Adolescents
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How adults respond to trauma can strongly influence how children and adolescents react to trauma. When caregivers and family members take steps to support their own ability to cope, they can provide better care for others.
Caregivers and family members can help by creating a safe and supportive environment, remaining as calm as possible, and reducing stressors. Children and adolescents need to know that their family members love them and will do their best to take care of them.
Many children and adolescents in the United States have obesity. Obesity is linked to a higher risk for diseases and conditions like high blood pressure, high cholesterol, diabetes, asthma, anxiety, and depression. In addition, children with obesity are more likely to be bullied and to have obesity as adults. Evidence suggests that intensive behavioral programs that use more than 1 strategy are an effective way to reduce childhood obesity. Policy and school curriculum changes that make it easier for children and adolescents to eat healthy and get physical activity can also help reduce obesity.
UNICEF recently launched the Adolescent Data Portal to monitor the many dimensions of adolescent well-being. This portal provides easy access to global, regional and country-level data on key indicators together with information on the socioeconomic contexts in which adolescents live. It includes thematic overviews, tools to interact with available data, country profiles and downloadable datasets.
MICS collect a wealth of information on adolescents, including age-specific indicators for adolescents aged 15-19 on reproductive health, education, sexual behaviour, and HIV/AIDS. There also are modules on select topics relevant to some or all of the adolescent age group, including child labour and child discipline.
Data on household characteristics and children of young mothers aged 15-19 years are available from the MICS datasets. Further, it is also possible to use data on adolescents at the household level to identify adolescent orphans and those with parents living elsewhere, as well as to combine data on adolescents with household-level measures, for example, access to improved drinking water and sanitation facilities.
With the aim to gather evidence on the emerging challenges facing adolescents and youth, a new set of questions and indicators in domains relevant to adolescents and young people were added beginning with the fourth round of MICS (MICS4, conducted 2009-2011). These included access to media (television, radio and printed media) and technology (use of computers and internet), use of alcohol and tobacco, and subjective well-being. The module on subjective well-being, specifically designed for young people, includes questions on perceived life satisfaction and expectations about the future.
Deaths due to drug overdose among adolescents nearly doubled in the first year of the pandemic, likely driven by illicit fentanyl. After remaining stable for several years, drug overdose deaths among adolescents increased from 282 deaths in 2019 to 546 deaths in 2020 (Figure 1). The rise in fentanyl-laced substances are likely the primary driver behind this change.
Drug overdose deaths have increased across all racial and ethnic groups, and particularly among Hispanic and Black adolescents. In the first year of the pandemic, the largest increases in drug overdose deaths were among adolescents of color (Figure 1). While White adolescents continue to account for the largest share of drug overdose deaths, adolescents of color are accounting for a growing share of these deaths over time. Between 2015 and 2020 the share of drug overdose deaths among White adolescents fell from 68% to 53%, while at the same time the shares of deaths among their Hispanic and Black peers rose (from 18% to 30% and 10% to 13%, respectively) (Figure 2). As a result of this increase, Hispanic adolescents now account for a disproportionate share of drug overdose deaths relative to their share of the total adolescent population (30% vs. 25%).
Among adolescents, deaths due to suicide increased from 2010 to 2018 and then slowed in 2019 and 2020. Suicide is the second leading cause of death among adolescents.2 From 2010 to 2020, the suicide death rate grew by 62% (Figure 3). These suicides increased from 2010 to 2018, declined in 2019, and remained relatively stable in 2020. It is possible that some suicides are misclassified as drug overdose deaths since it can be difficult to determine whether drug overdoses are intentional. Forty-four percent of adolescent suicides were by firearms in 2020, up from 38% in 2010.3
Suicide death rates have increased across all racial and ethnic groups over time and remain highest among American Indian and Alaska Native adolescents. AIAN adolescents continue to have the highest suicide death rate compared to their peers and remain over three times as likely to die by suicide than White adolescents (22.7 vs. 7.3 per 100,000 in 2020) (Figure 3). In contrast, Black, Hispanic, and Asian adolescents had lower rates of suicide deaths compared to their White peers, but they experienced larger increases in suicide death rates over time. These death rates more than doubled for Asian adolescents (from 2.2 to 5.0 per 100,000 from 2010 to 2020) and nearly doubled for Black (from 2.4 to 4.6 per 100,000 from 2010 to 2020) and Hispanic adolescents (from 2.8 to 5.0 per 100,000 from 2010 to 2020). Beginning in 2018, suicide death rates began to slightly decline among White and Asian adolescents but remained stable among Black and Hispanic adolescents.
Among adolescents, males and those living in non-metropolitan areas experienced much higher suicide rates than their respective peers. Differences in deaths by suicide also persist by sex and location. Although there has been a slight decline in suicide death rates among adolescent males since 2018, these rates remain much higher than death rates for their female peers (8.7 vs. 3.9 per 100,000 in 2020) (Figure 3). Since 2010, suicide death rates among adolescents in metropolitan areas have increased faster than among adolescents in non-metropolitan areas. However, adolescents in metropolitan areas consistently have a lower suicide death rate than their peers (5.9 vs. 8.8 per 100,000 in 2020).
The share of adolescents experiencing anxiety and/or depression has increased over time but remained relatively stable in the first year of the pandemic. Sixteen percent of adolescents experienced anxiety and/or depression in 2020 (16%) which is similar to the share in 2019 (15%), but significantly higher than in 2016 (12%) (Figure 5).4 Anxiety and depression can co-occur with other mental health disorders and are associated with suicide and substance use.
Anxiety and depression are more pronounced among adolescent females and White and Hispanic adolescents. The share of both adolescent females and males experiencing anxiety and/or depression has increased over time but remains higher among females compared to males (18% vs. 14% in 2020) (Figure 5). White and Hispanic adolescents have also seen increases in anxiety and/or depression over time although the rate has remained stable among Black adolescents (Figure 5). From 2016 to 2018, the share of Hispanic adolescents reporting anxiety and/or depression was lower than their White peers; however, in 2019 and 2020, the shares were statistically similar between these groups. Compared to their White peers, Black adolescents have been consistently less likely to report anxiety and/or depression over time. This finding may reflect underdiagnosis of mental health issues among children and adolescents of color due to gaps in culturally sensitive mental health care, structural barriers, and stigma associated with accessing care. Anxiety and/or depression data was not available for other racial and ethnic groups or by sexual orientation. However, a separate survey of high school students in 2021 found that lesbian, gay, or bisexual (LGB) students and students with another sexual identity other than heterosexual or students who were questioning their sexual identity were more likely to report persistent feelings of sadness and hopelessness than their heterosexual peers (76% and 69%, respectively vs. 37%). Similar differences between LGB and heterosexual high school students reporting persistent feelings of sadness and hopelessness were also found in a survey prior to the pandemic (66% vs. 37% in 2019). These feelings of sadness and hopelessness can be indicative of depressive disorder.
Leading up to the pandemic, access to mental health care varied across demographics. Adolescent males and adolescents in rural areas were less likely than their respective counterparts to access care. Compared to their White peers, children of color were also less likely to access care. In general, receipt of mental health treatment was low prior to the pandemic, with only one in five children and adolescents with mental, emotional, or behavioral disorders receiving mental health care from a specialized provider. Reasons for not receiving mental health care included costs, limited insurance coverage, social stigma, confidentiality concerns, a lack of providers, and the absence of culturally competent care.
During the pandemic, access and utilization of mental health care may have worsened. Among Medicaid and CHIP beneficiaries, utilization of mental health services declined by 23% for beneficiaries 18 and younger from March 2020 to August 2021 compared to prior to the pandemic; and utilization of substance use disorder services declined by 24% for beneficiaries ages 15-18 for the same time period. Private mental health care claims decreased from 2019 to 2020 among adolescents age 13-18. Despite a drop in the total number of mental health claims among privately insured patients, mental health care represented a larger share of total medical claims among these patients in 2020 than in 2019. Additionally, many children ages 18 and younger began accessing mental health and substance use care through telemedicine in light of the pandemic. However, as the pandemic continued into 2021, outpatient care through telemedicine began to decline among children. Separately, anecdotal evidence also suggests that the availability of inpatient psychiatric services has decreased during the pandemic, impacting children in need of emergency care during a mental health crisis. 781b155fdc