Dr. Katherine M. Keyes was the second speaker in the College of Health and Human Services Dean’s Seminar Series on January 27, 2020. Keyes is an associate professor of epidemiology and co-director of the Psychiatric Epidemiology Training Program at Columbia University’s Mailman School of Public Health. She shared her research and the current understanding on the increase of depressive symptoms and suicide in adolescent girls.
She challenged everyone in the room to come up with their own best explanations and then we can think of studies to test them.
What is happening with adolescent mental health?
Depressive episodes among males have remained constant, but they have increased among girls since 2010. The largest decrease in self-esteem was among girls who identify as a liberal or democrat following the 2016 election.
When looking at adolescent ER visits, the total number of visits for boys and girls has remained stable since 2010, while more of them have been for suicide attempts or ideation. In addition, completed suicides are increasing overall, and males are more likely to complete suicide than females.
Is the increase linked to drug and alcohol use (a historic predictor of depressive symptoms)?
Keyes is part of a long-time National Institute on Drug Abuse study, Monitoring the Future, which has been studying high school students since 1976 asking the same questions about drug and alcohol abuse so that they can be compared over time. They found that in the 90’s and early 2000’s, kids who binge drank were more likely to be depressed, but drug and alcohol have been going down since then.
“Declines in adolescent alcohol use are part of a broader decline in use of many substances and problem behaviors since the 90’s/2000’s,” Keyes explained. “We call this this ‘the great decline.’ And yet, depressive symptoms and suicide are increasing among this group, so this is a new trend we’re seeing.”
There are two exceptions to the great decline: use of cannabis and e-cigarettes. With the changes in legality for cannabis use within states, researchers questioned whether that had an effect. Both frequent use of cannabis and experimenting are increasing. Is this happening because certain states have legalized its use in one form or another? The consensus across the studies is that the legalization of cannabis has not increased adolescent use in the states it has been legalized in.
It appears that drug and alcohol use are not responsible for this 2010 increase. However, we need more research to understand the impact of e-cigarette use.
What about smart phones?
The iPhone was released in 2007, so this was one of the first questions researchers had – are smart phones responsible for these increases? While some studies have found a link between smart phone use and increased suicide, others have found a “goldilocks effect”—a little screen time is good, but too much has a detrimental effect on child and adolescent mental health.
In order to other potential influences on mental health, Orben and colleagues analyzed the many different ways adolescents spent their time and the effect on their mental health. They found that activities such as binge drinking were three times worse than smart phone use. Marijuana use was ten times worse for adolescent mental health. On the plus side, eating fruit was ten times better.
While excessive use of smart phones may have a negative effect on adolescent health, they are not solely responsible for the increase in depressive symptoms and suicide. There is something else going on here.
Keyes explains that while limiting excessive adolescent use of smart phones may be beneficial, we shouldn’t jump to taking away adolescent smart phones, as we have early indications that they can have a protective effect as well—offering a good way to deliver therapy.
Are adults experiencing a similar increase in depressive symptoms and suicide?
Yes and no. Adults in higher socioeconomic statuses (SES) are not seeing a decline in mental health. However, those in the lower SES certainly are. Adults in crisis have increased more than 30% in 10 years, and the group most likely to complete suicide are middle-aged men.
Adults are sleeping less. However, contrary to adolescent behavior, alcohol use among some adult groups has been increasing since the 2000)’s. Alcohol use has remained relatively constant among men (although they do drink more than women), and it has also remained constant among women with children or lower levels of education. The largest increase in alcohol use has been among middle-aged high-income and highly educated women who do not have children.
What can we do?
“The trends – adults drinking increasing, adolescent mental health, adult mental health, they’re not disconnected. These are the same people moving through historical time, and if you follow them as birth cohorts, you start to uncover critical trends,” Keyes explains. “This is why it’s so important to study people over the lifespan.”
Keyes recommends that we don’t stop with prevention efforts at age 18 and that we have programs—particularly for alcohol abuse prevention—beyond that.
“We still don’t know exactly why this increase in depressive symptoms and suicide is happening among young people in the United States, and so far, the research shows that it’s not due to any one thing,” Keyes explains.
Video Recording
View the full recording here. (YouTube)
Dean’s Seminar Series
This presentation was part of the College of Health and Human Services Dean’s Seminar Series. Learn more about the series, upcoming speakers, and RSVP.