Jordan Haygood, PharmD, BCPP
Clinical Pharmacy Specialist - Psychiatry
Medical University of South Carolina (MUSC) Health
“What word would you choose to describe the current state of mental health for teenagers in America?”
Dr. Jessica “Jessie” Merritt, Assistant Professor of Psychiatry at Vanderbilt University Medical Center, introduced her presentation entitled “Teen Suicide, the Silent Epidemic” with this audience participation question. As words like “crisis,” “scary,” “fragile,” and “concerning” grew larger in the screen, the audience began to explore feelings evoked by the profound initial question, and the topic at hand for one of the Wednesday morning keynote sessions at AAPP 2023.
“Almost every measure of mental health is getting worse, for every teenage demographic, and it’s happening all across the country.”1
According to the Centers for Disease Control and Prevention (CDC), rates of death by suicide in individuals ages 10-24 rose by more than 60% from 2007 to 2018, indicating an area of growing concern even before the COVID-19 pandemic began in 2020 and speaking to Dr. Merritt’s point that COVID-19 is not the cause but an important accelerant of worsening mental health in teenagers.2 Rates of “persistent feelings of sadness or hopelessness,” two known risk factors of suicide emphasized by Dr. Merritt, increased from 26% in 2009 to 44% in 2021. 1
Who is specifically at risk? According to results from the CDC’s Youth Risk Behavior Survey published in 2023, 57% of high school females reported feelings of sadness/hopelessness and contemplation of suicide compared to 29% of high school males. 1,3 Additionally, 50% of students identifying as a member of the lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) community report contemplating suicide versus 14% of students identifying as heterosexual. 1,3
What role does social media play? Dr. Merritt acknowledged that social media can be explicit and both intentionally and unintentionally promote self-harm or suicide, and that the amount of time spent online and the frequency of access can have negative impacts on mental health. Parents should utilize “the rule of threes,” and limit social media in teens to less than three hours per day and reduce access to less than three times per day to mitigate negative effects on mental health. Additional social media prevention strategies include limiting the impact of social media on daily functioning, avoiding social media at bedtime, parental monitoring of accounts, encouraging engagement in the face to face world, and discussing feelings related to social media.
Though Dr. Merritt reviewed statistics and concerns that paint a dismal picture for teenage mental health in America, she also took time to discuss what we can do to help improve the current landscape and reduce the risk of self-harm and suicide in this population. One word in particular rose to the top - connectedness. Dr. Merritt defined connectedness as “the sense of being cared for, supported and belonging,” and emphasized the positive impacts on mental health that feeling connected at home and school can have. The CDC’s Adolescent Behaviors and Experiences Survey found that for those students who reported feeling connected during the COVID-19 pandemic, 71.8% reported this connection was in some way virtual in nature indicating that these feelings could still be preserved in the virtual space. 4 This did not vary by gender or identity status, but had a lower prevalence in non-white students. 4
In addition to several school-based strategies to improve connectedness including having access to mental health professionals, Dr. Merritt highlighted various parent-based strategies that pharmacists can aid in educating parents on, including encouraging open discussion and engaging in shared activities based on the teen’s interests. The benefits of connectedness can be long lasting and have positive impacts into adulthood including reducing emotional distress and the odds of suicidal thoughts. 5
Take Home Points