The Washington PostDemocracy Dies in Darkness

A youth mental health crisis was already brewing. The pandemic made it worse, surgeon general says.

U.S. Surgeon General Vivek H. Murthy takes questions Dec. 6 after visiting the King/Drew Magnet High School of Medicine and Science in Los Angeles. (Damian Dovarganes/AP)

The situation painted across the U.S. surgeon general’s 53-page advisory is dire.

Compared with 2019, emergency room visits for suicide attempts rose 51 percent for adolescent girls in early 2021. Among boys, there was a four percentage point increase. Depression and anxiety doubled during the coronavirus pandemic, with 25 percent of youths experiencing depressive symptoms and 20 percent suffering anxiety symptoms, according to the report published Tuesday.

“It would be a tragedy if we beat back one public health crisis only to allow another to grow in its place,” U.S. Surgeon General Vivek H. Murthy wrote in an advisory published on Tuesday. “Mental health challenges in children, adolescents, and young adults are real, and they are widespread. But most importantly, they are treatable, and often preventable.”

Combined with an uptick in gun violence, a reckoning on racial justice, a climate emergency and a divisive political landscape, the coronavirus-related hardships have taken a toll on young Americans’ mental health at a time when it was already in decline. More people seeking help have strained the ability of practitioners to provide treatment, underscoring, experts say, the need to radically change how mental health is addressed in the United States.

For young people across the country, the pandemic has taken away milestone events and the semblance of normal life. Professors speaking from their screens supplant in-person classes. Watching players tumble behind a ball on the television replaces football games at packed stadiums. Gatherings have become smaller, confined to a bubble of friends. Study abroad, a lingering question.

“I acknowledge the privilege of being able to go to college, and I know so many people have suffered through worse things, but there’s also this feeling of ‘this is supposed to be the greatest time of my life’ and I’m sitting in my room staring at a computer,” said 20-year-old Isabelle Schindler, a junior at the University of Michigan.

Having struggled with anxiety before going to college, Schindler said, she already had a support system on which she could rely. But the coronavirus put a dent in her expectations and dreams, and that has made it all the more difficult to cope. The burden ripples through her classroom, she said, where other students share a similar lack of motivation, loneliness and a feeling of being burned out that have prompted experts to sound the alarms.

“The uncertainty can be crushing,” she said. “It’s like, I have to do this homework assignment, but every time when I go on Twitter, there’s something horrible going on. It just feels difficult to, like, reconcile those two things and sort of compartmentalize it.”

A survey conducted by the Associated Press-NORC Center for Public Affairs Research found that a higher proportion of Americans between the ages of 13 and 24, often referred to as Generation Z, say the pandemic has made their education, career goals and social lives more difficult — with uncertainty about the pandemic and fear of infection among the top sources of stress.

Gen Z most stressed by coronavirus, citing pandemic toll on careers, education and relationships, poll says

While the pandemic has served to worsen mental well-being, a crisis was already brewing before shutdowns and social distancing first emerged, said Mitch Prinstein, chief science officer for the American Psychological Association (APA).

“We were in a hole and now we just dug it a little bit deeper,” he told The Washington Post. “Suicide already was the second leading cause of death for children. We had already seen pretty high levels of substance use, depression and violent behavior. But the pandemic has been a perfect storm of a stressor, which we know leads to really notable increases in psychological symptoms among kids.”

By sharing her brother’s story, Hannah Zang hopes to normalize seeking help for mental health problems, which for many has been exacerbated by the pandemic. (Video: Joy Yi/The Washington Post)

Pandemic-related safety measures, while necessary to curb the spread of the virus, resulted in missed interactions. At the same time, increased time spent on social media deepened the chasm of isolation felt by so many, said Prinstein — a paradox, considering the digital age has increased connectivity.

“We’re seeing a real reduction in emotional intimacy among kids because so much of their communication is now electronical,” he said. “So there’s not an opportunity for disclosure and support and feeling like you’re able to really represent yourself in an authentic way.”

Mental health among the younger generation does not carry the same stigma it has in the past. Self-reports of depression and anxiety have increased, while the subject has been more openly discussed and assessed. Still, in a world where 1 in 7 people between 10 and 19 years old experiences a mental disorder, according to the World Health Organization, not all are able to access the help they need.

The pandemic allowed practitioners to provide services remotely, but demand has increased at a faster pace. An October survey by the APA found that waiting lists and referrals have nearly doubled, while 41 percent of psychologists reported being unable to treat all of their patients. Compared with last year, the number of psychologists reporting an increase in demand for anxiety treatment rose by 10 percentage points and for depression treatment by 12 percentage points.

Additionally, Prinstein said, a “tiny fraction” of federal funds “is used to really invest in our mental health workforce and, unfortunately, now we’re paying for that disparity because we see that we just don’t have the workforce available.”

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With no timetable on the horizon for the end of a pandemic that has upended lives and killed over 788,000 in the United States, the surgeon general’s advisory calls for rapid action, encouraging more resources and urging a greater acknowledgment of mental health as a vital component in overall well-being.

For Prinstein, the “moment to demand change,” as Murthy’s report implores, necessitates the focus to shift from acknowledging mental health problems at their onset to preventing them in the first place.

“We need to put psychological fluoride in the water,” Prinstein said. “Just like we teach people to eat low-fat food and exercise, we need to help people develop the skills so there’s resilience against stress before it even occurs.”

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