4 Explanations for the Teen Mental-Health Crisis

Photo-Illustration: Intelligencer; Photo: Getty Images

Adolescents in the U.S. are unhappier than they used to be. Between 2009 and today, rates of sadness and suicidal ideation among our nation’s youth have steadily climbed.

Self-reported measures of mental illness can be distorted by shifting social norms. If suffering from depression becomes less stigmatized, more teens may report feeling depressed even if the actual incidence of the malady remains constant. But the suicide rate among Americans 10 to 24 years old jumped by nearly 60 percent between 2007 and 2018, which suggests surveys are capturing a genuine increase in teen mental distress rather than a mere jump in distressed teens’ propensity to identify themselves as such.

Recent survey results paint a disconcerting picture of teen life in the U.S. — especially for girls. In its latest Youth Risk Behavior Survey, the Centers for Disease Control and Prevention found that nearly 60 percent of adolescent girls reported feeling sadness every day for at least two weeks during the previous year, while one in three had considered taking their own lives.

This bleak data has inspired a frenzy of armchair social theorizing, as psychologists, pundits, and Twitter personalities proffer a wide array of explanations for why the kids aren’t all right. Some of these theories shed more light on their proponents’ hobbyhorses than adolescents’ mental-health struggles. Last month, I took issue with one such hypothesis: the notion that there is nothing mysterious about soaring rates of teen depression and anxiety as these constitute a rational response to contemporary economic and ecological conditions.

Still, not all theories of the crisis amount to sloppy ax-grinding. The past few weeks of debate have generated a number of explanations that merit consideration. And while these disparate analyses are often framed as competing theories, they don’t strike me as mutually exclusive.

Here’s a rundown of four of the more compelling explanations for the surging rates of mental illness among U.S. adolescents along with a few reflections on the respective strengths and weaknesses of these theories.

The most prominent account of the teen mental-health crisis casts social media as its archvillain. Popularized by the psychologists Jonathan Haidt and Jean Twenge, this hypothesis holds that the advent of social media has transformed adolescence in ways that are detrimental to the mental well-being of teens in general and girls in particular.

Their story has much to recommend it. For one thing, it accounts for the timing of the crisis: Rates of adolescent depression, anxiety, and self-harm started climbing sharply around 2012, shortly after daily social-media use became pervasive among teens. For another, the theory is consistent with the disproportionate decline in mental well-being among young women.

Studies examining the adverse effects of social-media use have routinely found that girls are more likely to suffer psychologically from the platforms than boys are. Researchers at Brigham Young University tracked the media diets and mental health of 500 teens through annual surveys from 2009 to 2019; they found that social-media use had little effect on boys’ suicidality but that girls who used such platforms at least two hours a day when they were 13 were at “a higher clinical risk for suicide as emerging adults.”

This same gender gap has surfaced in several other studies of the relationship between social-media use and depression in the United States, the United Kingdom, and Canada.

Most of this research has merely established a correlation between girls’ social-media use and mental-health problems, which leaves open the possibility that depression causes girls to spend more time on social media rather than vice versa.

But some studies provide evidence that social media causes psychological distress. Much of this research consists of relatively small random-control trials conducted on undergraduates in which some subjects are instructed to use social media for a set period of time while a control group does not. For example, a 2020 study assigned 308 undergraduate women to either use Facebook, Instagram, or an iPad game for seven minutes. After this exercise, the women who looked at Instagram reported decreased “body satisfaction,” decreased positive affect, and increased negative affect, while the other groups did not.

Perhaps more compelling, multiple “natural experiments” indicate that when social-media use becomes more pervasive in a community, its collective mental-health declines. A 2022 study exploited the fact that Facebook was initially rolled out at a select number of college campuses. It found that the introduction of Facebook to a college was associated with a reduction in student mental health and an increase in reports of impaired academic performance from psychological distress. The study suggested that this was because Facebook led its users to compare themselves unfavorably to their peers.

In British Columbia, access to high-speed internet expanded in recent years, reaching some neighborhoods before others. Researchers found that when areas secured access to faster internet service, their rates of social-media usage went up along with their number of mental-health diagnoses among girls.

All of this said, plenty of studies have failed to find a causal or correlational relationship between social media and teen mental distress. And even if one favors the studies that do demonstrate such relationships, social media alone cannot account for the entirety of the increase in adolescent psychological struggles.

A 2019 analysis of survey data from the U.S. and U.K. found that the high levels of “digital media” use was associated with worse mental health — but this correlation was so weak as to be negligible: Heavy digital-media use increased an adolescent’s likelihood of poor mental health by about as much as “eating potatoes.”

Haidt and Twenge dismiss this finding on the grounds that “digital media” encompasses many activities, including ones that might be beneficial for mental health, such as playing video games and chatting with online friends. When they took the exact same data sets and zeroed in on the relationship between social media and poor mental health among girls, they found that the correlation was stronger than that between childhood lead exposure and adult IQ. In fact, among girls, social-media use was more predictive of mood disorders than binge drinking.

Yet even when Haidt and Twenge narrow the study’s lens, the correlation isn’t strong enough to explain more than 4 percent of the variance in girls’ mental-health levels — which is to say, even if we accept their account, some additional, complementary factors are likely necessary for explaining the scale of the increase in rates of teen depression and suicide in recent years. And the insufficiency of social media as an explanation is further demonstrated by the fact that the decline in teen mental health is not ubiquitous across the developed world: In many western countries, the introduction of social media occasioned no significant decline in adolescent mental well-being. So something else must be going on.

In recent decades, the wage gap between workers with college diplomas and those without has expanded, while competition for admission to the most selective colleges and employment in the most coveted industries has intensified. As a result, in order to enjoy high levels of financial security and rising living standards, children must dedicate much of their youth to the cultivation of their “human capital.”

It isn’t hard to see how this could lead to a rise in adolescent mental distress. The Atlantic’s Derek Thompson argues it has. His case for the role of “a culture of obsessive student achievement” in bringing about the teen mental-health crisis rests on the following observations: Adults in wealthy nations tend to report higher levels of happiness than those in developing ones, but among adolescents, the valence of national wealth is reversed: Young people in high-income countries are sadder than those in low-income ones.

One plausible explanation for this is that youth in advanced capitalist economies face more pressure in childhood to refine their skills and outcompete their peers, leading to more stress, invidious social comparisons, and depression.

Several studies have documented a connection between academic pressure and adolescent mental illness. After Germany subjected students to more instructional hours, its adolescents reported significant reductions in their mental health. When students enroll in Taiwan’s “cram schools,” they tend to see their academic achievement increase in tandem with their rates of depression. One 2018 study, meanwhile, found that, across nations, schools with higher test scores and larger homework loads tend to have lower levels of student well-being.

In the contemporary United States, rich teens in high-achieving high schools tend to be more anxious than less privileged youth. This is a relatively novel phenomenon that arose in the late 1990s. If an intensification of academic pressure were driving an increase in adolescent mental illness, one would expect this to impact kids who face high expectations for academic excellence more than those who do not. And such expectations tend to be more common in more-privileged households.

Thompson’s theory will be intuitive to any erstwhile high-achiever who spent their postpubescent years filling their brains with words like erstwhile — which is to say it will be intuitive to the high-achieving nerds who dominate the discourse. And it is hard to imagine that the high stakes of academic achievement in a profoundly inequitable capitalist economy have done nothing to increase teen mental-health problems.

Nevertheless, there are some problems with the “school sucks” theory. One is that it’s far from obvious that academic pressure suddenly increased around 2012. The millennial generation entered its college years en masse in the late aughts, a demographic bulge that dramatically increased the competitiveness of college admissions. And yet the period from 2007 to 2009 witnessed a historic low point in adolescent sadness and suicide rates in the U.S.

Twenge has noted a few other holes in Thompson’s argument. If the intensity of academic pressure were driving the spike in teen mental illness over the past decade, then we would expect to see that teenagers had been spending more time on homework in recent years. According to data from the Monitoring the Future study, however, the opposite is true: Zoomers have been spending less time on homework than millennials or Gen-Xers did at their age.

Were academic pressure the primary driver of the crisis, we would expect to see students reporting higher levels of competition for grades in their schools. In reality, for much of the past decade, American teens have reported a decline in such competitiveness.

Illustration: Jean M. Twenge

The biggest liability of Thompson’s argument is that it risks projecting social conditions peculiar to one social class onto the nation as a whole. Only about half of U.S. high-school students plan to attend a four-year college. And most of that group attends colleges that admit a majority of all applicants. The cutthroat competition for slots at elite colleges is an experience unique to a relatively small slice of the adolescent population. And according to the Monitoring the Future data, that portion of the population appears to be less depressed than its counterparts. In this chart, “higher achievers” are defined as students with A or A– grade-point averages and plans to attend a four-year college.

Illustration: Jean M. Twenge

None of this means that academic pressure is irrelevant to the teen mental-health crisis. Twenge builds her rebuttal off a single data set. Furthermore, just because a student does not have an A– grade-point average, it does not mean they aren’t suffering from academic pressure. Indeed, intuitively, we would expect those suffering most from hypercompetitive schooling to be students with high academic ambitions and expectations but low grades.

The intensification of academic pressure is a plausible enabling condition for the teen mental-health crisis; it’s possible that in the absence of that factor, we might not have seen so large a surge in teen depression in recent years. But it doesn’t make much sense as the primary causal variable since there’s little reason to believe that school became exponentially more competitive between 2009 and 2013.

In a New York Times column, David French notes that U.S. teens are scarcely alone in their mental distress: Our nation’s adults aren’t doing much better. Even as 44 percent of teens reported persistent sadness in 2021, 41.5 percent of adults suffered “recent symptoms of an anxiety or depressive disorder,” an increase from 36.4 percent months earlier.

By itself, this observation doesn’t really function as an explanation of why teen mental illness has increased over the past decade. But it is a helpful reminder that the causes of that phenomenon may include developments that have impacted American adults and children alike.

It is possible that U.S. adults are transmitting their anxieties to their children through helicopter parenting. A significant body of research in child development suggests that a modicum of autonomy and self-directed play is beneficial for a young person’s psychological health and resiliency. To the extent that anxious parents in the U.S. are overprotecting their kids, the former’s mental issues may be causing the latter’s.

The optimal rate of serious mental distress among American teenagers is zero percent. But what is the normal rate?

The policy analysts Will Rinehart and Taylor Barkley raise that question by examining the long-term trends in American adolescents’ rates of suicide and sadness. If we measure teen mental distress by the adolescent suicide rate (since that rate is relatively immune from changes in the propensity to report mental distress), then the contemporary moment looks unexceptional:

Viewed in historical context, the past decade’s increase in the teen-suicide rate looks less remarkable than that rate’s collapse in the early aughts. In other words, perhaps teens today aren’t exceptionally troubled so much as teens 20 years ago were exceptionally well.

As Rinehart and Barkley note, this pattern raises the question of whether the teen mental-health crisis reflects a trend (i.e., a change that is out of the normal cycle) or a cycle (i.e., a phenomenon that tends to fluctuate around a long-term average toward which it eventually reverts).

In my view, taking the latter interpretation wouldn’t mean that the teen mental-health crisis requires no explanation, let alone that we should accept it as inevitable. But it would suggest that some of its causes might be long-term features of American life. In the case of teen suicide, these might include our nation’s exceptionally high rates of firearm ownership. Perhaps the causes of American adolescents’ mental distress are largely the same as they were in the 1990s only they were temporarily mitigated in the early aughts by some exogenous shock.

On the other hand, some measures favor the “trend” interpretation over the “cycle” one. The overall teen suicide rate in the U.S. remains far below its 1990s peak. But this is entirely because of a decline in suicide rates among adolescent boys. The suicide rate among teen girls, by contrast, has never been higher. Separately, the percentage of teens suffering from self-reported persistent sadness or hopelessness is at record highs in the CDC’s data set.

This list of plausible explanations for the teen mental-health crisis is far from complete. And I think the disparate theories are all potentially complementary. It is possible that (1) the introduction of social media — into a society where teens face rising levels of academic pressure and parental surveillance — helped to catalyze a decline in teen mental health, but (2) rates of teen mental distress were always likely to rise over the past decade as those rates were historically low in the early years of this century and therefore liable to revert to their long-term level.

Arriving at a consensus explanation for the teen mental-health crisis will take more time, research, and debate. But while intellectuals squabble over their rival social theories, the government should increase the quality and affordability of mental-health services for adolescents. Whatever the crisis’s cause, improving care is surely part of the solution.