Depression. Just the word makes us feel uneasy. It's something we struggle to talk about while millions are struggling with it. In all honesty, I wouldn't have batted an eye on the subject until I saw the pain my sister endured and still copes with. Her hardships have brought me to understand the importance of mental health and the pandemic of teen depression facing today's America. But it's not just my sister; it's the 11.01% of youth (12-17) that suffered at least one major depressive episode in 2017, and the 64.1% of youth with major depression that did not receive any health treatment (2017 State of Mental Health in America). It's how there continues to be little to no efforts done to halt the rampant increase of depression in teens, and how we continue to ignore this problem plaguing our society. Researchers have discovered the impact that social media plays in depression, and possible triggers, but there is not enough funding or care on the subject to make the difference that needs to be made, and limit depression in teens throughout. One of the biggest problems faced in the underexplored topic of depression is that the public is ill informed. Many do not know what depression is, or the difference between depression and general moodiness. Something particularly difficult to differentiate in teens as they tend to be moody. Karen Swartz, the director of clinical programs at the Johns Hopkins Mood Disorder Center compares depression to asthma to help educate her patients: "It runs in your family, you're vulnerable to it, and when the combination of life stress and hormones react, you get it." Similar to asthma, depression is a condition where various factors can worsen or bring on the situation. An increase in dust or pollen can trigger an asthma attack, with depression, it could be family issues, or a stressful situation at school or work. Swartz emphasizes that outside factors do not always play a role in either condition.
Many people are baffled by this sudden uptick in depression across all ages, especially in teens, who are normally seen as happy spirits in the prime of their lives. Understandably, it is difficult for many to grasp these facts. I spoke with Katherine Peatross, the Clinical Services Program Manager at Youth Villages in Memphis. Youth Villages has many resources to help children and families succeed, in addition to offering residential campuses to help treat serious emotional and behavioral issues in young people. Peatross offers sensible insight as to why she thinks depression is rising among teens. Teens tend to feel free and invincible. This attitude, alongside their still developing brains, leads teenagers to have a tendency to do things that are, well, not so smart. As we are in a age of technology where everything is captured, it is nearly impossible to not have repercussions when making a mistake. Often times, these bad decisions are put on social media and spread around. It can be tragic for someone. And Peatross says that a tragic event can trigger depression. One may have a genetic trait making them prone to depression, which, combined with a traumatic experience can lead to clinical depression. Examples of possible tragic events are a socially embarrassing moment, the loss or struggle of a family member, a domestic violence incident, etc. There are many triggers out there.Possibly the most frightening aspect of this epidemic is that the figures do not seem to be slowing. In fact, they have been and continue to increase since 2012. Jean Twenge, a psychology professor at San Diego State University, has been examining trends and behavior changes in teens and young adults for many years through an ongoing study called Monitoring the future that surveys behavior and attitudes in teens since the 1970's. In 2012-13, there was a noticeable increase in teens having symptoms of depression. The feeling of happiness, which had been increasing among teens for 20 years, decreased around this time. Furthermore, Twenge found that more entering college students felt depressed and overwhelmed and 50% more teens in 2015 versus 2011 demonstrated clinically diagnosable depression. Even more frightening, the number of teens and children hospitalized for suicidal thoughts and self harm doubled between 2008 and 2015.
So, what caused these dramatic increases, and why did they come so sudden and all at the same time? Not one factor can be blamed for something so immense, but, like Twenge did, many wanted to know the major causes of this. There was a major mental health crisis and no one knew why.
In another project, Twenge found that teens were spending less time with their friends in person and more time communicating online. Humans need social, face-to-face interaction. It helps us strengthen our communication skills and has positive effects on mental and physical health. Among the many benefits of social interaction are improved bodily health, reduced risk of death from a heart attack, and it reduces levels of stress and inflammation. It seems as though around the time smartphones became a necessity and society became enveloped in the internet, there were alarming increases in depression statistics. Correlation does not equal causation. However, a study was done that randomly assigned subjects to give up Facebook (aka Instagram for adults) or not. Those that did give it up ended the week happier, less lonely, and less depressed. Although it may not be a factor, less time on the internet supports increases in happiness, something we all strive for.
It makes sense as to why the internet increases gives us thoughts of depression. While we aimlessly scroll through, we see others we know on wild adventures,ecstatic with their seemingly perfect lives.This leads us to reflect negatively on our own lives, and become self-conscious, develop insecurities, and become depressed. So, how do we fix this problem? It's unrealistic to cut out the internet, seeing that we use it everyday to communicate, stay up to date on the latest news, or indulge in entertainment. But if this is a major cause of the mental health epidemic, and it is something we have become so accustomed to, then what do we do? Teens spend on average 9 hours a day online, and a study by Jean Twenge suggests that after two hours of time spent online is when feelings of loneliness and depression start to ensue. The study also suggest that around one hour per day is the "sweet spot". Overall, the study showed that teens who spent more time on social media, and less time exercising and having personal interactions -two things that are proven to increase happiness- had lower "psychological well being".
First, it is important to note that smartphones and social media are not the sole cause of this crisis. Peatross suggests that part of this rapid increase could be that mental health issues are more accepted now as society progresses: "20-40 years ago kids were told to be quiet and not express their emotions. Counseling therapy has improved from what it was many years ago, it could be that depression is more recognized rather than more prevalent" (Peatross).
Nonetheless, there is still a major epidemic on our hands that needs to be fixed. Apps are being created which help people monitor their internet use. Flipd blocks certain apps for set periods of time, helping users keep in touch with the real world. Checky stores data of how often users use their devices day to day, and even monitors how often devices are unlocked daily. We have become so reliant on technology we lose focus of the world around us, and lose track of how much we really use our phones. Obviously, we can not cut out technology completely, but it is important to become aware of how often we use it and when we use it with a purpose. As we get better and better at becoming less reliant on technology, we have more time for personal communication. Dr. Emma Seppala of the Stanford Center for Compassion and Altruism Research and Education writes "people who feel more connected to each other have lower levels of anxiety and depression… social connectedness generates a positive feedback loop of social, emotional, and physical well-being" (Seppala).
But what good does limiting the symptoms do if the main issue is still ignored? The issue must be looked at directly and repaired. The American Academy of Pediatrics took an immense step in February of 2018 to work towards solving the crisis by calling for every child to be screened for depression every year starting at age 12. Another issue faced during this plight is how difficult it can be for those suffering to receive treatment. In a 2017 study, Harvard researchers called 601 pediatricians and 312 psychiatrists in five different cities. They posed as parents of a 12-year-old child with depression. Appointments were scheduled with 40% of the pediatricians and 17% of the child psychiatrists. Long wait times were the good outcomes and most of the psychiatry practices were not accepting new patients or had incorrectly listed phone numbers. Why is it so difficult to get treatment? According to Paul Gionfriddo, the president and CEO of Mental Health America, Psychiatrists are paid less than most other specialists, and psychologists' rates have fallen in the past couple decades. Many therapists have social work degrees and are reimbursed at even lower rates than psychiatrists and psychologists. Gionfriddo explains that "We don't pay enough to [health insurance] providers, so there's not enough providers around."
The main problem seems to be found in the Medicare system. Clinical social workers are the largest group of mental health services providers in the United States. Since social workers are reimbursed by Medicare at only 75% of the rate reimbursed to psychiatrists and psychologists, they are often discouraged from becoming Medicare providers, as well as making it difficult to retain clinical social workers as Medicare providers. As a medicare provider, one must follow the guidelines and prices set by Medicare. But since mental health professionals, and social workers specifically are cheated by the reimbursement rates set by Medicare (how they make money) they have no incentive to be a provider and tend to set up their own practices or join private practices. In private practices, professionals can set their own rates, and many insurance companies will not cover these more expensive practices because they have no incentive to if they can cover a cheaper option. Additionally, the professionals that are not Medicare providers tend to be the better ones because they feel their salary is not enough given the work they put in. So essentially there is greed on both sides of the equation, but the people making the decisions on reimbursement rates for Medicare providers tend to be a lot wealthier than your local practice social worker. Medicare is a federal organization, with funding controlled by the government and is set up in a 4 part system. Part A provides inpatient/hospital coverage. Part B provides outpatient/medical coverage (mental health treatment falls under this part). Part C offers an alternate way to receive medicare benefits (like through private insurers where special packages may be included). Part D provides prescription drug coverage. So who is eligible for Medicare parts A and B? You must be 65 or older and eligible for Social Security, be permanently disabled and receive benefits for at least two years, have kidney failure (End-stage renal disease), or have ALS. There are other specifications and details that go along with this. But the point is that it is understandable now as to why so many of those affected are not receiving treatment. There must be increased government spending on Medicare to give opportunities for everyone to receive treatment. There must be reform. For America to be true to its word of giving everyone equal opportunities, the government must take action. Now I know the whole government spending idea can make people feel uneasy as this appears to get politically charged but hear me out. The government granted Georgia Christmas Tree Association $50,000 to promote Christmas trees at Christmas time. The federal government also spent $150,000 on yoga classes for federal employees. A luxury to say the least. Additionally, $188,000 was spent on a study to figure out why Americans don't want to use the metric system. $350,000 was spent to perform a study on the video game "Pong". But those are just small sums that add up to be a lot. Well the government also spent $15 million to research the effectiveness of golf equipment in space. $43 million dollars was spent to build a gas station that uses compressed natural gas, and almost no cars in Afghanistan run on compressed natural gas. And these are just some fun fact specifics. This does not take into account the $598.5 billion dollars (around 54% of all government spending) put into the military. These are just a few examples of money that was wasted by the government in 2015 while in that same year, 8.6% of high schoolers had made at least one suicide attempt according to the Youth Risk Behaviors Survey. I hope this opens the eyes of people out there on the crisis we are facing regarding mental health of teens in America. We the people have the ability to make change and it is evident that change is needed. We need to wake up and realize how our reliance on technology has been detrimental to our mental health, and we need to declare change in government spending so that treatment can be given to all those suffering.