The Growing Mental Health Crisis in Teenage Girls (and Boys)
A recent survey on CNN reported that 90% of people in the USA believe that there is a mental health crisis happening right now, and more than half identified mental health issues among children and teenagers as a crisis.
My friend, Donna Jackson Nakazawa’s recently published book, Girls on the Brink, inspired me and my colleague, Dr Neil Sharp, to write this article.
Awareness of adolescent mental health challenges is growing rapidly, and
has become a topic of growing concern in recent years. 
Girls are of particular concern. In a US study, rates of depression in teen girls rose from 11.4% to 23.4% in the 10 years from 2009-2019 — more than triple the 3.7% rise seen in boys. The reasons for this disparity still aren’t clear. 
In a representative survey of 26,885 students aged 11–14 across the United Kingdom, as many as 1 in 3 reported significant depressive symptoms. 
Our daughters, students, and clients are more anxious and prone to depression and self-harm than ever before. But until recently we haven’t had the science to explain why this is happening—and why it is happening now.
Expectations for teenage girls to be brainy, athletic, nurturing, and look like supermodels – while juggling homework, social networking, and resumé-padding activities – are fueling a generational mental health crisis. 
Until the mid-1990s, the general consensus in psychiatry was that depression was a condition found only in adults, but it has since become clear that adolescence is a crucial period for mental health. Although children as young as three can be diagnosed with depression, typical onset is in the early teen years, which is a period of intense brain development. Half of all mental-health disorders begin by age 14, and 75% start by the mid-20s, research shows.  If a young person experiences depression or anxiety, that’s often a sign that they might face lifelong challenges with symptoms.
As mental-health concerns grow, scientists are looking to prevention as a strategy for addressing rising rates of depression among young people. Researchers say it is both possible and essential to ward off mental-health issues, which frequently begins in adolescence. But as programs that aim to build resilience proliferate in schools, research points to the complexity of the task. Some programs seem to be helpful and others not.
In some places, researchers are only just starting to document rates of depression and related disorders in young people, and in others it is still unrecognized or acknowledged.  60% of young people with depression in the United States, girls and boys, do not receive any mental-health treatment at all. 
New research and new road maps for hope
In the midst of this growing problem, and the growing awareness thereof, combined with the current limited understanding of why this is happening and how we can help, the book, Girls on the Brink, by Donna Jackson Nakazawa, the best-selling science writer, is a wonderful roadmap. 
In her book, Jackson Nakazawa unpacks the latest findings from the annals of neuroscience to offer us all surprising and valuable new insights as to how and why chronic stress during the critical neurodevelopmental window of puberty can ramp up girls’ stress machinery in body and brain in ways that derail mental health – and in ways that are different than in boys. This book also is filled with answers. The author unveils how the recent science that’s shown us the why has also shown us how we can solve this crisis. She also lays out 15 science-backed “antidote” strategies – including insights, tips, and scripts to use in all the difficult moments of girls’ lives – to help girls flourish in our increasingly stressful and troubled times.
Evolving awareness, recognition, and understanding
Girls on the Brink synthesizes research across many disciplines, including the groundbreaking research of Johns Hopkins University professor Christina Bethell, PhD, whose collective work over 3 decades has flipped the dialogue on youth mental health to focus on the social and relational context in which our children and youth live, learn, work and grow. In addition, very importantly it has focus to the critical importance of proactively promoting youth flourishing.
This includes cultivating a sense of meaning, purpose, belonging, mattering and an “on purpose” focus on strengths and what is “already whole” in the child, especially during difficult times.
Dr. Bethell’s globally disseminated paper showed, for the first time at a population level, the power of positive relational experiences at home, school and the community to reduce by 72% a person’s chances of having depression, even when they have experienced high levels of childhood trauma or adversity. 
The Power of Being Seen and Believed
When a child reacts negatively, such as in crying, or expressing strong upset in other ways, it is easy to dismiss it as “childish”, or to say, “get over it”, “you are ok” etc. Very often such an experience is not life threatening and from the point of view of the adult, it is not very serious. The conclusion, in an attempt to have the child get over it, or feel better, of have the adult feel better is to ignore, or invalidate the experience.
When the child’s experience is objectively traumatic and damaging, often it is traumatizing and very uncomfortable for the adults that care for that child. A common reaction is to ignore the existence of that experience and distract the child from from what they are feeling.
While hiking one day, I saw a child, probably 3 years old, seated on the railing of a bridge with a stream gushing eight feet below. The dad was trying to engage the boy in observing the rocks and vegetation below. The boy was terrified. He told his dad “I’m scared, I want to get off”. The dad told him he was fine. The boy cowered and got very tense. The father was not holding the child, just standing nearby. After a few seconds the boy told the dad again, louder, of his fear. The dad repeated to the boy that he was fine, at which point the boy burst out crying. It was difficult to watch the child’s experience be ignored, with the best intentions on the father’s part. The boy looked so lonely and helpless. I walked away.
In our NeuroMovement work, the felt experience of a person, adult, or child, is the source of information both to the child and to the adult of what is needed and what can be done to provide information to the brain with which to create new possibilities and regain the sense of safety, well-being and agency. Any change, i.e. new learning, can only emerge from the here and now, and the here and now includes the felt experience. Lack of a sense of safety and trauma are known to drive changes in the brain that can have negative, lifelong impact. Denying, making wrong, ignoring, or any other way of attempting to sidestep the subjective experience of a person creates disconnection with others and within oneself, and often leads to a sense of isolation.
As Dr Christina Bethell wrote, “when we peer deeply into the science of human flourishing, we find at its roots our fundamental interconnectedness. As children or adults, we experience our innate interconnectedness through a felt sense of belonging and mattering, which requires that we feel seen, valued and shown we are important to others and the web of life in which we exist. We come to know we belong and matter through moment-by-moment, attuned, safe, stable, and nurturing relationships in our first moments, early years, and all across life.
These connected, affirming relationships are required for healthy brain development and give rise to the embodied and felt sense of mattering we need to create a life of meaning and purpose and awaken our capacity to nurture ourselves, others and the natural world that sustains us.”
What can you begin doing right now for your child in these stressful times?
In her book, Girls on the Brink, Donna lays out 15 science-backed “antidote” strategies – including insights, tips, and scripts to use in all the difficult moments of girls’ lives – to help girls flourish in our increasingly stressful and troubled times.
Below are a few suggestions from us that you can start following right away:
- Creating a more nurturing environment for the child (and adult) is easier than it might sound. The first step is to know and feel withing yourself that the child’s experience is very real to them and how they react and what they learn from the experience depends on what they feel and perceive. In other words, take the child’s experience seriously while maintaining your adult perspective.
- The next step is to get interested in the child’s experience, unless the situation requires immediate intervention for the child’s safety, in which case take action right away. One of the easiest ways to get interested in the child’s experience is to ask questions. If we go back to the child seated on the railing of the Bridge, the dad could have believed and taken seriously the child’s experience, even if he estimated that the child was safe, and realize that when the child is terrified, he is not going to be interested in rocks and vegetation. If anything, he is learning that he is unsafe and alone in his experience. The alternative could be to simply have the dad put his arm around the child and ask him: “does that feel better?” and keep going until the child felt safe. Then the child can feel that he is safe and that he matters.
- There is a paradox found in Dr. Bethell’s research that “it is through the portal to meeting what’s difficult with safety that we show children how to have resilience even in the face of life’s suffering. It’s when you don’t allow for your child’s (the so called) negative emotions that you risk diminishing their mental health.”  When the child is having a tough, or stress generating experience, naming, and acknowledging that experience, and choosing whether to do something about it or not, can go a long way to preventing it from having an extended negative impact and at the same time build resilience.
The importance of the subjective sense of safety for our biology to work to our advantage cannot be overstated and is still far from where we need it to be.
Girls on the Brink, the work of Dr Bethell, NeuroMovement®, and an ever-growing number of scientists, health practitioners, and teachers are bringing this important knowledge and these practices more widely to individuals and to systems.
- Sohn, E. Tackling the mental-health crisis in young people. Nature 608, S39-S41 (2022)
- Daly M. Prevalence of Depression Among Adolescents in the U.S. From 2009 to 2019: Analysis of Trends by Sex, Race/Ethnicity, and Income. J Adolesc Health. 2022 Mar;70(3):496-499.
- Ford T, et al. The Role of Schools in Early Adolescents’ Mental Health: Findings From the MYRIAD Study. J Am Acad Child Adolesc Psychiatry. 2021 Dec;60(12):1467-1478.
- Hinshaw S., “The Triple Bind: Saving our Teenage Girls from Today’s Pressures” (Ballantine Books, 2009).
- Kessler RC et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005 Jun;62(6):593-602.
- Kuyken W, Ball S, Crane C, et al Effectiveness and cost-effectiveness of universal school-based mindfulness training compared with normal school provision in reducing risk of mental health problems and promoting well-being in adolescence: the MYRIAD cluster randomised controlled trial Evidence-Based Mental Health 2022;25:99-109
- Maalouf FT, Alrojolah L, Akoury-Dirani L ,et alPsychopathology in Children and Adolescents in Lebanon Study (PALS): a national household survey. Soc Psychiatry Psychiatr Epidemiol. 2022 Apr;57(4):761-774.
- Tamar Mendelson, director of the Center for Adolescent Health at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland quoted in Tackling the mental-health crisis in young people. Nature 608, S39-S41 (2022)
- Jackson Nakazawa, D. Girls on the Brink: Helping Our Daughters Thrive in an Era of Increased Anxiety, Depression, and Social Media Harmony (September 13, 2022)
- Bethell C, Jones J, Gombojav N, et al Positive Childhood Experiences and Adult Mental and Relational Health in a Statewide Sample: Associations Across Adverse Childhood Experiences Levels. JAMA Pediatr. 2019;173(11)
- Jackson Nakazawa, D. Girls on the Brink: Helping Our Daughters Thrive in an Era of Increased Anxiety, Depression, and Social Media Harmony (September 13, 2022) P 142