Teens in the United States are struggling. Rates of depression, anxiety, and suicidal thoughts and behaviors have surged in recent years, a trend that began even before the mental health fallout of the COVID-19 pandemic.
For teenage girls, emotional distress has reached a crisis level. According to the 2021 Youth Risk Behavior Survey, conducted by the Centers for Disease Control and Prevention (CDC), teenage girls have experienced an alarming rise in violence and poor mental health at levels far outpacing boys. The survey, based on a nationally representative sample of ninth through 12th grade students, found that sexual violence against girls worsened over a decade, with close to one in five girls reporting in 2021 that they had experienced sexual violence and 14% reporting ever having been forced to have sex. An alarming 57% of girls-nearly twice the rate of boys-reported persistent feelings of sadness or hopelessness and 30% reported seriously considering suicide, up from 19% in the 2011 survey. The proportion of girls who said they had made a suicide plan rose from 15% in 2011 to 24% in 2021; and 13% of girls said they had attempted suicide.
Researchers point to multiple factors underlying this unprecedented rise in violence and despair among youth, among them earlier onset of puberty, which activates hormones that heighten emotions possibly before brains have matured enough to manage them. Also cited are unrelenting social and academic pressures and worries about societal issues such as climate change, school shootings, and racial injustice. Excessive social media use comes into play as well; research has shown it to be a risk factor for depression and anxiety, disordered eating, and negative body image and self-esteem. Finally, the COVID-19 pandemic almost certainly influenced results of the CDC survey, given that it took place in 2021. Some 70% of girls reported suffering from social isolation compared to only 28% of boys.
Robin Cogan, a school nurse and board member of the National Association of School Nurses, underscored social isolation and the collective trauma of the pandemic as contributors to the crisis. "We are living in a world shaken by a lengthy global pandemic, the grief of losing so many family caregivers for our children, and added to that, a disconnected student body overly dependent on technology," Cogan told AJN, adding that the pandemic lockdowns, isolating vulnerable girls from protective school social networks, may have contributed to the escalation in violence against teenage girls, as it did for women of all ages.
In this context, the role of school nurses takes on added importance, according to Cogan. "We know that schools are among the best resources for families in our communities and school nurses are well-positioned to intervene in this public health crisis," she said. "The school nurse is often the first professional touchpoint to identify concerns, determine interventions, and link families to resources. Students often present to the school nurse with physical complaints when they may be suffering from a mental health problem."
Cogan emphasized three priorities of the 2022 Kids Count Data Book: State Trends in Child Well-Being from the Annie E. Casey Foundation, which tracks the status of children in the United States: basic needs of youth for nutritious food, stable housing, and safe neighborhoods; access to mental health care "where and when they need it"; and appropriate mental health care that is geared toward early intervention. She recommended that in their efforts to meet students' needs, school nurses adopt "a public health lens centered on the population health challenges we currently face."-Karen Roush, PhD, RN, FNP-BC, news director