Experts say that it’s hard to pinpoint what’s behind the staggering increase. “We all wonder what exactly is happening, but I doubt that we can focus on one reason. It’s multifactorial,” says Dr. Khalid Afzal, assistant professor and director of child and adolescent psychiatry at University of Chicago Medicine.
The increase can to some extent be attributed to greater awareness by both healthcare professionals and the general public, as well as by additional screening. “It’s hard to know how much of it is more cases or just that it’s being recognized more,” explains Dr. Benjamin Shain, a child and adolescent psychiatrist at NorthShore University HealthSystem. He adds, “Could it be more cases? For sure.”
“This period of time coincides with the significant increase in access to hand-held media,” notes Dr. Eric Nolan, child and adolescent psychiatrist at Northwestern Medicine Delnor Hospital and medical director at Northwestern Medicine Behavioral Health Services St. Charles. “The digital age can lead to an almost paradoxical sense of isolation and loneliness, which can increase the likelihood of emergence of depression.”
Nolan adds that the fact that “overall expectations for teens have skyrocketed” in terms of academic, social and parental pressures are “a likely huge contributing factor as well.”
How Will I Know If My Child Has a Problem?
Parents often struggle to discern between moodiness that is typical teenage behavior and what could be a larger mental health issue like depression.
Of course, if a teen is suicidal, the best plan is to go to the nearest hospital emergency room. But a depressive episode that is less severe can be tougher to detect.
“It’s much harder to tell just by looking at appearance. If you look at a room full of depressed adolescents, they’re laughing, smiling, interacting, running around,” Shain says. “Adolescents are particularly skilled in masking it. They put on a good front.”
Parents should look for changes in function in different areas, such as a drop in academic performance, changes in appetite or sleep patterns, or their child no longer enjoying activities they have previously liked. If a teen who had been social starts withdrawing, that can also be a tip-off.
Everyone has bad days, and teens are no different. “We have to allow them to have ‘off days’ without necessarily pathologizing them,” Nolan says. The bigger issue is if parents see shifts over time. Nolan stresses that depression manifests itself differently in each adolescent and that the key is to “look for changes from baseline and not just how any one point in time appears.”
“There will be ups and downs in family relationships and teens will push limits, but most teens don’t engage in huge battles with their families on a regular basis,” says Dr. Karen Gouze, director of training in psychology at Ann & Robert H. Lurie Children’s Hospital of Chicago and professor of psychiatry and behavioral sciences at Northwestern University’s Feinberg School of Medicine.
“If you’re concerned, you should probably seek help,” she says.
If a parent suspects depression, the first step is to ask their teen what’s going on and see if there’s a reasonable answer. Depending on what the teen says, the next step is seeing the child’s pediatrician or primary care doctor. They can often do an initial screening and discuss the best next steps, which could be therapy, medication, or even a higher level of care.
What Can I Do to Help My Teen?
“There is a genetic component to depression,” says Dr. Neal Ryan, professor of psychiatry at the University of Pittsburgh, so to some extent, whether or not a teen will face struggles with depression is dictated by their genetic makeup. “Although we don’t understand specific genes, there’s good data showing the overlap and indicating that it isn’t a matter of a few genes that contribute a lot, but rather hundreds of genes that contribute to depression,” he says.
In addition to genetics, environment also plays a role. While parents can’t control genes, they can try to create an environment for their kids that is conducive to good mental and physical heath.
Here are a 10 ways you can work to positively control different environmental factors that impact teens.
1. Connect with your kids
“The most critical issue is the parent-child relationship. You need a good foundation. Adolescents may seem like they need their parents less, but that’s not true,” says Gouze.
Be available in every way you can and express your interest in what they enjoy. Afzal confesses that he may not love video games, but tries to show interest in the ones his kid loves. When a parent stays involved in their adolescent’s world, they’re able to find many opportunities to connect, both big and small, such as through TV shows, sports teams, music, food and activities.
2. Avoid overloading them with advice
“It’s completely understandable that when a kid is miserable, a parent wants to help and share their experience, but teenagers don’t want to hear advice. What they do want and need is someone to listen,” says Shain. He adds, “That’s not to say that you never give advice, but try to keep it to a minimum and keep the listening at a maximum.”
“Make it clear that you’re willing to talk about almost anything,” suggests Ryan.
3. Foster independence
The tightrope that is parenting an adolescent requires you to maintain the connection while also allowing kids to develop a sense of self and independence, which Afzal says are the two normal developmental tasks teenagers need to accomplish. “As parents, it is our job to allow them to achieve both,” he says.
4. Promote sleep
The experts all agreed that lack of sleep is a pervasive problem in teens, due in part to the natural shift in their circadian rhythms that means their sleep cycle shifts toward awakening later. Several mentioned that teens would benefit from later school start times.
“Being sleep deprived increases the risk for depression and other problems,” says Ryan.
Gouze recommends taking a teen’s phone at night, noting studies that show kids are texting at all hours of the night and losing the valuable sleep that is already in short supply.
5. Model flexibility
The experts stressed that flexibility is important, and that can mean parenting in a way that’s new and very different from the way the prior generation approached raising adolescents.
“Sometimes we as parents try to utilize the same techniques we saw our parents use, but that doesn’t always work,” says Afzal. “We’ve upgraded our cars and our kitchens from the ones our parents had. It’s probably time to upgrade our skills as parents, too.”
6. Facilitate downtime
“Allow and encourage downtime. Every day doesn’t have to be full of extracurriculars and AP class homework,” says Nolan.
Downtime can also strengthen the connection with kids. Gouze says that often it’s “the casual times when parents and kids are just hanging out or talking about other things not related to your worries about them that the important stuff will come out.” And kids may not share something huge every time, but Gouze reminds parents that sharing little things will lead to sharing bigger things.
She also suggests that family dinners can be a good opportunity for connection, even if they happen only a few times a week.
7. Keep an eye on social media
Ryan says that there is no “right” amount of social media and no best or easy way to advise parents on how to handle kids and their devices, though he does say that parents should be aware of what kids are doing and look at how devices impact the way kids are functioning in other areas.
“It becomes a problem when it crowds out things that are important and that we know are good for you — like social relationships and exercise,” Ryan explains.
Gouze says limits are helpful but of course, kids don’t welcome rules they feel are imposed on them from above. Instead, she says try to talk about limits on devices in a collaborative way. Also, be open to hearing whether they think other family members (including you) should put devices down and make disconnecting a group effort.
Media is a double-edged sword when it comes to depression. On the way hand, it puts pressure on kids to look and behave in certain ways. But, on the other, it has brought attention to the issue of teen depression and suicide in constructive ways.
High-profile celebrities like Chance the Rapper and Lady Gaga have opened up about their own struggles with depression in an effort to encourage dialogue and destigmatize mental illness. Even the British royal family has joined the conversation. The Duke and Duchess of Cambridge and Prince Harry have teamed up with mental health initiative Heads Together, encouraging others to take the first step towards taking charge of their mental health by having “simple conversations” about their struggles.
The show “13 Reasons Why” generated strong responses both from those who praised the series for bringing attention to teen suicide as well as from those who thought the show was dangerous and called for its removal. (Netflix is currently filming Season 2.) The experts agreed that while parents likely couldn’t or shouldn’t forbid kids from watching the show, they can share with their kids why they aren’t enthusiastic about the show and use it as a way to discuss what is problematic and what their kids are taking away from it.
9. Reduce stigma
By openly discussing the importance of mental health and mental health care with their teens, parents can help eliminate the stigma that often keeps kids from getting the help they need.
“Stigma is still a major problem. We still have to convince people that treatment for mental health is as OK as treating a heart condition or a kidney problem,” says Shain.
10. Provide structure and boundaries
“Kids might not like structure, but they feel safe within it,” says Afzal. “They need to know their boundaries. If there is no boundary, it’s scary for them.”
More from Make It Better:
- What You Need to Know About Your Teen’s Brain on Marijuana
- How Worried Should Parents of Athletes Be About Concussions?
- How to Talk to Your Kids About Suicide: Experts Share Tips for Parents
Shannan Younger is a writer living in the western suburbs of Chicago with her husband and teen daughter. Originally from Ohio, she received her undergraduate and law degrees from the University of Notre Dame. Her essays have been published in several anthologies and her work has been featured on a wide range of websites, from the Erma Bombeck Humor Writers Workshopto the BBC. She also blogs about parenting at Between Us Parents.
Shannan is the Illinois Champion Leader for Shot@Life, a campaign of the United Nations Foundation that supports vaccination efforts in developing countries to ensure life-saving vaccines reach the hardest to reach children. “Vaccines are one of the most effective ways to save the lives of children in developing countries and I’d love nothing more than to see diseases eradicated,” Shannan says. “We are so close to getting rid of polio for good!”