On a typical day in April 2023, the alarm sounds, and Clara, 15, isn’t ready to get up. She forces herself to prepare for school. The day is long, with a research project due for geography, a tough geometry quiz, and a practice session for the Spanish Advanced Placement exam. At lunch, she gathers with her best friend to rehash the morning. After school, she takes the city bus home since both parents are working. In the evening, she goes to swim practice, walks the neighbor’s dog and stays up late doing homework for some of her eight classes.
It’s a lot to juggle. One of my priorities is to maintain a balance between school and the things I like doing, like playing music and seeing friends, but it’s hard when most of my time is taken up by homework and studying. I am lucky to have good support, but I still feel stressed about getting good grades, doing things to get into a good college and having all these demands on my time.
Clara’s busy schedule is not unusual. Many teenage girls are struggling to keep up with the requirements of school, family and extracurricular activities. Some also face poverty, abuse and discrimination. Add to that the pressure to navigate the tricky social dynamics of being a teenager, build a resume for college, and, in some cases, hold down a job. For many, it’s too much.
A survey conducted by the Centers for Disease Control and Prevention (CDC) in the fall of 2021 and released in February of this year showed alarming rates of depression, suicidality, and experiences of sexual violence among the 17,000 high school students who participated. Fifty-seven percent of the girls reported persistent feelings of hopelessness or sadness.
A startling 30 percent of girls said they had seriously considered suicide – up nearly 60 percent from a decade ago. Suicide is already a leading cause of death in young people ages 10 to 24. Attempts are nearly twice as common among high school girls compared to boys. Factors contributing to suicidality include economic hardship, discrimination, relationship and family conflicts, school failure, and lack of connection to others, which was exacerbated for many during the pandemic.
The risk of violence is another source of stress for teenagers, notes Barb Steinberg, a licensed master social worker and teen life coach. “There is more exposure to violence in the world, whether it be the possibility of a school shooting, a mall shooting, or a grocery store shooting,” she said. Teenagers like Clara face a frightening world.
I don’t remember the details, but in middle school somebody made a threat that they would ‘shoot up the school.’ I was scared to go to school that day. It’s sad to think about all the places where we should feel safe, like schools and stores, but we can’t because of the threat of gun violence.
Efforts to better understand and address the mental health needs of children and adolescents are essential to ensure their well-being. Even after accounting for adverse experiences such as low socioeconomic status, bullying and family problems, depression in youths has been linked to higher rates of future substance-use disorders, increased criminal activity, lower financial and educational achievement and worse health. Early identification and treatment are crucial.
Social media’s role
Social media has also been blamed for rising rates of depression and anxiety in teen girls. In May, Surgeon General Vivek Murthy issued an advisory on the connection between social media and children’s mental health, eating disorders, body dysmorphia and low self-esteem. He called on policymakers, technology companies and families to step up efforts to protect young people from dangerous content and excessive use.
Although Clara likes playing guitar more than watching TikTok, she does routinely check her Instagram feed. But she’s on it less than many of her peers. Teenage girls spend a lot of time on social media, with 22% of tenth-grade girls reporting seven or more hours a day, researcher and psychologist Jean Twenge said in an interview with NPR in April.
Too much time on social media can lead to kids getting less sleep, itself a risk factor for poor mental health. Data are conflicting but, overall, provide a convincing case for social media’s role in worsening mental health among teenage girls.
“I think social media makes girls in particular anxious because society has ideas of the way a girl should be,” said Elsie Smith, 15, one of Clara’s close friends. “Social media constantly shows the ‘ideal’ woman, and that can put a pressure on young girls to be that way which can cause anxiety and stress over looks, personality, behavior, etc.”
Social media also has changed the way girls connect with each other. Screens have replaced face-to-face interactions; behind a screen, girls may be less careful with their comments, leading to bruised feelings and increased insecurity.
Despite its shortcomings, Clara still sees social media’s advantages, including the ability to share experiences with many friends at once, keep up to date with pop culture, and stay in touch with friends who aren’t at the same school. It has become entrenched in teen (and adult) life.
There are definitely times where I catch myself spending lots of time on Instagram, but mostly I check it when I’m bored. In most of my classes, we can use our phones, and I often see people scrolling through social media. It’s difficult to get their attention. They’re so focused on their screens, and they’re not really being in the present.
Encouraging more mindful use of social media – and less time on screens overall – may help girls turn their attention to other activities and more meaningful interactions with others. Parents can negotiate limits with their kids, such as no phones at the dinner table (our family’s somewhat flexible rule) or within an hour of bedtime, and they need to model responsible use of smart phones and social media.
But addressing social-media use is only part of the solution.
Schools need to prioritize programs and activities to promote mental health among students. Appropriate, evidence-based health education should be provided as well as substance-use prevention and treatment. To promote school connectedness, teachers should focus on topics that are interesting and relevant to students, encourage widespread participation in discussions, and show respect for differing viewpoints and backgrounds.
Clara recalls too many long days in class doing worksheets, which isn’t surprising since many teachers are underpaid and overworked. Apart from paying teachers a living wage and offering flexibility to be creative with lesson plans to better engage students, we need to fund therapeutic support groups for teenagers, such as those offered in several Austin-area high schools. In group sessions, attendees learn about healthy relationships, communication strategies and proper boundaries. Expanding such services would create opportunities for more youth to develop beneficial coping strategies for anxiety and depression.
In addition, the new suicide and crisis line, 988, should be promoted to people of all ages. A survey published last month by Pew Charitable Trusts showed that only 13 percent of adults were aware of the line’s purpose nine months after its introduction. Presumably, awareness among teenagers is even lower.
“Teen girls are under a lot of pressure to be excellent [at everything they do],” Steinberg said. “That is exhausting and it’s not really sustainable.”
Lisa Doggett, senior medical director of Sagility, is a physician in Austin and a columnist for Public Health Watch. Her memoir, “Up the Down Escalator”, will be published in August 2023 by Health Communications, Inc. The views expressed in her columns do not necessarily reflect the official policies or positions of Public Health Watch or Sagility.
Clara Williams, 15, is Lisa’s daughter. She is an incoming 10th grader at McCallum High School in Austin.