causes of mental illness in youth essay

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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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• 07 October 2021

Young people’s mental health is finally getting the attention it needs

You have full access to this article via your institution.

A kite-flying festival in a refugee camp near Syria’s border with Turkey. The event was organized in July 2020 to support the health and well-being of children fleeing violence in Syria. Credit: Muhammed Said/Anadolu Agency/Getty

Worldwide, at least 13% of people between the ages of 10 and 19 live with a diagnosed mental-health disorder, according to the latest State of the World’s Children report , published this week by the United Nations children’s charity UNICEF. It’s the first time in the organization’s history that this flagship report has tackled the challenges in and opportunities for preventing and treating mental-health problems among young people. It reveals that adolescent mental health is highly complex, understudied — and underfunded. These findings are echoed in a parallel collection of review articles published this week in a number of Springer Nature journals.

Anxiety and depression constitute more than 40% of mental-health disorders among young people (those aged 10–19). UNICEF also reports that, worldwide, suicide is the fourth most-common cause of death (after road injuries, tuberculosis and interpersonal violence) among adolescents (aged 15–19). In eastern Europe and central Asia, suicide is the leading cause of death for young people in that age group — and it’s the second-highest cause in western Europe and North America.

Collection: Promoting youth mental health

Sadly, psychological distress among young people seems to be rising. One study found that rates of depression among a nationally representative sample of US adolescents (aged 12 to 17) increased from 8.5% of young adults to 13.2% between 2005 and 2017 1 . There’s also initial evidence that the coronavirus pandemic is exacerbating this trend in some countries. For example, in a nationwide study 2 from Iceland, adolescents (aged 13–18) reported significantly more symptoms of mental ill health during the pandemic than did their peers before it. And girls were more likely to experience these symptoms than were boys.

Although most mental-health disorders arise during adolescence, UNICEF says that only one-third of investment in mental-health research is targeted towards young people. Moreover, the research itself suffers from fragmentation — scientists involved tend to work inside some key disciplines, such as psychiatry, paediatrics, psychology and epidemiology, and the links between research and health-care services are often poor. This means that effective forms of prevention and treatment are limited, and lack a solid understanding of what works, in which context and why.

This week’s collection of review articles dives deep into the state of knowledge of interventions — those that work and those that don’t — for preventing and treating anxiety and depression in young people aged 14–24. In some of the projects, young people with lived experience of anxiety and depression were co-investigators, involved in both the design and implementation of the reviews, as well as in interpretation of the findings.

Quest for new therapies

Worldwide, the most common treatment for anxiety and depression is a class of drug called selective serotonin reuptake inhibitors, which increase serotonin levels in the brain and are intended to enhance emotion and mood. But their modest efficacy and substantial side effects 3 have spurred the study of alternative physiological mechanisms that could be involved in youth depression and anxiety, so that new therapeutics can be developed.

Mental health: build predictive models to steer policy

For example, researchers have been investigating potential links between depression and inflammatory disorders — such as asthma, cardiovascular disease and inflammatory bowel disease. This is because, in many cases, adults with depression also experience such disorders. Moreover, there’s evidence that, in mice, changes to the gut microbiota during development reduce behaviours similar to those linked to anxiety and depression in people 4 . That suggests that targeting the gut microbiome during adolescence could be a promising avenue for reducing anxiety in young people. Kathrin Cohen Kadosh at the University of Surrey in Guildford, UK, and colleagues reviewed existing reports of interventions in which diets were changed to target the gut microbiome. These were found to have had minimal effect on youth anxiety 5 . However, the authors urge caution before such a conclusion can be confirmed, citing methodological limitations (including small sample sizes) among the studies they reviewed. They say the next crop of studies will need to involve larger-scale clinical trials.

By contrast, researchers have found that improving young people’s cognitive and interpersonal skills can be more effective in preventing and treating anxiety and depression under certain circumstances — although the reason for this is not known. For instance, a concept known as ‘decentring’ or ‘psychological distancing’ (that is, encouraging a person to adopt an objective perspective on negative thoughts and feelings) can help both to prevent and to alleviate depression and anxiety, report Marc Bennett at the University of Cambridge, UK, and colleagues 6 , although the underlying neurobiological mechanisms are unclear.

In addition, Alexander Daros at the Campbell Family Mental Health Institute in Toronto, Canada, and colleagues report a meta-analysis of 90 randomized controlled trials. They found that helping young people to improve their emotion-regulation skills, which are needed to control emotional responses to difficult situations, enables them to cope better with anxiety and depression 7 . However, it is still unclear whether better regulation of emotions is the cause or the effect of these improvements.

Co-production is essential

It’s uncommon — but increasingly seen as essential — that researchers working on treatments and interventions are directly involving young people who’ve experienced mental ill health. These young people need to be involved in all aspects of the research process, from conceptualizing to and designing a study, to conducting it and interpreting the results. Such an approach will lead to more-useful science, and will lessen the risk of developing irrelevant or inappropriate interventions.

Science careers and mental health

Two such young people are co-authors in a review from Karolin Krause at the Centre for Addiction and Mental Health in Toronto, Canada, and colleagues. The review explored whether training in problem solving helps to alleviate depressive symptoms 8 . The two youth partners, in turn, convened a panel of 12 other youth advisers, and together they provided input on shaping how the review of the evidence was carried out and on interpreting and contextualizing the findings. The study concluded that, although problem-solving training could help with personal challenges when combined with other treatments, it doesn’t on its own measurably reduce depressive symptoms.

The overarching message that emerges from these reviews is that there is no ‘silver bullet’ for preventing and treating anxiety and depression in young people — rather, prevention and treatment will need to rely on a combination of interventions that take into account individual needs and circumstances. Higher-quality evidence is also needed, such as large-scale trials using established protocols.

Along with the UNICEF report, the studies underscore the transformational part that funders must urgently play, and why researchers, clinicians and communities must work together on more studies that genuinely involve young people as co-investigators. Together, we can all do better to create a brighter, healthier future for a generation of young people facing more challenges than ever before.

Nature 598 , 235-236 (2021)

doi: https://doi.org/10.1038/d41586-021-02690-5

Twenge, J. M., Cooper, A. B., Joiner, T. E., Duffy, M. E. & Binau, S. G. J. Abnorm. Psychol. 128 , 185–199 (2019).

Article   PubMed   Google Scholar  

Thorisdottir, I. E. et al. Lancet Psychiatr. 8 , 663–672 (2021).

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Murphy, S. E. et al. Lancet Psychiatr. 8 , 824–835 (2021).

Murray, E. et al. Brain Behav. Immun. 81 , 198–212 (2019).

Cohen Kadosh, K. et al. Transl. Psychiatr. 11 , 352 (2021).

Bennett, M. P. et al. Transl Psychiatr. 11 , 288 (2021).

Daros, A. R. et al. Nature Hum. Behav . https://doi.org/10.1038/s41562-021-01191-9 (2021).

Krause, K. R. et al. BMC Psychiatr. 21 , 397 (2021).

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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.

Get the latest MHFA blogs, news and updates delivered directly to your inbox so you never miss a post.

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• 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.

Peer Review reports

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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L.B and L.H conducted the literature search and scanned the abstracts. L.B drafted the manuscript, figures, and tables. All (L.B, L.H., S.H.) authors discussed and wrote the results, as well as the discussion. All authors reviewed the manuscript.

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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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The Morning

A fresh approach to a crisis.

A group of researchers posited another explanation for the youth mental health crisis: Too much discussion.

By Ellen Barry

She covers mental illness.

For years now, policymakers have sought an explanation for the mental health crisis among young people. Suicide attempts and psychiatric hospitalizations were rising even before the pandemic. Then the rates of anxiety and depression doubled worldwide.

Why is this happening? The social psychologist Jonathan Haidt points to smartphones, and the algorithms that draw kids away from healthy play and into dangerous, addictive thought loops. No, his critics say. The real problem is a grim social landscape of school shootings, poverty and global warming. Or academic pressure. Or insufficient health care.

A group of researchers in Britain now propose another, at least partial, explanation: We talk about mental disorders so much. I cover this notion in a story The Times published today .

This hypothesis is called “prevalence inflation.” It holds that our society has become so saturated with discussion of mental health that young people may interpret mild, transient suffering as symptoms of a medical disorder.

This is a problem, they say, because identifying with a psychiatric diagnosis may not be helpful. Students who self-label as anxious or depressed are more likely than similar students who don’t self-label to view themselves as powerless over the disorder, recent studies have shown. They may respond by avoiding stressful situations like parties or public speaking, which could make their problems worse.

One of the psychologists behind the prevalence inflation theory, Lucy Foulkes of the University of Oxford, traces her skepticism back to 2018, when she began teaching undergraduates. They were “bombarded” with messages warning that they might be in crisis, she said. “It seemed like the more we were trying to raise awareness about it, it wasn’t getting better, and in fact, it only seemed to be getting worse.”

She grew critical of curricula that teach children to recognize and manage their emotions, sometimes referred to as social emotional learning. Schools have introduced an array of programs, teaching children the basics of techniques like mindfulness and cognitive behavioral therapy, which have proved beneficial in adults.

Several recent studies have found lackluster or negative effects for students who received trainings, especially those who started out with more severe symptoms. That evidence has done little to dampen their popularity, Foulkes said.

An urgent need

Many experts in the field of adolescent mental health defend awareness campaigns and school-based trainings. “Especially with teens, we need more universal interventions, not less,” said Zachary Blumkin, a child psychologist at Columbia University Irving Medical Center.

The main reason, they say, is that traditional, one-on-one therapy and psychiatric care is not easily available. Teenagers in crisis can wait months to see a clinician. They often land in emergency rooms as a last resort.

For that reason, the field has gravitated toward preventive models. These teach all students — not just the troubled ones — to manage distressing emotions. A 2023 meta-analysis of 252 such programs concluded that, generally, children benefit from them. There is also promise in a more tailored approach , one that lets schools focus on kids with the most acute needs.

Some experts also disagree that over-diagnosis is a problem.

Andrew Gerber, a child psychiatrist, says we should think of mental illness as a spectrum: Disorders like anxiety or depression occur in a bell curve distribution, so they’re more like hypertension than appendicitis. And like hypertension, he said, they’re worth treating early in their progression, with medication and therapy. “Anyone who tries to define a sharp line between ‘real’ illness and what is not real, no matter where they put the line, is doomed to get it wrong and do damage in the process,” said Gerber, the president and medical director at Silver Hill Hospital in New Canaan, Conn.

Foulkes disagrees. Even when we have good treatments, we’re bad at identifying whose disorder is likely to deteriorate, she said. And some children struggle because something is wrong at home, like domestic abuse or poverty or bullying. Mindfulness trainings are unlikely to help these kids.

“A lot of the time, what’s causing the problem is not something that’s going to improve with medication or therapy,” she said. “You’re running the risk of just telling people they have a problem without helping alleviate it.”

A generation is growing up fluent in the language of mental health, something that will benefit teens who badly need treatment. But others may apply medical diagnoses to the painful, normal adversity of growing up.

The “prevalence inflation” hypothesis asks us to keep an eye on those excesses. People hurt after breakups and struggle to adjust to new schools; negative feelings aren’t always a sign of mental illness. They can even teach us resilience.

Rates of mental health disorders are rising among American adolescents. Read one 13-year-old’s story .

There aren’t always enough resources to support teenagers’ mental health. As schools search for solutions, some student-led clubs step in .

Are smartphones driving teenagers to depression? It’s complicated , writes David Wallace-Wells in Times Opinion.

THE LATEST NEWS

Israel-hamas war.

The Israeli military said it was asking tens of thousands of Gazans sheltering in eastern Rafah to temporarily evacuate to what it described as a humanitarian zone.

Hamas claimed responsibility for a rocket attack that Israeli officials said killed three soldiers and left three more critically wounded.

Israel moved to shut down local operations of Al Jazeera , a Qatar-based news outlet.

Cease-fire talks between Israel and Hamas are at an impasse. The main obstacle is the duration of a pause.

Four children from Gaza arrived in the U.S. to receive urgent medical treatment . They were greeted at Kennedy Airport with toys and balloons.

Campus Protests

U.C.L.A. said that it would resume in-person classes today and that it had created a new campus security office .

New York Magazine and the Columbia student newspaper surveyed the campus about the protests . More than 60 percent of respondents said they had views on the conflict they avoided saying publicly.

More college professors — many of whom came of age during the era of Vietnam War protests — are joining student demonstrations , The Wall Street Journal reports.

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Around Shanghai, women gather in bars and bookstores to debate their place in a country ruled by men.

Panamanians elected José Raúl Mulino, a former public security minister, as their next president .

Paris committed to making the Olympics more accessible for people with disabilities. Advocacy groups are concerned that the city remains unprepared .

In the 19th century, Belgian troops decapitated a Congolese leader and took his skull as a trophy. The leader’s descendants are struggling to have his remains returned .

Kim Godwin, the first Black woman to run a broadcast news division, said she would step down as president of ABC News after a tumultuous tenure.

Sony and the private equity firm Apollo are in talks to acquire Paramount .

Other Big Stories

New York City’s congestion pricing program aims to generate $15 billion for the mass transit system, but lawsuits threaten that windfall .

In Florida, Chinese residents expressed frustration with a new law that prohibits many Chinese citizens from buying homes in the state because of national security concerns.

We should welcome the emergence of this year’s cicadas with wonder, Margaret Renkl writes.

Ross Douthat suggests books and essays that could improve the intellectual diversity of university curricula.

Gail Collins and Bret Stephens discuss campus protests and Donald Trump .

Here are columns by Maureen Dowd on the three faces of Trump and Thomas Friedman on Israel and Saudi Arabia .

MORNING READS

Community: For generations of immigrants, Sunday soccer in a park in Queens is more than a game .

Health: Ultraprocessed foods are linked to poor health. But what are they exactly?

Loneliness: Social connection experts offer advice on cultivating a sense of belonging .

Ask Vanessa: “How do I know if my untucked shirt is too long?”

Kocktails: As nonalcoholic cocktails become a staple on American menus, some children have begun to partake .

Metropolitan Diary: A necklace rescue in Midtown .

Lives Lived: Bernard Hill was a British actor who incarnated humble masculine leadership as Capt. Edward J. Smith in “Titanic” and as Théoden, the king of Rohan, in two “Lord of the Rings” films. He died at 79 .

Formula One: McLaren’s Lando Norris secured his first victory at the Miami Grand Prix .

No punches pulled: At a live Netflix comedy roast, former Patriots players and Kevin Hart among others roasted Tom Brady about his divorce and Deflategate.

N.H.L.: The Dallas Stars eliminated the defending Stanley Cup champion Las Vegas Golden Knights in a thrilling 2-1 Game 7 win .

N.B.A.: Donovan Mitchell’s 24 second-half points led the Cleveland Cavaliers to a comeback win in their own Game 7 against the Orlando Magic.

ARTS AND IDEAS

The artist Frank Stella, who helped usher in the Minimalist movement of the 1960s, died on Saturday at 87. His career began during the Eisenhower era, when artistic tendencies — much like ideas about gender and sexuality — fell into fixed categories: one was either a figurative artist or an abstract one. Things changed, the critic Deborah Solomon writes, but Stella did not. “He never stopped insisting on the inherent superiority of abstract painting,” she adds. Read her full appraisal of Stella .

More on culture

Madonna ended her retrospective Celebration Tour with a free show in Rio de Janeiro, which was attended by an estimated 1.6 million people .

Trying to find your own song of the summer? Vulture has published a bracket to sort through this year’s pop deluge.

The HBO series “The Sympathizer” is a rebuttal to a Hollywood staple. It is its own Vietnam War movie and a detailed work of film criticism , James Poniewozik writes.

Over the weekend, “The Fall Guy,” starring Ryan Gosling, earned only $28.5 million . It is Hollywood’s lowest start to the summer box office season since 1995.

THE MORNING RECOMMENDS …

Make Dolester Miles’s famous coconut pecan cake .

Watch the Met Gala red carpet tonight.

Stargaze with a telescope for beginners .

Clear your phone’s camera roll .

Take our news quiz .

Here is today’s Spelling Bee . Yesterday’s pangram was maypole .

And here are today’s Mini Crossword , Wordle , Sudoku , Connections and Strands .

Thanks for spending part of your morning with The Times. See you tomorrow.

Correction: Yesterday’s newsletter named two different Kentucky Derby winners. The winner was Mystik Dan, not Sierra Leone.

Sign up here to get this newsletter in your inbox . Reach our team at [email protected] .

Ellen Barry is a reporter covering mental health for The Times. More about Ellen Barry

Home — Essay Samples — Nursing & Health — Mental Health — Teenage Mental Health: The Increase in Mental Illnesses

Teenage Mental Health: The Increase in Mental Illnesses

• Categories: Adolescence Mental Health

About this sample

Words: 834 |

Published: Jul 17, 2018

Words: 834 | Pages: 2 | 5 min read

Table of contents

Mental health essay outline, mental health essay example, introduction.

• Introduction to the mental health challenges faced by today's adolescents

Rising Rates of Depression and Anxiety

• Statistics on the increasing rates of depression and anxiety in teenagers Alarming consequences of mental health issues in adolescents

Causes of Teenage Depression and Anxiety

• The role of high stress levels and perfectionism The impact of constant media exposure and unrealistic expectations

Impact of Social Media and Technology

• The influence of social media on self-worth and self-image
• The role of comparing oneself to idealized images

Multidimensional Perfectionism

• The role of high stress levels and perfectionism
• The impact of constant media exposure and unrealistic expectations

Constant Exposure to Negative News

• How access to news articles affects anxiety levels
• Fear of global issues and its impact on mental health

The Lack of Mental Health Support

• Inadequacy of the current system to help adolescents with mental illnesses
• The need for better training and support for academic staff

Call for Action

• The urgency of addressing these mental health issues
• The importance of implementing mental health safety nets for adolescents

Works Cited

• American Psychological Association. (2017). Stress in America: The state of our nation. Retrieved from https://www.apa.org/news/press/releases/stress
• Bor, W., Dean, A. J., Najman, J., & Hayatbakhsh, R. (2014). Are child and adolescent mental health problems increasing in the 21st century? A systematic review. Australian & New Zealand Journal of Psychiatry, 48(7), 606-616.
• Brown, B. B., Larson, J., & Saraswathi, T. S. (2002). The world's youth: Adolescence in eight regions of the globe. Cambridge University Press.
• Cappelli, P. (2019). The anxious organization: Why smart companies do dumb things. Oxford University Press.
• Choukas-Bradley, S., Giletta, M., Cohen, G. L., & Prinstein, M. J. (2015). Peer influence, peer status, and prosocial behavior: An experimental investigation of peer socialization of adolescents' intentions to volunteer. Journal of Youth and Adolescence, 44(12), 2197-2210.
• Hunt, J., & Eisenberg, D. (2010). Mental health problems and help-seeking behavior among college students. Journal of Adolescent Health, 46(1), 3-10.
• McGorry, P. D., Purcell, R., Goldstone, S., & Amminger, G. P. (2011). Age of onset and timing of treatment for mental and substance use disorders: Implications for preventive intervention strategies and models of care. Current Opinion in Psychiatry, 24(4), 301-306.
• National Alliance on Mental Illness. (n.d.). Mental health facts: Children & teens. Retrieved from https://www.nami.org/Get-Involved/Awareness-Events/Children-s-Mental-Health-Awareness-Week
• O'Connor, R. C., Pirkis, J., Cox, G. R., & The International COVID-19 Suicide Prevention Research Collaboration. (2020). The International COVID-19 suicide prevention research collaboration: Protocol for a meta-analysis of suicidal thoughts and behaviours in the context of COVID-19. International Journal of Mental Health Systems, 14(1), 1-6.
• Twenge, J. M., Cooper, A. B., Joiner, T. E., Duffy, M. E., & Binau, S. G. (2019). Age, period, and cohort trends in mood disorder indicators and suicide-related outcomes in a nationally representative dataset, 2005-2017. Journal of Abnormal Psychology, 128(3), 185-199.

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Science News

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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Home Mental Health Information

• What causes mental illness?

Most mental illnesses don’t have a single cause. Instead they have a variety of causes, called risk factors . The more risk factors you have, the more likely you are to develop a mental health condition. Sometimes, mental illness develops gradually. Other times, it doesn’t appear until a stressful event triggers it.

There are many risk factors and triggers, but here are a few examples:

• Genetics. Mental illness often runs in the family.
• Environment. Living in a stressful environment can strain your mental health. Things like living in poverty or having an abusive family put a lot of stress on your brain and often trigger mental health concerns.
• Stressful events: like losing a loved one, or being in a car accident.
• Childhood trauma. Even if you’re no longer in a stressful environment, things that happened to you as a child can have an impact later in life. Complex PTSD is one particularly common mental health condition among people who grew up in abusive or neglectful environments.
• Negative thoughts. Constantly putting yourself down or expecting the worst can get you stuck in a cycle of depression or anxiety.
• Unhealthy habits: like not getting enough sleep, or not eating.
• Drugs and alcohol: Abusing drugs and alcohol can be bad for your mental health. It can also make it harder to recover from mental illness.
• Brain chemistry. Mental illness often involves an imbalance of natural chemicals in your brain and your body.

These risk factors don’t just affect who will develop a mental illness in the first place. They also affect how severe their symptoms will be, and when they will experience those symptoms.

You can also improve your own mental health by taking action to reduce your risk factors . That might include seeking treatment, like medication or therapy .

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• What is mental illness?
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• What mental illness do I have?
• How common is mental illness?
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Mental Health Essay

Introduction

Mental health, often overshadowed by its physical counterpart, is an intricate and essential aspect of human existence. It envelops our emotions, psychological state, and social well-being, shaping our thoughts, behaviors, and interactions. With the complexities of modern life—constant connectivity, societal pressures, personal expectations, and the frenzied pace of technological advancements—mental well-being has become increasingly paramount. Historically, conversations around this topic have been hushed, shrouded in stigma and misunderstanding. However, as the curtains of misconception slowly lift, we find ourselves in an era where discussions about mental health are not only welcomed but are also seen as vital. Recognizing and addressing the nuances of our mental state is not merely about managing disorders; it's about understanding the essence of who we are, how we process the world around us, and how we navigate the myriad challenges thrown our way. This essay aims to delve deep into the realm of mental health, shedding light on its importance, the potential consequences of neglect, and the spectrum of mental disorders that many face in silence.

Importance of Mental Health

Mental health plays a pivotal role in determining how individuals think, feel, and act. It influences our decision-making processes, stress management techniques, interpersonal relationships, and even our physical health. A well-tuned mental state boosts productivity, creativity, and the intrinsic sense of self-worth, laying the groundwork for a fulfilling life.

Negative Impact of Mental Health

Neglecting mental health, on the other hand, can lead to severe consequences. Reduced productivity, strained relationships, substance abuse, physical health issues like heart diseases, and even reduced life expectancy are just some of the repercussions of poor mental health. It not only affects the individual in question but also has a ripple effect on their community, workplace, and family.

Mental Disorders: Types and Prevalence

Mental disorders are varied and can range from anxiety and mood disorders like depression and bipolar disorder to more severe conditions such as schizophrenia.

• Depression: Characterized by persistent sadness, lack of interest in activities, and fatigue.
• Anxiety Disorders: Encompass conditions like generalized anxiety disorder, panic attacks, and specific phobias.
• Schizophrenia: A complex disorder affecting a person's ability to think, feel, and behave clearly.

The prevalence of these disorders has been on the rise, underscoring the need for comprehensive mental health initiatives and awareness campaigns.

Understanding Mental Health and Its Importance

Mental health is not merely the absence of disorders but encompasses emotional, psychological, and social well-being. Recognizing the signs of deteriorating mental health, like prolonged sadness, extreme mood fluctuations, or social withdrawal, is crucial. Understanding stems from awareness and education. Societal stigmas surrounding mental health have often deterred individuals from seeking help. Breaking these barriers, fostering open conversations, and ensuring access to mental health care are imperative steps.

Conclusion: Mental Health

Mental health, undeniably, is as significant as physical health, if not more. In an era where the stressors are myriad, from societal pressures to personal challenges, mental resilience and well-being are essential. Investing time and resources into mental health initiatives, and more importantly, nurturing a society that understands, respects, and prioritizes mental health is the need of the hour.

• World Leaders: Several influential personalities, from celebrities to sports stars, have openly discussed their mental health challenges, shedding light on the universality of these issues and the importance of addressing them.
• Workplaces: Progressive organizations are now incorporating mental health programs, recognizing the tangible benefits of a mentally healthy workforce, from increased productivity to enhanced creativity.
• Educational Institutions: Schools and colleges, witnessing the effects of stress and other mental health issues on students, are increasingly integrating counseling services and mental health education in their curriculum.

In weaving through the intricate tapestry of mental health, it becomes evident that it's an area that requires collective attention, understanding, and action.

  Short Essay about Mental Health

Mental health, an integral facet of human well-being, shapes our emotions, decisions, and daily interactions. Just as one would care for a sprained ankle or a fever, our minds too require attention and nurture. In today's bustling world, mental well-being is often put on the back burner, overshadowed by the immediate demands of life. Yet, its impact is pervasive, influencing our productivity, relationships, and overall quality of life.

Sadly, mental health issues have long been stigmatized, seen as a sign of weakness or dismissed as mere mood swings. However, they are as real and significant as any physical ailment. From anxiety to depression, these disorders have touched countless lives, often in silence due to societal taboos.

But change is on the horizon. As awareness grows, conversations are shifting from hushed whispers to open discussions, fostering understanding and support. Institutions, workplaces, and communities are increasingly acknowledging the importance of mental health, implementing programs, and offering resources.

In conclusion, mental health is not a peripheral concern but a central one, crucial to our holistic well-being. It's high time we prioritize it, eliminating stigma and fostering an environment where everyone feels supported in their mental health journey.

Frequently Asked Questions

• What is the primary focus of a mental health essay?

Answer: The primary focus of a mental health essay is to delve into the intricacies of mental well-being, its significance in our daily lives, the various challenges people face, and the broader societal implications. It aims to shed light on both the psychological and emotional aspects of mental health, often emphasizing the importance of understanding, empathy, and proactive care.

• How can writing an essay on mental health help raise awareness about its importance?

Answer: Writing an essay on mental health can effectively articulate the nuances and complexities of the topic, making it more accessible to a wider audience. By presenting facts, personal anecdotes, and research, the essay can demystify misconceptions, highlight the prevalence of mental health issues, and underscore the need for destigmatizing discussions around it. An impactful essay can ignite conversations, inspire action, and contribute to a more informed and empathetic society.

• What are some common topics covered in a mental health essay?

Answer: Common topics in a mental health essay might include the definition and importance of mental health, the connection between mental and physical well-being, various mental disorders and their symptoms, societal stigmas and misconceptions, the impact of modern life on mental health, and the significance of therapy and counseling. It may also delve into personal experiences, case studies, and the broader societal implications of neglecting mental health.

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Mental health crisis among teenagers requires bold action, but experts say community support is vital in fostering resilience

Whether it's in the suburbs, out bush or on country, today's teens are grappling with a mental health crisis. Experts say big, bold changes are needed, but what do we all do in the meantime? (Spoiler alert: These stories have a happy ending.)

What do you really know about teenagers, apart from once being one?

As body and brain evolves (and hormones emerge) teenagers shed that smaller person.

They do this while facing a different sort of childhood today — one that's uniquely interconnected and often isolating all at the same time.

This also brings fears for the future.

But this is no snowflake generation. These kids are not all moody moments and dancing for a like on their phone. They also navigate a combination of challenges most of us have never experienced.

Public health data reveals a jump in rates of psychological distress for teenagers in the past decade — as well as self-harm.

The "C" word gets thrown around alot these days, but in this instance, it's hard to deny. It's an alarming situation all experts we spoke to agree on: this  generation of teens is grappling with a mental health "crisis" .

No two stories (or teenagers) are alike, of course. For Pacey, Bathsheba and Katiana, where they live, their upbringing and even their gender impact their mental health.

Small city, big heart

Pacey lives in Devonport, in the north-west of Tasmania. It's a port city, and he's lived here his whole life.

He's only 19, but has already been through a lot.

Like almost half of all young Australians aged 15 to 25, Pacey has experienced psychological distress.

It's a term used to describe those broader symptoms of stress, depression or anxiety which can lead to mental health disorders.

We meet his dad Braden at an old fibro house in a quiet, elevated cul-de-sac.

Pacey's out of school now, working as an apprentice mechanic and living at home.

There's a real warmth about them. A vulnerability, too. They've been through stuff, and together.

We start with his childhood, where it often begins.

Nothing remarkably unique, but painful all the same: watching mum and dad split up and feeling caught up by all of that.

"It hurt, and as a kid, you open your eyes up to the world.

"Your home life is falling apart. You're growing up and seeing the divorce of two people you're looking up to. Your whole world falls apart.

"You hold these things on top of your shoulders … it becomes a burden."

At the age of nine or 10, Pacey says his mental health was "at its worst".

Not only was he grappling with the divorce, but his "best mate" and pop died.

"It was a good relationship, it was tight ... and his love for Holden was an undying love," Pacey says.

"As a kid, it was a grounding more than anything."

Pacey credits these difficulties — or as the experts call it, childhood adversities — as the catalysts for his downward spiral.

As the Murdoch Children's Research Institute's Harriet Hiscock explains, things that happen in our younger years — and the way we're supported or deal with them — can be "very complex", and can have a huge impact on teenage mental health and wellbeing.

"There's going to be separation and divorce … but how it's done, and the support for parents and families to do it, is often the key ingredient," the paediatrician and researcher says.

The loss of someone close  — and not always a parent — has a huge effect on a child's resilience, she adds.

Pacey says watching his parents' relationship fall apart and losing his pop was a "big change of tides".

"It shot me down heaps as a kid," he says.

"It all got tied up into one: depression and anxiety and anger."

Pacey was stuttering at this point, but the real red flag came when he started feeling physically sick every day.

"What made me think about things was spewing before going to school. Bottling up certain things," he says.

"Realising emotions that you should only realise as an adult."

In grade eight, the depression kicked in. Pacey saw a psychiatrist who monitored his brainwaves.

He says "one side was peaking, and the other wasn't," which explained the chronic anxiety that ultimately led to depression.

"Understanding what was going on helped," Pacey says.

And with the latest HILDA data suggesting that mental health improves with age, experts are saying there's something going on at this stage of a teenager's life that we need to help them with.

"I think we're facing a genuine mental health crisis in children and young people in Australia and in other developed countries," says Professor Ian Hickie, a global expert on mental health from the Brain and Mind Centre.

"We don't quite understand how all these things are at play. But we do see worsening mental health for young people, and we need to take action right now."

What we noticed about Pacey was his vulnerability, a tug-of-war between the kid he's always been and the new adult he's becoming.

And despite the unconditional love and support from his dad, his fight wasn't over yet.

He had some "good" friends in high school. But some, he says, weren't so "true".

"It was a big scene of substance abuse: codeine, weed, alcohol, anything you could get your hands on," he says.

Passed around at school, and "adventuring" with it himself, he says he started "just acting like a dickhead" and "lost a bit" of himself in the process.

"It was a dark place, with depression and anxiety," he says.

"I didn't want to do talk therapy. I thought I'd cop it on the chin, do it in my own time.

"Drugs took the edge off. Overthinking stopped when I was on the drugs.

"I go [to a party], I crushed up some pills -- it was codeine — downed 16 lines of it. And I just thought, 'f*** it'."

Pacey says he didn't think about how many pills he took, or the bottle of vodka he drank, only the "numb effect" it created.

"And yeah, I woke up in a hospital bed with dad to the side of me, bawling his f***ing eyes out, and that's when it all changed.

"What I also realised is that I had people that I classed as best mates, taking photos of me 'dead' on the chair. So that hurt.

"It did end up on the socials that night."

Pacey learnt something valuable — who you surround yourself with can make all the difference.

"Big thing is your peers. You've gotta protect your energy, watch who you're around," he says.

"When my mates posted it online it made me feel very hollow… very f***ing hollow. Very lost.

"It had me thinking about a lot of things … about who's the real mates and who's gonna care at the end of the day.

"When that stuff happened, it was a massive f***ing backstab."

Today, Pacey tries to stay off the "big platforms with all of the bullshit" (i.e. most social media) because it "just floods your head".

"I just got into psychology, and seeking things deep within the brain, how you can actually change things: food, meditation, anything," he says.

Making music helps.

It's what experts refer to as "mastery" — something we can do (no trophy required) to feel good about ourselves.

"I was putting down art, it wasn't just words," Pacey says.

"It wasn't slam poetry, it was rap. It had a rhythm."

"That's when I really started to open my heart up I guess, and find that love for myself."

He also bought an acoustic guitar, and he's been slowly building up the confidence to freestyle in front of anyone.

But more than that, it's the people in his world — his "true" friends, his family and those people in his life who build him up.

This sense of connection is described by Professor Hickie as key.

He says it's everyone's responsibility to take care of teenagers.

"Part of coping and part of the role of distress is to engage others and to make it clear to yourself, 'OKay, I've got to do something here. I've got to take action, not just sit here in helplessness'," Professor Hickie says.

Whether it's mucking around in the backyard with dad and his little brother Rory, or on a joy ride with his mates, Pacey says he can open up more now about his mental health because his dad was honest and open to him about his own struggles in life.

Dad's advice to Pacey wasn't simply about hanging out with the "right" kids. It was about being there for his mates who might be in trouble one day: just to talk to them.

"[Anxiety and depression] can destroy a lot, but having dad there to express [it] was a big thing. Dad would pick up on things," Pacey says.

"It made me closer to my mates. Gave me a different outlook on the world."

There might not be too much to do around the area, but Pacey says the gravel pit is their favourite local spot for a regular meet-up.

The boys will ask around, and someone — "whoever is up for it" — will be there.

"Most arvos we go for a drive," Pacey says.

"It builds your confidence.

"Community is always around — it's the culture. You've gotta feel it, right?"

We often hear of a young person's story "just beginning", but it feels like Pacey has already lived through a lot.

Resilience, connection and a sense of mastery or purpose in our lives — whatever that looks like — makes kids stronger.

"If I had just one message for adults, it would be to listen. Sit back, take a breath, listen. No matter what your kid's done," he says.

Young and proud

Katiana is only 16. Starting her senior year this year, and at a much different place in her life than Pacey. Katiana carries a quiet strength about her.

She lives in a small place called Fryerstown/Djaara country in Victoria's Goldfields region, just outside of Castlemaine.

She says it's a town "where everyone knows everyone, and with social media, everyone knows everyone".

She's also a proud Wadawurrung woman, which forms the backbone of her story.

For someone so young, this is a special relationship that means everything to her.

She feels the power and connection to this place when she's here.

We were lucky enough to meet Katiana in Ballarat on her country.

It's an important day for her, as she's preparing for a women's cleansing ceremony with her mob as part of the Treaty Day Out festival.

We ask if she's nervous.

"Not really, I'm more excited," she says.

She's been doing this since she was a little girl: preparing her body and her spirit with her mum and mob.

"[There's] a lot of excitement, and I feel very proud, too," she says.

"Like I always feel proud, when I do this. Because I know that some of my family couldn't do it, back in the day. Because of the Stolen Generation.

"So it does make you feel a little bit emotional, because I feel so privileged to be able to do it now."

We can see her confidence and enthusiasm build as the night goes on.

Katiana says that this connection to her culture, to her country, is also an "escape" from the difficulties she experiences at home — and the anxiety she's struggled with since she was a kid.

"It was hard to talk about how you feel, so many things were going on," she says.

"You couldn't just be the focus.

"Too much was happening around me."

In those moments of need, Katiana relied on her nan, her safe place. Someone she could receive "motherly affection" from.

"My mum was not too busy that she didn't care, but too busy that she literally couldn't give me that affection that I needed, that nurturing," she says.

Sometimes, the loss of her nan feels raw. Even six years on.

By the age of 12, Katiana says she was skipping school, smoking weed and drinking with some older cousins.

Life felt overwhelming, and it was at the height of lockdown, during the pandemic.

She knew she had to make changes.

"It was tricky. I just tried to spend as much time with my friends as I could without going into a trap where I was [still] smoking weed and doing all those things," she says.

"I just tried to really understand myself deeper. But even then, I'll still like doing other things because…I just hated everything about my life in that moment."

It was then that she was told she'd be heading off to an all-girls Indigenous boarding school. At first she was angry at her mum.

But today she is grateful she had a chance to prove to herself that she could cope with her feelings of fear, and achieve things she never thought were possible.

When she landed a leading role in the school's production and screening of the Sapphires, Katiana was in shock.

"It made me feel like I was top of the world and made me feel like I could do anything," she says.

"From thinking I was like, nothing, you know? Really bad mentally, useless. And then this was like, wow, look. I've done all this in the span of one year when I was very low."

Performing reminds Katiana that she isn't alone.

Spiritually she is part of something that has been around for thousands of years, and that's a comfort to her.

The next day, we meet Katiana back at her home on Djarra country. She talks to us about how she uses her love of country and the memories of her worst days to stay strong.

"If I have had a moment with my little sister, I'll go on a walk and just breathe and listen to music and just walk around the block, because there's a lot of trees around," she says.

"I like looking at the trees and having the wind and the breeze in my face."

Her relationship with her mum has improved too, especially since being back at home from boarding school and starting at the local high school nearby.

"My great, great grandma was stolen. Our women were taken away. My mum didn't grow up with her mum around," she says.

"And then I can really understand why her and I can be distant. She never had that mother."

Katiana is like most other teenagers — she spends a lot of time on her phone. About six hours a day.

While she often uses the "do not disturb" function and knows that "constantly staring at my phone is horrible", she doesn't think that is unusual at her age.

There's some Indigenous content she follows. The problem with that, she says, is there can be "a lot of hate" in the comments, and that "really hurts".

And she knows how easy it is to get sucked into the body comparison trap online. She's been there before.

"I'm a bigger girl. I don't really care. I'm healthy, I know I can run and exercise. I don't want to be dieting. I don't like commenting on other people's bodies, it makes me mad," she says.

We wanted to know what Katiana saw in her future, if she had it all figured out yet?

Not quite. But there was a lot of hope.

"I've had a thought of what I want to do when I'm older. I want to be a social worker, I could help young people. I really want to work with Indigenous kids. And multicultural kids. To understand them and not just my own culture.

"[But] for now, I feel so proud.

"I've grown into, like, who I want to be at the moment.

"I'm a woman now."

Coming home

First child born into a family with seven kids. First of her relatives to graduate high school in Australia.

First chance to make the family proud.

These firsts count for a lot in Bathsheba's story.

WARNING: this story documents experiences of self-harm.

We meet her at her family home, where she's living with mum and six siblings in a small brick house in outer western Sydney.

It has been a modest upbringing. Bathsheba came to Australia as a toddler from a refugee camp.

Her parents had lived there for 11 years, fleeing conflict as members of the minority Karen community on the Thai-Myanmar border.

They carried the trauma of conflict, but with it, incredibly high hopes for their future children in a new country.

Bathsheba, 17, has learnt a lot in the past year, and she's experienced considerable pain at a young age.

It didn't help that her relationship with her father was strained at best.

Suffering symptoms of depression early in high school, it was easy to grab a beer from her parents' fridge when she came home.

Easy to say yes at parties when weed was handed around.

Especially when there was so much pressure from her parents to achieve at school.

She knows now they just wanted the best for her, but it took its toll.

"I did everything, but still didn't feel 'accomplished'. I'd do more. Reach more standards.

"I wanted to come first at subjects, to tell my mum. It wasn't for me, it was for my family.

"It's only recently that I started realising it's my life, not theirs."

These expectations on young teenagers, particularly from a cultural perspective, can be overwhelming.

"If they have a problem, it's seen as the whole family's problem. So it's the shame of that," Associate Professor Harriet Hiscock says.

"And if I've got a mental health problem, not only am I letting myself down, but I could be letting down the whole extended family."

Associate Professor Hiscock says when talking to young people, particularly from Asian families, they spoke of the high expectations at home and a need to thrive academically. Suffering from, or talking about, poor mental health was often not an option.

"That's a lot of pressure to bear," she says.

And with her close friend already self-harming, Bathsheba tried that too. Just to feel something different.

"Looking back now, it was a very difficult time in my life. Especially being the oldest," she says.

"[My parents] couldn't understand me, and they didn't know what to do. So I had to try to find my own way."

"I wanted to feel something. I wanted to feel normal. I didn't want to feel sober.

"It helped to focus my pain on something else. I'd rather feel physical pain than emotional pain."

The gendered data on how girls and boys deal with their mental health is quite alarming.

The latest national figures from the Australian Institute of Health and Welfare (AIHW) show rates of self-harm for girls aged 15 to19 have nearly doubled since 2008.

And for girls aged 14 and under, it tripled.

Things started to turn around thanks to a cry for help and a concerned teacher.

But in the end, Bathsheba says it was "much more about [my parents] telling me they're proud of me. That little bit of support kept me going".

Bathsheba says she decided to forgive her father for not being there.

Today, she looks at the mistakes she's made as valuable lessons she's grateful for.

Her family responsibilities, her role as the eldest daughter and her dedication to her church and tight-knit Karen community aren't stifling her sense of freedom and excitement for the future.

She's started a dual degree at university, and for the first time in her life, the future looks promising.

Not because she has it all figured out, but because she is "excited for the future, for what's ahead".

"But it's going to take a lot of hard work. I feel like I have such a clean slate, high school is gone, I have a brand new life canvas," she says.

Reporter: Gemma Breen

Photography: Brendan Esposito

Digital production: Gemma Breen and Dinushi Dias

Digital editor: Heidi Davoren

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Reasons for hope

Solutions for the mental health crisis emerge through innovative research, diagnostics and treatments

By Nina Bai

Illustration by Jules Julien

Photography by Leslie Williamson

It’s the spring of hope for mental health, astir with novel discoveries, life-changing therapies and more openness than ever before — yet, for many, it feels like the winter of despair. The pandemic years, that crucible of stress, isolation and uncertainty, fueled and exposed mental health problems. In 2022, nearly 1 in 4 American adults (about 59 million people) said they experienced a mental illness in the previous year, but only half of those afflicted reported receiving any mental health treatment.

Among children and adolescents, the prevalence of mental illness, which had been steadily creeping upward, jumped during the pandemic, according to the U.S. Substance Abuse and Mental Health Services Administration. In 2019, 15.7% of American adolescents aged 12-17 reported experiencing a major depressive episode in the past year. In 2022, that number was 19.5%. That same year, 13.4% of adolescents — just over 1 in 8 — seriously thought about killing themselves.   

And even as the pandemic has stoked demand for mental health care, it also has worn down the mental health workforce, already short-handed, with early retirements and widespread burnout. Access to affordable, effective interventions remains a daunting barrier. People face long waiting lists and lack of insurance coverage. Many treatable conditions remain undiagnosed because people lack a way to obtain assessments. 

Yet, below this perfect storm of mental health crisis, there is a strong undercurrent of hope that begins in the lab. Research is leading the way toward treatments that are more effective, more personalized and more accessible.

“The manner in which we know the brain now, compared with what we knew in previous decades, is incredibly different,” said Victor Carrión , MD, the John A. Turner, MD, Endowed Professor for Child and Adolescent Psychiatry and vice chair of the department of psychiatry and behavioral sciences.

Direct impact on patients

New imaging technologies allow researchers to see the neural circuitry that goes awry in neuropsychiatric disorders, lab-grown clumps of brain tissue — known as organoids — can simulate the impact of genetics in autism, and artificial intelligence can surmise signals that predict the onset of depression and anxiety.

Moreover, these discoveries, rather than moving slowly through specialist silos, can now rapidly inform new treatments. “Collaboration is vital for translation, and our departmental awards and programs promote and emphasize synergy between research and clinical practice,” said Laura Roberts , MD, the Katharine Dexter McCormick and Stanley McCormick Memorial Professor and chair of the department of psychiatry and behavioral sciences.

“Our bench scientists doing tremendous research also work alongside our clinicians to make sure that new knowledge translates to the clinical setting and has a direct impact on patient care,” she said.

Researchers developing transcranial magnetic stimulation, for example, work with clinicians who treat patients with severe depression to design clinical trials, and their techniques are informed by teams inventing new ways to measure the flow of brain signals and those building virtual reality models of the brain.

A clearer understanding of the biology of mental health disorders not only leads to breakthrough treatments — but just as powerfully, helps dissipate stigma.

“There’s been a large shift in stigma in the past 25 years,” said Heather Gotham , PhD, clinical professor of psychiatry and behavioral sciences, who leads the coordination of a nationwide network of centers dedicated to implementing evidence-based mental health care.

The Mental Health Technology Transfer Center Network, funded by the Substance Abuse and Mental Health Services Administration, offers training in preventing school violence, substance use in the workplace, adolescent depression and more, and it offers support for mental health providers seeing refugees and asylum seekers.

“Collaboration is vital for translation, and our departmental awards and programs promote and emphasize synergy between research and clinical practice.” Laura Roberts, the Katharine Dexter McCormick and Stanley McCormick Memorial Professor and chair of the department of psychiatry and behavioral sciences

“One thing that’s made a difference is the greater understanding that mental health disorders and substance use disorders are chronic, relapsing disorders of the body, just like diabetes and heart disease,” Gotham said.

With this new awareness, more people want to be mental health literate. In the past few years, Gotham has seen a surge of interest, from a broader community, in the network’s online courses — from teachers, for example, who want to be more responsive to the needs of students and reduce stigma in the classroom.

Less stigma also means more money for research and mental health services. Funding for mental health has become a rare bipartisan issue. In 2022, Congress passed the Bipartisan Safer Communities Act, which has provided $245 million to fund mental health services like training for school personnel, first responders and law enforcement and expanding the 988 suicide and crisis lifeline.

Stanford Medicine researchers know that to make the most impact with their discoveries they must reach those who need help the most — through online symptom screenings, virtual therapy, group therapy, inclusive clinical trials and community interventions.

They are training mental health professionals locally and globally in new evidence-based techniques. Providers in more than 38 countries, for example, have been trained in cue-centered therapy, a 15-week treatment program developed at Stanford Medicine to help children and teens recover from chronic trauma. Recently, pro bono training in cue-centered therapy was provided to clinicians in Ukraine.

What gives Roberts hope is that a more open conversation on mental health is drawing together experts from different fields with a shared purpose. “It used to be that clinicians would stay in their clinical practice and refer to journals for new research, and researchers would stay in the lab and never see a patient — and we don’t have that now,” she said. “I see more openness and more flexibility from the current generation of researchers and clinicians.”

Read on in this issue of Stanford Medicine to learn about some of the ways Stanford Medicine researchers and clinicians are advancing the understanding of mental health and sharing that knowledge.

Nina Bai is a science writer in the Stanford Medicine Office of Communications.

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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.