America’s teens are still not alright.

Instead, many continue to engage in risky behaviors, U.S. health officials reported Thursday.

Top among these is an increase in suicidal thoughts and suicide planning and attempts among teen girls, according to a new study from the U.S. Centers for Disease Control and Prevention. However, rates among teen boys stayed stable.

Meanwhile, LGBQ+ students had particularly high increases in suicidal thoughts and behavior when compared with heterosexual students, and the same went for minorities when compared with white students, the researchers found.

“The COVID-19 pandemic exacerbated mental health issues amongst children and teenagers,” said Dr. Scott Krakower, an adolescent psychiatrist at Zucker Hillside Medical Center in Great Neck, N.Y., who was not involved in the report. “These issues continue to be problematic, with increasing disparities amongst minority groups.”

Access to mental health care is key, the researchers noted.

“A substantial number of students rely on school-based mental health care, especially youth in racial and ethnic minority groups from under-resourced families,” said Karin Mack, associate director for science in the CDC’s Division of Injury Prevention.

“While lack of access to mental health services may have contributed to increased suicide risk, many other factors, including substance misuse, family or relationship problems, community violence, discrimination, among others, may have also contributed to the increased risk,” Mack added.

But the pandemic definitely had an effect on teens’ mental health, as did social media, agreed Neil Bernstein, a clinical psychologist in Washington, D.C.

“I think there’s an increase in a lot of these problems certainly due to COVID, no question about it,” said Bernstein, who was also not involved in the report. “Technology also fuels the fire. Kids wondering what everybody else is saying about them has a lot of kids thinking about suicide.”

“Additionally,” Mack said, “despite often good intentions, media – including social media, traditional media and entertainment – may add to an individual’s suicide risk. For example, research suggests that exposure to sensationalized or otherwise uninformed reporting on suicide may heighten the risk of suicide among disproportionately affected individuals, and can inadvertently contribute to what is known as suicide contagion.”

On the plus side, substance use among high school students dropped, according to the report. But the use of e-cigarettes containing THC, the active ingredient in marijuana, increased.

One of the factors that might fuel the rise in both suicidal behavior and substance abuse could be an increase in violence experienced by teens, the researchers said.

For example, 1 in 5 high school students witnessed violence in their community, which made them more likely to carry a gun, use drugs and contemplate suicide, the investigators found.

Students also experienced more interpersonal violence, including dating violence, sexual violence and bullying. These experiences were more common among girls, LGBQ+ teens and some minorities.

One way to mitigate these negative experiences and outcomes is when parents are involved in their kids’ lives, the authors of the report noted.

Luckily, that seems to be happening a lot: Most teens (86%) said their parents kept tabs on their activities, including their whereabouts and friends. Those whose parents were more involved in their lives had better health outcomes, including fewer experiences of violence and mental health challenges. They also were less likely to engage in risky sexual behaviors or use drugs or have suicidal thoughts or attempts.

But Bernstein noted that parents who are too controlling can also cause problems.

“In reality, if a teen talks to me about their parents being control freaks, it’s the opposite,” he said.

“Being an informed parent is good. Being a control freak who controls and monitors everything to where the kid has no privacy is looking for trouble. Parents have to strike a balance between being, what the kids call a chill parent and a control freak,” Bernstein said.

A solid relationship is the goal. “A solid relationship is based on mutual communication and understanding. Kids have to be safe sharing things,” he explained.

Mack agreed, noting that, “Parents can set a good example for youth by initiating conversations about suicide and suicide prevention. This can help youth feel safer talking about these topics, and can underscore that hope is possible, and that help is available.”

Schools also have an important role to play in keeping teens from engaging in risky behaviors, the researchers said. Most teens (62%) felt connected to others at school, which made them less likely to engage in risky behaviors, the findings showed.

For the report, published April 28 in the Morbidity and Mortality Weekly Report, CDC researchers turned to data from the Youth Risk Behavior Surveillance System from 2021.

These reports highlight the importance of acknowledging school connectedness as a contributing factor for better health outcomes, Krakower said.

“Creative, safe and supportive space at school would help to foster connectedness,” he said. “This can be done through developing programs and initiatives which would incorporate diversity and awareness surrounding racial, ethnic and sexual minority youth.”

Bernstein is hopeful that, as kids get back to normal as the pandemic subsides, some of these negative trends can be reversed. But COVID-19 and technology have forever changed the world people live in, he added.

“I think they will get back to normal somewhat,” Bernstein said. “But it’s a different world we live in now, for adults and for kids. There’s a lot of things we’re all adjusting to.”

More information

For more on teens’ mental health, head to the U.S. Centers for Disease Control and Prevention.

SOURCES: Neil Bernstein, PhD, clinical psychologist, Washington, D.C.; Scott Krakower, DO, adolescent psychiatrist, Zucker Hillside Medical Center, Great Neck, N.Y.; Karin Mack, associate director, science, division of injury prevention, U.S. Centers for Disease Control and Prevention; Morbidity and Mortality Weekly Report, April 28, 2023