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The Impact of Peer Pressure on Depressed and Anxious Teens – Risks and Warning Signs

Written by Evolve's Behavioral Health Content Team​:

Alyson Orcena, LMFT, Melissa Vallas, MD, Shikha Verma, MD, Ellen Bloch, LCSW, Lianne Tendler, LMFT, Megan Johnston, LMFT Meet The Team >

Depression and Anxiety Increase Vulnerability to Peer Pressure

When we talk about peer pressure, most of us immediately think about high school. Although peer pressure exists in elementary school, escalates in middle school, and permeates college culture on social, academic, and personal levels, high school is the time and place peer pressure appears to exert its most powerful influence over the growing human.

This makes perfect sense when we think about adolescent development. During adolescence, school-age children transform into adults. The definition of physical adolescence – the full development of the sexual organs – means that youth who were children at 12 are adults at 18.

Physically speaking, at least.

The brain is the last thing to finish developing, with the prefrontal cortex reaching full maturity at some point during the early- to mid-twenties. This means that the development of our primary mechanism for rational decision-making, impulse control, and risk-reward analysis lags behind everything else, including our bodies and our emotions, by five to ten years.

This means certain elements of psychological and emotional maturity lag behind, as well.

Now let’s consider the breadth of changes that occur during adolescence. Teens undergo radical development in the following areas:

    1. Ethical and Moral Decision Making
      • Teens may challenge rules and test limits
      • Teens may experiment with sex and illegal substances
    2. Independence and Emotions
      • Teens may become preoccupied with the way they appear, dress, and behave
      • Teens may feel awkward in their bodies and out of place in their social lives
    3. Sexuality
      • Teens may begin to worry about their relative level of attractiveness
      • Teens may become interested in and/or experiment with sex

While all these radical changes happen, another thing happens, as we mention above: peer influence increases in intensity.

For teens diagnosed with depression or anxiety, this can create a dangerous set of circumstances.

Peer Pressure and Teens with Depression, Anxiety

Research shows that teens diagnosed with a mental health disorder – particularly depression or anxiety – are at increased vulnerability to peer pressure. Teens with depression and anxiety display increased levels of the following emotional/psychological states and experiences, as compared to peers without similar mental health diagnoses:

  • Low self-esteem
  • Extreme self-consciousness
  • Sensitivity to criticism
  • Preoccupation with failures
  • Sensitivity to rejection

Combined with some of the more difficult changes that occur during adolescence – developing sexuality, pushing boundaries, worrying about appearance, experimenting with sex/alcohol/drugs, preoccupation with social status, prioritizing peer opinion over parental guidance – the characteristics of depression and anxiety listed above leave adolescents with depression and anxiety vulnerable to engaging in risky behaviors and making decisions based on poorly regulated emotional impulses and guided by what others think, rather than making decisions based their own best interest and guided by their personal sense of wellbeing.

At this point, this article diverges and takes two parallel tracks. One is for parents of teens diagnosed with depression or anxiety. The other is for teens without a diagnosis, but who may be vulnerable to the disorders – and also vulnerable to peer pressure.

Peer Pressure and Teen Mental Health: What Parents Should Watch For

On the one hand, we advise parents of teens with a depression or anxiety diagnosis to increase their vigilance. According to the data in the study linked to above, their teen is at risk of disproportionate influence by peers who don’t understand the power they have. Peers may exert extreme pressure to participate in risky behavior without knowing that a teen with depression or anxiety may desperately want to fit in, find a peer group, and gain acceptance – which impairs their ability to make a rational decision. They’ll go to great lengths to get that acceptance. The fact their prefrontal cortex is underdeveloped exacerbates the problem.

On the other hand, parents of teens who have depression or anxiety but have not yet received a diagnosis need to understand the power of peer pressure on their teens, as well. If their teen is in the process of developing depression or anxiety but they don’t know it, they may make choices that have everything to do with their undiagnosed disorder and peer pressure, and little to do with what they want for themselves. Their emotions – under the twin influence of adolescence and a mood disorder – may lead them to places they truly do not want to go.

That’s why we say this article diverges, yet takes parallel tracks. It diverges in that it’s for two sets of parents: those with teens with a mental health diagnosis, and those with teens without a mental health diagnosis. It’s parallel in that the risks and warning signs to watch for are identical. Parents of teens with a diagnosed disorder should watch for a recurrence of the warning signs, while parents of teens without a diagnosed disorder should watch for the initial appearance of the risks and warning signs.

Depression and Anxiety in Teens: Risks and Warning Signs

Both sets of parents should understand that peer pressure – combined with the vulnerabilities associated with depression and anxiety – can lead to risky behavior that may have long-term, negative consequences.

We’ll start by defining depression, then offer the warning signs of teen depression.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) defines depression as:

“An overwhelming feeling of sadness, isolation, and despair that last two weeks or longer at a time.”

Parents should pay close attention to the key phrase “…that last for two weeks or longer at a time.”

Teen Depression: Warning Signs

  • Persistent sadness and low mood
  • Frequent crying
  • Recurring, daily hopelessness or pessimism
  • Frequent irritability
  • Frequent anger or hostility
  • Daily feelings of hopelessness or worthlessness
  • Withdrawal from friends and family
  • Lack of interest favorite activities
  • Decreased participation in extracurricular activities, including sports, band, or academic clubs
  • Daily fatigue
  • Communication issues with friends or family
  • Restlessness
  • Agitation
  • Problems with concentration and decision-making
  • Memory issues
  • Problems completing tasks at home or school
  • Changes in sleep: too much/too little
  • Changes in eating: too much/too little
  • Extreme loss or gain of weight
  • Physical ailments, such as headaches or stomachaches, that have no clear cause and do not improve with common remedies
  • Suicide-related thoughts and behaviors: thinking about, talking about, or attempting suicide*
* If your teen is in immediate danger or poses an imminent threat to themselves or someone else, call 911 immediately or take them to an emergency room at a regular hospital or a psychiatric hospital.

Parents reading this should understand those symptoms in terms of the key phrase in the clinical diagnosis above, which states that for symptoms to meet the threshold for clinical depression, they “…are present every day for two weeks or longer at a time.”

Since we all know teens can be moody, it’s worth repeating something. Short bouts of sadness, anger, or withdrawal are common. But when they last for two weeks or more, that’s a clear red flag. Parents of teens with no previous diagnosis should arrange a full assessment with a mental health professional. Parents of teens with a previous diagnosis should contact their teen’s therapist or treatment center.

We’ll now define anxiety, then offer the warning signs of teen anxiety.

According to the National Association on Mental Illness (NAMI), all anxiety disorders share one unifying trait:

“Persistent, excessive fear or worry in situations that are not threatening.”

NAMI describes specific symptoms to watch for:


  • Fear of typical, day-to-day situations
  • Constant restlessness
  • Persistent irritability
  • Habitually predicting the worst outcome in any situation
  • Excess tension or jumpiness


  • Racing heart/shortness of breath
  • Headaches, insomnia, fatigue
  • Twitching, sweating, or tremors
  • Nausea
  • Frequent trips to the bathroom (diarrhea or frequent urination)

There’s a general rule of thumb to follow with regards to most mental health issues, anxiety and depression in particular. The rule has two parts:

  1. If the anxiety lasts for more than a few days – up to two consecutive weeks – then it may indicate clinical anxiety.
  2. If the anxiety disrupts daily activity – meaning it impairs home life, school life, and social life – then that may indicate the presence of an anxiety disorder, rather than typical anxiety.

Now it’s time to talk about risk factors. Experiencing the following things can increase the chance that a teenager will develop clinical depression:

It’s important to understand that the presence of a risk factor, or multiple risk factors, does not mean a teen will develop depression or anxiety. Also, the presence of symptoms and risk factors simultaneously does not mean a teen has or will develop depression or anxiety. However, if a teen displays signs and symptoms of depression or anxiety every day for two weeks or more – and risk factors are also present – then it’s time to take action.

Evidence-Based Treatment is Effective for Teen Depression and Anxiety

As we mention above, parents of teens with no previous diagnosis of depression or anxiety should arrange a full assessment with a mental health professional if they see the signs we list above. Parents of teens with a previous diagnosis of depression or anxiety should contact their teen’s therapist or treatment center if they see the signs we list above.

One more thing: it’s important for parents to know that treatment works. That goes for both sets of parents. Parents of teens with no previous diagnosis should understand that their teen can receive evidence-based treatment, which allows them to manage their disorder and lead a full and productive life. Parents of teens with a previous diagnosis should understand that a relapse or recurrence of symptoms does not mean treatment failed. It means that recovery is a lifelong process, and their teen needs to reconnect with their coping skills and return to treatment if necessary.

Finding Help: Resources

If you’re seeking treatment for your teen, please navigate to our page How to Find the Best Treatment Programs for Teens and download our helpful handbook, A Parent’s Guide to Mental Health Treatment for Teens.

In addition, the American Academy of Child and Adolescent Psychiatry (AACAP) is an excellent resource for locating licensed and qualified psychiatrists, therapists, and counselors in your area. Both the National Institute of Mental Health (NIMH) and the National Alliance on Mental Illness also provide and high-quality online resources, ready and waiting for you right now.

Our Behavioral Health Content Team

We are an expert team of behavioral health professionals who are united in our commitment to adolescent recovery and well-being.

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