Early detection is key to treating depression in teenagers. dragana991/iStock via Getty Images Plus
More than 44% of teens reported persistent feelings of sadness and hopelessness in the first half of 2021, according to a report from the Centers for Disease Control and Prevention. The early 2022 report, which was based on an online survey, also found that nearly 20% had seriously considered suicide, and 9% attempted suicide.
The COVID-19 pandemic is a likely contributor to these startling figures, but rates of teen mental illness have been rising over the past decade.
One crucial factor that has received little attention in supporting teen mental health is the role that parents can play.
This is surprising, since research has clearly established that participation by a caregiver in their child’s mental health treatment is directly related to a successful outcome. A key reason for this is that parents generally interact with their teen on a daily basis and can model and cultivate coping skills.
Yet, for mental health professionals, it can be challenging to integrate parents into teens’ treatment when there are discrepancies between the perspectives, goals and expectations of teens and parents. In addition, consent and privacy laws sometimes limit providers’ abilities to disclose key details about a teen’s mental health to parents.
The teenage years can be brutal
Parents often dread the teenage years, anticipating mood swings, risk-taking behaviors and endless arguments. Some of this is developmentally normal: Teens are developing their identities, testing limits and asserting their autonomy. These combined factors can lead to hostility and a lower-quality parent-teen relationship.
Physically, teens are sleep-deprived, in part due to overly early school start times and hormonal changes associated with puberty. As a result, teens can be irritable and sensitive to stressors. They also haven’t developed the self-control to manage their reactions.
And it’s important to note that half of all mental illness emerges by age 14 and 75% by age 24, making adolescence a highly sensitive period for the prevention and treatment of mental health problems.
Signs and symptoms of a mental health concern
Mental health problems in teens can sometimes take unexpected forms. Depression and anxiety can manifest as irritability and noncompliance, which parents may reasonably view as disrespect and laziness. Understanding what is beneath those behaviors is challenging. Teens are quite secretive, so they may not disclose the extent of their struggles.
Although anxiety is a normal emotional response at any age, about a third of adolescents have some type of anxiety disorder, and about 10% experience severe impairment as a result. Teens struggling with chronic anxiety may experience agitation or irritability, issues with sleep, perfectionist tendencies, or may try to avoid stressful things altogether.
Keeping a journal, exercising regularly and maintaining a sleep routine are three ways for teens to cope with stress.
Among teens, 17% struggle with depression. Depression generally involves a loss of interest or pleasure in daily activities, but it is more than feeling blue. For teens, symptoms of depression may look like withdrawing from family or social activities, shutting down during conversations or conflict, lethargy, difficulty concentrating, hopelessness about the future or negative feelings of self-worth.
Depression can also be associated with self-harm and suicide.
In determining whether a teen is experiencing a mental illness, parents should consider how behaviors are affecting their teens’ everyday lives and plans for the future. Those who are falling behind in school, damaging important relationships or engaging in high-risk behaviors may be most likely to be experiencing a mental health issue – as opposed to typical teenage challenges.
A shortage of mental health care
Despite the growing need for mental health care, the U.S. has a dire shortage of professionals to meet the demand. Insurance companies create barriers to accessing mental health care by restricting the numbers of in-network providers and approved sessions. As a result, many providers prioritize patients who will pay out of pocket.
Parents and teens may wait months for an appointment, and the quality and effectiveness of the services they receive are highly variable. All the while, symptoms may worsen, straining the family and compromising teens’ social and academic opportunities.
The powerful role parents can play
This is where parents come in, since they can serve as role models for teens’ coping and emotional development.
While good sleep, consistent exercise and quality meals can often be the first line of defense in preventing and managing symptoms of mental health problems, there are several behavioral strategies for parenting struggling teens. Indeed, foster parents care for children with complex histories of trauma, and many of the behavior management strategies taught to foster parents may be useful for traditional family settings as well.
When teens are unkind or disrespectful, parents may take it personally. But parents who are aware of and able to manage their own triggers can react calmly to challenging behavior, creating opportunities for effective communication with their teen.
Building and maintaining the parent-teen connection, such as by watching a TV show together or other low-pressure opportunities to be together, is key. These experiences create safe spaces and opportunities for teens to communicate about difficult emotions or situations. Parents who assist teens in recognizing, talking about and dealing with difficult thoughts and feelings help them to understand how their thoughts and feelings can affect their behavior.
Set up a behavior contract with your teen.
Parents can also help their teens manage negative emotions by reinforcing their self-esteem and strengths and encouraging self-efficacy. Parents who offer praise to their teens who are working hard to overcome challenges – as opposed to focusing solely on the outcome – can help teens see their worth beyond their accomplishments.
At the same time, teens require boundaries that allow them to build self-reliance, exercise independence and practice compromise in certain situations. Behavior contracts – in which teens and their parents agree to certain conditions in writing – can provide a structured way to establish shared expectations.
When consequences are necessary, natural consequences allow teens to learn without parental intervention. For example, if a teen stays up late the night before a big softball game, their coach may bench them for playing poorly. Parents can help teens to connect the frustration and disappointment they experience to their choices regarding sleep, which can be more helpful for their future decision-making than getting into an argument with a parent about their decision or receiving a parent-imposed consequence, such as removing phone privileges.
When natural consequences are not an option, discipline should be specific, time-limited and focused on a specific outcome, such as not allowing preferred activities until homework and chores are complete.
It is also important that parents avoid power struggles with their teens by modeling respectful communication without trying to manage the teen’s reaction or perspective. Teens are unlikely to admit to being wrong – particularly in a heated moment – and if the point is made, there is rarely a benefit to insisting upon a particular reaction such as a forced apology.
Parents can best support their teens by maintaining connection alongside enforcing structure and discipline. While challenging behaviors can be the status quo of adolescence, parents should be on the lookout for signs that might reflect a pervasive mental health issue, since early detection and treatment is crucial.
The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.