Overcoming Mental Health

Challenges in Today’s Youth

Ram Chettiar, DO

Children’s Mercy Hospital, Kansas City, MO

Child and Adolescent Psychiatry

Assistant Professor of Pediatrics and Psychiatry

Division of Developmental and Behavioral Sciences

Disclosures

▪ No relevant financial interests,

arrangements, or affiliation with

any organizations related to the

content of this presentation

Objectives

▪ Review current data on mental health

rates in youth

▪ Discuss the impact of smartphones and

technology on mental health

vulnerabilities

▪ Provide strategies to best address

anxiety and depression in young people

An American iGen in 2019…

Potential Mental Health

Problems in Youth

▪ Depressive Disorder

▪ Anxiety Disorder

▪ Bipolar Disorder

▪ Attention Deficit Hyperactivity Disorder

▪ Obsessive Compulsive Disorder

▪ Borderline Personality Disorder

▪ Eating Disorder

▪ Substance Use Disorder

Possible Red Flags

▪ Withdrawn

▪ Poor grooming

▪ Appetite/Eating Changes

▪ Failing grades

▪ Discord with friends/parents

▪ Victim of bullying

▪ Frequent stomach/head complaints

▪ Sexual Identity Issues

▪ Gender Identity Issues

▪ Cutting back on activities

▪ Suicide models, Contagion effect

▪ Reckless behavior

▪ Substance abuse

▪ Self-injury*

▪ Shutting down

▪ Previous suicide attempt*

QuickStats: Age-

Adjusted*

Suicide† Rates, by

State§ — United

States, 2012

• Source: National Vital

Statistics System. Mortality

public use data files, 2012.

Available

at http://www.cdc.gov/nchs/dat

a_access/vitalstatsonline.htm.

Between 1999-2016, suicide rates rose 45% in KS,

36% in MO (CDC, 2018)

Suicide Rate for Youth in KC, MO

0.00

4.50

9.00

13.50

18.00

22.50

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

CR

ud

e R

ate

Year

RATE OF COMPLETED SUICIDE FOR YOUTH 10-24 YEARS, KCMO

BY YEAR

(2007-2016) Death Records, City of Kansas City, Missouri Health Department

Suicide Deaths in KS, 5-24 y/o, 2007-2016,

Firearms & Other Causes

Orange:

OTHER

MEANS

Blue:

FIREARMS

Percent of children with a parent-reported ADHD

Diagnosis

National Survey of Children’s Health, National Health Interview Survey, CDC

Source: CDC

Mental Illness Prevalence in Youth

▪ Mental/Behavioral/Developmental disorder – 17.4%

▪ ADHD - 9.4%

▪ Behavioral disorder - 7.4%

▪ Anxiety disorder - 7.1%

▪ Depressive disorder - 3.2%

Helpful Hints

▪ Know what you are going to do if you identify risk

▪ Never keep a secret regarding suicidal thoughts

▪ “I’m so glad you told me”

▪ Emphasize help is available

▪ Review with others if unsure

▪ Always lean on the side of caution

▪ Parents deserve to know of suicide risk

▪ Demonstrate COMPASSION

▪ remain calm

▪ listen

▪ avoid judgement

▪ offer unconditional support

▪ normalize the experience

▪ Gather INFORMATION - safety, emergent/non-

emergent, suicidality

You Have Identified Risk: What’s Next?

Start with having a conversation

▪ Don’t leave the young person alone

▪ Have him or her taken directly to the emergency

department or call 911

▪ Means restriction: making the environment as safe

as possible by limiting access to lethal means, i.e.

firearms, medications, etc

Imminent Risk

Digital Information World, 2018

Most Popular Social Networks of Teenagers in

the US from Fall 2012 to Fall 2018

Source: Statistica, 2018

A brief history of Facebook…

A Generational Story…Millennials

(born 1980-1994)▪ Parent: “When will you be

home?”▪ Teen: “When do I have to be

home?

▪ Value independence

▪ Remember a time without internet and cell phones

▪ As teens…worked more, went on more dates, spent more time on homework

iGen

(born 1995-2012)▪ Tend to go out less

frequently▪ Check in with parents every

30 minutes by text

▪ Value connectedness

▪ Do not remember a time without internet

▪ As teens…worked less, went on less dates, spent less time on homework

2012▪ An abrupt shift in teen behaviors and emotional

states▪ the most dramatic shift in a century, based on

generational data

▪ The changes were seen across all socioeconomic

statuses, every ethnicity, and across

urban/suburban/rural locations

▪ Why 2012??▪ The exact moment when the proportion of

Americans who owned a smartphone

surpassed 50%▪ 2017 Survey: ¾ of teens own a smartphone

Teen Romance in a Digital Age

▪ How Teens Flirt (Pew Rearch Center, 2015)

▪ 55% in person

▪ 50% on Facebook

▪ 47% “Like” or “Comment” on a

post

▪ 46% say something funny or

interesting online

▪ 31% send a flirty message

Obstacles for teens who use social

media for romance

▪ The delay in a significant

other in responding to a

text message can make

them feel ignored or

unimportant, especially

when they can see on

social media that their

partner is online

▪ 27% of teens who date

have had a partner use

social media to track their

whereabouts

▪ 27% of teens who date say

that social media makes

them feel jealous or

unsure of their

relationship

▪ 69% of teen daters agree

that too many people can

see what is going on with

their relationships on

social media

Pew Research Center, 2016

Videogames

PRO

▪ Practical social skills/role play

▪ Shared activity, teamwork

▪ Less vulnerable

▪ Easy to “log off”

CON

▪ Less in-person skill development

▪ Enable social avoidance

▪ Negative impact on health (less physical activity)

▪ Desensitization to violence

*Ability to create an online identity:

?idealized

?like you or not like you

?anonymity

?self-expression

Reported benefits of social media use

▪ Socialization

▪ Especially socially isolated youth

▪ Connectedness

▪ Need high social media engagement

▪ Staying in touch

▪ Making new friends

▪ Community engagement

▪ Share collective creativity

▪ art, ideas, etc

▪ Grow ideas

▪ blogs, podcasts, videos, gaming

▪ Foster individual identity and social skills

▪ Enhance learning opportunities

Reported harm of social media use

▪ Bullying, clique-forming, sexual experimentation

▪ …may lead to cyberbullying, privacy issues, sexting

▪ Parents do not often have the technical abilities or

time to keep pace with their child’s online activities

▪ “Vaguebooking” – posting unclear but alarming

sounding posts to get attention▪ Predictive of suicidal ideation

▪ ADHD, ODD, anxiety symptoms, depressive

symptoms, loneliness, and FOMO (fear of missing out)▪ Screen time linked to diminished happiness

▪ 6-9h/wk = 47% more likely to feel unhappy

▪ 10h/wk = 56% more likely to feel unhappy

FOMO(fear of missing out)

▪ Correlated with anxiety

and depression

▪ Adolescents with high

FOMO (measured by

emotional investment into

social media) exhibit

higher levels of distress

when they have limited

access to social media

▪ 21% of teens report feeling

worse about their own life

because of what they see

from other friends on

social media

A pervasive apprehension that

others might be having rewarding

experiences from which one is

absent→ Leads to a desire to stay

continually connected with what others

are doing

Cyberbullying

▪ Leads to depression,

anxiety, severe

isolation, and suicide

▪ Girls are affected

greater than boys

▪ Cyberbullying has

shown to be more

frequent and severe

than offline bullying (Lloyd, 2014)

Sexting

▪ 20% of teens have sent nude or seminude

photographs or videos of themselves to

others▪ This number is rising and will likely continue to

increase

▪ Legal consequences → distribution of

child pornography

▪ Social consequences → friends

distribute pictures to other friends

Sleep problems

▪ Increased social media use is

correlated with sleep problems

▪ Consuming social media when

they should be sleeping

▪ Stimulation from the lights on

the screens making sleep

difficult

Privacy Concerns

▪ Disregard for privacy

▪ Teens share too much

▪ Digital footprint →

may affect future

reputation (college

acceptance, future

jobs)

▪ Easier for marketers

and fraudsters

▪ Children’s Online Privacy Protection Act (COPPA)

▪ Prevents websites from collecting information on children younger than 13yo without parental permission

▪ 13 is the minimum age to sign up on most social media sites

▪ AAP encourages following the minimum age for use on social media websites

Boys vs Girls

▪ Who uses social media

more?

▪ Feels more lonely with

social medial use?

▪ Higher rates of depression

tied to social medial use?

▪ Increase in suicide

attempts?

▪ Higher risk for

cyberbullying

▪ Girls

▪ Girls

▪ Girls

▪ Girls (50% vs 21%,’12-’15)▪ (boys still complete suicide at

higher rates d/t more lethal means)

▪ Girls▪ (boys more likely to bully

physically)

Life-History Theory

▪ Human development will be slower when

families are smaller, people live longer,

children are safe and healthy, and

education takes longer to complete

▪ Explains delays in adolescent engagement in

adult activities (alcohol, dating, sex, going out

without parents, driving a car, working a job)

▪ Jean Twinge, Professor of Psychology, San

Diego State University (Time Health, 2017)

Not all adolescents are created the same…

▪ Some feel sad and lean to social

media for support

▪ Some get more sad and feel

lonely after using social media

▪ Some feel creative and inspired

▪ Some become angry and

irritable

Technology Recommendations

▪ 1. Parents should become better educated about the technologies

their kids are using

▪ 2. Create a Family Media Plan

▪ Regular family meetings to discuss online topics, check

privacy settings, and online profiles for inappropriate posts

(emphasize healthy behavior, not punitive action)

▪ Website: HealthyChildren.org/MediaUsePlan (AAP)

▪ 3. Parents should be aware of the nature of social media sites,

monitor for cyberbullying, “Facebook depression,” sexting, and

exposure to inappropriate content

▪ 4. Use social media in moderation

▪ Fewer social media platforms, unfollow/block negative people

or pages, take social media breaks (positive effect within 7

days), put down the screen to do something (DO ANYTHING!)

▪ 5. Carve out screen-free time (parents too!) – meals, before

breakfast, during homework, car rides, lights off/screens off,

bedtime

Thank You!