well-being remains ambiguous [ 1 ]. Despite an increase in self-reported mental health problems, levels of mental well-being have remained stable, and severe psychiatric diagnoses have not significantly risen [ 3 , 4 ]. Recent research indicates that understanding how children and youth grasp mental health, its manifestations, and the demarcation between mental health issues and everyday challenges is intricate and diverse. Wickström and Kvist Lindholm [ 5 ] show that problems such as feeling low and nervous are considered deep-seated issues among some adolescents, while others refer to them as everyday challenges. Meanwhile, adolescents in Hellström and Beckman [ 6 ] describe mental health problems as something mainstream, experienced by everyone at some point. Furthermore, Hermann et al. [ 7 ] point out that adolescents can distinguish between positive health and mental health problems. This indicates their understanding of the complexity and holistic nature of mental health and mental health issues. It is plausible that misunderstandings and devaluations of mental health and illness concepts may increase self-reported mental health problems and provide contradictory results when the understanding of mental health is studied. In a previous review on how children and young people perceive the concept of “health,” four major themes have been suggested: health practices, not being sick, feeling good, and being able to do the desired and required activities [ 8 ]. In a study involving 8–11 year olds, children framed both biomedical and holistic perspectives of health [ 9 ]. Regarding the concept of “illness,” themes such as somatic feeling states, functional and affective states [ 10 , 11 ], as well as processes of contagion and contamination, have emerged [ 9 ]. Older age strongly predicts nuances in conceptualizations of health and illness [ 10 , 11 , 12 ].

As the current definitions of mental health and mental illness do not seem to have been successful in guiding how these concepts are perceived, literature has emphasized the importance of understanding individuals’ ideas of health and illness [ 9 , 13 ]. The World Health Organization (WHO) broadly defines mental health as a state of well-being in which the individual realizes his or her abilities, can cope with the normal stresses of life, work productively and fruitfully and make a contribution to his or her community [ 14 ] capturing only positive aspects. According to The American Psychology Association [ 15 ], mental illness includes several conditions with varying severity and duration, from milder and transient disorders to long-term conditions affecting daily function. The term can thus cover everything from mild anxiety or depression to severe psychiatric conditions that should be treated by healthcare professionals. As a guide for individual experience, such a definition becomes insufficient in distinguishing mental illness from ordinary emotional expressions. According to the Swedish National Board of Health and Welfare et al. [ 16 ], mental health works as an umbrella term for both mental well-being and mental illness : Mental well-being is about being able to handle life's difficulties, feeling satisfied with life, having good social relationships, as well as being able to feel pleasure, desire, and happiness. Mental illness includes both mild to moderate mental health problems and psychiatric conditions . Mild to moderate mental health problems are common and are often reactions to events or situations in life, e.g., worry, feeling low, and sleep difficulties.

It has been argued that increased knowledge of the nature of mental illness can help individuals to cope with the situation and improve their well-being. Increased knowledge about mental illness, how to prevent mental illness and help-seeking behavior has been conceptualized as “mental health literacy” (MHL) [ 17 ], a construct that has emerged from “health literacy” [ 18 ]. Previous literature supports the idea that positive MHL is associated with mental well-being among adolescents [ 19 ]. Conversely, studies point out that low levels of MHL are associated with depression [ 20 ]. Some gender differences have been acknowledged in adolescents, with boys scoring lower than girls on MHL measures [ 20 ] and a social gradient including a positive relationship between MHL and perceived good financial position [ 19 ] or a higher socio-economic status [ 21 ].

While MHL stresses knowledge about signs and treatment of mental illness [ 22 ], the concern from a social constructivist approach would be the conceptualization of mental illness and how it is shaped by society and the thoughts, feelings, and actions of its members [ 23 ]. Studies on the social construction of anxiety and depression through media discourses have shown that language is at the heart of these processes, and that language both constructs the world as people perceive it but also forms the conditions under which an experience is likely to be construed [ 24 , 25 ]. Considering experience as linguistically inflected, the constructionist approach offers an analytical tool to understand the conceptualization of mental illness and to distinguish mental illness from everyday challenges. The essence of mental health is therefore suggested to be psychological constructions identified through how adolescents and society at large perceive, talk about, and report mental health and how that, in turn, feeds a continuous process of conceptual re-construction or adaptation [ 26 ]. Considering experience as linguistically inflected, the constructionist approach could then offer an analytical tool to understand the potential influence of everyday challenges in the conceptualization of mental health.

Research investigating how children and youth perceive and communicate mental health is essential to understand the current rise of reported mental health problems [ 5 ]. Health promotion initiatives are more likely to be successful if they take people’s understanding, beliefs, and concerns into account [ 27 , 28 ]. As far as we know, no review has mapped the literature to explore children’s and youths’ perceptions of mental health and mental illness. Based on previous literature, age, gender, and socioeconomic status seem to influence children's and youths’ knowledge and experiences of mental health [ 10 , 11 , 12 ]; therefore, we aim to analyze these perspectives too. From a social constructivist perspective, experience is linguistically inflected [ 26 ]; hence illuminating the conditions under which a perception of health is formed is of interest.

Therefore, we aim to study the literature on how children and youth (ages 10—25) perceive and conceptualize mental health, and the specific research questions are:

What aspects are most salient in children’s and youths’ perceptions of mental health?

What concepts do children and youth associate with mental health?

In what way are children's and youth’s perceptions of mental health dependent on gender, age, and socioeconomic factors?

Literature search

A scoping review is a review that aims to provide a snapshot of the research that is published within a specific subject area. The purpose is to offer an overview and, on a more comprehensive level, to distinguish central themes compared to a systematic review. We chose to conduct a scoping review since our aim was to clarify the key concepts of mental health in the literature and to identify specific characteristics and concepts surrounding mental health [ 29 , 30 ]. Our scoping review was conducted following the PRISMA-ScR Checklist [ 31 ]. Two authors (L.B and L.H) searched and screened the eligible articles. In the first step, titles and abstracts were screened. If the study included relevant data, the full article was read to determine if it met the eligibility criteria. Articles were excluded if they did not fulfill all the eligibility criteria. Any uncertainties were discussed among L.B. and L.H., and the third author, S.H., and were carefully assessed before making an inclusion or exclusion decision. The software Picoportal was employed for data management. Figure  1 illustrates a flowchart of data inclusion.

PRISMA flow diagram outlining the search process

Eligibility criteria

We incorporated studies involving children and youth aged 10 to 25 years. This age range was chosen to encompass early puberty through young adulthood, a significant developmental period for young individuals in terms of comprehending mental health. Participants were required not to have undergone interviews due to chronic illness, learning disabilities (e.g., mental health linked to a cancer diagnosis), or immigrant status.

Studies conducted in clinical settings were excluded. For the purpose of comparing results under similar conditions, we specifically opted for studies carried out in Western countries .

Given that this review adopts a moderately constructionist approach, intentionally allowing for the exploration of how both young participants and society in general perceive and discuss mental health and how this process contributes to ongoing conceptual re-construction, the emphasis was placed on identifying articles in which participants themselves defined or attributed meaning to mental health and related concepts like mental illness. The criterion of selecting studies adopting an inductive approach to capture the perspectives of the young participants resulted in the exclusion of numerous studies that more overtly applied established concepts to young respondents [ 32 ].

Information sources

We utilized electronic databases and reached out to study authors if the article was not accessible online. Peer-reviewed articles were exclusively included, thereby excluding conference abstracts due to their perceived lack of relevance in addressing the review questions. Only research in English was taken into account. Publication years across all periods were encompassed in the search.

Search strategy

Studies concerning children’s and youths’ perceptions of mental health were published across a range of scientific journals, such as those within psychiatry, psychology, social work, education, and mental health. Therefore, several databases were taken into account, including Medline, Scopus, CINAHL, PsychInfo, Sociological abstracts, and Google Scholar, spanning from inception on September 20, 2021 to September 30, 2021. We involved a university librarian from the start in the search process. The combinations of search terms are displayed in Table 1 .

Quality assessment

We employed the Quality methods for the development of National Institute for Health Care Excellence (NICE) public health guidance [ 33 ] to evaluate the quality of the studies included. The checklist is based on checklists from Spencer et al. [ 34 ], Public Health Resource Unit (PHRU) [ 26 , 35 ], and the North Thames Research Appraisal Group (NTRAG) [ 36 ] (Refer to S2 for checklist). Eight studies were assigned two plusses, and three studies received one plus. The studies with lower grades generally lacked sufficient descriptions of the researcher’s role, context reporting, and ethical reporting. No study was excluded in this stage.

Data extraction and analysis

We employed a data extraction form that encompassed several key characteristics, including author(s), year, journal, country, details about method/design, participants and socioeconomics, aim, and main results (Table 2 ). The collected data were analyzed and synthesized using the thematic synthesis approach of Thomas and Harden [ 37 ]. This approach encompassed all text categorized as 'results' or 'findings' in study reports – which sometimes included abstracts, although the presentation wasn’t always consistent throughout the text. The size of the study reports ranged from a few sentences to a single page. The synthesis occurred through three interrelated stages that partially overlapped: coding of the findings from primary studies on a line-by-line basis, organization of these 'free codes' into interconnected areas to construct 'descriptive' themes, and the formation of 'analytical' themes.

The objective of this scoping review has been to investigate the literature concerning how children and youth (ages 10—25) conceptualize and perceive mental health. Based on the established inclusion- and exclusion criteria, a total of 11 articles were included representing the United Kingdom ( n  = 6), Australia ( n  = 3), and Sweden ( n  = 2) and were published between 2002 and 2020. Among these, two studies involved university students, while nine incorporated students from compulsory schools.

Salient aspects of children and youth’ perceptions of mental health

Based on the results of the included articles, salient aspects of children’s and youths’ understandings revealed uncertainties about mental health in various ways. This uncertainty emerged as conflicting perceptions, uncertainty about the concept of mental health, and uncertainty regarding where to distinguish between mild to moderate mental health problems and everyday stressors or challenges.

One uncertainty was associated with conflicting perceptions that mental health might be interpreted differently among children and youths, depending on whether it relates to their own mental health or someone else's mental health status. Chisholm et al. [ 42 ] presented this as distinctions being made between ‘them and us’ and between ‘being born with it’. Mental health and mental illness were perceived as a continuum that rather developed’, and distinctions were drawn between ‘crazy’ and ‘diagnosed.’ Participants established strong associations between the term mental illness and derogatory terms like ‘crazy,’ linking extreme symptoms of mental illness with others. However, their attitude was less stigmatizing when it came to individual diagnoses, reflecting a more insightful and empathetic understanding of the adverse impacts of stress based on their personal realities and experiences. Despite the initial reactions reflecting negative stereotypes, further discussion revealed that this did not accurately represent a deeper comprehension of mental health and mental illness.

There was also uncertainty about the concept of mental health , as it was not always clearly understood among the participating youth. Some participants were unable to define mental health, often confusing it with mental illness [ 28 ]. Others simply stated that they did not understand the term, as in O’Reilly [ 44 ]. Additionally, uncertainty was expressed regarding whether mental health was a positive or negative concept [ 27 , 28 , 40 , 44 ], and participants associated mental health with mental illness despite being asked about mental health [ 28 ]. One quote from a grade 9 student illustrates this: “ Interviewer: Can mental health be positive as well? Informant: No, it’s mental” [ 44 ]. In Laidlaw et al. [ 46 ], with participants ranging from 18—22 years of age, most considered mental health distinctly different from and more clinical than mental well-being. However, Roose et al. [ 38 ], for example, the authors discovered a more multifaceted understanding of mental health, encompassing emotions, thoughts, and behavior. In Molenaar et al.[ 45 ], mental health was highlighted as a crucial aspect of health overall. In Chisholm et al. [ 42 ], the older age groups discussed mental health in a more positive sense when they considered themselves or people they knew, relating mental health to emotional well-being. Connected to the uncertainty in defining the concept of mental health was the uncertainty in identifying those with good or poor mental health. Due to the lack of visible proof, children and youths might doubt their peers’ reports of mental illness, wondering if they were pretending or exaggerating their symptoms [ 27 ].

A final uncertainty that emerged was difficulties in drawing the line between psychiatric conditions and mild to moderate mental health problems and everyday stressors or challenges . Perre et al. [ 43 ] described how the participants in their study were uncertain about the meaning of mental illness and mental health issues. While some linked depression to psychosis, others related it to simply ‘feeling down.’ However, most participants indicated that, in contrast to transient feelings of sadness, depression is a recurring concern. Furthermore, the duration of feeling depressed and particularly a loss of interest in socializing was seen as appropriate criteria for distinguishing between ‘feeling down’ and ‘clinical depression.’ Since feelings of anxiety, nervousness, and apprehension are common experiences among children and youth, defining anxiety as an illness as opposed to an everyday stressor was more challenging [ 43 ].

Terms used to conceptualize mental health

When children and youth were asked about mental health, they sometimes used neutral terms such as thoughts and emotions or a general ‘vibe’ [ 27 ], and some described it as ‘peace of mind’ and being able to balance your emotions [ 38 ]. The notion of mental health was also found to be closely linked with rationality and the idea of normality, although, according to the young people, Armstrong et al. [ 28 ], there was no consensus about what ‘normal’ meant. Positive aspects of mental health were described by the participants as good self-esteem, confidence [ 40 ], happiness [ 39 , 43 ], optimism, resilience, extraversion and intelligence [ 27 ], energy [ 43 ], balance, harmony [ 39 , 43 ], good brain, emotional and physical functioning and development, and a clear idea of who they are [ 27 , 41 ]. It also included a feeling of being a good person, feeling liked and loved by your parents, social support, and having people to talk with [ 27 , 39 ], as well as being able to fit in with the world socially and positive peer relationships [ 41 ], according to the children and youths, mental health includes aspects related to individuals (individual factors) as well as to people in their surroundings (relationships). Regarding mental illness, participants defined it as stress and humiliation [ 40 ], psychological distress, traumatic experiences, mental disorders, pessimism, and learning disabilities [ 27 ]. Also, in contrast to the normality concept describing mental health, mental illness was described as somehow ‘not normal’ or ‘different’ in Chisholm et al. [ 42 ].

Depression and bipolar disorder were the most often mentioned mental illnesses [ 27 ]. The inability to balance emotions was seen as negative for mental health, for example, not being able to set aside unhappiness, lying to cover up sadness, and being unable to concentrate on schoolwork [ 38 ]. The understanding of mental illness also included feelings of fear and anxiety [ 42 ]. Other participants [ 46 ] indicated that mental health is distinctly different from, and more clinical than, mental well-being. In that sense, mental health was described using reinforcing terms such as ‘serious’ and ‘clinical,’ being more closely connected to mental illness, whereas mental well-being was described as the absence of illness, feeling happy, confident, being able to function and cope with life’s demands and feeling secure. Among younger participants, a more varied and vague understanding of mental health was shown, framing it as things happening in the brain or in terms of specific conditions like schizophrenia [ 44 ].

Gender, age, socioeconomic status

Only one study had a gender theoretical perspective [ 40 ], but the focus of this perspective concerned gender differences in what influences mental health more than the conceptualization of mental health. According to Johansson et al.[ 39 ], older girls expressed deeper negative emotions (e.g., described feelings of lack of meaning and hope in various ways) than older boys and younger children.

Several of the included studies noticed differences in age, where younger participants had difficulty understanding the concept of mental health [ 39 , 44 ], while older participants used more words to explain it [ 39 ]. Furthermore, older participants seemed to view mental health and mental illness as a continuum, with mental illness at one end of the continuum and mental well-being at the other end [ 42 , 46 ].

Socioeconomic status

The role of socioeconomic status was only discussed by Armstrong et al. [ 28 ], finding that young people from schools in the most deprived and rural areas experienced more difficulties defining the term mental health compared to those from a less deprived area.

This scoping review aimed to map children's and youth’s perceptions and conceptualizations of mental health. Our main findings indicate that the concept of mental health is surrounded by uncertainty. This raises the question of where this uncertainty stems from and what it symbolizes. From our perspective, this uncertainty can be understood from two angles. Firstly, the young participants in the different studies show no clear and common understanding of mental health; they express uncertainty about the meaning of the concept and where to draw the line between life experiences and psychiatric conditions. Secondly, uncertainty exists regarding how to apply these concepts in research, making it challenging to interpret and compare research results. The shift from a positivistic understanding of mental health as an objective condition to a more subjective inner experience has left the conceptualization open ranging from a pathological phenomenon to a normal and common human experience [ 47 ]. A dilemma that results in a lack of reliability that mirrors the elusive nature of the concept of mental health from both a respondent and a scientific perspective.

“Happy” was commonly used to describe mental health, whereas "unhappy" was used to describe mental illness. The meaning of happiness for mental health has been acknowledged in the literature, and according to Layard et al. [ 48 ], mental illness is one of the main causes of unhappiness, and happiness is the ultimate goal in human life. Layard et al. [ 48 ] suggest that schools and workplaces need to raise more awareness of mental health and strive to improve happiness to promote mental health and prevent mental illness. On the other hand, being able to experience and express different emotions could also be considered a part of mental health. The notion of normality also surfaced in some studies [ 38 ], understanding mental health as being emotionally balanced or normal or that mental illness was not normal [ 42 ]. To consider mental illness in terms of social norms and behavior followed with the sociological alternative to the medical model that was introduced in the sixties portraying mental illness more as socially unacceptable behavior that is successfully labeled by others as being deviant. Although our results did not indicate any perceptions of what ‘normal’ meant [ 28 ], one crucial starting point to the understanding of mental health among adolescents should be to delineate what constitutes normal functioning [ 23 ]. Children and youths’ understanding of mental illness seems to a large extent, to be on the same continuum as a normality rather than representing a medicalization of deviant behavior and a disjuncture with normality [ 49 ].

Concerning gender, it seemed that girls had an easier time conceptualizing mental health than boys. This could be due to the fact that girls mature verbally faster than boys [ 50 ], but also that girls, to a larger extent, share feelings and problems together compared to boys [ 51 ]. However, according to Johansson et al. [ 39 ], the differences in conceptualizations of mental health seem to be more age-related than gender-related. This could be due to the fact that older children have a more complex view of mental health compared to younger children.. Not surprisingly, the older the children and youth were, the more complex the ability to conceptualize mental health becomes. Only one study reported socioeconomic differences in conceptualizations of mental health [ 28 ]. This could be linked to mental health literacy (MHL) [ 18 ], i.e., knowledge about mental illness, how to prevent mental illness, and help-seeking behavior. Research has shown that disadvantaged social and socioeconomic conditions are associated with low MHL, that is, people with low SES tends to know less about symptoms and prevalence of different mental health problems [ 19 , 21 ]. The perception and conceptualizations of mental health are, as we consider, strongly related to knowledge and beliefs about mental health, and according to von dem Knesebeck et al. [ 52 ] linked primarily to SES through level of education.

Chisholm et al. [ 42 ] found that the initial reactions from participants related to negative stereotypes, but further discussion revealed that the participants had more refined knowledge than at first glance. This illuminates the importance of talking to children and helping them verbalize their feelings, in many respects complex and diversified understanding of mental health. It is plausible that misunderstandings and devaluations of mental health and mental illness may increase self-reported mental health problems [ 5 ], as well as decrease them, preventing children and youth from seeking help. Therefore, increased knowledge of the nature of mental health can help individual cope with the situations and improve their mental well-being. Finding ways to incorporate discussions about mental well-being, mental health, and mental illness in schools could be the first step to decreasing the existing uncertainties about mental health. Experiencing feelings of sadness, anger, or upset from time to time is a natural part of life, and these emotions are not harmful and do not necessarily indicate mental illness [ 5 , 6 ]. Adolescents may have an understanding of the complexity of mental health despite using simplified language but may need guidance on how to communicate their feelings and how to manage everyday challenges and normal strains in life [ 7 ].

With the aim of gaining a better understanding of how mental health is perceived among children and youth, this study has highlighted the concept’s uncertainty. Children and youth reveal a variety of understandings, from diagnoses of serious mental illnesses such as schizophrenia to moods and different types of behaviors. Is there only one way of understanding mental health, and is it reasonable to believe that we can reach a consensus? Judging by the questions asked, researchers also seem to have different ideas on what to incorporate into the concept of mental health — the researchers behind the present study included. The difficulties in differentiating challenges being part of everyday life with mental health issues need to be paid closer attention to and seems to be symptomatic with the lack of clarity of the concepts.

A constructivist approach would argue that the language of mental health has changed over time and thus influence how adolescents, as well as society at large, perceive, talk about, and report their mental health [ 26 ]. The re-construction or adaptation of concepts could explain why children and youth re struggling with the meaning of mental health and that mental health often is used interchangeably with mental illness. Mental health, rather than being an umbrella term, then represents a continuum with a positive and a negative end, at least among older adolescents. But as mental health according to this review also incorporates subjective expressions of moods and feelings, the reconstruction seems to have shaped it into a multidimensional concept, representing a horizontal continuum of positive and negative mental health and a vertical continuum of positive and negative well-being, similar to the health cross by Tudor [ 53 ] referred to in Laidlaw et al. [ 46 ] A multidimensional understanding of mental health constructs also incorporates evidence from interventions aimed at reducing mental health stigma among adolescents, where attitudes and beliefs as well as emotional responses towards mental health are targeted [ 54 ].

The contextual understanding of mental health, whether it is perceived in positive terms or negative, started with doctors and psychiatrists viewing it as representing a deviation from the normal. A perspective that has long been challenged by health workers, academics and professionals wanting to communicate mental health as a positive concept, as a resource to be promoted and supported. In order to find a common ground for communicating all aspects and dimensions of mental health and its conceptual constituents, it is suggested that we first must understand the subjective meaning ascribed to the use of the term [ 26 ]. This line of thought follows a social-constructionist approach viewing mental health as a concept that has transitioned from representing objective mental descriptions of conditions to personal subjective experiences. Shifting from being conceptualized as a pathological phenomenon to a normal and common human experience [ 47 ]. That a common understanding of mental health can be challenged by the healthcare services tradition and regulation for using diagnosis has been shown in a study of adolescents’ perspectives on shared decision-making in mental healthcare [ 55 ]. A practice perceived as labeling by the adolescents, indicating that steps towards a common understanding of mental health needs to be taken from several directions [ 55 ]. In a constructionist investigation to distinguish everyday challenges from mental health problems, instead of asking the question, “What is mental health?” we should perhaps ask, “How is the word ‘mental health’ used, and in what context and type of mental health episode?” [ 26 ]. This is an area for future studies to explore.

Methodological considerations

The first limitation we want to acknowledge, as for any scoping review, is that the results are limited by the search terms included in the database searches. However, by conducting the searches with the help of an experienced librarian we have taken precautions to make the searches as inclusive as possible. The second limitation concerns the lack of homogeneous, or any results at all, according to different age groups, gender, socioeconomic status, and year when the study was conducted. It is well understood that age is a significant determinant in an individual’s conceptualization of more abstract phenomena such as mental health. Some of the studies approached only one age group but most included a wide age range, making it difficult to say anything specific about a particular age. Similar concerns are valid for gender. Regarding socioeconomic status, only one study reported this as a finding. However, this could be an outcome of the choice of methods we had — i.e., qualitative methods, where the aim seldom is to investigate differences between groups and the sample is often supposed to be a variety. It could also depend on the relatively small number of participants that are often used in focus groups of individual interviews- there are not enough participants to compare groups based on gender or socioeconomic status. Finally, we chose studies from countries that could be viewed as having similar development and perspective on mental health among adolescents. Despite this, cultural differences likely account for many youths’ conceptualizations of mental health. According to Meldahl et al. [ 56 ], adolescents’ perspectives on mental health are affected by a range of factors related to cultural identity, such as ethnicity, race, peer and family influence, religious and political views, for example. We would also like to add organizational cultures, such as the culture of the school and how schools work with mental health and related concepts [ 56 ].

Conclusions and implications

Based on our results, we argue that there is a need to establish a common language for discussing mental health. This common language would enable better communication between adults and children and youth, ensuring that the content of the words used to describe mental health is unambiguous and clear. In this endeavor, it is essential to actively listen to the voices of children and youth, as their perspectives will provide us with clearer understanding of the experiences of being young in today’s world. Another way to develop a common language around mental health is through mental health education. A common language based on children’s and youth’s perspectives can guide school personnel, professionals, and parents when discussing and planning health interventions and mental health education. Achieving a common understanding through mental health education of adults and youth could also help clarify the boundaries between everyday challenges and problems needing treatment. It is further important to raise awareness of the positive aspect of mental health—that is, knowledge of what makes us flourish mentally should be more clearly emphasized in teaching our children and youth about life. It should also be emphasized in competence development for school personnel so that we can incorporate knowledge about mental well-being in everyday meetings with children and youth. In that way, we could help children and youth develop knowledge that mental health could be improved or at least maintained and not a static condition.

Availability of data and materials

All data generated or analyzed during this study are included in this published article [and its supplementary information files].

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Beckman, L., Hassler, S. & Hellström, L. Children and youth’s perceptions of mental health—a scoping review of qualitative studies. BMC Psychiatry 23 , 669 (2023). https://doi.org/10.1186/s12888-023-05169-x

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Speaking Up About Mental Health

National essay contest.

SUBMIT YOUR ESSAY The contest is open to high school students ages 16-18

PROMOTION TOOLKIT Help spread the word with social media and email tools

December 1, 2023

Dec. 1, 2023

January 16, 2024

Jan. 16, 2024

May 31, 2024

Mental health is an important part of overall health across all life stages. However, far too often, symptoms are not addressed or recognized among teens.

Speaking Up About Mental Health is an essay contest that challenges high school students ages 16-18 to raise awareness of mental health. The contest gives students a platform to share ways to eliminate and/or reduce mental health stigma faced by young people, especially in diverse communities.

This contest is soliciting essays that:

• Discuss ways to eliminate and/or reduce mental health stigma faced by young people, especially in diverse communities
• Share resilience and coping strategies to overcome mental health issues such as social isolation and loneliness, depression, and anxiety
• Address mental health stigma
• Encourage conversations about mental health, social media, and/or technology
• Suggest school policies or practices that could help reduce stigma
• Describe barriers to mental health treatment
• Cover other areas of concern to individuals and their communities with respect to mental health

Get details on contest rules and submit your entry on Challenge.gov

Promotion toolkit : Help promote the Speaking Up About Mental Health essay contest

The contest is led by:

National Institute of Mental Health

National Institute on Minority Health and Health Disparities

Eunice Kennedy Shriver National Institute of Child Health and Human Development

Page updated Jan. 23, 2024

September 2022: NIH Announces Winners of High School Mental Health Essay Contest

2022 Essay Awardees

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Teens are talking about mental health

High schoolers' stories give a glimpse into the national crisis.

Adolescence can be a complicated time, especially for mental health, and some teens want their communities to do more in response.

The prevalence of mental health issues is hard to measure, but federal data show how widespread the challenges are. The Centers for Disease Control and Prevention (CDC) said we need to address threats to mental health in young people—especially adolescents.

More than one third (37%) of high schoolers in the United States reported experiencing poor mental health during the COVID-19 pandemic, according to a 2021 CDC study . Almost half (44%) of high schoolers reported feeling persistently sad or hopeless in the last year. Some of these feelings were also linked to experiences of racism, social stigma around gender and sexual identity, and sexual violence.

"I was also having issues with my friendships at school and an increased level of stress when it came time for tests, projects, and other assessments…the feeling of isolation, lack of appetite, and absolute hatred of school were not normal." –Morgan, New Jersey

Studies like these can help shed light on issues that teens may be hesitant or unable to discuss with parents, doctors , and school staff.

Stigma and a lack of information or access to care also keep many teens from getting help. But sharing personal stories about mental health can offer encouragement and connection. This can help teens feel like they are not alone. That’s why NIH asked high schoolers to describe these challenges in their own words for the 2022 Speaking Up About Mental Health! essay contest.

The contest was sponsored by the National Institute of Mental Health (NIMH), the National Institute on Minority Health and Health Disparities (NIMHD), and the Eunice Kennedy Shriver  National Institute of Child Health and Human Development (NICHD). They wanted to start conversations around youth mental health and highlight different aspects of this national health crisis.

In their essays, many students talked about feeling lost, embarrassed, or frustrated by their mental health struggles. Others wrote about going from being confident in early childhood to feeling alone or unseen in adolescence.

NIH-funded researcher Tamar Mendelson, M.A., Ph.D., Bloomberg Professor of American Health and Director for the Center for Adolescent Health at the Johns Hopkins Bloomberg School of Public Health, says that’s not surprising. Depression rates tend to increase around puberty, especially among girls but also in boys. Dr. Mendelson said this can be caused by a combination of hormonal changes, new social relationships, and new pressures from academic, athletic, and other activities.

"For many Asian American youths, getting help for mental health can be hindered by stereotypes.  Asian American boys, in particular, may not seek therapy since their cultures expect them to be more resilient than girls. After all, as the older brother, how can I let my little sister know when I am not feeling well emotionally?" –Evan, Texas

“Young people who are feeling overwhelmed or are not sure how to cope with emotions may be more likely to use substances to kind of help with that,” Dr. Mendelson said. Such substances could include alcohol, tobacco, or prescription or illicit drugs, for example.

Puberty is also when many young people become more aware of their sexual orientations and gender identities. For some, this can lead to being unaccepted or bullied. Rates of substance use and misuse also tend to increase during puberty.

In addition to navigating the typical stressors that teens face, more recently they also had to cope with the COVID-19 pandemic and related family losses or financial struggles. They’ve experienced or witnessed racial- and identity-based discrimination, gun violence, political unrest, natural disasters, and climate change. These challenges coupled with other risk factors, including some parenting styles, can lead to mental health issues such as anxiety and depression.

Even though environmental triggers have changed over time, adolescent anxiety was rising even before the pandemic.

Michele Ybarra, Ph.D., an adjunct professor of mental health at the Johns Hopkins Bloomberg School of Public Health and also an NIH-supported researcher, said that not long ago, it was widely believed that youth could not have depression because people thought, “What do [they] have to be depressed about?”

"Schools are places where students should feel safe and comfortable enough to ask for help. By using simple technology and dedicating time toward impactful mental health screening, schools can truly serve students and assist them in living happier, healthier lives." –Huda, North Carolina

But in the last several decades, Dr. Ybarra said, mental health professionals have realized that depression can happen to anyone at any age.

Several students wrote about schools with limited, outdated, or no education on the topic. Some said they could not speak to a therapist or school counselor when they needed to.

The issue is worse for students in rural areas , in schools with limited financial resources, or who need culturally appropriate care such as bilingual mental health information.

But digital tools can connect youth to information about their mental health. For example, Dr. Ybarra said, the rise of telehealth and teletherapy since the pandemic has helped increase access for some.

Dr. Ybarra said that while technology (including social media) can have both positive and negative effects on mental health, it can also be a force for good. The nature of relationships has changed in the internet age, and connecting online is natural for adolescents . Options like crisis lines or online therapy can get help to teens quickly.

Multiple students said when they could not find resources from their schools or communities, they started their own. Some also said their experiences have inspired them to study mental health and treatments after high school.

One student said they began volunteering for a teen crisis hotline after their cousin used the same service for help. The student also joined a youth advisory group for their state governor’s office and offered help as a peer-to-peer counselor at their school.

“My passion towards becoming a researcher on psychiatric disorders is stronger than ever,” they wrote.

The way people talk about mental illness could also be better, one student wrote . They preferred the phrase “living” with a mental illness rather than “suffering” from one. This small change in language signals it’s possible for people with such conditions to live happy and fulfilling lives. This student also said their own school began marking mental health-related absences as excused and holding an annual mental health week to encourage open conversation.

It’s too early to tell what the long-term effects of the past few years will have on youth mental health. But Dr. Ybarra said some teens have become more resilient since the pandemic began.

“I don’t think this generation is doomed in any way,” she said. “Several kids have said [the pandemic] really gave them the time to better understand themselves, they better understand their sexuality … Other kids took on new hobbies, and they learned how to do new things. Maybe they gave themselves permission to not talk to that toxic person in their lives.” While there’s no denying the pandemic has been a stressful experience, Dr. Ybarra’s impression is that most teens have come out the other side with perspective and an ability to thrive.

“This is good news. It also means that we need to be diligent about identifying teens who continue to struggle and connect them to services,” she said.

If you think a teen is experiencing a mental health crisis, the 988 Suicide and Crisis Lifeline is a national, 24/7 hotline  that can connect you with a trained crisis counselor by phone or online chat. Call or text 988 to connect to a trained crisis counselor 24/7 or use the live online chat option. TTY users can contact the Lifeline via their preferred relay service or by dialing 711, then 988.   

By the numbers

According to the centers for disease control and prevention, in 2021:.

• Asian (non-Hispanic): 64%
• Black (non-Hispanic): 55%
• Multiracial (non-Hispanic): 55%
• Hispanic or Latino: 42%
• American Indian/Alaska Native (non-Hispanic): 27%
• Native Hawaiian/Pacific Islander (non-Hispanic): 55%
• White (non-Hispanic): 23%
• 18% of female high schoolers and 5% of male high schoolers experienced sexual violence, up from 15% and 4%, respectively, in 2017
• Up from 41% and 21%, respectively, in 2017
• 14% of LGBQ+ high schoolers and 7% of heterosexual students did not go to school because of safety concerns

*Data set did not account for gender identity, although previous research has shown that transgender youth experience more stigma and are more likely to have more suicidal thoughts or behaviors compared to their peers.

NIH-supported research on adolescent mental health

Greater engagement in gender-sexuality alliances (gsas) and gsa characteristics predict youth empowerment and reduced mental health concerns.

This study, supported by NIMHD, focused on the connections between sexual and gender minority youth’s involvement in extracurricular activities and their mental health. Researchers focused on gender-sexuality alliances (also sometimes called gay-straight alliances), which are school-based clubs to bring young people together to discuss shared issues or interests. Learn more about this study .

Understanding Bystanders for Self-Directed Violence Prevention: A Prospective National Study Highlighting Marginalized Youth and Young Adults

Self-directed violence refers to anything a person does intentionally that can cause injury or death to themselves. This study will examine the effectiveness of programs that train youth to be “active bystanders” and help those in danger of self-directed violence. Researchers will survey approximately 5,000 participants ages 13 to 22, recruited via social media, about the impacts of these bystander training programs in real-world situations. Read more about this study .

Strategic Framework for Addressing Youth Mental Health Disparities

This plan outlines research studies and other activities by NIMH, NICHD, and NIMHD to reduce mental health disparities among underserved and underrepresented youth by 2031. Some of the plan’s goals are to develop culturally appropriate mental health interventions for youth and parents and to research co-occurring mental illness among young people in groups that have been marginalized. Read more about the framework .

Alternative accessible version (pdf)

Centers for Disease Control and Prevention ; Morbidity and Mortality Weekly Report Supplement, Vol. 71, No. 3 ; CDC report shows concerning increases in sadness and exposure to violence among teen girls and LGBQ+ youth ; LGBQ+ Teens

May 16, 2023

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A Mental Health Crisis Among the Young

More from our inbox:, ‘i have an emergency alert for democrats’, ‘an endlessly increasing pentagon budget’, move away from coal.

To the Editor:

Re “ Alarm Sounded on Youth Mental Health ” (news article, Dec. 8):

There is a serious mental health crisis for the youth of America, according to Dr. Vivek Murthy, surgeon general of the United States. There is a mountain of evidence supporting this.

Pediatric hospitals are overrun with mental health cases. There is a lot of hand-wringing but little more. A thorough analysis of our cultural flaws is seriously lacking.

These children and adolescents are bombarded with a toxic mix of vicious social media and harmful violent video games, television shows and films. In addition, this is the only advanced nation in the world where going to school has turned into a form of Russian roulette.

The discordant state of politics guarantees that nothing will change for these unfortunate youth. Our culture, which emphasizes winning at sports, egotism and accumulation of wealth, creates a weakened society unable to comprehend and deal with its most serious problems. The Covid pandemic is exhibit A.

The mental health crisis of American youth is a function of a culture that promotes ignorance, self-indulgence and self-aggrandizement with little sense of decency, mutual respect or self-reflection. How do you repair a defective culture? I am not sure, but it needs to start with a serious examination of its substantial flaws.

Arnold R. Eiser Philadelphia The writer, a doctor, is a senior adjunct fellow at the Leonard Davis Institute of Health Economics and an adjunct fellow at the Center for Public Health Initiatives at the University of Pennsylvania.

Re “ Schools in Bind as Bitter Feuds Cripple Board ” (front page, Dec. 2):

As schools across the country confront “an array of urgent challenges,” we’re failing to address the most systemic, the most alarming and the most dangerous crisis of all: a youth mental health emergency. The lack of a significant national response is stunning.

Not only do we need to shift our collective focus, but we also need to shift the culture of our schools if we are to meaningfully address this mental health crisis that is exhausting and overstretching entire school communities.

That means putting an end to toxic school stressors that have long caused anxiety and depression in young people, and starting to create environments that are humane for students, teachers and families. Instead of being driven by a narrow vision of achievement and success, our schools must prioritize the experiences that support health — like connection, agency and meaningful learning.

If we finally bring humanity to our schools, maybe then not only will our kids be healthier, but also we as a society can start to heal together.

Vicki Abeles Lafayette, Calif. The writer is the author of “Beyond Measure: Rescuing an Overscheduled, Overtested, Underestimated Generation,” and director of the documentaries “Race to Nowhere” and “Beyond Measure.”

Re “ Democrats’ Dangerous Appetite for Eating Their Own ,” by Frank Bruni (newsletter, nytimes.com, Dec. 9):

I have an Emergency Alert for Democrats. Our nation’s democratic form of government is in the cross hairs. The political moment is grave. It is not clear if our remarkable democracy will survive the vicious and organized assault from the right, nor is it clear if the Dems have the clarity and stamina to save it.

Remember that you are politicians, elected to meet the political moment, equipped and focused on what is now the greatest threat to our country since the Civil War. Critical issues of climate change, equality and health care must be addressed.

But if we lose the country as we have known it, how will it be possible to fight for those things? It is a terrifying prospect.

Susan Teicher Urbana, Ill.

“ Houses Passes Defense Bill in Rare Display of Unity to Salvage Shared Priority ” (news article, Dec. 8) didn’t do justice to the sheer size of the Pentagon budget. After months of intense debate over the president’s Build Back Better, at $1.8 trillion over 10 years, a Pentagon budget with annual spending ($768 billion) four times as much as those domestic investments is astounding.

The U.S. military budget is larger than that of the next 11 countries combined, and more than twice that of China, a constantly cited justification for more spending. After 20 years, the end of the war in Afghanistan resulted not in a budget decrease, but more increases. And Congress cut Build Back Better in half, but added to the president’s defense budget request.

The majority of Americans don’t support an endlessly increasing Pentagon budget. But double standards in Congress combined with low media coverage tip the scales toward that outcome, time and again.

Lindsay Koshgarian Northampton, Mass. The writer is program director for the National Priorities Project at the Institute for Policy Studies.

Re “ A Sticking Point in Climate Plan ” (Business, Dec. 13):

The proper function of Republicans (and of Senator Joe Manchin, a Democrat) is to jump right in on clean energy plans from the get-go, ensuring not just benefits and transition pay, but also a robust retraining program for displaced workers — a program conceived and monitored in cooperation with those workers and their advocates.

In the current polarized era of dysfunction, coal miners’ political advocates have abdicated this vital responsibility. By denying, obfuscating, obstructing and slow-walking the necessary decarbonization of the economy, they have fostered a double disaster.

Coal miners will be shortchanged by poorly thought out Democratic policies, while climate catastrophe will proceed apace.

Jeff Freeman Rahway, N.J.

Being a teen comes with exciting milestones that double as challenges – like becoming independent, navigating high school and forming new relationships. For all the highs that come with getting a driver’s license or acing that difficult test, there are lows that come with growing up in a rapidly changing world being shaped by the COVID-19 pandemic, social media and distance learning.

Teens’ brains are growing and developing, and the ways they process their experiences and spend their time are crucial to their development. Each great experience and every embarrassing moment can impact their mental health.

Sometimes a mood is about more than just being lonely or angry or frustrated.

Mental health challenges are different than situational sadness or fatigue. They’re more severe and longer-lasting, and they can have a large impact on daily life. Some common mental health challenges are anxiety, depression, eating disorders, substance use, and experiencing trauma. They can affect a teen’s usual way of thinking, feeling or acting, and interfere with daily life.

Adding to the urgency: Mental health challenges among teens are not uncommon. Up to 75% of mental health challenges emerge during adolescence, and according to the Mental Health First Aid (MHFA) curriculum, one in five teens has had a serious mental health disorder at some point in their life.

Not every mental health challenge will be diagnosed as a mental disorder, but every challenge should be taken seriously.

A mental health challenge left unchecked can become a more serious problem that also impacts physical health — think of how substance use, and changes in sleep patterns and eating habits affect the body as well as the mind. Signs of fatigue, withdrawing socially or changes in mood may point to an emerging mental health challenge like a depressive or substance use disorder.

As teens mature, they begin spending more time with their friends, gain a sense of identity and purpose, and become more independent. All of these experiences are crucial for their development, and a mental health challenge can disrupt or complicate that development. Depending on the severity of the mental health challenge, the effects can last long into adulthood if left unaddressed.

How do we address teens’ mental health?

Teens need tools to talk about what’s going on with them, and they need tools for when their friends reach out to them. Research shows that teens are more likely to talk to their friends than an adult about troubles they’re facing.

That’s why it’s important to talk to teens about the challenges they may deal with as they grow up and navigate young adulthood. They need to know it’s OK to sometimes feel sad, angry, alone, and frustrated. But persistent problems may be pointing to something else, and it is crucial to be able to recognize early warning signs so teens can get appropriate help in a timely manner. teen Mental Health First Aid teaches high school students in grades 10-12 how to identify, understand and respond to signs of a mental health problem or crisis among their friends — and how to bring in a trusted adult when it’s appropriate and necessary. With proper care and treatment, many teens with mental health or substance use challenges can recover. The first step is getting help.

Learn more about teen Mental Health First Aid by watching this video and checking out our blog . Your school or youth-serving organization can also apply to bring this training to your community.

teen Mental Health First Aid is run by the National Council for Mental Wellbeing and supported by Lady Gaga’s Born This Way Foundation.

Resource Guide:

• Mental Health First Aid USA. (2020). teen Mental Health First Aid USA: A manual for young people in 10 th -12 th grade helping their friends. Washington, DC: National Council for Mental Wellbeing.

National Institute of Mental Health. (2020). The Teen Brain: 7 Things to Know. U.S. Department of Health and Human Services, https://www.nimh.nih.gov/health/publications/the-teen-brain-7-things-to-know/index.shtml.

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• BOOK REVIEW
• 29 March 2024

The great rewiring: is social media really behind an epidemic of teenage mental illness?

• Candice L. Odgers 0

Candice L. Odgers is the associate dean for research and a professor of psychological science and informatics at the University of California, Irvine. She also co-leads international networks on child development for both the Canadian Institute for Advanced Research in Toronto and the Jacobs Foundation based in Zurich, Switzerland.

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Social-media platforms aren’t always social. Credit: Getty

The Anxious Generation: How the Great Rewiring of Childhood is Causing an Epidemic of Mental Illness Jonathan Haidt Allen Lane (2024)

Two things need to be said after reading The Anxious Generation . First, this book is going to sell a lot of copies, because Jonathan Haidt is telling a scary story about children’s development that many parents are primed to believe. Second, the book’s repeated suggestion that digital technologies are rewiring our children’s brains and causing an epidemic of mental illness is not supported by science. Worse, the bold proposal that social media is to blame might distract us from effectively responding to the real causes of the current mental-health crisis in young people.

Haidt asserts that the great rewiring of children’s brains has taken place by “designing a firehose of addictive content that entered through kids’ eyes and ears”. And that “by displacing physical play and in-person socializing, these companies have rewired childhood and changed human development on an almost unimaginable scale”. Such serious claims require serious evidence.

Collection: Promoting youth mental health

Haidt supplies graphs throughout the book showing that digital-technology use and adolescent mental-health problems are rising together. On the first day of the graduate statistics class I teach, I draw similar lines on a board that seem to connect two disparate phenomena, and ask the students what they think is happening. Within minutes, the students usually begin telling elaborate stories about how the two phenomena are related, even describing how one could cause the other. The plots presented throughout this book will be useful in teaching my students the fundamentals of causal inference, and how to avoid making up stories by simply looking at trend lines.

Hundreds of researchers, myself included, have searched for the kind of large effects suggested by Haidt. Our efforts have produced a mix of no, small and mixed associations. Most data are correlative. When associations over time are found, they suggest not that social-media use predicts or causes depression, but that young people who already have mental-health problems use such platforms more often or in different ways from their healthy peers 1 .

These are not just our data or my opinion. Several meta-analyses and systematic reviews converge on the same message 2 – 5 . An analysis done in 72 countries shows no consistent or measurable associations between well-being and the roll-out of social media globally 6 . Moreover, findings from the Adolescent Brain Cognitive Development study, the largest long-term study of adolescent brain development in the United States, has found no evidence of drastic changes associated with digital-technology use 7 . Haidt, a social psychologist at New York University, is a gifted storyteller, but his tale is currently one searching for evidence.

Of course, our current understanding is incomplete, and more research is always needed. As a psychologist who has studied children’s and adolescents’ mental health for the past 20 years and tracked their well-being and digital-technology use, I appreciate the frustration and desire for simple answers. As a parent of adolescents, I would also like to identify a simple source for the sadness and pain that this generation is reporting.

A complex problem

There are, unfortunately, no simple answers. The onset and development of mental disorders, such as anxiety and depression, are driven by a complex set of genetic and environmental factors. Suicide rates among people in most age groups have been increasing steadily for the past 20 years in the United States. Researchers cite access to guns, exposure to violence, structural discrimination and racism, sexism and sexual abuse, the opioid epidemic, economic hardship and social isolation as leading contributors 8 .

How social media affects teen mental health: a missing link

The current generation of adolescents was raised in the aftermath of the great recession of 2008. Haidt suggests that the resulting deprivation cannot be a factor, because unemployment has gone down. But analyses of the differential impacts of economic shocks have shown that families in the bottom 20% of the income distribution continue to experience harm 9 . In the United States, close to one in six children live below the poverty line while also growing up at the time of an opioid crisis, school shootings and increasing unrest because of racial and sexual discrimination and violence.

The good news is that more young people are talking openly about their symptoms and mental-health struggles than ever before. The bad news is that insufficient services are available to address their needs. In the United States, there is, on average, one school psychologist for every 1,119 students 10 .

Haidt’s work on emotion, culture and morality has been influential; and, in fairness, he admits that he is no specialist in clinical psychology, child development or media studies. In previous books, he has used the analogy of an elephant and its rider to argue how our gut reactions (the elephant) can drag along our rational minds (the rider). Subsequent research has shown how easy it is to pick out evidence to support our initial gut reactions to an issue. That we should question assumptions that we think are true carefully is a lesson from Haidt’s own work. Everyone used to ‘know’ that the world was flat. The falsification of previous assumptions by testing them against data can prevent us from being the rider dragged along by the elephant.

A generation in crisis

Two things can be independently true about social media. First, that there is no evidence that using these platforms is rewiring children’s brains or driving an epidemic of mental illness. Second, that considerable reforms to these platforms are required, given how much time young people spend on them. Many of Haidt’s solutions for parents, adolescents, educators and big technology firms are reasonable, including stricter content-moderation policies and requiring companies to take user age into account when designing platforms and algorithms. Others, such as age-based restrictions and bans on mobile devices, are unlikely to be effective in practice — or worse, could backfire given what we know about adolescent behaviour.

A third truth is that we have a generation in crisis and in desperate need of the best of what science and evidence-based solutions can offer. Unfortunately, our time is being spent telling stories that are unsupported by research and that do little to support young people who need, and deserve, more.

Nature 628 , 29-30 (2024)

doi: https://doi.org/10.1038/d41586-024-00902-2

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Vuorre, M. & Przybylski, A. K. R. Sci. Open Sci. 10 , 221451 (2023).

Miller, J., Mills, K. L., Vuorre, M., Orben, A. & Przybylski, A. K. Cortex 169 , 290–308 (2023).

Martínez-Alés, G., Jiang, T., Keyes, K. M. & Gradus, J. L. Annu. Rev. Publ. Health 43 , 99–116 (2022).

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Social media harms teens’ mental health, mounting evidence shows. what now.

Understanding what is going on in teens’ minds is necessary for targeted policy suggestions

Most teens use social media, often for hours on end. Some social scientists are confident that such use is harming their mental health. Now they want to pinpoint what explains the link.

Carol Yepes/Getty Images

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By Sujata Gupta

February 20, 2024 at 7:30 am

In January, Mark Zuckerberg, CEO of Facebook’s parent company Meta, appeared at a congressional hearing to answer questions about how social media potentially harms children. Zuckerberg opened by saying: “The existing body of scientific work has not shown a causal link between using social media and young people having worse mental health.”

But many social scientists would disagree with that statement. In recent years, studies have started to show a causal link between teen social media use and reduced well-being or mood disorders, chiefly depression and anxiety.

Ironically, one of the most cited studies into this link focused on Facebook.

Researchers delved into whether the platform’s introduction across college campuses in the mid 2000s increased symptoms associated with depression and anxiety. The answer was a clear yes , says MIT economist Alexey Makarin, a coauthor of the study, which appeared in the November 2022 American Economic Review . “There is still a lot to be explored,” Makarin says, but “[to say] there is no causal evidence that social media causes mental health issues, to that I definitely object.”

The concern, and the studies, come from statistics showing that social media use in teens ages 13 to 17 is now almost ubiquitous. Two-thirds of teens report using TikTok, and some 60 percent of teens report using Instagram or Snapchat, a 2022 survey found. (Only 30 percent said they used Facebook.) Another survey showed that girls, on average, allot roughly 3.4 hours per day to TikTok, Instagram and Facebook, compared with roughly 2.1 hours among boys. At the same time, more teens are showing signs of depression than ever, especially girls ( SN: 6/30/23 ).

As more studies show a strong link between these phenomena, some researchers are starting to shift their attention to possible mechanisms. Why does social media use seem to trigger mental health problems? Why are those effects unevenly distributed among different groups, such as girls or young adults? And can the positives of social media be teased out from the negatives to provide more targeted guidance to teens, their caregivers and policymakers?

“You can’t design good public policy if you don’t know why things are happening,” says Scott Cunningham, an economist at Baylor University in Waco, Texas.

Increasing rigor

Concerns over the effects of social media use in children have been circulating for years, resulting in a massive body of scientific literature. But those mostly correlational studies could not show if teen social media use was harming mental health or if teens with mental health problems were using more social media.

Moreover, the findings from such studies were often inconclusive, or the effects on mental health so small as to be inconsequential. In one study that received considerable media attention, psychologists Amy Orben and Andrew Przybylski combined data from three surveys to see if they could find a link between technology use, including social media, and reduced well-being. The duo gauged the well-being of over 355,000 teenagers by focusing on questions around depression, suicidal thinking and self-esteem.

Digital technology use was associated with a slight decrease in adolescent well-being , Orben, now of the University of Cambridge, and Przybylski, of the University of Oxford, reported in 2019 in Nature Human Behaviour . But the duo downplayed that finding, noting that researchers have observed similar drops in adolescent well-being associated with drinking milk, going to the movies or eating potatoes.

Holes have begun to appear in that narrative thanks to newer, more rigorous studies.

In one longitudinal study, researchers — including Orben and Przybylski — used survey data on social media use and well-being from over 17,400 teens and young adults to look at how individuals’ responses to a question gauging life satisfaction changed between 2011 and 2018. And they dug into how the responses varied by gender, age and time spent on social media.

Social media use was associated with a drop in well-being among teens during certain developmental periods, chiefly puberty and young adulthood, the team reported in 2022 in Nature Communications . That translated to lower well-being scores around ages 11 to 13 for girls and ages 14 to 15 for boys. Both groups also reported a drop in well-being around age 19. Moreover, among the older teens, the team found evidence for the Goldilocks Hypothesis: the idea that both too much and too little time spent on social media can harm mental health.

“There’s hardly any effect if you look over everybody. But if you look at specific age groups, at particularly what [Orben] calls ‘windows of sensitivity’ … you see these clear effects,” says L.J. Shrum, a consumer psychologist at HEC Paris who was not involved with this research. His review of studies related to teen social media use and mental health is forthcoming in the Journal of the Association for Consumer Research.

Cause and effect

That longitudinal study hints at causation, researchers say. But one of the clearest ways to pin down cause and effect is through natural or quasi-experiments. For these in-the-wild experiments, researchers must identify situations where the rollout of a societal “treatment” is staggered across space and time. They can then compare outcomes among members of the group who received the treatment to those still in the queue — the control group.

That was the approach Makarin and his team used in their study of Facebook. The researchers homed in on the staggered rollout of Facebook across 775 college campuses from 2004 to 2006. They combined that rollout data with student responses to the National College Health Assessment, a widely used survey of college students’ mental and physical health.

The team then sought to understand if those survey questions captured diagnosable mental health problems. Specifically, they had roughly 500 undergraduate students respond to questions both in the National College Health Assessment and in validated screening tools for depression and anxiety. They found that mental health scores on the assessment predicted scores on the screenings. That suggested that a drop in well-being on the college survey was a good proxy for a corresponding increase in diagnosable mental health disorders. 

Compared with campuses that had not yet gained access to Facebook, college campuses with Facebook experienced a 2 percentage point increase in the number of students who met the diagnostic criteria for anxiety or depression, the team found.

When it comes to showing a causal link between social media use in teens and worse mental health, “that study really is the crown jewel right now,” says Cunningham, who was not involved in that research.

A need for nuance

The social media landscape today is vastly different than the landscape of 20 years ago. Facebook is now optimized for maximum addiction, Shrum says, and other newer platforms, such as Snapchat, Instagram and TikTok, have since copied and built on those features. Paired with the ubiquity of social media in general, the negative effects on mental health may well be larger now.

Moreover, social media research tends to focus on young adults — an easier cohort to study than minors. That needs to change, Cunningham says. “Most of us are worried about our high school kids and younger.” 

And so, researchers must pivot accordingly. Crucially, simple comparisons of social media users and nonusers no longer make sense. As Orben and Przybylski’s 2022 work suggested, a teen not on social media might well feel worse than one who briefly logs on. 

Researchers must also dig into why, and under what circumstances, social media use can harm mental health, Cunningham says. Explanations for this link abound. For instance, social media is thought to crowd out other activities or increase people’s likelihood of comparing themselves unfavorably with others. But big data studies, with their reliance on existing surveys and statistical analyses, cannot address those deeper questions. “These kinds of papers, there’s nothing you can really ask … to find these plausible mechanisms,” Cunningham says.

One ongoing effort to understand social media use from this more nuanced vantage point is the SMART Schools project out of the University of Birmingham in England. Pedagogical expert Victoria Goodyear and her team are comparing mental and physical health outcomes among children who attend schools that have restricted cell phone use to those attending schools without such a policy. The researchers described the protocol of that study of 30 schools and over 1,000 students in the July BMJ Open.

Goodyear and colleagues are also combining that natural experiment with qualitative research. They met with 36 five-person focus groups each consisting of all students, all parents or all educators at six of those schools. The team hopes to learn how students use their phones during the day, how usage practices make students feel, and what the various parties think of restrictions on cell phone use during the school day.

Talking to teens and those in their orbit is the best way to get at the mechanisms by which social media influences well-being — for better or worse, Goodyear says. Moving beyond big data to this more personal approach, however, takes considerable time and effort. “Social media has increased in pace and momentum very, very quickly,” she says. “And research takes a long time to catch up with that process.”

Until that catch-up occurs, though, researchers cannot dole out much advice. “What guidance could we provide to young people, parents and schools to help maintain the positives of social media use?” Goodyear asks. “There’s not concrete evidence yet.”

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• Health Care

How Racism Affects the Mental Health of Black Youth

O n Sept. 25, 2023, the Biden-Harris administration announced that it will be investing some  $200 million  in the youth mental health crisis. Since youth mental health was declared a national  emergency  in 2021, multiple experts, including the U.S.  Surgeon General , have cited social media and the COVID-19 pandemic, among other things, as major contributing factors. 

But what has not been talked about to the same extent, is how anti-Black racism is fueling the youth mental health crisis. Racism has a crucial impact on the mental health of Black youth, and the current mental health system is not equipped to address it. 

As a child and adolescent psychiatrist, I’ve witnessed the depressive, even suicidal effects of racism on Black youth. The kindergartener who was sad and withdrawn for weeks after her white classmates said her skin was too dark to play with them. The fourth grader who said she wanted to die because her white neighbors told her that her black skin was ugly. The affluent high schooler who was hospitalized after a suicide attempt because she was ostracized by her peers and excessively punished by teachers at her predominantly white prep school. Each time, I was the only mental health clinician involved who cited the crucial contribution of anti-Black racism in their mental health assessment. Interpersonal experiences of anti-Black racism play a large role in the mental health of Black youth, and the current youth mental health crisis, but they are largely left out of the conversation in the mental health field.  

The truth is that the effects of racism on the mental health of Black Americans start even before birth. The stress of racism experienced by Black mothers has been linked to  low birthweight  babies, which puts those children at  greater risk  for developing depression and other child mental health issues. Prenatal anti-Black racism can also have other persistent effects. Maternal reports of racism affect the socio-emotional development of Black children in their first year of life, with links to  negative emotionality . 

Yet another indication that the distinct experiences of racism in America affect Black birth outcomes in ways that do not apply to other racially minoritized groups: Foreign-born Black mothers who experience better birthweight outcomes lose the “healthy immigrant effect” after only  one generation , according to a 2020 study published by Princeton University, while foreign-born Hispanic mothers retain it for generations. 

More From TIME

Indeed, Black children and adolescents are suffering at unprecedented rates, and have been for over 20 years . Black youth are dying by suicide at rates increasing faster than any other racial or ethnic group: Black children as young as five years old are 1.8 times as likely to commit suicide compared to their white peers. The suicide rates of other ethnic groups, except for Latinx and American Indian/Alaskan Native youth, have remained virtually the same or declined , even from 2019 to 2020 in the height of the pandemic.

Read More: The Physical Toll Systemic Injustice Takes On the Body

By preschool age , Black children have their own experiences of anti-Black racism, in addition to those of their mothers and families. One study showed that anti-Black racist beliefs emerge as early as age four. In particular, white children have been found to have more negative attitudes towards Black peers and prefer white over Black children as playmates. Black children experience racism from adults, as well, and are disciplined more harshly in schools from an early age. Black preschoolers, especially Black boys, are significantly more likely to be expelled than white peers. This is not surprising given that teachers complain more about the behaviors of Black boys and white adults view them as more dangerous than their white peers.

Although sometimes overlooked, Black girls are not spared, receiving  harsher school  discipline compared to white girls. This criminalization of Black students leads to  poor grades  and overall school performance, which have been associated with low self-esteem, depressive symptoms, and even  suicidality .  

These “zero tolerance policies” in schools lead to children, especially Black children, being expelled, suspended, or even arrested by cops in schools. It also puts them at greater risk of being funneled into juvenile detention system, a racist phenomenon known as the school-to-prison pipeline , and is linked to  higher rates  of depression in Black males. Many of these children have learning problems and are struggling from abuse and neglect.  In other words, they need psychiatric, not punitive, measures.

The harsh punishment of Black children is  intertwined  with the phenomenon of “adultification,” the perception of Black kids as being older and more mature than they are.  Adultification  has anti-Black racist origins dating back to enslavement , and is a major contributor to Black children being not only criminalized, but also hypersexualized at an earlier age than their white peers. A 2020 Georgetown study found that Black girls as young as five and as old as 19, were viewed to be more knowledgeable about sex and less in need of nurturing and protection than their white female peers. This can lead to Black children receiving less emotional support than white children, which can in turn increase the risk of depression, stress, and suicidality.   

As Black children age into adolescence, like all children, their social and cognitive abilities increase, including  abstract reasoning .  This development enables them to be increasingly  attuned  to experiences of anti-Black racism—which, on average, they report experiencing five times a day . But, even children in the preadolescent age range, from ages nine to 12, report  increased suicidality  with experiences of anti-Black racism and more experiences of racism overall compared to non-Black youth. In young adulthood, around ages 18 of 25, experiences of anti-Black racism continues to be predictive for  depressive symptoms  and  suicidal ideations .

 The racist mutigenerational wealth gap also continues to harm Black youth and families, playing an undeniable role in the declining mental health of Black youth. (It is tied to suicidality , as well.) But poverty is not the whole story. Higher socioeconomic status was associated with  greater depressive  symptoms in Black children living in predominantly white neighborhoods compared to those living in predominantly Black areas. For white youth, greater parental education was associated with fewer depressive symptoms. In Black youth, however, the opposite was true; one 2015 study found that Black youth with highly educated parents had higher depression and higher perceived lifetime discrimination scale ratings. These findings suggest that experiences of racism outweigh the protective effects of parental education. 

Anti-Black racism is a driver of the Black youth mental health crisis, separate from socio-economic status, and solutions are urgently needed to tailor the mental health treatment of Black youth. Research funding is necessary for further studies examining the impact of anti-Black racism on child mental health throughout development. The topic remains understudied and underfunded, especially for very young children. We also need more funding for anti-Black racism-conscious mental health treatment tailored to Black youth—staffed by mental health clinicians who have expertise in providing anti-Black racism targeted care. Some organizations already exist, such as the AAKOMA Project , Therapy for Black Girls, and the National Black Child Development Institute, but there are not enough.

Standardized medical education does not teach the mental health effects of anti-Black racism, so traditionally trained psychiatrists are ill-prepared to help Black children navigate these harmful complexities. Curricula for psychiatrists that specifically deal with anti-Black racism are very limited, with only a  few published  in the literature. I was fortunate to study under one of these, the  Social Justice  Health Equity Curriculum at Yale Department of Psychiatry. The landscape is gradually changing, with an  increasing number  of medical schools working to educate students and residents about the impacts of racism.  For example, an anti-racism curriculum tailored to child psychiatry, the  first known  of its kind, was piloted at UCLA in 2021. 

But education is just the start; accountability is also necessary. Mental health clinicians cannot provide anti-Black-racism-informed care for children if they are engaging in racist behaviors themselves. Leaders of mental health institutions, like hospitals and clinics, must take an active role in ensuring that, when Black children do seek help, that their mental health is not further harmed by racism in medical care. Black children are more likely than white children to be diagnosed with  stigma-laden  disruptive mood disorders and  physically restrained  in emergency departments, so it is crucial that leaders ensure anti-racist hiring practices and reporting systems are in place to recruit and retain staff. When racist behaviors do occur, leaders need to hold mental health staff accountable, even if it means penalizing highly prized colleagues or close friends. 

The youth mental health crisis will not end until the mental health of all children stabilizes. I refuse to let Black children be left behind—and that means facing anti-Black racism head on. 

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Winning Essay: Youth & Mental Health – Raymond Magomu

Transforming Education: Prioritizing Mental Health Support in Ugandan Schools

Raymond magomu | 20 | kiira college butiki.

In the bustling halls of Uganda’s educational institutions, a hidden struggle silently unfolds—the mental health challenges faced by countless students. Anxiety, depression, and other unseen burdens plague young minds, often unnoticed and unaddressed. Yet, these struggles not only hinder academic success but also threaten the overall well-being and future prospects of Uganda’s youth. It’s time to shine a light on these invisible battles and make mental health support a cornerstone of Ugandan school systems.

The impact of mental health on academic performance cannot be overstated. Students grappling with anxiety, depression, or stress find themselves battling against more than just textbooks. Their ability to concentrate, comprehend, and actively engage in class diminishes, leading to a decline in grades and a shrinking sense of potential. By cultivating a mentally healthy environment within schools, we can liberate these young minds from the grips of mental distress, nurturing holistic growth and unlocking boundless opportunities.

Yet, the significance of mental health extends far beyond report cards and exam scores. Students trapped in the throes of untreated mental health issues often endure a myriad of emotional struggles—low self-esteem, isolation, and the lure of negative coping mechanisms. This perilous cycle can spiral into substance abuse, self-harm, and tragically, even suicide. By courageously confronting mental health concerns head-on, we empower resilient individuals who are poised to make positive contributions to society.

Central to this transformation is the need to dismantle the culture of silence that surrounds mental health in Ugandan society. Seeking help is too often stigmatized, regarded as a sign of weakness or spiritual deficiency. Consequently, many suffer in silence, deprived of the support they desperately need. It’s imperative that comprehensive mental health education programs are woven into school curriculums, creating a safe space for open dialogue. By fostering awareness and normalizing conversations about mental health, we can dismantle barriers and cultivate a society grounded in compassion.

Realizing tangible change necessitates collaboration among schools, parents, healthcare professionals, and government entities. Schools must employ trained mental health professionals, establishing readily accessible counseling services for students. Regular mental health screenings can detect and address issues in their nascent stages. Moreover, stress management techniques, physical activity, and mindfulness practices should be integrated into the curriculum, equipping students with resilience and self-care strategies.

However, these endeavors demand steadfast commitment and investment from the government. Sufficient resources must be allocated to sustain mental health initiatives within schools. Prioritizing mental health in policy-making demonstrates a recognition of the issue’s urgency and importance. Through consistent funding and the widespread implementation of programs, we can usher in transformative change for Ugandan students.

By shining a light on mental health struggles and revolutionizing support systems within Ugandan schools, we have the power to transform countless young lives. This mission transcends borders, inspiring collective action and reshaping the trajectory of education. Let us stand united in breaking the silence, uplifting the vulnerable, and forging a compassionate society that places the mental well-being of its young citizens at the forefront.

1st RunnerUp: John Mark Okalebo | 18 | St.Mary’s College Kisubi

Elevating mental health awareness and support in uganda.

Mental health stands as a cornerstone of overall well-being, yet it often lingers in the shadows, shrouded by stigma and silence. Within Uganda, the recognition of mental health’s significance is burgeoning, acknowledging its pivotal role in both public health and individual prosperity. This discourse delves into the imperative of mental health awareness and support, shedding light on Uganda’s distinctive context and its attendant challenges.

Foremost, the imperative of addressing mental health lies in its indispensable contribution to holistic development, both at the individual and societal levels. Mental well-being extends beyond the mere absence of mental illness; it encompasses emotional resilience, psychological equilibrium, and the capacity to confront life’s vicissitudes. Uganda, akin to other regions, contends with formidable societal pressures, economic uncertainties, and entrenched cultural norms that profoundly influence mental health. Thus, fostering widespread awareness about mental health issues and ensuring the availability of accessible support services emerge as imperatives.

Moreover, investing in mental health constitutes an astute societal investment, promising substantial returns. Research underscores the repercussions of untreated mental health conditions, which include diminished productivity, heightened absenteeism, and augmented healthcare expenditures. By prioritizing mental health initiatives, Uganda stands poised to ameliorate these adverse consequences, bolster workforce efficiency, and stimulate economic prosperity.

Additionally, mental health intersects with a myriad of social determinants, spanning education, employment, and housing. Within Uganda, marginalized communities confront compounded challenges in accessing mental health services, owing to entrenched socioeconomic disparities and systemic inequities. Addressing mental health disparities mandates a multifaceted strategy, one that duly considers the distinct needs of diverse populations and champions equity in mental healthcare dispensation.

In recent years, Uganda has made notable strides in fostering mental health awareness and expanding support services. Nevertheless, formidable challenges endure, encompassing persistent stigma, resource inadequacies, and the limited integration of mental health into primary healthcare systems. Overcoming these obstacles necessitates concerted, collaborative endeavors involving governmental entities, healthcare practitioners, community-based organizations, and individual stakeholders.

Education emerges as a potent catalyst in dispelling misconceptions surrounding mental health and nurturing understanding and empathy. By seamlessly incorporating mental health education into school curricula and workplace training initiatives, Uganda can cultivate a culture of empathy and support for individuals grappling with mental health adversities.

Furthermore, Uganda must accord precedence to investments in mental health infrastructure, encompassing the establishment of mental health facilities, the training of proficient professionals, and the deployment of evidence-based interventions. Leveraging telehealth services and digital mental health platforms can also extend the reach of mental health care, particularly to remote locales where access remains scarce.

In summation, the exigency of mental health within Uganda is incontrovertible. By fostering heightened awareness, combating stigma, and fortifying support services, Uganda can nurture a society wherein mental well-being assumes paramount significance, and individuals receive the requisite care and assistance to flourish. It is through unified, collective action and unwavering commitment that Uganda can forge a healthier, more resilient society, one that dignifies the well-being of all its citizens.

2nd RunnerUp: Ddumba Emmanuel Kamya | 22 | Uganda Martyrs University Nkozi

A poem on mental health.

In silent depths, a struggle hides from sight,

Within young souls, a silent fight.

A quest for goals, a chase for dreams,

In every teen, a cornerstone gleams.

But whispers linger, haunting minds,

Shaping how they cope with life’s designs.

A treasury unseen, a wealth untold,

Seeking solace, a sanctuary to hold.

Navigate relationships, pursue with might,

Find purpose, in the darkest night.

Teach not violence, but peace instead,

In the hearth of minds, let hope be fed.

Amidst the chaos, in bustling days,

Weight of expectations, in countless ways.

Nurture seeds of peace in fertile minds,

With love as water, compassion binds.

In hearts of young soldiers, fires burn bright,

Support networks flourish, in the darkest night.

Resilience and courage, in every stride,

Speak not in whispers, let voices glide.

Break the silence, cast away the fear,

Mental health is not a flaw, but clear.

A voyage, an open door to explore,

The core of existence, at the core.

Teach not just facts, but understanding’s art,

Compassion from the depths, let it impart.

A symphony of wellness, pure and bright,

In unity, let voices take flight.

For every youth, a right to choose,

Let self-love be their true muse.

In the mirror’s reflection, power resides,

Heed the call, let it coincide.

Across the landscapes, let it ring,

Mental health, an essential thing.

In the grandest dream, let it play its part,

For in unity, lies its beating heart.

Coagulations to Raymond Magomu, and the runner ups John Mark Okalebo and Emmanuel Kamya Ddumba.

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• Mental Health Essay

Essay on Mental Health

According to WHO, there is no single 'official' definition of mental health. Mental health refers to a person's psychological, emotional, and social well-being; it influences what they feel and how they think, and behave. The state of cognitive and behavioural well-being is referred to as mental health. The term 'mental health' is also used to refer to the absence of mental disease. 

Mental health means keeping our minds healthy. Mankind generally is more focused on keeping their physical body healthy. People tend to ignore the state of their minds. Human superiority over other animals lies in his superior mind. Man has been able to control life due to his highly developed brain. So, it becomes very important for a man to keep both his body and mind fit and healthy. Both physical and mental health are equally important for better performance and results.

Importance of Mental Health 

An emotionally fit and stable person always feels vibrant and truly alive and can easily manage emotionally difficult situations. To be emotionally strong, one has to be physically fit too. Although mental health is a personal issue, what affects one person may or may not affect another; yet, several key elements lead to mental health issues.

Many emotional factors have a significant effect on our fitness level like depression, aggression, negative thinking, frustration, and fear, etc. A physically fit person is always in a good mood and can easily cope up with situations of distress and depression resulting in regular training contributing to a good physical fitness standard. 

Mental fitness implies a state of psychological well-being. It denotes having a positive sense of how we feel, think, and act, which improves one’s ability to enjoy life. It contributes to one’s inner ability to be self-determined. It is a proactive, positive term and forsakes negative thoughts that may come to mind. The term mental fitness is increasingly being used by psychologists, mental health practitioners, schools, organisations, and the general population to denote logical thinking, clear comprehension, and reasoning ability.

 Negative Impact of Mental Health

The way we physically fall sick, we can also fall sick mentally. Mental illness is the instability of one’s health, which includes changes in emotion, thinking, and behaviour. Mental illness can be caused due to stress or reaction to a certain incident. It could also arise due to genetic factors, biochemical imbalances, child abuse or trauma, social disadvantage, poor physical health condition, etc. Mental illness is curable. One can seek help from the experts in this particular area or can overcome this illness by positive thinking and changing their lifestyle.

Regular fitness exercises like morning walks, yoga, and meditation have proved to be great medicine for curing mental health. Besides this, it is imperative to have a good diet and enough sleep. A person needs 7 to 9 hours of sleep every night on average. When someone is tired yet still can't sleep, it's a symptom that their mental health is unstable. Overworking oneself can sometimes result in not just physical tiredness but also significant mental exhaustion. As a result, people get insomnia (the inability to fall asleep). Anxiety is another indicator. 

There are many symptoms of mental health issues that differ from person to person and among the different kinds of issues as well. For instance, panic attacks and racing thoughts are common side effects. As a result of this mental strain, a person may experience chest aches and breathing difficulties. Another sign of poor mental health is a lack of focus. It occurs when you have too much going on in your life at once, and you begin to make thoughtless mistakes, resulting in a loss of capacity to focus effectively. Another element is being on edge all of the time.

It's noticeable when you're quickly irritated by minor events or statements, become offended, and argue with your family, friends, or co-workers. It occurs as a result of a build-up of internal irritation. A sense of alienation from your loved ones might have a negative influence on your mental health. It makes you feel lonely and might even put you in a state of despair. You can prevent mental illness by taking care of yourself like calming your mind by listening to soft music, being more social, setting realistic goals for yourself, and taking care of your body. 

Surround yourself with individuals who understand your circumstances and respect you as the unique individual that you are. This practice will assist you in dealing with the sickness successfully.  Improve your mental health knowledge to receive the help you need to deal with the problem. To gain emotional support, connect with other people, family, and friends.  Always remember to be grateful in life.  Pursue a hobby or any other creative activity that you enjoy.

What does Experts say

Many health experts have stated that mental, social, and emotional health is an important part of overall fitness. Physical fitness is a combination of physical, emotional, and mental fitness. Emotional fitness has been recognized as the state in which the mind is capable of staying away from negative thoughts and can focus on creative and constructive tasks. 

He should not overreact to situations. He should not get upset or disturbed by setbacks, which are parts of life. Those who do so are not emotionally fit though they may be physically strong and healthy. There are no gyms to set this right but yoga, meditation, and reading books, which tell us how to be emotionally strong, help to acquire emotional fitness. 

Stress and depression can lead to a variety of serious health problems, including suicide in extreme situations. Being mentally healthy extends your life by allowing you to experience more joy and happiness. Mental health also improves our ability to think clearly and boosts our self-esteem. We may also connect spiritually with ourselves and serve as role models for others. We'd also be able to serve people without being a mental drain on them. 

Mental sickness is becoming a growing issue in the 21st century. Not everyone receives the help that they need. Even though mental illness is common these days and can affect anyone, there is still a stigma attached to it. People are still reluctant to accept the illness of mind because of this stigma. They feel shame to acknowledge it and seek help from the doctors. It's important to remember that "mental health" and "mental sickness" are not interchangeable.

Mental health and mental illness are inextricably linked. Individuals with good mental health can develop mental illness, while those with no mental disease can have poor mental health. Mental illness does not imply that someone is insane, and it is not anything to be embarrassed by. Our society's perception of mental disease or disorder must shift. Mental health cannot be separated from physical health. They both are equally important for a person. 

Our society needs to change its perception of mental illness or disorder. People have to remove the stigma attached to this illness and educate themselves about it. Only about 20% of adolescents and children with diagnosable mental health issues receive the therapy they need. 

According to research conducted on adults, mental illness affects 19% of the adult population. Nearly one in every five children and adolescents on the globe has a mental illness. Depression, which affects 246 million people worldwide, is one of the leading causes of disability. If  mental illness is not treated at the correct time then the consequences can be grave.

One of the essential roles of school and education is to protect boys’ and girls' mental health as teenagers are at a high risk of mental health issues. It can also impair the proper growth and development of various emotional and social skills in teenagers. Many factors can cause such problems in children. Feelings of inferiority and insecurity are the two key factors that have the greatest impact. As a result, they lose their independence and confidence, which can be avoided by encouraging the children to believe in themselves at all times. 

To make people more aware of mental health, 10th October is observed as World Mental Health. The object of this day is to spread awareness about mental health issues around the world and make all efforts in the support of mental health.

The mind is one of the most powerful organs in the body, regulating the functioning of all other organs. When our minds are unstable, they affect the whole functioning of our bodies. Being both physically and emotionally fit is the key to success in all aspects of life. People should be aware of the consequences of mental illness and must give utmost importance to keeping the mind healthy like the way the physical body is kept healthy. Mental and physical health cannot be separated from each other. And only when both are balanced can we call a person perfectly healthy and well. So, it is crucial for everyone to work towards achieving a balance between mental and physical wellbeing and get the necessary help when either of them falters.

Why are so many young Americans suffering from mental distress?

The cost of living, university fees and even gun crime are contributing to an alarming rise in depression and anxiety among young adults.

The number of young men and women suffering from depression and other mental health disorders in the United States has risen sharply since the start of the COVID-19 pandemic, according to a series of reports.

The latest World Happiness Report, which is produced once a year by the Wellbeing Research Centre at the University of Oxford in the UK, shows that people under the age of 30 have experienced a dramatic decrease in happiness in recent years. Unhappiness is particularly pronounced in the US, which has dropped out of the index’s 20 happiest countries for the first time since 2012 when it was first published.

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This year’s report, published last week, is the first to divide respondents by age but is only the latest to show that young people are struggling inordinately with mental distress.

What do the reports show?

Overall, reports are showing that mental health among young adults has declined sharply since the onset of the COVID-19 pandemic in March 2020, the effects of which are still taking a toll on the mental health of young people.

The 2023 State of Mental Health report from non-profit Mental Health America cited CDC figures showing that 67 percent of high school students had found school work more difficult during the pandemic, while 55 percent had experienced emotional abuse in the home during lockdowns. It added that 11 percent had experienced physical abuse and 24 percent said they did not have enough food to eat.

In addition, according to the US Census Bureau’s Household Pulse Survey, which surveyed adults from 2020 and 2022, there were higher levels of anxiety and depression among younger adults after surges of COVID-19 cases.

Pew Research, which undertook surveys across the general population from the start of the pandemic 2020 until September 2022, found that 58 percent of Americans aged 18 to 29 years old had experienced high levels of psychological distress – the highest of any age group.

More recently, the February 2024 Student Mental Health Landscape report by the publishing and research group Wiley, found that 80 percent of 2,500 college students surveyed in the US and Canada say they have experienced some degree of mental distress as a result of the pandemic – with anxiety, mental “burnout” and depression the most common conditions cited.

Which mental health disorders are young people suffering from?

In a recent interview, Admiral Dr Rachel Levine, the assistant secretary for health at the Department of Health and Human Services (HHS), said: “So we are looking at depression and anxiety, suicidality. We’re looking at eating disorders, we’re looking at the risk of substance use and the full range of mental health challenges that youth face.”

Common mental disorders among young adults can include depression, anxiety disorders, eating disorders such as bulimia nervosa and anorexia nervosa, body dysmorphia, attention deficit hyperactivity disorder (ADHD) and substance abuse.

Depression is the most common condition cited by young adults. According to a February 2023 Gallup survey undertaken across all 50 US states, young adults aged 18 to 29 are more likely to be diagnosed with depression than those older than 44.

Why are so many young people suffering from mental distress in the US?

There are many factors, however, some of the most commonly cited by young people suffering from mental distress are as follows:

Financial worries

The cost of university fees and the general cost of living are weighing heavily on the minds of young adults. In a 2022 Harvard study [ PDF ] of more than 1,800 people aged 18 to 25, more than half of respondents reported that financial worries (56 percent) were negatively impacting their mental health.

Similarly, in the Wiley study, close to half of students cited tuition fees (50 percent) and the cost of living (49 percent) as their biggest challenges.

The economic burden of undertaking university study has steadily grown over the past few decades. According to the National Center for Education Statistics (NCES), between the academic year of 1979-1980 and the academic year of 2021-2022, the cost of going to college increased by 136 percent, even after inflation is accounted for. This means that in real terms, the cost of going to college is more than twice as expensive now than it was 40 years ago. The biggest cost rise has been in tuition fees, which have increased by 170 percent over the past 40 years.

Feelings of isolation and loneliness were also cited by respondents to the Wiley study. In the Harvard study, 44 percent of young adults reported a sense of “not mattering to others” while 34 percent reported “loneliness”.

According to a 2023 Gallup poll, overall loneliness has decreased since early 2021, but young adults and those in lower-income homes are more likely to feel lonely than other age groups.

Some experts attribute this to the rise in social media use which has caused “virtual isolation” – or social isolation due to the use of mobile devices.

In May 2023, US Surgeon General Vivek H Murthy issued a report about the effects of social media on mental health, which stated: “Loneliness is far more than just a bad feeling – it harms both individual and societal health. It is associated with a greater risk of cardiovascular disease, dementia, stroke, depression, anxiety, and premature death.”

“Loneliness is the subjective feeling that you’re lacking the social connections you need. It can feel like being stranded, abandoned, or cut off from the people with whom you belong – even if you’re surrounded by other people. What’s missing when you’re lonely is the feeling of closeness, trust, and the affection of genuine friends, loved ones, and community,” Dr Murthy wrote in his 2020 book, Together: Why Social Connection Holds the Key to Better Health, Higher Performance, and Greater Happiness.

Social issues

In the 2022 Harvard study, 42 percent of respondents reported that gun violence in schools had a negative influence on their mental health, while 34 percent said they were worried about climate change and 30 percent expressed concerns about corruption among political leaders.

According to a 2018 survey conducted by the Harris Poll for the American Psychological Association, 75 percent of those aged between 15 and 21 reported that mass shootings were a considerable source of stress.

How can we solve this crisis?

There remain significant challenges to addressing mental distress among young adults, especially in the US.

Jan-Emmanuel De Neve, director of the Wellbeing Research Center and editor of the World Happiness Report, said: “To think that in some parts of the world children are already experiencing the equivalent of a midlife crisis, demands immediate policy action.”

Experts say helping young people build better relationships, giving them a sense of purpose and fostering a healthy environment that helps them achieve their future goals is the way forward.

What does seem clear, say campaigners, is that the emotional plight of so many young people demands far more concerted and serious attention from governments, colleges and universities, workplaces and many other institutions.

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Research Identifies Characteristics of Cities That Would Support Young People’s Mental Health

Survey responses from global panel that included young people provide insights into what would make cities mental health-friendly for youth

As cities around the world continue to draw young people for work, education, and social opportunities, a new study identifies characteristics that would support young urban dwellers’ mental health. The findings, based on survey responses from a global panel that included adolescents and young adults, provide a set of priorities that city planners can adopt to build urban environments that are safe, equitable, and inclusive. 

To determine city characteristics that could bolster youth mental health, researchers administered an initial survey to a panel of more than 400, including young people and a multidisciplinary group of researchers, practitioners, and advocates. Through two subsequent surveys, participants prioritized six characteristics that would support young city dwellers’ mental health: opportunities to build life skills; age-friendly environments that accept young people’s feelings and values; free and safe public spaces where young people can connect; employment and job security; interventions that address the social determinants of health; and urban design with youth input and priorities in mind. 

The paper was published online February 21 in  Nature .

The study’s lead author is Pamela Collins, MD, MPH, chair of the Johns Hopkins Bloomberg School of Public Health’s Department of Mental Health. The study was conducted while Collins was on the faculty at the University of Washington. The paper was written by an international, interdisciplinary team, including citiesRISE, a global nonprofit that works to transform mental health policy and practice in cities, especially for young people.

Cities have long been a draw for young people. Research by UNICEF projects that cities will be home to 70 percent of the world’s children by 2050. Although urban environments influence a broad range of health outcomes, both positive and negative, their impacts manifest unequally. Mental disorders are the leading causes of disability among 10- to 24-year-olds globally. Exposure to urban inequality, violence, lack of green space, and fear of displacement disproportionately affects marginalized groups, increasing risk for poor mental health among urban youth.

“Right now, we are living with the largest population of adolescents in the world’s history, so this is an incredibly important group of people for global attention,” says Collins. “Investing in young people is an investment in their present well-being and future potential, and it’s an investment in the next generation—the children they will bear.” 

Data collection for the study began in April 2020 at the start of the COVID-19 pandemic. To capture its possible impacts, researchers added an open-ended survey question asking panelists how the pandemic influenced their perceptions of youth mental health in cities. The panelists reported that the pandemic either shed new light on the inequality and uneven distribution of resources experienced by marginalized communities in urban areas, or confirmed their preconceptions of how social vulnerability exacerbates health outcomes. 

For their study, the researchers recruited a panel of more than 400 individuals from 53 countries, including 327 young people ages 14 to 25, from a cross-section of fields, including education, advocacy, adolescent health, mental health and substance use, urban planning and development, data and technology, housing, and criminal justice. The researchers administered three sequential surveys to panelists beginning in April 2020 that asked panelists to identify elements of urban life that would support mental health for young people.

The top 37 characteristics were then grouped into six domains: intrapersonal, interpersonal, community, organizational, policy, and environment. Within these domains, panelists ranked characteristics based on immediacy of impact on youth mental health, ability to help youth thrive, and ease or feasibility of implementation. 

Taken together, the characteristics identified in the study provide a comprehensive set of priorities that policymakers and urban planners can use as a guide to improve young city dwellers' mental health. Among them: Youth-focused mental health and educational services could support young people’s emotional development and self-efficacy. Investment in spaces that facilitate social connection may help alleviate young people’s experiences of isolation and support their need for healthy, trusting relationships. Creating employment opportunities and job security could undo the economic losses that young people and their families experienced during the pandemic and help cities retain residents after a COVID-era exodus from urban centers.  

The findings suggest that creating a mental health-friendly city for young people requires investments across multiple interconnected sectors like transportation, housing, employment, health, and urban planning, with a central focus on social and economic equity. They also require urban planning policy approaches that commit to systemic and sustained collaboration, without magnifying existing privileges through initiatives like gentrification and developing green spaces at the expense of marginalized communities in need of affordable housing.

The authors say this framework underscores that responses by cities should include young people in the planning and design of interventions that directly impact their mental health and well-being. 

“ Making cities mental health friendly for adolescents and young adults ” was co-authored by an international, interdisciplinary team of 31 researchers led by the University of Washington Consortium for Global Mental Health, Urban@UW, the University of Melbourne, and citiesRISE. Author funding is listed in the Acknowledgements section of the paper.

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Social Media and Youth Mental Health

• Published: 16 December 2023
• Volume 26 , pages 1–8, ( 2024 )

Cite this article

• Paul E. Weigle 1 , 2 , 3 &
• Reem M. A. Shafi 4 , 5  

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Purpose of Review

We review recent evidence regarding the relationship between the social media (SM) habits, experiences, and the mental health of youth. We examine effects of social media use (SMU) on specific diagnoses including depression and anxiety. The relationship between psychiatric illness, specific SM experiences, and the issue of SM mental health contagion is also explored.

Recent Findings

Youth engagement in SMU has increased dramatically in recent years, concurrent with increases in prevalence of depression and anxiety. The relationship between SMU and mental illness is complex and depends on characteristics of the user (e.g., social comparison and fear of missing out (FOMO) and their SM habits and experiences (e.g., cyberbullying, and sexting,). SM engagement has distinct impacts on anxiety, depression, and suicidality. Growing evidence documents how SM may be a medium for psychiatric contagion. Research findings are largely correlational and dependent on subjective report, limiting their interpretation.

The mental health of youth is increasingly tied to their SMU, depending greatly on how youth engage with SM and resultant feedback. Future research must look to establish causality in relationships between SM and mental illness.

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Teenagers, screens and social media: a narrative review of reviews and key studies

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Reem M. A. Shafi

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Weigle, P.E., Shafi, R.M.A. Social Media and Youth Mental Health. Curr Psychiatry Rep 26 , 1–8 (2024). https://doi.org/10.1007/s11920-023-01478-w

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• v.192(6); 2020 Feb 10

Smartphones, social media use and youth mental health

• Evidence from a variety of cross-sectional, longitudinal and empirical studies implicate smartphone and social media use in the increase in mental distress, self-injurious behaviour and suicidality among youth; there is a dose–response relationship, and the effects appear to be greatest among girls.
• Social media can affect adolescents’ self-view and interpersonal relationships through social comparison and negative interactions, including cyberbullying; moreover, social media content often involves normalization and even promotion of self-harm and suicidality among youth.
• High proportions of youth engage in heavy smartphone use and media multitasking, with resultant chronic sleep deprivation, and negative effects on cognitive control, academic performance and socioemotional functioning.
• Clinicians can work collaboratively with youth and their families, using open, nonjudgmental and developmentally appropriate approaches to reduce potential harms from social media and smartphone use, including education and practical problem-solving.
• There is a need for public awareness campaigns and social policy initiatives that promote nurturing home and school environments that foster resilience as youth navigate the challenges of adolescence in today’s world.

In the last decade, increasing mental distress and treatment for mental health conditions among youth in North America has paralleled a steep rise in the use of smartphones and social media by children and adolescents.

In Ontario, the proportion of teenagers reporting moderate to serious mental distress increased from 24% in 2013, to 34% in 2015 and to 39% in 2017, 1 with parallel increases in health service utilization. Inpatient hospital admissions of children and adolescents for mental health reasons increased substantially across Canada between 2007 and 2014, while admissions for other medical conditions in this age group decreased by 14%. 2 Between 2009 and 2014, admissions to hospital for intentional self-harm increased by 110% in Canadian girls. 3 Suicide is now the second leading cause of death for Canadian youth. 4 A recent analysis of survey data found the 12-month prevalence of suicidal ideation, attempts and nonsuicidal self-injury to be 8.1%, 4.3% and 8.8%, respectively, among adolescents aged 14 to 17 years, with all rates being higher in girls. 5 Similarly, administrative data in the United States show that presentations to hospital for suicidal ideation or attempts among children and adolescents almost doubled between 2008 and 2015, with the highest increase for adolescent girls. 6 Self-poisoning rates among 10- to 18-year-olds, which had declined in the US since the turn of the century, increased substantially from 2011 to 2018, primarily among girls. 7 Surveys of high school students in the US have shown a similar pattern for self-reported symptoms of depression, major depressive episodes and suicidality over the last 2 decades. 8 , 9

At the same time, social media use has increased markedly. In the US, the proportion of young people between the ages of 13 and 17 years who have a smartphone has reached 89%, more than doubling over a 6-year period; moreover, 70% of teenagers use social media multiple times per day, up from a third of teens in 2012. 10 The percentage of Ontario’s teenagers who reported spending 5 or more hours a day on social media increased from 11% in 2013, to 16% in 2015 and to 20% in 2017. 1 An analysis of Australian longitudinal data found that 86% of students owned smartphones in grade 8, increasing to 93% by grade 11, with increased use of social media communication with age. 11

We review the evidence that links smartphone and social media use with mental distress and suicidality among adolescents. We do not review evidence for online gaming. Although most existing data are observational, making causality difficult to establish, findings from a few longitudinal, randomized and controlled studies suggest that social media and smartphone use may be contributing to the rising burden of mental distress among youth. We consider the clinical implications of existing evidence, to help practising clinicians to work collaboratively with youth and families to mitigate potential negative effects of social media and smartphone use on mental health.

How has use of social media been shown to affect adolescents’ sense of self?

Two cross-sectional surveys of American and German university students, respectively, 12 , 13 found that students who spent more time on the social media platform Facebook were more likely to endorse feeling envy or sensing that others in their social network were better off than they were. The term “FOMO” — fear of missing out — has been defined as “a pervasive apprehension that others might be having rewarding experiences from which one is absent,” 14 and has been associated with increased stress related to Facebook use. 15

A systematic review of 20 studies found that use of social media was associated with body image concerns and disordered eating. 16 In a randomized study, female participants reported more negative mood after just 10 minutes of browsing their Facebook account compared with those who browsed an appearance-neutral control website. 17 Moreover, participants who were high in appearance comparison tendency reported an increased desire to change the appearance of their face, hair or skin after spending time on Facebook, in comparison with those who browsed the control website. 17

The nature of social media interactions, which are arm’s length, makes negative commenting both easy and more frequent than in-person interactions with peers. An Ontario survey of middle- and high school students showed that the odds of suicidal ideation, plans and attempts were all significantly higher among those who had experienced cyberbullying, even after controlling for a range of potential confounders. 18

Does social media addiction exist and can it affect mental health?

One study of repeat survey data from 2013, 2014 and 2015 associated the extent of self-reported use of Facebook with subsequent poor self-reported mental health and life satisfaction. 19 Concerns have been raised about social media platforms having been deliberately designed — in highly sophisticated ways that use behavioural psychology, neuroscience and artificial intelligence — to promote behavioural reinforcement and behavioural addiction. 20 , 21 Several cross-sectional studies have shown that high proportions of youth appear to be addicted to their smartphones, 22 , 23 but there is no standard or agreed-upon definition of smartphone or Internet addiction; studies have used different definitions and scales, varying from those that rely on behavioural addiction criteria, to measurement of the extent of functional impairment and level of device use. 24 , 25 As such, reported prevalence rates are highly variable. 25

A systematic review identified Internet addiction as being particularly associated with self-harm or suicidal behaviour based on 7 included studies, all of which were cross-sectional school-based surveys that used validated outcome measures and were rated as high or medium to high quality. 24 A recent large prospective study of senior high school adolescent students in Taiwan found that youth classified as experiencing Internet addiction had a significantly increased risk of having newly emerged self-harm or suicidal behaviour or both when re-evaluated 1 year later. 26

Two systematic reviews have shown that media multitasking is associated with negative effects on cognitive control, academic performance and socioemotional functioning in youth. 27 , 28 Most existing studies, however, are cross-sectional, and measures are heterogenous across studies with limited attempts to consider individual and contextual differences, making it impossible to establish causality. Youth with lower impulse control may be more susceptible to deleterious effects of media multitasking. A large longitudinal study of adolescents who did not have significant symptoms of attention-deficit/hyperactivity disorder (ADHD) at baseline found that high-frequency digital media use was positively associated with emergence of symptoms meeting Diagnostic and Statistical Manual of Mental Disorders–4th Edition (DSM-IV) criteria for ADHD over a 2-year follow-up period, even after adjusting for known confounders. 29

Can social media promote self-harm?

Youth communicate thoughts of suicidality and self-harm behaviours online, including sharing images of self-inflicted injuries. Explicit depiction of self-injury — particularly cutting — on social media is common, as shown by site content studies 30 , 31 that found photographs or live videos of self-injurious behaviour, many of which had no warnings about graphic content. Of particular concern were viewers’ comments, which typically contained positive feedback or personal disclosures about self-injury experiences, and rarely offered encouragement or discussion of recovery. Such findings show the potential for mental illness romanticizing and messaging that normalizes self-harm among youth. Indeed, a systematic review that included 26 studies (using qualitative, descriptive or cross-sectional methodology) found that social media platforms included normalization of self-harm behaviour, discussions about practical issues regarding suicidality and live depictions of self-harm acts. 32 At the same time, there were also positive elements, including providing a sense of community, suggestions for seeking treatment and advice on stopping self-harm behaviour.

Do the effects of smartphones on social skills affect mental health?

An observational study showed that spending more than a few hours per week using electronic media correlated negatively with self-reported happiness, life satisfaction and self-esteem, whereas time spent on nonscreen activities (in-person social interactions, sports or exercise, print media, homework, religious services, working at a paid job) correlated positively with psychological well-being, among adolescents. 33 Other observational studies have linked spending more than 2 hours a day on social networking sites and personal electronic devices with high rates of suicidality and depressive symptoms among adolescent girls, although youth who sustained high levels of face-to-face socializing were relatively protected against the negative consequences of too much time online. 13 , 34

Youth do increasingly interact online rather than in person, and smartphones can interfere even with face-to-face interactions via what has been termed “phubbing”: attending to one’s phone when in the presence of others. 35 A recent empirical field study using experience sampling in 304 participants showed that even the mere presence of phones on a table caused participants who were randomly assigned to that condition to feel more distracted and have lower enjoyment during social interactions compared with those who were randomized to putting their phone away. 36 Phone use was also found to predict distraction, which in turn predicted greater boredom and worse overall mood. 36

Does sleep-loss associated with use of social media affect mental health?

An analysis of US annual survey data found an abrupt increase in the proportion of adolescents getting insufficient sleep after 2011–2013, with more than 40% sleeping less than 7 hours most nights in 2015. 37 The study also showed an exposure–response relationship between daily electronic media use beyond 2 or more hours per day, and insufficient sleep. 37 An analysis of survey data from Ontario found that 63.6% of 5242 students aged 11–20 years slept less than recommended, 38 also showing a significant relationship between use of social media beyond 1 hour a day and odds of insufficient duration of sleep. 38

In a 14-day, randomized, crossover experimental study under well-controlled conditions, use of electronic screens before bedtime was shown to disrupt sleep in multiple ways: longer time to fall asleep and decreased evening sleepiness, reduced melatonin secretion, circadian clock delay, reduced amount and delay in rapid eye movement sleep, and reduced next-morning alertness. 39 A systematic review and meta-analysis that included 20 studies on the association between portable screen-based media devices and sleep outcomes found that use of media at bedtime was associated with decreased duration and quality of sleep and excessive daytime sleepiness. 40 Of note, the mere presence of portable screen-based media devices in the bedroom was shown to disrupt sleep, 40 possibly related to the temptation to check media devices when they are present or owing to a conditioned response involving increased arousal.

Data from a longitudinal study of 1101 adolescents in Australia showed that poor sleep mediated the relationship between nighttime mobile phone use and subsequent depressed mood, externalizing behaviours and decline in self-esteem and coping based on various validated scales. 11 In another longitudinal study involving 2286 adolescents in Europe, magnitude of Internet use in general had a negative impact on mental health, but the most robust effects came from the consequences — in particular, lack of sleep from Internet use had a notable adverse effect on mental health on 4-month follow-up based on measures from a validated depression, anxiety and stress scale. 41

Are some individuals more susceptible to mental health effects than others?

Although population-based studies suggest a link between social media use and mental distress among youth, the impact of these technologies may vary among individuals — and some may be less susceptible to harm, as indicated by an emerging literature of experimental studies. Girls and young women tend to spend more time on social media than boys do, have more exposure to cyberbullying and show tendency to experience more mental health effects, 10 , 34 which is consistent with recent epidemiologic trends indicating that depressive symptoms, self-harm and suicidality have increased among young females in particular. 5 – 9

The context of social media use may mediate its effects. A structural equation modelling analysis of a cross-sectional survey of 910 high school students in Belgium found that, among girls, passive use of Facebook had a negative impact on mood but active use had a positive impact on perceived online social support, which in turn had a positive impact on mood. 42 However, for boys active site use had a negative effect. A systematic review of 70 studies found that while social media use was correlated with depression, anxiety and measures of well-being, effects could be both detrimental (such as from negative interactions and social comparison) and beneficial (such as through social connectedness and support) depending on the quality of interactions and individual factors. 43 Certain cognitive styles, such as those that involve rumination and brooding, appeared to exacerbate negative effects of social media. 43 Moreover, the negative impact of social media on depressive symptoms appears to be much greater for adolescents with low levels of in-person interaction; in contrast, youth with high levels of face-to-face socializing appear to be relatively protected against the negative consequences of too much time online. 34 A recent survey of 1124 college students found that while social media contact in the absence of a face-to-face relationship was associated with depressive symptoms, the proportion of social media contacts with whom participants had a close face-to-face relationship was negatively associated with depressive symptoms. 44 In addition, the challenges associated with social media may be especially risky for young people who are already experiencing mental health difficulties, as suggested by the bidirectional relationship between use of electronic media and decrease in psychological well-being. 33 Of particular concern for such vulnerable individuals is that educational or even promotional content about suicide and self-harm is readily available and widely accessed online. 30 , 31

The role of individual differences in terms of the effects of social media is a topic of active investigation. Recent experimental studies have shown relationships between individual characteristics and social media experiences. In a randomized study of 120 college students, those who scored highly on the tendency to engage in social comparison based on measures from a validated scale had poorer self-perceptions, lower self-esteem and more negative affect after browsing the Facebook profile of an acquaintance, relative to those randomized to the control conditions, an effect not seen among students who scored low on social comparison traits. 45 In another empirical study, 102 college students who were asked to take a selfie were randomized to either of 3 conditions with different numbers of “likes” (average, above average and below average); those rated as having a greater sense of purpose in life based on measures from a validated scale had lower sensitivity to feedback (based on number of “likes”) on their self-photograph posts. 46 A study that categorized participants by social comparison orientations (“ability-based” versus “opinion-based”) found that different orientations showed different emotional responses to being compared with others, which in turn was related to life satisfaction. 47 These early findings offer some insights for the individualized care of youth presenting with emotional and mental distress.

How might physicians use this evidence to inform their practice?

Despite the limitations of the evidence base at this time, clinicians may be able to use currently available knowledge in their practice, combined with evidence on effecting behavioural change in youth.

Clinicians treating youth with mental illness and those at risk of mental distress can discuss with adolescents and their families the known risks of social media and smartphone use to mental health. Clinicians may choose to advocate for a harm reduction approach, suggesting reduced use of social media and the Internet rather than abstinence for youth, given evidence that suggests prolonged use is associated with poorer mental health. A recent large systematic review found that communication with adolescents is most effective in the context of a therapeutic alliance that is open and nonjudgmental, elicits trust and emotional safety, and offers a sense of inclusion and autonomy. 48

Encouraging parents to be proactively involved in limiting children’s and teens’ use of smartphones and social media may be helpful, given that social media use appears to become problematic when it surpasses 1 to 2 hours daily. 34 , 38 Results from a recent meta-analysis suggest that while parental limits may be effective at reducing the amount of media use by younger children, open discussion focused on positive engagement and guidance might be best for reducing media-related risks for adolescents; however, only 5 of the 52 included studies pertained to social media, all of which were based on cross-sectional surveys. 49 It is also worth reminding parents that they model smartphone use with their own behaviour; a randomized study showed that heavy parental smartphone use was associated with poorer quality of interactions with their children. 50 Youth and their families can be encouraged to set boundaries for smartphone and social media use. These could include such measures as using social media only for set times, and preferably only in common living areas in the home. A further motivator may be to discuss evidence showing an adverse impact of smartphones on learning, 51 and the benefit on academic outcomes when phones are put away when studying, preferably in another room. 52

A qualitative study that collected data via focus groups with adolescent girls found that high levels of confidence, high media literacy and sound appreciation of individual differences appeared to mitigate negative effects of social media on body image. 53 The participants reported that “these characteristics were nurtured by positive parental influence and a supportive school environment.” 53 These findings underscore the importance of a nurturing home and school environment in fostering resilience as youth navigate the challenges of adolescence. An empirical study of the effect of Instagram browsing on affect in just more than 500 adolescents found that randomization to conditions that provided greater contextual awareness regarding posts by others mitigated against postbrowsing negative affect in teens who reported higher levels of negative social comparison. 54

Sleep hygiene measures specific to social media and smartphone usage are crucial, as several studies have shown that increased smartphone use can disrupt sleep and shorten sleep duration. These would include avoiding use of electronic screens within 1 to 2 hours before bedtime, and not having portable, screen-based media devices in bedrooms overnight.

The American Academy of Pediatrics provides a number of useful health and safety tips to support youth regarding the use of social media, 55 as well as a Family Media Use Plan that offers structure to the recommendations related to limiting use and having discussions regarding appropriate use. 56 Further, the American Academy of Pediatrics has partnered with Common Sense Media to produce a Family Media Toolkit that has useful information for parents. 57 Other practical strategies to mitigate negative effects from using smartphones and related media are offered by the Center for Humane Technology ( http://humanetech.com/ ), an organization developed by former technology industry members out of concern for the potential deleterious effects of new media on psychological states.

A motivational interviewing approach may be useful to help young people start to make changes in their pattern of online behaviour. Motivational interviewing is an intervention with established effectiveness for adolescents with substance use, which could be useful for youth who appear to have poor self-control in their use of social media or smartphone. 58 This approach should involve open, nonjudgmental exploration of all aspects of a youth’s digital life, including positive and negative. Some youth might benefit from habit reversal training to address compulsive use, including having daily “nonscreen time” that can be progressively increased. Sharing evidence that a randomized controlled trial found that participants assigned to not using Facebook reported significantly greater “life satisfaction” and positive emotions after 1 week, compared with controls who were told to continue using the site as usual, 59 may be helpful in effecting change. Youth might be encouraged to inform their friends that they are taking a break from, or otherwise limiting, their social media use. Talking with youth about alternative ways to connect, including meeting in person or even talking directly by phone, could help with strategies to fill the social media gap, reinforced by discussion of evidence that in-person interaction may protect mental health.

At the system level, school and community-based programs can institute limits on social media and smartphone use, along the lines of those that have recently been shown to have a positive effect on healthy behaviours. 60 However, such interventions should be developmentally appropriate and aim to respectfully ensure adolescents’ autonomy. 61 Mobile-phone policies at the school and classroom level have been implemented in several jurisdictions, with mixed results. 62 Enforcement of blanket bans is often a challenge; rather, a more productive approach involves negotiation between teacher and students, as developmentally appropriate, in the context of a relationship built on mutual trust and respect for autonomy. 63 , 64

More broadly, public awareness campaigns can provide education on the impact of problematic use of digital media and promote healthy behaviours in this regard. Various social media platforms have placed bans and restrictions on content related to self-harm. 24 A qualitative study of focus groups involving a total of 66 adolescents found that while adolescents valued freedom and privacy, they recognized a need for protection and most were in favour of automatic monitoring in situations that were beyond their control. 65 Finally, there should be public discussion about the extent to which social media companies can use features that are deliberately designed to promote behavioural reinforcement and addiction, 20 , 21 particularly on platforms used primarily by youth.

Encouragingly, youth are increasingly recognizing the negative impact of social media on their lives and starting to take steps to mitigate this. 66 According to a recent poll, 54% of teens felt they spend too much time on their cell phone, and about half reported cutting back on the time they spend on it. 67

Given the importance of engaging youth in mitigating potential harms from social media, a prohibitionist approach would be counterproductive. The American Academy of Pediatrics suggests that online relationships are part of typical adolescent development. 55 Indeed, for adolescents today, who have not known a world without social media, digital interactions are the norm, and the potential benefits of online access to productive mental health information — including media literacy, creativity, self-expression, sense of belonging and civic engagement — as well as low barriers to resources such as crisis lines and Internet-based talking therapies cannot be discounted.

However, today’s youth could benefit from proven individual and systemic interventions to help them navigate the challenges brought about by use of smartphones and social media, protect themselves from harm and use social media in a manner that safeguards their mental health, against a background of policy initiatives aimed at addressing the social, environmental and economic factors that underpin family well-being and nurture youth resilience. 68

Acknowledgements

The authors acknowledge the valuable contributions of the anonymous reviewers and journal editors.

CMAJ Podcasts: author interview at https://soundcloud.com/cmajpodcasts/190434-ana

Competing interests: None declared.

This article has been peer reviewed.

Contributors: All of the authors contributed to the conception and design of the work. Elia Abi-Jaoude and Karline Treurnicht Naylor drafted the manuscript. All authors revised the manuscript critically for important intellectual content, gave final approval of the version to be published and agreed to be accountable for all aspects of the work.

BREAKING: Israeli military fires 2 officers, saying probe found serious errors and protocol violations led to deadly strikes on World Central Kitchen workers

A new book has amplified fierce debate around teens, mental health and smartphones

A new book has embroiled the academic community in a heated debate over whether spending time on smartphones affects young people’s mental health and, if so, how.

Social psychologist Jonathan Haidt’s “ The Anxious Generation ,” published last week, argues that the smartphone-driven “great rewiring of childhood” is causing an “epidemic of mental illness.” He suggests four ways to combat this: no smartphones before high school, no social media before age 16, no phones in schools; and prioritizing real-world play and independence.

“I call smartphones ‘experience blockers,’ because once you give the phone to a child, it’s going to take up every moment that is not nailed down to something else,” Haidt told TODAY.com , adding, “It’s basically the loss of childhood in the real world.”

Phones and social media have become a ubiquitous part of everyday life. But as much as researchers study their impact, there remains no easy answer to how exactly these technologies affect the mental health of kids and teens.

Haidt’s book quickly has generated a wave of both support and backlash, including a viral review in the scientific journal Nature that argues Haidt is contributing to a “rising hysteria” around social media and screen time that’s unproductive in addressing the “real causes” of teen depression and anxiety.

“We have a generation in crisis and in desperate need of the best of what science and evidence-based solutions can offer,” psychologist Candice Odgers wrote in her scathing review. “Unfortunately, our time is being spent telling stories that are unsupported by research and that do little to support young people who need, and deserve, more.”

Over the past decade, scholars and politicians have grown increasingly concerned about the potential impact of social media and screen time on young people. A Senate hearing in January grilled the CEOs of several major social media companies on a variety of topics related to child safety, including their platforms’ impacts on youth mental health.

Also in January, California introduced a bill aimed at protecting children from social media addiction. And last week, Florida Gov. Ron DeSantis signed into law a ban on children under 14 joining social media, which takes effect next January.

Research linking social media use to poor youth mental health led U.S. Surgeon General Vivek Murthy to issue an advisory last year warning of social media’s potential harms to child and adolescent well-being. Up to 95% of youth ages 13 to 17 say they use social media, according to the report , with more than one-third saying they use it “almost constantly.”

Some academics and scientists remain unconvinced that current evidence shows a causal link between social media and poor mental health. Christopher Ferguson, a psychology professor at Stetson University, said he believes the concern is part of a recurring moral panic largely driven by older adults.

He pointed to a cyclical pattern in which disruptive new technologies — from TV to video games to, more recently, generative AI — almost always undergo periods of uproar over their potential harms. He said the buildup of concern around smartphones started slower than most, only taking significant shape in the late 2010s.

But the toothpaste can’t be squeezed back into the tube. The kids who are on smartphones and social media now will be using those technologies well into old age, Ferguson said, and it’ll be their turn to “freak out” once a new, unfamiliar technology threatens to displace their habits.

“I just think this is how it is now. It’s just a matter of getting used to that,” Ferguson said. “For some reason, society always wants to throw a temper tantrum when a new thing comes along. And eventually, like all temper tantrums, they go away.” 

But researcher Jean Twenge, author of “Generations” and “iGen,” said there’s a “reasonably robust” consensus among academics that smartphones and social media are at least partially linked to the rise in teen depression, self harm and loneliness.

She said she believes the pushback comes from a smaller group of academics whose arguments imply that screen time and social media are harmless. Unlike Ferguson, Twenge said she believes the skepticism around them will continue to grow over time.

“The critics in this area need to answer one important question,” said Twenge, a psychology professor at San Diego State University. “If smartphones and social media are not behind the increase in teen depression, what is? Because over and over, the answers that they have given have not been supportable.”

Ninety percent of this debate is basically just back-and-forths about different studies that are subtly designed differently and create totally different results.

-Joseph Bak-Coleman, an associate research scientist at the Columbia School of journalism

Joseph Bak-Coleman, an associate research scientist at the Columbia School of Journalism who studies collective decision-making, said part of why the effects of phone and social media use are so difficult to study is because research subjects cannot be fully isolated from the impact of these technologies.

This leads to conflicting research results, he said, as even individuals who eschew social media and smartphones still live within networks of people who do use them — and in a world already shaped by them.

As Bak-Coleman puts it: “ Ninety percent of this debate is basically just back-and-forths about different studies that are subtly designed differently and create totally different results. And then everyone fights.”

While social platforms and regulators have an obligation to figure out how to protect children and teens, he suspects any restrictive protections would be a “nightmare” to enforce. Measures such as removing access to phones entirely could cause different troubles in a world where kids rely on cellphones to contact their parents, he said, and where many aspects of life now take place in the digital realm.

And because the average effects of social media use might also look different from the effects on those who are most at risk for certain harms, Bak-Coleman said it could be more worthwhile to hone in on specific concerns instead of trying to identify a broad trend in how phones impact mental health.

“Rather than asking, is it a net negative or positive, which is an absurd discussion,” he said, “it’d be much nicer if we could ask: What are the impacts? To who? And which thing does it, and how can you change it?”

Angela Yang is a culture and trends reporter for NBC News.

Mental Health America of the Northern Suburbs

Annual Essay and Multimedia Contest

Since 2003, MHANS has held an annual contest for youth on a topic related to mental health. In 2013, what had been a writing contest became an Essay and Multimedia Contest, as we encouraged youth to use artwork as a way to express themselves. In 2018, we opened the Contest to Middle/Junior School students, who are judged in a separate age category.

Since 2013, we began using what participants told us, analyzing the submissions for common themes and creating anonymized data, which we have subsequently used to create educational programming, brochures, and social media posts – all designed to provide information on what teens think and experience around a variety of topics related to mental health and wellness. The “Teens Speak Out” series, which has expanded into “Teens and Tweens Speak Out” since the Contest began taking admissions from Middle/Junior school students, is now an integral part of our annual community education programming.

2024 Essay and Multimedia Contest

Our Annual Essay and Multimedia Contest is now open for submissions from students 6th-12th grade. Our annual contest is designed to empower youth to share their concerns, ideas, and solutions. Cash prizes up to $500 are available. Submissions must be sent on or before March 15, 2024.

Using the questions below as a prompt, either write an essay or create a piece of artwork.

Prompt: Social Media and Its Impact on Mental Health & Relationships

How has social media affected your mental health? How does social media contribute to or hinder your relationships?

Entries can be submitted in any language !

Essays: Tell a powerful story in 250 to 500 words, using personal experiences.

Art/Videos: Tell a powerful story through original art and include an artist statement. Can be submitted on a poster, digital media, a 1-2 minute video, or any other creative form.

Entry Instructions:

Do not include your name or school on your essay or media. Instead, attach a separate sheet and include your name, email, address, school, grade, and teacher’s name.

Mail submissions to: Mental Health America of the Northern Suburbs, c/o Turning Point, 8324 Skokie Blvd., Skokie, IL 60077

OR Email to: [email protected]

All personal information is kept confidential. Entries become property of Mental Health America of the Northern Suburbs (MHANS) and may be published with the author’s permission. Winners will be selected by a panel of judges.

Eligibility:

Students submitting essays should be in grades 6 through 12 living going to school in Illinois. Students do not need to be US citizens or have legal status in the US to be eligible to submit essays.

MHANS Essay Contest Winners Ceremony

On April 28th at 2PM at the Morton Grove Public Library in Baxter Auditorium we will be honoring the essay contest winners! If you win, you will be contacted with a formal invitation.

Questions? Email [email protected]

We thank the 2024 Essay and Multimedia Contest Sponsor, Yellowbrick .

As youths grapple with climate anxiety, they turn to activism, education for hope

As a child, Stephanie Salgado Altamirano would rush to the shores of Omoa on her semi-annual family visits, a secluded beach in her home country of Honduras. It felt like her family’s precious secret. 

But the beach grew more crowded each year — not with people, but junk. 

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Altamirano and her family started to wear shoes on the beach to avoid the needles and plastic jutting out of the sand. She’d always try to clean the beach, but it was too much for one child. And the next day, the junk was there again.

“That was the first time I can actually remember feeling hopeless and powerless,” Altamirano, 22, said, her voice strained with emotion. “Not being able to get back to how it was originally, because it was out of our control, was hard to hear as an 8-year-old. It was heartbreaking.”

Years later, as a student at Vel Phillips Memorial High School in Madison, Altamirano would understand that the problems tainting Omoa Beach — and the lack of potable water, Honduras’ deadly hurricanes and the rise of painful diseases like chikungunya virus and dengue fever — were all connected to climate change.

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“I remember thinking, ‘My God, where are we headed, and why are people not paying attention?’” Altamirano said.

Altamirano isn’t alone in that line of questioning, a jolting one that elicits fear, anxiety and existential worry for the future. 

Youth, in general, are stressed about the climate, exhibiting signs of “climate anxiety.” 

The term refers to the negative emotions people feel when they think about climate change, according to Judy Braus, the executive director of the North American Association for Environmental Education. It affects everyone differently and can lead to depression, the inability to act, anger or hopelessness.

“The climate anxiety piece is worrying about climate to the point where it's affecting your ability to actually respond in a positive way,” Braus said. 

A 2022 national survey by EdWeek Research Center found that 37% of 14- to 18-year-olds are anxious when they think about climate change. About 34% said they feel afraid, and 30% said they feel helpless. 

What's more, certain populations of children are even more vulnerable to climate change-related mental health struggles due to poverty, racism, gender, disability and other factors, according to a 2023 report from the American Psychological Association .

In Wisconsin, climate change is top of mind for young people, up there with political division and gun violence, according to a 2023 report from Wisconsin State Office of Children’s Mental Health .

One of the key ways to help youths navigate these complex feelings about climate change is to talk about them, according to Braus.

That’s where environmental education comes in: helping youth understand the environment and their ability to make a difference. 

Environmental education gives students knowledge and agency to make change

Environmental education is not new to Wisconsin. It was one of the first states to have standards, which were established in 1935. While the standards have changed since the 1930s, students today learn about the relationships between natural and cultural systems and the effects humans have on those systems.

In fact, the Badger State is the birthplace of Earth Day, celebrated for the first time in 1970 , after state Sen. Gaylord Nelson suggested a day devoted to environmental education to become better stewards. Earth Day is celebrated each year on April 22.

At Fox River Academy, an environmental charter school in Appleton , environmental education is woven into virtually all aspects of students’ learning. 

More: Three Milwaukee area schools honored by U.S. Department of Education for environmental work

More: Milwaukee area school districts are using the great outdoors to further student learning

While the school teaches that climate change is happening, it tries not to take a doom-and-gloom approach, focusing instead on what’s being done through individual actions or environmental policies to combat it.

"We make changes as individuals through knowledge, how powerful knowledge is, and then sharing that knowledge," said Joann Kasper, a teacher at Fox River Academy.

On a dreary Thursday afternoon, Kasper's middle schoolers headed to the woodsy expanse behind their classroom to “nature journal” — drawing and observing natural phenomena occurring around them, hypothesizing what natural event took place.

Skyler Ayres, a sixth-grader, busily sketched the roots of a great oak. She suspected a hole beneath its roots was the den of “a very large chipmunk.”

Skyler has been receiving an environmental education since kindergarten. She loves nature so much it’s a struggle to pick her favorite thing about it. But if she had to choose, she’d say it's animals, especially endangered species. 

“I love animals for their beauty and their impact on the ecosystem,” Skyler said. “Animals need to eat other animals so they can survive. Once they die, they go into the soil, and that helps the soil so other things can grow better. It’s the circle of life.”

Humans have done a lot of harm to these precious ecosystems, Skyler said, and she’s worried about the continued effect deforestation will have on a system she admires. She isn’t as worried about how climate change will affect her, but she does worry about the animals.

She has some ideas about what humans can do to help them.

“If someone cuts down a tree, they should plant two trees,” Skyler said. “Cutting down trees takes away habitats and makes cities larger, which makes human things larger. More cars, more gas. So if you cut down a tree, plant two trees, so animals have a chance to survive.”

Moira Letourneaux and Madhumathi Sankar, sixth-graders at Fox River Academy, said they're nervous about the future of the climate. But, like Skyler, they have hope.

“I hope factories come less and less, and then pollution will become less and less and then the world will become good again,” Moira said. 

If they could fix one thing about the environment, it would be the people. 

“The people are the reason that this happened,” according to Moira.

But sometimes people don’t listen when it comes to the environment, Madhumathi said. She said she can get people to pay attention by showing them what to do, like respecting the outdoors. And if enough people show each other what to do, people can make a lot of change.

More: Hundreds of Wisconsin schools are teaching with a focus on environmental education

“If you believe in them, that is,” she said. 

"One piece of plastic —" Moira said. “Can make a whole change,” Madhumathi added, finishing her friend’s sentence.

Connecting with nature has profound impacts on youth mental health

Climate anxiety isn’t necessarily on the minds of younger kids yet. But environmental education can still have profound effects on their mental health. 

Green Bay mother Leah Weakley has a first-grader, Emerson, who attends the environmental school Wequiock Elementary. Students get hands-on environmental instruction like tending gardens and raising chickens on the school’s grounds. 

For Weakley, it’s important her kids get an environmental education because she doesn’t want them glued to their electronics. 

“I wanted to kind of break them of that and to make sure that they know when they’re stressed, there’s always nature,” she said.

While Weakley’s children aren’t experiencing climate anxiety, per se, they are developing connections to nature through their environmental education that positively affect their emotional well-being. 

Weakley’s daughter, Evelyn, attends Oak Learning Center, a half-day 4K program where students spend most of their time outdoors exploring nature. Evelyn, who previously wasn’t big on the outdoors, now loves being outside.

“She is my little nature girl now,” Weakley said. 

Spending time in nature has been linked to lower stress, improved attention, better mood and reduced risk of psychiatric disorders, according to the American Psychological Association.  

Having access to nature and green spaces also has a lasting effect on children. A study of over 900,000 Denmark residents between 1985 and 2003 found that children who had low exposure to green spaces were 55% more likely to develop a mental illness than children with abundant green space access.  

Jessica Medina is also a Wequiock parent with two sons, Jack and Austin, in third and first grades, respectively. 

Her sons are more active since they started attending Wequiock and are more likely to spend time outside than to play video games.

While she hasn’t talked with her sons about climate change, she does talk with them about the mental health benefits of being outside.

“I feel like it helps their mood,” Medina said. “I’m hoping in the future they still remember that like, ‘Hey, if you’re feeling down, go for a walk.’”

Activism helps youth channel their climate anxiety into positive community influence

Most 15-year-olds don’t find themselves at a long conference table holding energy executives accountable, but Isak Drangstveit, now 17, learned the power of activism from an early age.

Drangstveit has been part of green clubs since he was in middle school. Such clubs are voluntary groups that educate students on environmental issues and encourage them to take action to improve their environment.

As a student representing his green club, he had scheduled a meeting to ask Waunakee Utilities what steps it was taking to reduce its carbon footprint and expand renewable energy. At the meeting, Drangstveit felt intimidated. He wasn't prepared for the line of questions he was asked, and he felt like their seating him at this cartoonishly long table was part of a power move.

Drangstveit surprised himself in the end by pointing out that WPPI Energy — of which Waunakee Utilities is an executive member — produced more coal energy than the national average.

He realized that, for environmental changes to happen, "we need to talk to our politicians, especially if (energy executives) aren't going to move progress along," Drangstveit said. That meeting with Waunakee Utilities "broke everything loose" for him, even if that night didn't lead to any direct changes.

Drangstveit is one of thousands of youths pushing to make big and small changes in their communities. And Drangstveit knows all about that.

Drangstveit, a resident of Waunakee, grew up in Crandon, a hotbed for the decadeslong environmental activism in the battle over Exxon attempting to mine metallic sulfide . Crandon has become synonymous with the power of grassroots organizing after the town and tribal nations successfully fought to protect the land against the world’s largest energy company. In fact, Drangstveit's great-grandfather helped lead the charge in the successful fight against Exxon.

Drangstveit is young enough that the Crandon mines were the stuff of lore, but the stories have inspired him since he can remember. He remembers being in fifth-grade science when the concept of climate change took on a new and frightening meaning.

“All of a sudden I realized, like, ‘Wait a minute, the woods, which is pretty much my home, could die; it could go away in my lifetime,’” Drangstveit said. “That was an instant fear.” 

Fear quickly turned into action. 

In fifth grade, he petitioned to get the plastic water bottles sold in the school cafeteria removed. Although he was unsuccessful, he didn't beat himself up over it because "it never works the first time."

Then, he started a green club at his middle and intermediate schools. In high school, he joined the already-established group ECO, which stands for "environmentally compassionate organization.”

Eventually, he joined Action for the Climate Emergency , a national organization that educates and supports young people to get involved in climate solutions, and created a local chapter in Waunakee. And he petitioned the Waunakee Village Board to form a sustainability committee starting his sophomore year of high school.

The committee was not formed until February of this year, but in late March, the village president nominated Drangstveit to sit on that committee; his nomination is awaiting full board approval.

According to Braus, collective action through individual work is the ultimate goal of a climate education.

“It's really thinking about how … can you take action in your community? What can you do in your house and work (and) at school that can make a difference and contribute to a healthier world?” Braus said.

But action can also make people feel better about the future, said Linda Hall, director of the state Office of Children’s Mental Health. It’s something she and her team have noticed functions as an antidote to the sense of futility and betrayal so many young people associate with climate change.

“We’ve noticed that when students, especially high school and college students, feel they have agency to impact the world around them, that it contributes to their well-being,” Hall said. “In that process, youth are developing skills and social connections that will help them into adulthood.”

At 22, Altamirano is putting those skills to practice. Her anxiety has calmed since she started getting involved in climate change policies, but in high school, she felt apprehensive about the future. She didn’t see the point of going to college or having kids “if the planet was going to ruins anyway.” 

But she kept learning about her environment and what she could do. She started making connections between climate change, immigration and racial justice, all of which brought her back to her roots in Honduras. 

Those lessons came to a head when she organized and co-led Madison’s youth-led climate strike her senior year of high school in 2019.

“I think all that climate anxiety built up, and it just exploded in the best way possible,” Altamirano said. “Nobody could stop younger Stephanie.”

Not even her parents, who worried about their green card-carrying teenage daughter, could stop her from speaking on the steps of the state Capitol. But taking a cue from climate activist Greta Thunberg , she knew she couldn’t stay silent.

More than 1,000 students walked out of their classrooms as part of the youth climate strike on Sept. 20, 2019, an international day when thousands of students across the country and abroad participated in solidarity with Thunberg, who went on strike every Friday at her school to draw awareness to climate change.

“I realized the worst thing I could do with my anxiety was foster it, isolate it,” Altamirano said. “What always brings me back to hope now is my friends who are also doing the work, being passionate alongside me.”

Danielle DuClos is a Report for America corps member who covers K-12 education for the Green Bay Press-Gazette. Contact her at  [email protected] . Follow on Twitter  @danielle_duclos.  You can directly support her work with a tax-deductible donation at  GreenBayPressGazette.com/RFA  or by check made out to The GroundTruth Project with subject line Report for America Green Bay Press Gazette Campaign. Address: The GroundTruth Project, Lockbox Services, 9450 SW Gemini Drive, PMB 46837, Beaverton, Oregon 97008-7105 .

Natalie Eilbert covers mental health issues for USA TODAY NETWORK-Wisconsin. She welcomes story tips and feedback. You can reach her at  [email protected]  or view her Twitter profile at  @natalie_eilbert . If you or someone you know is dealing with suicidal thoughts, call the National Suicide Prevention Lifeline at 988 or text "Hopeline" to the National Crisis Text Line at 741-741.