Preventative Psychiatry for Teen Mental Health

Teen mental health is a primary concern in our society right now. The pandemic significantly disrupted the end of the 2019-2020 school year and the entire 2020-2021 school year. So far, the 2021-2022 school year – fingers crossed – appears to be a return to our regularly scheduled programming. Or, at very least, most high school students across the country right now are at school, in-person. If the current combination of prevention and mitigation strategies continues to work, then we’re cautiously optimistic that this school year will continue as usual, with no return to virtual or online school necessary.

That’s our hope. It looks like we’re on track for our first typical school year since 2018-2019. Granted, anything can happen, but we think we’re at the tail end of this public health crisis.

Here’s something many people don’t know. That crisis happened in the middle of another public health crisis: the teen mental health crisis. If you haven’t heard about the teen mental health crisis, it’s okay. The opioid and overdose crisis in the U.S. overshadowed the teen mental health crisis, because the numbers were shocking.

To learn more about the opioid crisis, please read the following article on our blog:

Topics in Treatment: Treatment and Recovery Legislation, Part One – The Comprehensive Addiction and Recovery Act (CARA)

It’s about our public response to the opioid overdose epidemic and contains an overview of how it happened and what we’re doing about it.

Now, back to the topic at hand: teen mental health.

The opioid crisis was front and center in the news, then pandemic arrived and dominated public health discourse for two years. Meanwhile, in the background, our adolescents experienced stress and disruption that exacerbated an under-reported phenomenon: the teen mental health crisis.

Teen Mental Health: A Role for Preventive Adolescent Psychiatry

The following data on depression and suicide rates among adolescents illustrates shows the basics of what you need to know about the teen mental health crisis in the U.S.

Depression and Suicide: Increases Among Teens and Preteens Between 2005-2017

• Depression:
  • Girls (14-17): Increased 4 percentage points from 2005-2014
  • Boys (14-17): Increased 1.2 percentage points from 2005-2014
• Suicide
  • Suicide attempts:
    • Among young adults (10-24): increased 56% percent from 2007-2017
    • Among girls (10-14): Increased 300% from 1999 and 2017
  • Fatal suicide in 2018:
    • Girls (10-14): 1,400
    • Boys (10-14) 5,000
  • In 2014, suicide became the second leading cause of death for people ages 10-24

Those statistics are sobering. When we consider the effect of the pandemic on teen mental health, it’s easy to see why teens – whether they have a diagnosed mental health disorder or not – may benefit from preventive psychiatry now and in the near future.

To gauge how much support our teens might need now, and in the years to come, let’s look at the effect of the pandemic on teen mental health.

We collected the following statistics from the U.S. Department of Health and Human Services (HHS) and the Centers for Disease Control (CDC). These facts and figures are available in the publications the National Survey on Drug Use and Health (2022 NSDUH) the Monitoring the Future Survey (2020 MTF).

We’ll start with the statistics on teen depression.

2020: Teen Depression in the U.S

• Among U.S. Teen Ages 12-17:
  • Major depressive episode (MDE): 17%
    • MDE with severe impairment: 12.0%
  • Major depressive disorder (MDD): 6.5%
  • Bipolar disorder (BD): 2.9%
    • BD with severe impairment: 2.6%
  • Seasonal affective disorder (SAD): 3.6%

Now let’s look at the statistics on teen anxiety.

2020: Teen Anxiety in the U.S.

• Among U.S. Teen Ages 12-17:
  • Any anxiety disorder: 32.9%
    • Severe impairment: 8.3%
  • Generalized anxiety disorder (GAD): 2.2%
    • Severe impairment: 0.9%
  • Panic disorder (PD): 2.3%
    • Severe impairment: 2.3%
  • Social anxiety disorder (SAD): 9.1%
    • Severe impairment: 1.3%
  • Obsessive-compulsive disorder (OCD): 2.5%
  • Post-traumatic stress disorder (PTSD): 5.0%
    • Severe impairment: 1.5%

That’s where we are right now in the U.S. Rates of the most common mental health disorders are on the rise. If you’re the parent of a teen, you probably wonder what you should do to support your teen as they face the challenges of how to manage stress, anxiety, and emotion in a rapidly changing, post-pandemic world.

A new academic paper called “Preventive Psychiatry: A Blueprint for Improving the Mental Health of Young People” examined this issue, and offers a clear set of actions we can take to support teen mental health in the U.S.

Mental Health Disorders Among Teens: What Are the Causes?

Based on our current understanding of mental illness and mental health disorders, scientists identify three primary causes of clinical mental health disorders:

• Genes:
  • The presence of a mental health disorder in blood relatives increases risk of developing a mental health disorder
• Environment:
  • Exposure toxic chemicals in utero, or early in life, can increase risk of developing a mental health disorder.
  • Exposure to adverse childhood experiences, such as violence, emotional neglect/abuse, sexual abuse, and other traumatic events increases risk of developing a mental health disorder
  • Traumatic experiences during adolescence or adulthood can trigger the onset of a mental health disorder
• Neurochemistry:
  • Impaired or damaged neural networks can alter the way a person thinks, feels, and acts, and can increase risk of developing a mental health disorder

Those are the three primary causes of mental illness recognized by the medical and scientific community. With regards to the first and third bullet points on this list, researchers can identify specific genes, neurotransmitters (chemical messengers in the brain), and neurobiological systems that are associated with mental health disorders. However, at the time of writing – August 2022 – researchers have yet to identify common biological markers that predict mental health disorders.

Therefore, it follows that prevention focuses on environmental factors. That means reducing the presence of things that can increase the likelihood of developing a mental health disorder, known as risk factors, and increasing presence of things that can decrease the likelihood of developing a mental health disorder, called protective factors.

Teen Mental Health Disorders: Prevention and Intervention

Before we share the findings of the paper we introduce above, we need to define what we mean by positive mental health or good mental health, as well as what we mean by prevention. We’ll start with the concept of positive or good mental health.

Here’s how the World Health Organization (WHO) defines good mental health:

“A state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”

Good mental health means more than the absence of mental health symptoms. It means a person has the personal capacity to access and meet their inherent potential, handle the ups and downs of daily life, and participate in and share the benefits of being a member of a community. Good mental health is associated with professional, vocational, and academic success. It’s also associated with personal and interpersonal wellbeing, which means people with good mental health are generally satisfied with life and develop sustaining, rewarding relationships with family, friends, and peers.

Next, let’s define what we mean by prevention.

The WHO defines prevention and preventive psychiatry as:

“Reducing incidence, prevalence, recurrence of mental disorders, the time spent with symptoms, or the risk condition for a mental illness, preventing or delaying recurrences and also decreasing the impact of illness in the affected person, their families and the society”

They go on to identify three levels of prevention.

WHO: Preventive Approaches for Mental Health Disorders

1. Primary Prevention: The goal of primary prevention is to prevent the onset of a mental health disorder, and has three types:

• • • Universal prevention targets members of the general public with no known risk factors.
    • Selective prevention targets people with known risk biological, psychological, and/or social risk factors.
    • Indicated prevention target people who show initial symptoms or general biological markers for mental health disorders, but do not meet diagnostic criteria

2. Secondary Prevention: The goal of secondary prevention is to lower the rate of prevalence of mental health disorders through early detection and treatment.
3. Tertiary prevention: The goal of tertiary prevention is to provide evidence-based interventions that reduce disability and prevent relapses or recurrence of mental health symptoms

Now we have everything we need to understand the results of the study on the role of preventive psychiatry for teens. We know our teens need our support, we know what to look for, and we have a good idea how to employ secondary and tertiary prevention strategies.

Let’s take a look at what the study says about primary preventions strategies, i.e. things we can do to prevent or reduce instances of mental health disorders in teens.

Evidence-Based Preventions and Interventions

The lack of known and accepted evidence-based therapeutic interventions to prevent the development of mental health disorders in adolescents explains why the study authors conducted this review of all available peer-reviewed data on the subject.

We have evidence-based techniques to support our teens when they show symptoms of a mental health disorder. We know the factors associated with the absence of mental health disorders, but we don’t have a solid peer-reviewed evidence base for the prevention of mental health disorders. That bears repeating, in a slightly different way: we know about preventive factors for mental health in general, but we don’t have clear evidence for exactly what kind of specific intervention might work to prevent the onset of specific mental health disorders.

That’s what the study authors were looking for.

Let’s see what they found. We’ll start with the most common teen mental health disorders – depression and anxiety – then discuss psychotic disorders and bipolar disorder.

Evidence-Based Preventive Intervention: Mental Health Disorders

Depressive Disorders:

• • Cognitive behavioral therapy (CBT) can reduce incidence of depressive symptoms and onset of depressive disorders
  • Interpersonal psychotherapy (IPT) can reduce incidence of depressive symptoms and onset of depressive disorders
  • Physical exercise can reduce severity of depressive symptoms
  • Physical exercise can reduce incidence of diagnosis of depressive disorder

Anxiety Disorders

• • Cognitive behavioral therapy (CBT) can reduce symptoms of anxiety and reduce onset of anxiety disorders
  • Acceptance and commitment therapy (ACT) can reduce symptoms of anxiety and reduce onset of anxiety disorders
  • Psychoeducation classes and/or workshops can reduce symptoms of anxiety and reduce onset of anxiety disorders
  • Physical exercise can reduce severity of anxiety symptoms
  • Physical exercise can reduce incidence of anxiety diagnosis

Note: Here’s a definition of psychoeducation from an established textbook on neuropsychiatry:

“Psychoeducation (PE) is an intervention with systematic, structured, and didactic knowledge transfer for an illness and its treatment, integrating emotional and motivational aspects to enable patients to cope with the illness and to improve its treatment adherence and efficacy.”

Psychotic Disorders/Psychosis/Schizophrenia

• • There are currently no evidence-based preventive interventions shown to reduce psychotic symptoms of the onset of psychotic disorders such as schizophrenia

Bipolar Disorder

• • There are currently no evidence-based preventive interventions shown to reduce symptoms of bipolar disorder or reduce/prevent the onset of psychotic disorders such as schizophrenia

In addition to these specific preventive interventions, researchers indicate that any efforts to address the social determinants of health can also work to prevent mental health disorders. Social determinants of health are related to structural inequities in the following areas:

• Demographic: age, gender, and race/ethnicity can increase or decrease risk
• Economic: income, housing, and food instability can increase or decrease risk
• Environment: violence, conflict, natural disasters, and climate can all increase or decrease risk
• Social/cultural: attitudes and/or stigma toward mental health disorders and treatment for mental health disorders can increase or decrease risk

When we work to minimize disparities in the social determinants of health and increase access to and equity in treatment, we not only help teens, but we improve the likelihood of positive mental health for all members of our communities, young or old.

What Can Help Our Teens Now?

Addressing and mitigating structural inequity will help reduce the incidence and prevalence of mental health disorders for everyone: that’s important information to know. The study authors also identified the following interventions that may specifically benefit young people:

• Reducing gender-based violence
• Reducing child maltreatment
• Improving employment programs
• Increasing neighborhood safety
• Improving quality of and access to education
• Implementing psychoeducation programs in schools

There’s a movement in medicine and psychiatry called The P4 Approach. This movement calls for medicine – including mental health treatment – to shift to a model describe by the four Ps. Psychiatry can be:

• Predictive
• Preventive
• Personalized
• Participatory

We embrace the last two points here, and use them every day: we personalize treatment and our teens actively participate in treatment. With regards to prediction and prevention, our position is that anyone and everyone can benefit from some form of therapy at any age. What people learn in recovery from a mental health disorder is a robust set of coping skills to manage distress and process painful or uncomfortable emotions.

We all need those skills – and that’s why we can all benefit by talking to a mental health professional, whether we have a mental health disorder or not.

We’ll end this article with general advice: if you’re the parent of a teen and anyone in your family has a mental health disorder, it’s a good choice to arrange a full biopsychosocial evaluation for your teen, administered by a qualified mental health professional. They can identify the early stages of a mental health disorder, and recommend targeted treatment if needed. They can also rule out the presence of any clinical mental health disorder, and recommend a list of protective habits and lifestyle choices that support ongoing positive mental health and decrease the likelihood of problems during late adolescence or early adulthood.