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‘It’s Life or Death’: The Mental Health Crisis Among U.S. Teens
Depression, self-harm and suicide are rising among American adolescents. For one 13-year-old, the despair was almost too much to take.
Matt Richtel spent more than a year interviewing adolescents and their families for this series on the mental health crisis.
One evening last April, an anxious and free-spirited 13-year-old girl in suburban Minneapolis sprang furious from a chair in the living room and ran from the house — out a sliding door, across the patio, through the backyard and into the woods.
Moments earlier, the girl’s mother, Linda, had stolen a look at her daughter’s smartphone. The teenager, incensed by the intrusion, had grabbed the phone and fled. (The adolescent is being identified by an initial, M, and the parents by first name only, to protect the family’s privacy.)
Linda was alarmed by photos she had seen on the phone. Some showed blood on M’s ankles from intentional self-harm. Others were close-ups of M’s romantic obsession, the anime character Genocide Jack — a brunette girl with a long red tongue who, in a video series, kills high school classmates with scissors.
In the preceding two years, Linda had watched M spiral downward: severe depression, self-harm, a suicide attempt. Now, she followed M into the woods, frantic. “Please tell me where u r,” she texted. “I’m not mad.”
American adolescence is undergoing a drastic change. Three decades ago, the gravest public health threats to teenagers in the United States came from binge drinking, drunken driving, teenage pregnancy and smoking. These have since fallen sharply, replaced by a new public health concern: soaring rates of mental health disorders.
In 2019, 13 percent of adolescents reported having a major depressive episode, a 60 percent increase from 2007. Emergency room visits by children and adolescents in that period also rose sharply for anxiety, mood disorders and self-harm. And for people ages 10 to 24, suicide rates, stable from 2000 to 2007, leaped nearly 60 percent by 2018, according to the Centers for Disease Control and Prevention.
Emergency room visits for self-harm by children and adolescents rose sharply over the last decade, particularly among young women.
600 E.R. visits
per 100,000
FEMALE
500
Emergency room visits
for self-inflicted injuries
Ages 10–19
400
BOTH
300
200
MALE
100
1989
1999
2009
2019
Emergency room visits for self-harm by children and adolescents rose sharply over the last decade, particularly for young women.
600 E.R. visits
per 100,000
Emergency
room visits
for self-harm
Ages 10–19
FEMALE
500
400
BOTH
300
200
MALE
100
1989
1999
2009
2019
Rates of smoking, drugs, alcohol and sex declined among high school students over the last decade, continuing trends that started over two decades ago.
One notable exception was a rise in excessive smartphone and computer use over the last decade.
70%
Use a smartphone,
tablet, computer or
game console at least
3 hours a day, not
including school work
60
Ever tried
vaping
Recently drank
alcohol
Ever had
sex
Watch television
at least
3 hours a day
50
40
Ever tried
cigarettes
Ever used
marijuana
30
MALE
Last sex was
unprotected
20
Get at least
8 hours of sleep
Ever used
cocaine
FEMALE
10
1989
1999
2009
2019
Feelings of sadness and hopelessness rose over the same decade, and suicidal thoughts increased.
50%
Persistently felt
sad or hopeless
Seriously
considered
suicide
40
Made a suicide plan
FEMALE
30
FEMALE
Attempted suicide
Injured in a suicide
attempt and needed
medical treatment
FEMALE
20
MALE
FEMALE
10
MALE
MALE
MALE
FEMALE
MALE
1989
1999
2009
2019
Rates of smoking, drugs, alcohol and sex declined among high school students over the last decade, continuing trends that started over two decades ago.
70%
60
Ever tried
vaping
Recently drank
alcohol
Ever had
sex
50
40
Ever tried
cigarettes
Ever used
marijuana
30
Last sex was
unprotected
20
Ever used
cocaine
10
1989
1999
2009
2019
One notable exception was a rise in excessive smartphone and computer use over the last decade.
70%
Use a smartphone,
tablet, computer or
game console at least
3 hours a day, not
including school work
60
Watch television
at least
3 hours a day
50
Get at least
8 hours of sleep
40
30
MALE
20
FEMALE
10
1989
1999
2009
2019
Feelings of sadness and hopelessness rose, and suicidal thoughts increased.
50%
Persistently felt
sad or hopeless
Seriously
considered
suicide
40
FEMALE
30
FEMALE
Attempted suicide
20
MALE
FEMALE
10
MALE
MALE
1989
1999
2009
2019
Rates of smoking, drugs, alcohol and sex declined among high school students over the last decade, continuing trends that started over two decades ago.
70%
Ever tried
cigarettes
Recently
drank
alcohol
60
Ever had
sex
50
40
Ever used
marijuana
30
Last sex was
unprotected
20
Ever used
cocaine
10
1989
1999
2009
2019
One notable exception was a rise in excessive smartphone and computer use over the last decade.
70%
Use a smartphone,
tablet, computer or
game console at least
3 hours a day, not
including school work
60
Watch television
at least
3 hours a day
50
40
30
MALE
20
Get at least
8 hours of sleep
FEMALE
10
1989
1999
2009
2019
Feelings of sadness and hopelessness rose, and suicidal thoughts increased.
50%
Persistently felt
sad or hopeless
Seriously
considered
suicide
40
FEMALE
30
FEMALE
20
MALE
10
MALE
1989
1999
2009
2019
How Matt Richtel spoke to adolescents and their parents for this series
In mid-April, I was speaking to the mother of a suicidal teenager whose struggles I’ve been closely following. I asked how her daughter was doing.
Not well, the mother said: “If we can’t find something drastic to help this kid, this kid will not be here long term.” She started to cry. “It’s out of our hands, it’s out of our control,” she said. “We’re trying everything.”
She added: “It’s like waiting for the end.”
Over nearly 18 months of reporting, I got to know many adolescents and their families and interviewed dozens of doctors, therapists and experts in the science of adolescence. I heard wrenching stories of pain and uncertainty. From the outset, my editors and I discussed how best to handle the identities of people in crisis.
The Times sets a high bar for granting sources anonymity; our stylebook calls it “a last resort” for situations where important information can’t be published any other way. Often, the sources might face a threat to their career or even their safety, whether from a vindictive boss or a hostile government.
In this case, the need for anonymity had a different imperative: to protect the privacy of young, vulnerable adolescents. They have harmed themselves and attempted suicide, and some have threatened to try again. In recounting their stories, we had to be mindful that our first duty was to their safety.
If The Times published the names of these adolescents, they could be easily identified years later. Would that harm their employment opportunities? Would a teen — a legal minor — later regret having exposed his or her identity during a period of pain and struggle? Would seeing the story published amplify ongoing crises?
As a result, some teenagers are identified by first initial only; some of their parents are identified by first name or initial. Over months, I got to know M, J and C, and in Kentucky, I came to know struggling adolescents I identified only by their ages, 12, 13 and 15. In some stories, we did not publish precisely where the families lived.
Everyone I interviewed gave their own consent, and parents were typically present for the interviews with their adolescents. On a few occasions, a parent offered to leave the room, or an adolescent asked for privacy and the parent agreed.
In these articles, I heard grief, confusion and a desperate search for answers. The voices of adolescents and their parents, while shielded by anonymity, deepen an understanding of this mental health crisis.
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