The Declining Mental Health of Millennials: Is Depression the New Normal?

It is a familiar sight to see a group of teens bent over phones or gaming devices, checking in, tagging each other, posting pictures and commenting, and waiting impatiently for all their cyber friends to ‘like’ their work, or re-tweet their location, or post an accompanying video.

Teenagers today are some of the most enthusiastic users of social media sites like Facebook, and as an age group their Internet use is near universal—a full 95 percent of teens are now online.

This trend has provoked anxiety, raising a range of concerns, from sex predators to promoting a sedentary lifestyle. Less noticed has been the effects of heavy media use on mental health.

But just as teen internet use has risen in recent years, teen depression and psychopathology has risen five-fold since the early part of the 20th century.

This relationship has recently been of concern to psychologists and psychiatric epidemiologists. Dr. Jean Twenge, a professor of psychology at San Diego State University, has been one of the most outspoken in her field on linking these two trends.

As she says in her recent book, The Narcissism Epidemic: Living in the Age of Entitlement, rising rates of depression are partly the result of a culture that promotes the narcissism pulsing through social media usage.

Americans—especially teenagers—now rely so much on external and immediate gratification, social status and image, and the superficial gain they get from social media that they are forgoing values that contribute to a sound internal life—like strong communities built more on shared goals than on individual success, and the pursuit of activities that provide internal satisfaction, Dr. Twenge says.

Eight percent of 12-17 year-olds in the United States experienced at least one major depressive disorder in the past year. While some have argued that this is simply the result of greater recognition and diagnosis of the illness than in the past, Dr. Twenge and others say it owes to the rise in materialism and narcissism in what she has termed “Generation Me.”

Teens who have grown up in today’s social media environment know no other reality than the one in which anyone in their ‘network’ has a lens into their life and the chance to judge every act of it. 80 percent of teens active online participate in social networking sites, according to a Pew Research Center study from 2011. For this reason, they get the message that “extrinsic” values like how people perceive—virtually or in reality—is of greater importance than “intrinsic” values like their personal goals and the development of a unique self.

Dr. Twenge has elaborated on this in her blog at Psychology Today, saying that culturally, we have lost rites of passage that demarcate adulthood, emphasize individual fame for fame’s sake as opposed to real accomplishment, over-indulge our children from early developmental stages, and support and even laud self-promotion at the expense of others.

Additionally, Dr. Twenge and colleagues have indicated in their research that this generation of teens and young adults are less civic-minded, care less about social and political issues, are less interested in working towards solutions to environmental concerns, and have less empathy or interest in social justice.

Dr. Twenge’s theory is backed up by parallel psychological research, which has suggested that feeling one’s fate is shaped by external forces rather than one’s own efforts—what is known as ‘locus of control’—is more likely to cause depression and anxiety than feeling an internal drive and control over one’s future.

“Externality,” a measure of one’s perception of the influence of external forces over one’s life versus the influence of internal motivation and action, can be used to determine to what extent someone takes responsibility for their own actions and how accurately one identifies how their own behavior leads to certain outcomes.

High externality also indicates little conviction in one’s ability to behave in a specific way, something known as self-efficacy.

This could mean that those who focus on more materialistic and superficial lavishing of attention are in part doing so because they lack the self-esteem and efficacy to think that they can achieve something more significant and tangible.

This is in line with Dr. Twenge’s hypotheses. She argues that narcissism and the rising but inaccurate levels of self-evaluation can ultimately lead to deeper disappointment in one’s self and depression from alienation caused by increased self-involvement.

There has been a marked increase since 1960 in the number of people who feel this way—that external elements control their lives and future, according to a 2004 epidemiological study that Dr. Twenge and her colleagues conducted.

These feelings are associated not only with depression but also ineffective stress management, feelings of helplessness, and decreased self-control. They are also associated with higher levels of cynicism and self-serving bias.

Two studies of Dr. Twenge’s are illustrative of the fact that this rise in teen depression is indeed both significant and new.

One is a recent meta-analysis she and other researchers conducted, which explored self-reported feelings of depression and sadness in college and high school students from the 1930s to the present.

Even though self-reporting is often questioned, studies have shown that self-reported feelings of depression and compromised mental health tend to be accurate in children and adolescents—perhaps even more so than in adults— and even complement diagnostic criterion for mental illness.

Five times as many teens and young adults now score above cutoffs meeting psychopathology criteria as they did in the earlier through mid 20th century, according to Dr. Twenge’s analysis.

Population level results indicate the underlying shift has societal causes and is not merely the result of genetic predisposition to mental illness or an individual’s circumstances.

The second study took a closer look at teen depression in the past twenty years. Dr. Twenge noted that while major depressive disorder and suicide appear to have slightly receded since the early 1990s—likely a result of an increase in anti-depressant medications—current prevalence remains higher today than before the 1990s and psychosomatic complaints have continued to increase, such as feelings of being overwhelmed and anxious.

Other research has found a relationship between external motivators and neurological patterns.

One study revealed that teens suffering from depression had diminished responses to rewarding stimuli, such as genuine assurance of a job well done, a friendly affirmation from a friend, or small monetary compensations for the actual completion of tasks. Follow-up research showed that 20 year-olds who experienced depression as teens still have muted reward responses, indicating that help needs to be offered as early as possible.

Teen depression of course can have significant consequences, such as the increased likelihood of substance use and abuse, social withdrawal, strained relationships with family and friends, and in the worst cases, suicide.

To be sure, Twenge’s findings are controversial, and some continue to insist that there is no increase in depression or psychopathology in teens. But, in the opinion of Dr. Twenge, to prevent further increases in these depression statistics, teens need to move from constant self-promotion to feeling gratification from real achievement, and to reward feelings deriving from accomplishment as opposed to blindly seeking praise and compliment.

In today’s ubiquitous social media environment, that may be difficult to do, and the results slow to come.

Originally Published at The 2×2 Project November 7, 2012

American Graduate, American Dropout

I don’t know how many of you educators were able to catch parts of PBS’ ‘American Graduate‘ series this year. It’s a great series that’s focused on the major issues of (mostly public) education in America, including urban versus rural education struggles, mentoring and counseling, adolescent health issues like substance use and sexual activity, ensuring that we’re serving the needs of immigrant students, social and economic class issues and how they impact opportunity and subsequently achievement (measured most commonly as high school graduation) and what’s behind some of the alarming and rising rates of dropping out across the country.

The latter three issues were behind a documentary that I was featured in and that aired in September. It was pioneered by a group of teen filmmakers at an organization based in Brooklyn called Reel Works, a group with a great mission that I encourage you to check out. If you want more background on the piece, check out the PBS brief before the video, which also includes a great interview with some of the teen filmmakers. Hope you find it interesting!

Is Media Use Slowing Kids Down Intellectually?

A couple interesting studies recently came out that I thought were clearly linked with implications for the development of our younger generations. I recently wrote a post for The 2×2 Project that discusses the impact of media use on the mental health of teens, so I thought this was fairly pertinent.

The first study showed how much the U.S. economy loses to social media use every year. Take a guess at what that amount is.

10 billion bucks? Nope.

100 billion? Not even close.

500 billion? Still no.

According to Mashable’s summary via LearnStuff, social media costs the U.S. economy $650 billion. Check out the infographic they put together:

I’m someone who is generally really torn about social media. I have a blog and am active on Twitter, though along with my Facebook profile I use these all primarily for semi-professional purposes. ‘Semi’ in the sense that they aren’t part of my job, but I use them to promote interesting finds or essays related to my field of public health; I’ve found the sites to be remarkably helpful in communicating important points and connecting with wider audiences compared to different – usually more traditional – media channels. I use social media heavily to promote work being done in my fellowship – my own and other fellows’ – and it unquestionably has helped us reach researchers and organizations it would have been otherwise very difficult to do.

That being said, I am also fairly hesitant about social media given that I don’t particularly like my personal life broadcast across channels, so I have to be pretty meticulous about what and how I use the mediums. I think it can be enormously helpful for children who have difficulty communicating and making connections; I also find that it can feel almost more isolating than no communication at all since it emphasizes and underscores that real interpersonal interaction isn’t exactly happening. So, I’m clearly torn.

The second study, by the great group Common Sense Media, addresses the concerns of teachers and educators that the various kinds and amount of time kids are using media at home is impacting the quality of their classroom work and engagement. 71% of teachers said that they think media use is hurting kids’ attention spans in school, 59% said that it’s impacting the students’ ability to communicate face to face, and 58% have said that the media use is impacting kids’ writing skills – and not in a good way.

Given that the LearnStuff infographic shows that 97% of college students are daily Facebook users, it seems that these symptoms have the potential to get worse at increasingly younger ages, and that by the time kids who grew up in this media-rich environment are in college…well, who knows. And 60% of people visit social media sites at work (something I found most interesting? that more people are on LinkedIn than Twitter), which are obviously impacting work in the sense that they are taking away from productivity or activities related to the job – unless the job is one that incorporates social media, as many jobs increasingly are. Not to be a doomsday reporter, but I do think the implications for these studies are very real.

Thoughts? Come chat on Twitter.

Teens + Smart Phones = More Sexual Activity?

A new study by researchers at my alma mater, University of Southern California, found that young people with smart phones were 1.5 times more likely to be sexually active than those without. Results were presented at this week’s American Public Health Association annual conference. I’ve written before about the relationship between media and imagery and its particular impact on healthy human development, so I found this study particularly interesting.

The lynchpin is the internet access, obviously, since that’s where smart phones differ from regular cell phones. The key findings pulled from the study are:

  • young people with smartphones are two times as likely to have been approached online for sex — and more than twice as likely to be sexually active with an Internet-met partner;
  • 5 percent of high school students used the internet to seek sex; and
  • non-heterosexual high school students were five times more likely to seek sex online — and more than four times as likely to have unprotected sex during their last intercourse with an online-met sex partner.

The odds of having unprotected sex with a casual and perhaps anonymous partner are of course the most troubling to public health professionals. It’s not surprising that non-heterosexual students were five times more likely to seek sex online than heterosexual teens, since those findings have been seen before and highlight the difficulty that many non-heterosexual students may have come out, the lack of social support they may feel, and the isolation that coming out may have brought on.

The researchers used a sample of 1,839 Los Angeles high school students between the ages of 12-18, and they controlled for age, race, gender, and sexual orientation. Since this is the first study to really explore this,  I’d be really interested in follow-up studies looking at other markers of sexual behavior in teens in relation to these findings. I’m also fascinated by the fact that 5% of high school students used the internet to seek sex, and am really interested in seeing how that number changes as smart phones become ubiquitous even in high school.

How Free is Your Internet?

Very interesting report from Freedom House, showing how countries rank in terms of Internet freedom. United States is number 2. Any guesses on number 1?

Estonia! Mashable points out that “NATO’s Cooperative Cyber Defense Centre of Excellence was built in Estonia in 2008, resulting in the funneling of funds to improve the country’s IT infrastructure.”

The rankings were compiled based on a few factors: obstacles to access, limits on content and violations of users’ rights. What I thought was great was that they also factored in issues like bloggers’ rights and arrests.

Thoughts? Surprised?

The 2×2 Project

It’s been a long while since I’ve written again, and the reasons are similar to my absence back in April—while I wasn’t writing another dissertation, my fellowship has just begun!

The 2×2 Project aims to increase discussion, debate, and understanding around current public health and epidemiological trends. Based at the Mailman School of Public Health at Columbia, we have a great team of writers and fellows. Come check us out! My latest post on abstinence-only education is up, along with some commentaries on the recent New York city soda ban, social networks and health, mobile apps, and climate change. We update a lot during the week, so make sure to like us on Facebook, and follow us on Twitter! I’ll have some pieces about the Affordable Care Act up shortly.

Happy Monday!

The Conundrum of Caving to the Food Industry in the Battle Against Obesity

I just wanted to bring your attention to an excellent piece by Kelly Brownell of the Rudd Center for Food Policy and Obesity at Yale, in which she addresses the perilous slippery slope of appeasing the food industry and how that specifically impacts our fight against obesity.

He points out that all the research of calories in versus calories out, increasing exercise, cutting sodium, sugar, and fat, the problems with cutting physical activity from the daily routine of children, the abundant prevalence of fast food, and the cost of healthy, organic alternatives has been well and good – but that we are purposely avoiding and not addressing one of the biggest challenges in combating the increasing waistlines in America. The total avoidance of tackling head-on the way food is marketed, made, sold, and how quickly even healthcare organizations in need of a little extra cash may take a sponsorship or donation from a group directly contributing to many of the health issues that organization is tackling.

I know we live in a capitalist society. I know that the element most prized in this economic system is a competitive market and that supporters think private enterprise should be able to do whatever it likes in terms marketing and aggressive behavior towards consumers and that the individual is supposed to be able to make an independent choice. I also think that’s ridiculous. To assume that someone’s behavior is not influenced by the massive inundation of public messages, no matter how smart they are, disproves years of communication and sociological research. I always find it amusing when major corporations or businesses decry critics who say that advertising is harmful and misleading, when in fact most corporations and businesses are counting exactly on that – that the constant (and often subliminal, or in the least, very sly) messages they’re strategically slinging at us all the time are working their magic and ensuring that people will take the bait. As a critic of many advertising practices, a supporter of progressive paternalism (known to those on the opposite side of the aisle as a nanny state), and someone who has worked with people trying to change a range if disordered eating behaviors and poor nutrition habits, I found her piece particularly compelling and in agreement with her claim that the food industry has had plenty of time to prove itself trustworthy.

I think this line really sums it up: “When the history of the world’s attempt to address obesity is written, the greatest failure may be collaboration with and appeasement of the food industry. I expect history will look back with dismay on the celebration of baby steps industry takes (such as public–private partnerships with health organizations, “healthy eating” campaigns, and corporate social responsibility initiatives) while it fights viciously against meaningful change (such as limits on marketing, taxes on products such as sugared beverages, and regulation of nutritional labeling).”

Check it out.