Adolescent Mental Health is Worsening with Varied Impacts by Race, Sex, Sexual Orientation

Adolescent mental health has worsened over recent years, with increases in drug overdose deaths, self-harm and eating disorders, according to an issue brief published by the Kaiser Family Foundation (KFF). The impact varied by race, sex, sexual orientation and other demographic factors.

Nirmita Panchal

An analysis from Nirmita Panchal, senior policy analyst for KFF’s Program on the ACA and the Program on Medicaid and the Uninsured, and colleagues was conducted to explore the state of adolescent (ages 12-17) mental health and substance use across demographics factors using data gathered from the 2020 National survey of Children’s Health and the CDC.

Substance use and related deaths

Drug overdose deaths among adolescents nearly doubled from 282 deaths in 2019 to 546 deaths in 2020. In adolescent men, drug deaths more than doubled, and from 2019 to 2020, the gap between male and female adolescent drug deaths grew. The primary driver in the growth of these deaths is likely the rise in fentanyl-laced substances, according to KFF.

Overdose deaths increased across all racial and ethnic groups. While White adolescents account for the largest share of drug overdose deaths, the share of deaths rose among Black adolescents (10% to 13%) and Hispanic adolescents (18% to 30%) from 2015 to 2020.

The use of some other substances, such as alcohol and illicit drugs, has declined in the last decade; however, substance use was more pronounced among lesbian, gay and bisexual (LGB) and American Indian and Alaskan Native (AIAN) adolescents.

Suicide and self-harm

Suicide is the second-leading cause of death among adolescents, and from 2010 to 2020, the suicide death rate increased by 62%.

In 2020, AIAN adolescents had the highest suicide death rate, more than three times higher than that of White adolescents. Black, Hispanic and Asian adolescents had lower rates of suicide deaths compared with White counterparts, but they “experienced larger increases in suicide death rates over time.”

Suicide rates remained higher among male adolescents (8.7 per 100,000) compared with female adolescents (3.9 per 100,000) in 2020.

The rate of emergency department (ED) visits for self-harm increased by 10% among adolescent females from 2019 to 2020. ED visits for suicide attempts during the pandemic increased, largely driven by female adolescents.

Anxiety and depression

In 2020, 16% of adolescents experienced anxiety and/or depression, which was similar to 2019 (15%) but higher than 2016 (12%).

The share of adolescents experiencing these conditions remains higher for females (18%) compared with their male peers (14%).

Black adolescents are consistently less likely to report anxiety and depression, potentially reflecting an underdiagnosis of mental health issues in adolescents of color “due to gaps in culturally sensitive mental health care, structural barriers, and stigma associated with accessing care.”

Negative impacts on health and well-being

The KFF brief indicated that 55% of adolescents experienced parent emotional abuse, 11% experienced physical abuse, 29% experienced parental job loss and 24% experienced hunger in 2021. Parental emotion abuse was more common among female and LGB adolescents.

Peer connections, a social support for adolescents, were strained in 2021 with only 47% of high school students reported feeling close to people at school.

The report also suggests that increases in gun violence in 2021 may have led to negative health impacts on children and adolescents.

Access to care

Leading up to the pandemic, male adolescents, adolescents in rural areas and children of color were less likely to access care than their peers. Only one in five children and adolescents with mental, emotional or behavioral disorders received mental health care from a specialized provider.

During the pandemic, access and utilization of mental health care appeared to have worsened. Utilization of mental health services declined by 23% and substance use disorder services declined by 24% during the pandemic.

Although many children began accessing mental health and substance use care through telemedicine during the pandemic, outpatient care through telemedicine began to decline in 2021, according to the brief.

Measures to address mental health and barriers to care

The report outlines measures taken to address these issues, including anxiety and depression screening recommendations from the U.S. Preventive Services Task Force, Medicaid programs implementing crisis services and expanding coverage of telemedicine, the introduction of bipartisan bills to designate funding toward behavioral care and suicide prevention, and the launch of a federally mandated crisis number.

Panchal and her colleagues suggest that collecting data on vulnerable populations will be pivotal in understanding how to address and mitigate these growing concerns.