Importance

Childhood and adolescence are critical times for physical and mental development. Development of good mental health is important for overall good health and well-being throughout the lifespan.

The Surgeon General’s Advisory on Protecting Youth Mental Health outlines a series of recommendations to improve youth mental health across 11 sectors, including young people and their families, educators and schools, and media and technology companies. Topline recommendations include¹:

• Recognize that mental health is an essential part of overall health.
• Empower youth and their families to recognize, manage, and learn from difficult emotions.
• Ensure that every child has access to high-quality, affordable, and culturally competent mental health care.
• Support the mental health of children and youth in educational, community, and childcare settings, and expand and support the early childhood and education workforce.
• Address the economic and social barriers that contribute to poor mental health for young people, families, and caregivers.
• Increase timely data collection and research to identify and respond to youth mental health needs more rapidly, including more research on the relationship between technology and youth mental health. In addition, technology companies should be more transparent with data and algorithmic processes to enable this research.

Findings

The figures in the child and adolescent mental health section of the NHQDR illustrate significant trends over time and the most significant disparities in the most recent data year. For a deeper look at the disparities by geographic location, statistics about rural/urban location are also included where data are available.

Increases in Emergency Department Visits Related to Mental Health Higher for Adolescents

Among U.S. children ages 5-11 years, the percentage of mental health-related ED visits increased 24%, and the percentage of these ED visits for adolescents ages 12-17 increased 31% from 2019 to March-October 2020.¹¹

Figure 1

Emergency department visits with a principal diagnosis related to mental health only per 100,000 population, by age, 2016-2019.

• From 2016 to 2019, overall, there were no statistically significant changes in the rate of ED visits with a principal diagnosis related to mental health (from 1,052.6 per 100,000 population to 1,080.4 per 100,000 population (Figure 1).
• From 2016 to 2019, the rates of ED visits with a principal diagnosis related to mental health only increased for ages 0-17 years, from 784.1 per 100,000 population to 869.3 per 100,000 population. The rate for this age group dropped slightly in 2019, but in 2018, the rate was 976.8 per 100,000 population, a 25% increase from 2016.
• Due to the slight drop in 2019, there was no statistically significant change for ages 0-17, but its trend was worsening from 2016 to 2018.
• From 2016 to 2019, the rate of ED visits with a principal diagnosis related to mental health for adults age 85 and over was improving. There were no statistically significant changes for all other age groups.

Increase in Suicide Deaths Among Most Age Groups

In 2020, suicide was the 12th leading cause of death in the United States overall; the second leading cause of death for youths ages 10-14 years; and the third leading cause of death for people ages 15-24 years.¹² Depression is strongly related to both suicidal ideation and it is one of the characteristics that increase the risk of suicide among people with depression.¹³

For children or teens who identify as lesbian, gay, bisexual, transgender, questioning, or queer (LGBTQ), the risk of suicidal thoughts and behaviors is higher.

Figure 2

Suicide deaths among people age 12 and over per 100,000 population, by age, 2008-2020. Note: Estimates are age adjusted to the 2000 U.S. standard population. Age data are unadjusted. Respondents for which age is not reported are not included in the age (more...)

• From 2008 to 2020, the rates of suicide death among people age 12 and over per 100,000 population increased 16% overall from 14.0 per 100,000 population to 16.3 per 100,000 population (Figure 2).
• From 2008 to 2020, the rate of suicide death among youths ages 12-17 increased from 3.7 per 100,000 population to 6.3 per 100,000 population.
• Adults under age 65 have the highest rates and youths ages 12-17 have the lowest rates of suicide death per 100,000 population, but the 70% increase in the rate for youths ages 12-17 is the biggest increase among all age groups.
• For adults ages 45-64, the suicide rate dropped between 2019 and 2020 after having the highest rate in 2018, while the rates for youths ages 12-17 and adults ages 18-44 had no statistically significant changes.

High Rate of Increase in Suicide Deaths Among Adolescents

In recent years, suicide death rates for Black children and adolescents significantly increased. From 2007 to 2017, the suicide death rate increased for Black youths from 2.6 per 100,000 population in 2017 to 4.8 per 100,000 population in 2018. Black males ages 5-11 years are more likely to die from suicide compared with their White peers.¹⁴

Figure 3

Suicide deaths among youths ages 12-17 per 100,000 population, by ethnicity, 2018-2020. Note: Estimates are age adjusted to the 2000 U.S. standard population. Age data are unadjusted. Respondents for which age is not reported are not included in the age (more...)

• From 2018 to 2020, the rate of suicide death decreased 10% overall for youths ages 12-17, from 7.0 per 100,000 population to 6.3 per 100,000 population (Figure 3).
• From 2018 to 2020, the rate of suicide death among adolescents ages 12-17 increased 2% for Hispanic adolescents, from 4.9 per 100,000 population to 5.0 per 100,000 population. The rate for non-Hispanic White adolescents decreased from 8.5 per 100,000 population to 7.4 per 100,000 population, a 13% decrease.

Preliminary 2020 National Vital Statistics System data also show that suicide was the leading cause of death for Asian and Pacific Islander (API) and American Indian or Alaska Native (AI/AN) youths ages 10-14 years. Suicide among minority youths such as API and AI/AN groups is increasing and concerning.

Increase in Major Depressive Episodes for Adolescents Among All Ethnic Groups and Residence Locations

The most diagnosed mental health disorders among children ages 3-17 years in 2016-2019 were attention deficit disorder (9.8%, approximately 6 million), anxiety (9.4%, approximately 5.8 million), behavior problems (8.9%, approximately 5.5 million), and depression (4.4%, approximately 2.7 million). For adolescents, depression is concerning because 15.1% of adolescents ages 12-17 years had a major depressive episode in 2018-2019.⁴

Figure 4

Children ages 12-17 with a major depressive episode in the last 12 months who received treatment, by ethnicity, 2008-2019 (top) and 2020 (bottom). Note: The 2020 data included quarters 1 and 4 only due to the COVID-19 public health emergency. Non-Hispanic (more...)

• From 2008 to 2019, the percentage of adolescents ages 12-17 with a major depressive episode in the last 12 months who received treatment increased overall, from 37.7% to 43.3% (Figure 4, top). For 2020, the overall rate was 41.6% (Figure 4, bottom).
• From 2008 to 2019, the percentage of adolescents ages 12-17 with a major depressive episode in the last 12 months who received treatment increased for non-Hispanic White children from 43.1% to 50.3%. For 2020, the rate for non-Hispanic White adolescents was 49.1%.
• From 2008 to 2019, there was no statistically significant change in the percentage of Hispanic adolescents ages 12-17 with a major depressive episode in the last 12 months who received treatment. For 2020, the rate for Hispanic adolescents was 37.0%.
• Although the percentage of adolescents ages 12-17 with a major depressive episode who received treatment was lower for Hispanic adolescents than for non-Hispanic White adolescents, the 21% increase for Hispanic adolescents was higher than the 17% increase for non-Hispanic White adolescents between 2008 and 2019.
• From 2008 to 2019, there was no statistically significant change in the percentage of non-Hispanic Black adolescents ages 12-17 with a major depressive episode in the last 12 months who received treatment, but the percentage varied greatly over time.

Figure 5

Children ages 12-17 with a major depressive episode in the last 12 months who received treatment, by location of residence, 2009-2019. Note: The 2020 data are excluded from this figure because 2020 data included quarters 1 and 4 only due to the COVID-19 (more...)

• From 2009 to 2019, in large fringe metro areas, the percentage of adolescents ages 12-17 with a major depressive episode in the last 12 months who received treatment increased from 34.1% to 45.0%, a 32% increase (Figure 5).
• From 2009 to 2019, in noncore areas, the percentage of adolescents ages 12-17 with a major depressive episode in the last 12 months who received treatment increased from 37.6% to 48.1%, a 28% increase.
• From 2009 to 2019, in large central metro areas, the percentage of adolescents ages 12-17 with a major depressive episode in the last 12 months who received treatment increased from 32.4% to 40.5%, a 25% increase.

Conclusion

These findings indicate that the need for mental health treatment, especially among children and youths, is not being met. Depression is associated with suicide and has increased for adolescents ages 12-17 while utilization of mental health services has not changed significantly.

Families often face significant challenges in navigating mental health treatment and services through a complex network of schools, primary care, community mental health centers, public and private insurance systems, and more. Individuals do not experience mental health issues in a vacuum. The social and economic context are important factors that contribute to one’s physical and mental health.

The NHQDR will continue to support work to improve quality measures for mental health care in order to provide important information on areas of improvement and areas that require more attention. Efforts are underway to improve measures for assessing and implementing improvements in the quality of care for mental health treatment for children. These include increasing the percentage of children and adolescents who receive evidence-based preventive mental health interventions in school. In addition, a mental health measure related to early childhood care and education programs is under development through Healthy People 2030.¹⁵

Research is also being conducted on the impact of climate change awareness on children’s mental well-being and negative emotions among a greater diversity of people and places. The research on the impact of awareness of climate change on children’s mental well-being and negative emotions is in its early phases, but existing studies provide a basis from which to develop future research.¹⁶

Resources

The Department of Health and Human Services (HHS) and other government agencies are committed to improving child and adolescent mental health. The following are examples of available resources:

• The National Suicide Hotline Designation Act of 2019 requires the Federal Communications Commission to designate 988 as the universal telephone number for a national suicide prevention and mental health crisis hotline.¹⁷ 988 has been designated as the new three-digit dialing code that will route callers to the National Suicide Prevention Lifeline.
  While some areas could connect to the Lifeline by dialing 988, this dialing code became available to everyone across the United States on July 16, 2022.¹⁸ The current Lifeline phone number (1-800-273-8255) will always remain available to people in emotional distress or suicidal crisis.
• HHS leaders urge states to maximize efforts to support children’s mental health by highlighting opportunities to strengthen the healthcare system’s capacity to meet mental health needs, connect more people to care, and create a continuum of support to address mental health comprehensively and equitably by coordinating across federal programs, including:

  • HRSA’s Title V Maternal and Child Health Services Block Grant that supports the health and well-being of all mothers, children, and families;
  • The Substance Abuse and Mental Health Services Administration’s Community Mental Health Services Block Grant that provides funding for substance abuse and mental health services;
  • Mental health and behavioral health care covered by Medicaid and the Children’s Health Insurance Program;
  • The Administration for Children and Families’ Title IV-E Prevention Program for children and families involved with the child welfare system and early childhood mental health supports;
  • The Centers for Disease Control and Prevention’s evidence-based primary prevention programs and mental health resources; and
  • The Administration for Community Living’s programs for people with disabilities, including children with mental health needs.
• The National Institute of Child Health and Human Development has a long track record of research to identify and rapidly respond to youth mental health needs.
• MentalHealth.gov’s Parents and Caregivers page provides help in starting a conversation with children or teens about mental health.
• The Substance Abuse and Mental Health Services Administration supports efforts to promote mental health and substance use prevention in schools and on campuses and to provide safe learning environments.
• The National Institute of Mental Health has a Help for Mental Illnesses web page to help users find a healthcare provider or treatment and learn how to get immediate help.
• Digital Shareables on Child and Adolescent Mental Health provide resources on the “Get Involved” section of National Institute of Mental Health (NIMH) websites to help raise awareness about the importance of children’s mental health and early diagnosis and treatment by sharing information and materials based on the latest research. These resources include videos, webinars, brochures, fact sheets, and coloring books for children.
  Also available from NIMH are Research Highlights About Children and Adolescents, Science News About Children and Adolescents, and NIMH Director’s Message.

References

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Office of the Surgeon General. Protecting Youth Mental Health: The U.S. Surgeon General’s Advisory. Washington, DC: U.S. Department of Health and Human Services; December 2021. https://www​.hhs.gov/sites​/default/files/surgeon-general-youth-mental-health-advisory.pdf. Accessed October 4, 2022.

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World Health Organization. Adolescent Mental Health. November 2021. https://www​.who.int/news-room​/fact-sheets​/detail/adolescent-mental-health. Accessed October 4, 2022.

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