America’s Teenage Girls Are Not Okay
Rising teen anxiety is a national crisis.
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American teenagers—especially girls and kids who identify as lesbian, gay, bisexual, or questioning—are “engulfed” in historic rates of anxiety and sadness. And everybody seems to think they know why.
Some psychologists point to social media, whereas others blame school shootings; others chalk it up to changes in parenting. Climate-change activists say it’s climate change. Atlantic writers like me blather on about the decline of physical-world interactions. These explanations aren’t equally valid, and some of them might be purely wrong. But the sheer number of theories reflects the complexity of mental-health challenges and suggests that, perhaps, nobody knows for sure what’s going on.
The numbers are undeniable. The Youth Risk Behavior Survey, which is published by the Centers for Disease Control and Prevention, is the gold standard for measuring the state of teen behavior and mental health. From 2011 to 2021, the survey found, the share of teenage girls who say they experience “persistent feelings of sadness or hopelessness” increased from 36 to 57 percent, with the highest jump coming during the coronavirus pandemic. The share of girls who said they’ve contemplated suicide increased 50 percent in the decade. (For teenage boys, the increase was smaller.)
Life is worse for LGBQ teenagers in almost every respect measured by the survey. (The YRBS did not ask about trans identity.) Compared with heterosexual teens, they are more likely to experience poor mental health; more likely to experience unstable housing or homelessness; more likely to be threatened or injured by a weapon in school; more likely to miss school for safety reasons; less likely to feel close to people at school; more likely to be raped; twice as likely to be bullied; almost three times more likely to have recently misused prescription opioids; three times more likely to have considered suicide, made a suicide plan, or attempted suicide; and seven times more likely to be injured in a suicide attempt.
This surge in sadness, hopelessness, and suicidal thoughts among teenagers has coincided with other behavioral trends that aren’t obviously bad. Reports of smoking are down. Drug use and drinking have declined. Bullying has not increased among boys; for girls, it’s declined slightly. Big-picture economic trends don’t have much explanatory power either. In the period when teen anxiety increased, joblessness, poverty, and child hunger mostly declined, and real disposable income mostly grew.
The inexorable rise of teen anxiety ought to be a national crisis. Mental-health services have become more available due to the rise of telehealth. The number of therapists is growing faster than the U.S. average for all occupations, as demand for counselors rises in high schools and colleges. More people are using mental-health services, yet outcomes for teens just keep getting worse. How can this be?
Last year, I offered four possible theories: the prevalence of social-media use; the decline of time spent with friends; a more stressful world of mass-shooting events and existential crises such as global warming; and changes in parenting that might be reducing kids’ mental resilience.
I still think the fullest explanation for teen anxiety may live in that causal stew. But this year, I want to lead with four questions rather than four answers.
Is peak teen anxiety just another pandemic bubble?
Teen anxiety and depression grew more from 2019 to 2021 than during any other two-year period on record, raising the question of whether they might decline as most of the country moves on from the pandemic. Indeed, many pandemic trends that seemed like accelerations into the future turned out to be more like mini-bubbles. Crypto-asset prices went up in 2020 and 2021, and then came crashing down. Streaming looked like the future of entertainment for a few years, and now it looks like a money pit for many entertainment companies. We’ll have to wait another year or more for the YRBS to tell us if the reopening of schools and other physical spaces has lessened teen anxiety.
Why is it so hard to prove that social media and smartphones are destroying teen mental health?
The story seems simple from a distance: Teen anxiety increased during a period when smartphones and social media colonized the youth social experience. Offline time with close friends went down. Time spent alone staring into a virtual void went up. Sounds pretty bad.
But the academic literature on social media’s harms is complicated. Perhaps the most famous and trusted study of the effects of social media on polarization and mental health is “The Welfare Effects of Social Media.” When researchers paid people to deactivate their Facebook accounts, they found that online activity went down, offline activity went up, both polarization and news knowledge declined, and subjective well-being increased. Many participants who had been randomly selected to leave Facebook stayed off the site even weeks after they had to, suggesting that using social media may be akin to compulsive or addictive behavior. The researchers describe the effect of Facebook deactivation on depression and anxiety as “small—about 25-40 percent of the effect of psychological interventions including self-help therapy.”
In a few years, the assumption that social media is making us crazy might look eye-bleedingly obvious, like a surgeon-general warning that sucking on cigarettes to pull addictive carcinogens into your lungs is, in fact, bad for your lungs. But the best evidence we have suggests that social media isn’t really like smoking. My guess is that it’s more of an attention alcohol—a substance that, in small doses, can be fun or even useful for adults, but in larger doses can cause problems for certain people. But maybe even that’s too strong. Just as academics now believe we overrated the danger of online echo chambers (in fact, social media probably exposes us to a much wider range of views than cable news does), we’ll realize that we unfairly blame social media for declining mental health.
“There’s been absolutely hundreds of [social-media and mental-health] studies, almost all showing pretty small effects,” Jeff Hancock, a behavioral psychologist at Stanford University, told The New York Times last year. I think we still need more high-quality studies and randomized trials to fully understand what’s happening here.
What do we make of the relationship between rising LGBQ self-identification and rising LGBQ anxiety?
Major progress has been made in terms of accepting gay, lesbian, and trans Americans in the past few decades. The Supreme Court struck down bans on same-sex marriage; major institutions, such as the NBA and Disney, have stood up against bigoted laws; more television shows now depict gay and transgender characters in a positive, or appropriately complex, light.
Meanwhile, LGBTQ self-identification has increased markedly. According to Gallup, more than 20 percent of Gen Z Americans identify as lesbian, gay, bisexual, or transgender. That figure is several times higher than for any previous generation, including seven times higher than for Baby Boomers—many of whom now tell stories about how harmful it was to be in the closet during a more intolerant era.
But the state of mental health in the LGBQ community is dire, and it’s worsening faster than the national average. “Close to 70% of LGBQ+ students experienced persistent feelings of sadness or hopelessness during the past year and more than 50% had poor mental health during the past 30 days,” the CDC reported.
Liberal and conservative explanations for this phenomenon are irreconcilable. According to liberals, the election of Donald Trump unleashed a torrent of anti-gay and transphobic attitudes, which are now overrunning schools, most notably in Florida; wiping out whatever legal progress we might have celebrated at the national level; and making vulnerable teens feel like their very identity is being challenged by the country’s loudest politicians. According to conservatives who brand themselves as anti-woke, the real culprit is liberals’ obsession with victimization and identity.
The point of juxtaposing these interpretations is not to suggest that I find them equally convincing (I side with the liberal argument) but rather to show just how broken this front of the culture war has become. This is the tragic state of things: Both conservatives and liberals are convinced that the way their political opponents talk about identity is making teens want to kill themselves. America needs its best and least-biased sociology and psychology researchers to take up the question “Why is mental health deteriorating rapidly among a segment of the Gen Z population that is also growing rapidly?” Given that almost 25 percent of LGBQ teens attempted suicide in the past year, a convincing empirical answer could help save thousands of lives.
Why are Americans so mentally distressed even as they’ve become better at talking about mental distress?
It’s obvious, you might say: As anxiety rates have escalated, more people have had to build their own personal therapeutic glossary.
Or maybe something else is going on. In the past few years, a great deal of U.S. discourse has absorbed the vocabulary of therapy, with frequent references to trauma, harm, emotional capacity, and self-care. But the ubiquity of “therapy-speak” on the internet has coincided with the emergence of an internet culture that is decidedly anti-therapeutic.
Research from both the University of Pennsylvania’s Wharton School and Beihang University, in Beijing, have found that intense and negative emotions are among the most likely to go viral online. Anger and outrage seem to be aerodynamic on the internet not only because we’re drawn to the emotional meltdowns of our fellow humans, but also because demonstrating outrage about a topic is a good way of advertising one’s own moral standing.
Anger, outrage, and catastrophizing are exactly what modern therapists tell their patients to avoid. One of the most popular modes of clinical psychology is cognitive behavioral therapy, or CBT, which formalizes an ancient wisdom: We don’t often control what happens in life, but at the margins, we can change how we think about what happens to us. We can learn to identify the most negative and unhelpful thoughts and restructure them, so as to guide us toward better feelings and behaviors. In life, treating minor problems as catastrophes is a straight path to misery—but online, the most catastrophic headlines get the most attention. In life, nurturing anger produces conflict with friends and family; online, it’s an excellent way to build an audience.
Modern internet culture has adopted therapy-speak while repeatedly setting fire to the actual lessons of modern therapy. It’s a bizarre spectacle, like a hospital where fake doctors know the words for every disease but half of the surgeries result in sepsis. In the open expanse of the internet, we could have built any kind of world. We built this one. Why have we done this to ourselves?