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Mental health crises on the rise among US teenagers. What parents can watch for.

Charlotte Observer - 7/14/2022

Editor's note: This article addresses issues of mental and behavioral health, including depression, anxiety, self-harm and suicide.

"A national emergency."

That's what the American Academy of Pediatrics calls a recent increase in mental health crises among children and teens in the United States.

"It's unlike anything I've experienced in doing this for 20 years," said Gary Maslow, a child and adolescent psychologist at Duke University.

Maslow joined fellow Duke pediatric psychologist Nathan Copeland and professor Sharika Hill in a virtual discussion Wednesday to help parents and caregivers help children and teens facing anxiety, depression, self-harm and suicidal thoughts.

Youth suicide in 2019

More kids died by suicide in 2019 "than at any point in American history," said Copeland. In fact, suicide was the second leading cause of death among youth that year.

"Among the 10 to 24 age group, suicide accounted for nearly 25% of all death among kids," he said. "And among ... individuals 15 to 24, suicide accounted for more deaths than the next seven core medical causes combined."

Those causes include accidents, congenital issues, homicide, and cancer, according to the Center for Disease Control and Prevention.

"The worst outcome is children dying by suicide," Maslow said. "That is happening, but that is the tip of the iceberg."

Just as in many facets of health care, Black youth were among the most impacted by suicide in 2019.

"Where we were seeing things like systemic racism and how it was impacting Black youth, we were seeing that [suicide] rate increase faster for Black youth than for any other demographic.," Copeland said.

In Durham, Maslow added, Hispanic youth are also "presenting at much higher rates that we've seen before."

'Pediatric mental illness is common'

Nearly 1 in 5 youth will experience pediatric mental illness during their childhood, Copeland said.

People in this group often go undiagnosed and untreated for years, he said. It can take five to 11 years for a child to get treatment for mental health and behavioral issues from the moment they start experiencing symptoms.

"For a kid that's a significant 11 years," he said. "That's a long period of time that a kid has been experiencing mental illness."

What's more, only 20% of youth experiencing mental illness end up receiving the potentially life-saving care that they need.

Academic pressure and school in general also fuel "peer victimization" and bullying, Copeland said.

"In Durham, what we frequently see or what we have seen is that when school starts, compared to when kids are on break, there is a 60% increase in rates of pediatric mental health emergency department visits," he said.

Copeland said, before the pandemic, "mental illness was the most common cause of drop out in school of any disability group."

'Outcomes from the pandemic'

While there mental health crises among children and teens were up even before the pandemic, Hill said COVID-19 has made things worse.

Copeland agreed.

"We saw increased loneliness. Increased isolation. Increased parental distress. Increased substance abuse disorders across the entire population," he said. "The murder of George Floyd exacerbating racial trauma and highlighting the systemic racism that so many individuals experience. And we've just seen that temperature rise."

Data show a nearly two-fold increase in depressive and anxiety symptoms among children and adolescents, he said.

"Nearly 20% of kids experiencing depression that's impairing them, nearly 25 percent of kids experiencing anxiety that's impairing them. And I fully believe the full outcomes that we're going to see -- the outcomes from the pandemic -- we're going to continue to learn over time."

On the academic front, Maslow said the switch to virtual learning and losing direct connections also hurt.

"In North Carolina, more than 3,000 children have lost a caregiver due to COVID," he said.

What can parents and caregivers do?

Copeland, Maslow and Hill shared tips on how parents and caregivers can help.

Make sure you, the parent or caregiver, feel supported and well: "The notion for parents, for caregivers, for teachers, is to put on your own oxygen mask first," Maslow said. "From a prevention side, supporting teachers, supporting parents, camp counselors, the people on the front lines of supporting kids, if we go back to what we really need, that's the place to start."

Ask kids if they're feeling sad or worried: "While it can be difficult for parents, I think there needs to be a role for bringing up suicidal ideation or suicidal thoughts," Copeland said.

Watch for increased irritability and anger. "If you have a kid that is having difficulty in other ways ... consider, could there be some other condition going on?" Copeland said.

Talk to your child's primary care provider: "A pediatrician, a family doctor, a nurse practitioner, that's a really good place to start. Primary care providers see 70% of mental health visits in the country," Maslow said.

Don't self-diagnose your child. If you are concerned about their well-being, seek professional help: "There are different behavioral patterns a parent might recognize as being specific to a child," Hill said. "Talking to a provider can help them realize what is actually abnormal or a clinical event."

Pay attention: "If you have a teenager that has always been a straight-A student or has done relatively well in school and is isolating more but they are still doing relatively well in school and are still engaged in the activities they enjoy doing, that's when our concerns are a little bit less," Copeland said. "When you start seeing from lots of different angles that your teenager is getting worse, that's when we really start worrying."

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