Mental health disorders are common among adolescents. Screening for these disorders is considered a routine part of adolescent health care.
Depression and anxiety are common and should be screened for routinely. Many adolescents may have feelings of sadness and worry. These feelings are normal, and clinicians can provide reassurance to adolescents and families about the importance of navigating these feelings.
When feelings of anxiety and depression are pervasive and interfere with functioning (eg, at school, with relationships, at home), clinicians may diagnose an anxiety or depressive disorder. After assessment and diagnosis, clinicians may suggest behavioral treatment, pharmacotherapy, or both. The COVID-19 pandemic and the global response to it, including disruptions in home and school schedules, have been associated with increased the rates of depression and anxiety among adolescents.
Suicidal ideation is also common among this patient population, and suicide is the third leading cause of death among 14- to 18-year-olds in the United States (1). There are steps that clinicians can take to mitigate suicide risk, including appropriate screening for mental health disorders, recognizing risk factors, and facilitating access to community resources (2).
Mood disorders and disruptive behavioral disorders (eg, oppositional defiant disorder, conduct disorder) often manifest during adolescence. These disorders are typically treated with psychotherapy for the child and advice and support for the parents. Overdiagnosis of disruptive behavioral disorders is common because of bias (3).
Eating disorders, especially in girls, are common. Eating disorders are best managed by a specialized team that includes mental health professionals.
Attention-deficit/hyperactivity disorder (ADHD) is the most common mental health disorder of childhood and often persists into adolescence and adulthood. Research has shown poor long-term functional outcomes in children diagnosed with ADHD who are untreated or inadequately treated as compared to their peers (4). Behavioral therapy and medications can improve outcomes.
Clinicians are cautioned to make the diagnosis of ADHD carefully before initiating treatment because other conditions, such as depression, anxiety, and learning disabilities, may manifest primarily with symptoms of inattention and can mimic ADHD. Because of the potential for misuse, stimulants should be prescribed only after a diagnosis of ADHD has been confirmed.
Clinicians should continue to treat and monitor adolescents diagnosed with ADHD in childhood. Although substance use disorders are more common among people with ADHD, treating with stimulants does not appear to increase the risk of developing a substance use disorder and may even decrease the risk (5).
People with thought disorders (psychosis) will often present with a "psychotic break" during adolescence. Treatment includes a combination of medication, psychotherapy, and social support.
The clinician who has developed an open, trusting relationship with an adolescent often can identify these problems, develop a therapeutic relationship, offer practical advice, and, when appropriate, encourage the adolescent to accept a referral to specialized care.
Impact of social media on mental health
The emergence of social media has changed how adolescents communicate with each other and access information. Adolescents report feeling more creative and connected on social media (6). For adolescents who identify as LGBTQIA, the internet and social media can provide a safe space for peer support and social connection (7). However, there is a strong and growing association between poor mental health and social media use among adolescents (8, 9).
References
1. Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance—United States, 2021. MMWR Suppl. 2023:72(1):1–99.
2. Hua LL, Lee J, Rahmandar MH, Sigel EJ; COMMITTEE ON ADOLESCENCE; COUNCIL ON INJURY, VIOLENCE, AND POISON PREVENTION. Suicide and Suicide Risk in Adolescents. Pediatrics. 2024;153(1):e2023064800. doi:10.1542/peds.2023-064800
3. Fadus MC, Ginsburg KR, Sobowale K, et al. Unconscious Bias and the Diagnosis of Disruptive Behavior Disorders and ADHD in African American and Hispanic Youth. Acad Psychiatry. 2020;44(1):95-102. doi:10.1007/s40596-019-01127-6
4. Shaw M, Hodgkins P, Caci H, et al. A systematic review and analysis of long-term outcomes in attention deficit hyperactivity disorder: effects of treatment and non-treatment. BMC Med. 2012;10:99. Published 2012 Sep 4. doi:10.1186/1741-7015-10-99
5. Wilens TE, Adamson J, Monuteaux MC, et al. Effect of prior stimulant treatment for attention-deficit/hyperactivity disorder on subsequent risk for cigarette smoking and alcohol and drug use disorders in adolescents. Arch Pediatr Adolesc Med. 2008;162(10):916-921. doi:10.1001/archpedi.162.10.916
6. Vogels EA, Gelles-Watnick R. Teens and social media: Key findings from Pew Research Center surveys. Pew Research Center. 2024.
7. Berger MN, Taba M, Marino JL, Lim MSC, Skinner SR. Social Media Use and Health and Well-being of Lesbian, Gay, Bisexual, Transgender, and Queer Youth: Systematic Review. J Med Internet Res. 2022;24(9):e38449. Published 2022 Sep 21. doi:10.2196/38449
8. Riehm KE, Feder KA, Tormohlen KN, et al. Associations Between Time Spent Using Social Media and Internalizing and Externalizing Problems Among US Youth. JAMA Psychiatry. 2019;76(12):1266-1273. doi:10.1001/jamapsychiatry.2019.2325
9. U.S. Department of Health and Human Services. Social Media and Youth Mental Health. Accessed July 31, 2024.
