Adolescence is an important time to prevent, detect, and treat mental health issues as many illnesses often appear for the first time during the teenage years. Teens and adults may not recognize symptoms of mental illness that may be a cause for concern because normal adolescent development is a time of tremendous cognitive, behavioral, and emotional changes. Among those changes which can contribute to the expression of mental health conditions include sleep disturbances, hormonal changes, substance use, increased levels of stress and academic pressures (1). In a 2007-2008 statewide survey of California students, 30.5% of 9th graders and 34.7% of 11th graders reported feeling sad and hopeless almost every day for two weeks (2). Research has shown that unrecognized or untreated mental and emotional health disorders increase young people’s risk of school failure and dropout, alcohol and drug use, HIV transmission, somatic ailments, and suicide, the third-leading cause of death in adolescents.
According to the California Health Information Survey (CHIS), 21% of California teens are at risk for depression. A 2009 national study estimates nearly 1 in 10 adolescents had a major depressive episode in the past year, with specific subgroups—females, older adolescents, and those with co-occurring substance use problems—being at higher risk (3). Estimates of the prevalence of mental health disorders among youth vary depending on the definitions used and the age group studied. Given the high level of depression among young people it is critical to raise awareness of the signs of adolescent depression, to increase screening for adolescent depression in multiple health care settings including primary care , and to more widely disseminate information on the availability of treatment options for adolescents.
Although recent California-specific data is difficult to obtain, national figures speak to the seriousness of mental health issues among teens and young adults.
- Approximately 11 percent of adolescents have a depressive disorder by age 18 according to the National Comorbidity Survey-Adolescent Supplement (NCS-A). National institute of Mental health (4). Left untreated, such issues can lead to high dropout rates, substance abuse, violence—and suicide, the third-leading cause of death in adolescents.
- Teens with unidentified mental disorders are in generally poorer physical health and engage in more risky behaviors than their peers such as unsafe sex, fighting and carrying weapons (5).
- Up to fifty percent of all lifetime cases of mental illness begin by age fourteen, and seventy-five percent by age 24 (6).
- Adolescents with untreated mental disorders represent a disproportionately large segment of the populations in the juvenile justice and adult criminal justice systems (7).
Nationally, there is a lack of mental health services for youth. Despite the effectiveness of treatment for depression and a variety of treatment options available, nearly two thirds of adolescents who had past year major depressive episode did not receive treatment for depression in the past year (8). A large, national survey of adolescent mental health reported that about 8 percent of teens ages 13-18 have an anxiety disorder. However, of these teens, only 18 percent received mental health care (9).
Suicide rates increase dramatically as teens move from early adolescence to middle adolescence and to young adulthood (10). Suicide consistently ranks as the third most common adolescent mortality.iv
Suicide is a complex behavior caused by a combination of factors. According to the National Institute of Mental Health risk factors vary with age, gender, or ethnic group and may occur in combination or change over time. Research shows that risk factors for suicide include: history of depression and other mental disorders, or a substance-abuse disorder (often in combination with other mental disorders), family history of mental disorder or substance abuse, family history of suicide, family violence, including physical or sexual abuse, firearms in the home – the method used in more than half of suicides- and exposure to the suicidal behavior of others, such as family members, peers, or media figures (11).
There are significant gender disparities in suicide rates; females typically have higher numbers of attempts, with males having much higher completion rates during adolescence and throughout life. Nearly five times as many males as females ages 15 to 19 died by suicide and just under six times as many males as females ages 20 to 24 died by suicide (12).
There are also ethnic disparities in suicide rates. In California, 2009 suicide rates per 100,000 in the 15 to 24 age group were: white 101.3, African American 81.6, Hispanic 55.5, Native American 51.2 and Asian 35 (13).
Data and research are essential tools for raising awareness of adolescent health issues, to plan programs and service delivery, and to formulate policy at the state and local levels. CAHC is committed to maintaining a website that serves as a gateway to a wide array of resources, and regularly updating our site to include the most up-to-date research. Direct links are provided when possible, and abstracts are provided for journal articles.
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(1) J. Shalwitz, T. Sang, N. Combs, K. Davis, D. Bushman, B. Payne (2007). Behavioral Health: An Adolescent Provider Toolkit. San Francisco, CA: Adolescent Health Working Group, San Francisco.
(2) Retrieved from: http://www.wested.org/online_pubs/hhdp/css_12th _compendium.pdf
(3) Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (April 28, 2011). The NSDUH Report: Major Depressive Episode and Treatment among Adolescents: 2009.Rockville, MD.
(5) Ozer, E.M., Zahnd, E.G., Adams, S.H., Husting, S.R., Wibblesman, C.J., Normal, K.P., & Smiga, S.M. (2009). Are adolescents being screened for emotional distress in primary care? Journal of Adolescent Health, 44, 520-527.
(6) Kessler, R.C., Berglund P., Demler O., Jin, R., Merkangas, K.R., & Walters, E.E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey replication. Archives of General Psychiatry, 62, 593-602.
(7) Cauffman, E. (2004). A statewide screening of mental health symptoms among juvenile offenders in detention. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 430-439
(8) Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (April 28, 2011). The NSDUH Report: Major Depressive Episode and Treatment among Adolescents: 2009. Rockville, MD.
(9) Retrieved from: http://nimh.nih.gov/health/publications/depression-in-children-and-adolescents/index.shtml
(10) National Center for Health Statistics (NCHS), National Vital Statistics System Produced By: Office of Statistics and Programming, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention
(11) Retrieved from: http://www.nimh.nih.gov/health/publications/suicide-in-the-us-statistics-and-prevention/index.shtml
(12) Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS): www.cdc.gov/ncipc/wisqars
(13) Source: California Office of Statewide Health Planning and Development, Inpatient Discharge Data Prepared by: California Department of Public Health, Safe and Active Communities Branch. Report generated from http://epicenter.cdph.ca.gov on: September 20, 2011