Depression and anxiety in young adults

[00:00:27]

RICK WEISS: Hello everyone and welcome to SciLine’s media briefing on depression and anxiety in young adults, a topic that’s only getting bigger these days. And I think, as you will learn, is really worthy of some media attention in virtually every locality across the country. So, thank you all for joining. I’m SciLine’s director, Rick Weiss. For those of you who are not familiar with us, SciLine is a philanthropically funded, editorially independent, free service for journalists and scientists based at the nonprofit American Association for the Advancement of Science. Our mission is simply make it easier for reporters like you to get more scientifically validated evidence into your news stories. And that means not just stories that are about science but really any story that can be strengthened with some science, which in our biased opinion is about any story you can think of. Among other things, we offer a free matching service that helps connect you to scientists who are both deeply knowledgeable and are excellent communicators on deadline. Just go to sciline.org, click on I need an expert, and while you’re there, check out our other helpful reporting resources.

A couple of quick logistical details before we get started: we have three panelists who are going to make short presentations of up to 7 minutes or so each before we open things up for Q and A. To enter a question just—during or after these presentations—just hover over the bottom of your Zoom windows, select Q and A, and enter your name, news outlet and your question. And if you want to pose your question to a specific panelists, be sure to note that. A full video of this briefing should be available on our website by later today or tomorrow morning, and a time-stamped transcript will follow a day or so later. But, if you’d like a raw copy of this recording more immediately, please just submit a request with your name and email in the Q and A box, and we can send you a link to the video today. You can also use the Q and A box to let us know about any technical difficulties.

Okay, I’m not going to give full introductions to all our speakers. Their bios are on the SciLine website. I will just tell you that we will hear first from Dr. Anne Marie Albano, who is a professor of medical psychology and psychiatry at Columbia University. And she’s going to give us an overview of depression and anxiety disorders, especially as they manifest in young adults with some attention to potential causes and recent trends. Next, we’re going to hear from Dr. Melissa Bessaha, an associate professor in the School of Social Welfare at Stony Brook University who’s going to talk about some of the barriers and, I mean internal barriers, psychological barriers and external ones that may get in the way of young adults seeking or getting help. And third, we’ll hear from Dr. Adrian Aguilera, UC Berkeley School of Social Welfare, Department of Psychiatry at UCSF as well who will talk about the fast growing field of digital interventions like support apps and teletherapies and what we know about their efficacy and their potential benefits and shortcomings. Okay, to get started, it’s over to you, Dr. Albano.

[00:03:32]

ANNE MARIE ALBANO: Thank you so much for having me here today, and I’m glad to be here to talk with you all about something that’s been very concerning, I’m trying to, to all of us in the field. And that is the rise of anxiety and depression in young adults and young people. So, I just want to start to, I hope you don’t see this share screen thing. Okay, got rid of it. I just want to start by orienting us to the fact that emotions such as anxiety and depression are really normal. They are rooted in our central nervous system. Very evolutionarily based in that they’re there to serve a purpose to help alert us to danger that may be immediate or in the future. That’s what anxiety does for us. And then actually depression from an evolutionarily point of view, depression orients us to focus our attention on one thing and ruminate on how to problem solve.

Now this is when anxiety and depression work for us on our behalf. A healthy response from our nervous system incorporating our cortex and even some of the alarm systems deep in our brain means we get a response that is reasonable for the situation at hand. It’s manageable. We can deal with. It activates us and mobilizes us to deal with the issue. And it just sort of fades away with a little bit of time. Now contrast that to when these emotions that we all experience in day to day life become problematic. And that is when it’s excessive. The anxiety that doesn’t stop. It’s worry, what if, what if, what if, can go wrong, panic attacks that are happening when you’re just walking into a room meeting new people. Taking a test or exam if you’re in school and so forth. Or depression, it just you can’t get yourself to move forward and deal with things. You’re getting more and more sad and upset and feeling hopeless. These conditions, anxiety and depression, the symptoms are uncontrollable. They happen like, it seems like from out of the blue. And they either paralyze and restrict the person. And the hallmark feature, both of these, are you withdraw or avoid things. Meaning every day life situations that otherwise are a part of your role in life and being a part of the world. And they don’t just simply pass with time. So, they become problematic. And the question always comes, how and why are these things so difficult for people. And so, what I have to say here is we might hear a little bit more about this later.

But if you take a look at this very busy slide, everyone is born with some Achilles’ heels—those are some key risk factors. And it could be the social determinants of health that holds someone back and make their anxiety or depression more prominent. And that would be poverty, minoritized status, economic issues and things that go on. But then there are also key protective factors, and that might be having a more resourced environment, a more warm and engaging family system. So, we just look at there’s so many different variables in the equation that can maybe put someone at greater risk for experiencing problematic anxiety or depression or may protect them from things that are going on that do cause these kinds of emotions. But it doesn’t allow them then to overwhelm the individual. And we’ll have this slide for you of course to take a look at and think through. Now when we think about what about these disorders. What’s happening in the world with kids and into young adulthood. And the number one thing to understand is anxiety disorders are the disorders of fist onset, and they start very early. We diagnose upwards of 6 to 9% of preschoolers with anxiety disorders. But look at, by adolescence you’re seeing about 15% of adolescents suffering with an anxiety disorder. Panic disorder, social anxiety disorder, generalized anxiety disorder, separation anxiety, specific phobias. There’s a whole bunch of them that go on. And kids don’t grow out of them with a high school diploma. In fact, then you see 22% of young adults 19 to 29 years of age have a bona fide anxiety diagnosis in the past year. So this is critical for us to understand that these conditions start early, and they continue if they’re left untreated. And anxiety happens to be one of those conditions that is most often not treated but for those who need some intervention.

The second thing to know, and these are very new data, is that when it comes to depression, just understand that in terms of adolescence, depression has been rising. So along the x-axis here we have 2009 through 2019, and this is then cumulative percent. And we’re seeing that pretty much since 2013-14, there’s been a steady increase in major depressive episodes which is clinically significant depression with high impairment and functioning. Not being able to function as a student, as a friend, take care of oneself within the family, a very steady increase in depression amongst adolescents. And when you break these data down, what you see then is that females, girls, are really struggling, significantly more depression is happening for girls than for boys in this country. Now why I show you this is because it leads into understanding these hot of the press data from SAMHSA that when it comes to young adults, this line along the x-axis here is just adults 25 to 49 years of age. Their rates of depression, cumulative rates per 100 persons in a year. This is an annual survey that happens. And it’s pretty stable for adults who are like middle aged. But when it comes to young adults, we, again, from 2015, we have seen this significant, steady increase of depression with impairment in the young adult population. And again, most of these people who need help are not receiving any form of help for it.

Now when you look at anxiety and depression together, and again, anxiety starts early. It’s known as a gateway disorder. If you have had anxiety early in childhood and through your adolescence, it’s more likely you’re going to develop depression. What we see is if an individual has no anxiety and no depression here along the x-axis, very little suicidal ideation, very little suicide attempts occur. If you have anxiety by itself, you will have, we tend to have some suicidal ideation, very little attempts. Depression is where you start getting a lot of suicidal ideation that life is not worth living. Why am I here? I wish I didn’t have a life anymore. No one would care if I was gone. And more attempts presenting in the emergency room. The lethal combination then occurs when anxiety and depression are present at the same time where there’s a steady increase, huge spike in ideation about life not being worth living. And more visits to the ER because of suicide attempts and also completion. And when you throw substance use into the mix, really, that disinhibits a person, and you can get, again, a spike then in higher rates of people presenting to the ER for attempts. So, these are not benign conditions. They deserve a very good look. And when we ask about what’s making it worse? Why is over since 2015 really a little earlier, 2009, why do we see this spike? You just have to think about all the things that are hitting kids today. Today and over the last 20 years really. These are recent surveys that were conducted on what do youth worry about. And worry is a part of anxiety as well as the rumination of depression. And they worry about their future. Is the environment going to be conducive to us living, raising families and having a life that is healthy out there. Technology, the downside. And we know that bullying, especially cyberbullying, has been a huge contributor to girls’ mental health plummeting as we saw on that chart.

These youth today worry about political issues. Here in the United States, why can’t we get along? As well as what’s going on globally. As well as the fact that they’re especially, this is unique to the U.S., school and campus shootings. This is something, their safety, just everyday safety is something that they worry about quite a bit. And then you see these other things that are like really present, deportation issues, bullying of peers. And what the economy means to them today for getting a job, having to go to school and how much do they have to then get in terms of degrees and such. And will they be able to survive? Will they be able to afford a future? And will there be jobs there for them. So, these are the things that are contributing, we think, to what’s happening with youth. And I will leave it there then to allow my colleagues to take it from there.

[00:13:04]

RICK WEISS: Thank you, Dr. Albano. Fantastic introduction as depressing as that is. And Dr. Bessaha to talk about what happens next.

[00:13:29]

MELISSA BESSAHA: Hey, thank you. Bring my screen up here. Alright, you all can see that?

[00:13:36]

RICK WEISS: Great.

[00:13:38]

MELISSA BESSAHA: Alright, so thank you, Dr. Albano. I am Dr. Melissa Bessaha. My presentation here will be continuing this very important conversation on young adult mental health. But looking specifically to barriers to mental service use. So my colleague Dr. Albano already discussed depression and anxiety. I wanted to talk a little bit, highlighting more on the findings on young adult health and wellbeing and looking distinctly at the transition to adulthood period and the developmental stage here. So, typically we look at 18 to 29 up to 32. It really depends on the study that you’re exploring. But generally, 18 to 32 is what we’re discussing at young adult age. There’s really a time of great opportunity in life, in work, in relationships but also a challenge.

So, the effects of stress and mental illness can really include higher rates of depression and anxiety, even loneliness and young adulthood that can really disrupt critical developmental milestones, identity formation and relationships, academics if you’re pursing higher education. Professional achievement and occurring various things that are occurring during this really special time in one’s life. Many transitions during this period can also have potential cause for disruption in existing relationships which is really concerning, especially during this age group. During the psychological need for social relationships. So when that’s disrupted, you start seeing a lot of different psychological issues. So additionally looking at different mental health issues, depression, anxiety, we’re also looking at more of a growing mark in loneliness and social isolation. And a large Cigna study conducted in 2018, predating the pandemic, looked at different rates of experiences of loneliness and social isolation and connection to different mental health issues and found that young adults in the United States were classified as the loneliest generation then other adults in different generations including the boomers. So findings from this study really looked at different issues of why this is the case. And some of their reported issues were not having enough social support, too few meaningful social interactions, poor physical and mental health. So, you can see that connection there. And not enough balance in our lives. So, we see here that connection to mental health issues such as depression and anxiety to really our social interactions. And the influence of social relationships in young people’s lives is really important. Additionally in terms of mental health and underserved or marginalized groups such as LBGTQ+ populations, those that are minoritized groups. You’re starting to see, or you have seen through the years, a growing problem. Anxiety, depression and loneliness, social isolation, connection to mental service use, and that tends to be having more vulnerabilities, more possibility of lower socioeconomic status, anti-immigrant sentiments, lack of connection to consistent reliable healthcare. These all can be really compounding issues over time. So researchers—

[00:16:37]

RICK WEISS: Dr. Bessaha, I just to interrupt for a moment. I’m not sure if you meant to be on your first slide still or whether we’re behind.

[00:16:43]

MELISSA BESSAHA: Yes, I’m transitioning to the next. Sorry about that. Next slide. So, potential barriers to seeking care. Looking at young adults have the highest prevalence of mental health issues but then the lowest rate of service use, and that’s another SAMHSA study, SAMHSA had really great work coming out on this very issue. These rates have become even more pronounced due to the pandemic. There are already low rates in mental health service use among young adults or even lower among those who are from low income backgrounds and minoritized racial ethnic groups. Despite the actual prevalence in mental health issues, young adults are not really seeking care. They’re reluctant to do so. In fact, in a recent study I coauthor with my colleagues in May, JAMA Network Open, we looked at some SAMHSA data over time from 2011 to 2019, and found that about 53% of young adults who had experienced major depressive episode in the past year didn’t receive any treatment. There was a lot of reasons why, and I’ll go through some of that.

So, what is going on here? Why? One of the main reasons came up and from other research studies explored, you start seeing a stigma in negative attitudes towards treatment of mental illness and significant barrier to mental health service use and recovery. So, the impact to mental illness stigma has been identified by many, including service users, clinicians, researchers, like me, like us, policymakers of the fundamental determinant of health and a persistent barrier to mental health issues and to psychosocial wellbeing has really been stigma and feeling stigmatized. So, you seek care. So it’s important to consider clinical characteristics for understanding stigma. So, for example, research has found associations between greater depression severity and higher levels of stigma, including anticipated stigma, self stigma, perceived stigma among adults. So, really, that knowing that you have symptomology feelings of not yourself but, still something is keeping you from pursuing support and that has really related to stigma. And the disadvantage is to seeking care.

Another potential barrier are the mental health systems often have inadequate understanding of young adults, developmental needs. I just went on the other slide, this distinct period of life. So, while they’re not longer in adolescence, they may not identify the full blown adult or adulting. So, understanding those transitions that are going on during this period and their unique qualities including transitions to relationships, schools, to work, independence and major life decisions that they have to make. So, training is of the essence of well for mental health service delivery. Another one, a major one, and going back to that study I referred to and JAMA, looking at mental health barriers. Cost associated with mental health treatment and access to mental health insurance was at the forefront, and it’s a growing problem that we saw from 2011 to 2019. And I imagine still so now. There’s a myriad of reasons, and the top reason had been cost. So the leading reason of cost and like of adequate insurance was a reason for avoiding treatment and not feeling that they can really afford the treatment that they want. And feeling that they may not have access to the support that they need. So looking at possible social supports.

Potential impact of social support and increasing mental health service use highlights the importance of developing interventions that really can encourage young people to develop strong support networks and promote young adults to really look at different measures that are preventative or reduced mental health issues over the life course. So, although there’s low levels of perceived social support, or infrequent social interactions can contribute really to increased mental illness and loneliness through time. So, I want to end with a transition to my next colleague. We do see a growing promising work coming out about telehealth expansion. A positive from the pandemic in terms of healthcare, where there’s a growing expansion of telehealth and tele-mental health. So, really can be, has been found a small growing body of work has been found that it is an effective form of treatment of depression, anxiety and other mental health issues. Cost was a major reason why young adults weren’t seeking care. This is a little bit more affordable. Definitely time efficient in terms of not having to seek care outside of your home. You can have control of where you’re going and the eliminates of logistics of travel and parking can really be a promising thing. So, in terms of the future and future directions. Looking at role of social supports, interventions and what other research can really come out of this work. So, I will pass it on to my next colleague.

[00:21:39]

RICK WEISS: Thank you. Obviously work to be done both in helping people overcome their own internal feelings of stigmatization, so if they seek help. And lots of work to be done on the outside institutional level to make this kind of help more successful. And for some of that, we turn to Dr. Adrian Aguilera.

[00:22:01]

ADRIAN AGUILERA: Great. Thank you very much. So, I’ll continue on the conversation that my colleagues have so grounded to talk a little bit more about the role of digital technologies and mental health. So, first, to give you a sense of what are some of the different options for using digital health technologies. So, on the left you see some of the categories. First, our web base or mobile app self-help, so this would be other programs that you would identify online or app that you would download to get information about how to, about what mental health challenges are and how to deal with them. Many of them are based on things such as cognitive behavioral therapy, which is an evidence-based treatment for depression and anxiety. Or mindfulness is also very popular, for example. And telehealth was alluded to.

It’s essentially taking what was the traditional one on one therapy or even group therapy and changing the medium to be either via video or via audio. Blended is some combination of live care with technology, let’s say doing an app while getting some support with that. Social media is also a big source for information both formally and informally. And then lastly their interactive technologies, so these are things that are a little bit more on the cutting edge thinking about chat bots or artificial intelligence, the games, even virtual reality would fit in this category. Just wanted to give you a sense of this is only kind of some of the private companies that are addressing mental health. As you can see, they kind of categorize in a variety of ways. Some are self-help, others are more telehealth based. Digital therapeutics is actually using the model of prescribing let’s say medication. In this case, you would be prescribed an app from your provider. And some others as well. There are a few companies that are specifically targeting teens and young adults. So, these are some examples. For full disclosure, I have done some advising for Be Me and Big Health.

And then here’s some data looking at how much youth and young adults are going online for mental health information using apps, et cetera. As you can see—what might not be surprising are folks are pretty comfortable in this age range looking for resources. And even more so when there’s a need, when there’s a high level of symptoms. LGBTQ youth are even more likely to go online to search for information related to depression, anxiety and stress. What we know is that generally speaking, researchers have digital interventions based on evidence-based methods are efficacious. The challenge becomes translating that to real world effectiveness. And one of the biggest challenges is engagement. Engagement has always been a challenge in mental health, even in traditional in person care. What we know is that providing support increases engagement and therefore increases effectiveness. Support came come in the form of family, peers and clinicians for example.

One of the challenges of the, since so much of this is led by private industry, one of the challenges with digital health companies is that they don’t always focus on the most high burden or high cost conditions. So they may be working with folks who are doing okay, and maybe can help people do a little bit better. But are not necessarily addressing the highest need. This is where issues of equity come in. We also see, for example, that technology adoption is a little bit variable. Smartphones are something that most folks have access to. But when we look at home broadband for example, that’s a little bit more variable. So if you need to do videos, things like that, people may have variable access. Some ways to make digital mental health more inclusive involves developing tools with a range of communities. I would argue focusing on those of the highest need and fewest resources. There’s a big push for young adults to focus on college, which is great. It’s a great place to reach people. But we also need to think about those who are not in college, who have quite a bit of need as well. Rural populations also have access, challenges accessing services. We need to increase support for peers and clinicians. This includes diversifying the workforce, improving access in a variety of ways, so language. We’re seeing a lot of refugees, for example, or immigrants, whose first language is not English. And providing both the access in terms of broadband as well as cost.

And then lastly, some of the challenges to using telehealth and digital would be just getting in the front door, right. So these could be, related to issues of stigma as was alluded to before. Or just knowing about the resources. Broadband and data limitations, privacy issues. So these have to do with the privacy of the applications but also privacy in the home. Either privacy from let’s say parents or if you live in a crowded home, even multi families in the home. Getting space for privacy is a challenge. One thing to keep an eye out is whether these technologies encourage avoidance. So, for example, if folks don’t want to be on video but are anxious, that could be detrimental to their progress. And lastly, there’s lower engagement if there’s not some sort of support. Thank you very much.

[00:28:41]

RICK WEISS: Thank you. Obviously, a huge area of perceived growth in the private sector, and we’ll see how this pans out in terms of efficacy. So thank you all three of you for this great introduction to the landscape here. I want to remind reporters you can send your questions in through the Q and A icon at the bottom of your screen. And also that these slides will be available immediately after the media briefing so you can take a closer look at some of the data that were shown. To get things started, I usually start with my own question, same question for most media briefings. It’s a question that asks each of our experts here to address something for reporters directly. That is to say from their own viewing of how this topic is being covered in the news these days. What are reporters either doing well or maybe doing not so well and could do better at? So some direct advice to those of you who include this in your beats. So I’d love to go through the three of you just for starters and see if you have any advice thumbs up or thumbs down for how reportage of this subject should go forward. And I’ll head back to you, Dr. Albano, to start.

[00:29:51]

ANNE MARIE ALBANO: It’s always been hard being A, A, no matter which way I get it, I’m first. One of the things I do very much appreciate when we get calls from journalists asking us, because if I can’t answer a question, I’ll send you to an epidemiologist of someone I know. I think what they’re doing very well is when you find someone who’s had the lived experience of confronting a barrier, as you’ve heard about some of those. Or has had successes in therapy. But I think what we have to do much more of is really getting accurate data out there to dispel myths that are out about how terrible SSRIs are, let’s say, or medication. So, that’s a big thing. Really get accurate data when you hear this is the way to treat anxiety. Take these vitamins or what have you. Please seek us out. I’ll leave it at that.

[00:30:51]

RICK WEISS: Thanks. Dr. Bessaha.

[00:30:54]

MELISSA BESSAHA: I concur whole heartedly. I would say in addition to that, a good thing or a benefit or doing well, adapting to change in terms of delivering of news or important information. There’s just so many outlets. I’m even learning about some of them. I’m not well-versed. I love technology. I try to be bull on top of things. But there’s so many apps and different ways of sharing resources. Whenever I learn of something new I’m like wow, that’s really innovative. So, I do appreciate that because there’s different people, different learning styles, different ways of retaining or absorbing information. So, I would say that’s a huge benefit. And I think something that’s been improving is timely topics. So if something like this. Like we see a problem, we see a growing issue, we hear things. Now we’re seeking information and really trustworthy information. So, I will say the improving and timely topics, the hot topics that are really relevant to people’s health and wellbeing.

[00:31:48]

RICK WEISS: All right, and Dr. Aguilera.

[00:31:53]

ADRIAN AGUILERA: I would echo my colleagues. I think probably the biggest thing I see is the balancing between the personal stories and the broader data and how those two fit together. Because I think sometimes we, the stories are emotional, and they’re great. But they may or may not be reflective of the numbers broadly. Which I think then leads to the final kind of point is, I think having a little bit more humility, I think for us kind of scientists, researchers, and we’re always very careful about our conclusions. Because we know that there’s more data, and this is only part of the picture. So I think having that in mind. That doesn’t always make for the kind of sexiest stories necessarily but trying to balance out being careful about the conclusions we make I guess.

[00:32:47]

RICK WEISS: Great. Thank you for that. We will turn now for some questions coming in. And I’m going to start with a question from Renata Hill at Moodfuel News in Colorado. What type of news or information have young adults told you that they need in order to help themselves achieve mental health or to access mental health care? I think what we’re getting at here is what should reporters be including in their stories that would help them help direct you to their services or the ways they can get help? Anyone want to jump on that first?

[00:33:28]

ANNE MARIE ALBANO: Well, I take a stab. I think one of the things that’s very helpful is embedded in the story or at least having a callout box where you can put not just local resources. And this actually takes a little more legwork on your time because you should investigate whether those local resources have wait, are they have big wait lists, or are they able to take people in. So, different types of local resources, individual, group therapy, support and self-help. At the same time, what are some of the online tele methods. If there can be some ways of at least directing them to where they might be able to get some of their immediate needs met.

[00:34:16]

MELISSA BESSAHA: I agree with that. In addition, I would definitely, short bites of information. They may not have the longest attention span. They might be busy. They have different attention sensitive things, work, school, probably caregiving. So quick, short bites of information. And I like that callout box on the side. I love the inclusion of 1-800 numbers or those informational national hotlines are important as well. But I think maybe going an extra time effort of maybe actually really putting really quick things that you’ve heard from us or from others. I think the quick bites could be really helpful.

[00:34:54]

RICK WEISS: Very good. Question here that maybe asks you to expand a little bit, Adrian, on some of things you were talking about earlier. This is from Noah Glick at the Sierra Nevada Ally in Reno. Says was hoping to have someone speak briefly to how depression and anxiety particularly affects youth who identify as LGBTQIA.

[00:35:21]

ADRIAN AGUILERA: Yeah, so I think that’s a developing picture, but we do see that LGBTQ youth are looking for information, are looking to access more information about mental health. Generally, speaking, they tend to have higher rates of depression and anxiety. So, there’s kind of the need. And so, it speaks to, again, the need to develop services and resources for these populations and all the various things that they’re struggling with. So, it’s good that they’re out there looking for it. Now we have to make sure that there’s something out there to match what their needs are.

[00:36:04]

RICK WEISS: And a question from Cindy Goodman, South Florida Sun-Sentinel in Fort Lauderdale. What more can colleges do to prevent suicide attempts and other mental health crises on campus?

[00:36:21]

ANNE MARIE ALBANO: Well, if you don’t mind, I’ll jump in. I think this is the number one topic the three of us can tell you across campuses. And there’s foundations such as the Jed Foundation working specifically with college campuses. Healthy Minds is another one. And it’s all geared towards suicide prevention. So, one of the things colleges can do is number one is an internal needs survey and also a real look at what their resources are in their college counseling centers. What kind of emergency response teams do they have. What are they doing with outreach to students about how to get help, how to recognize when someone you know is struggling. We also here at Columbia we’re working with our professors on how to recognize and respond to students who may be reaching out. So it really means a deep dive within. To take a look at what’s going on on your own campus and what resources are there and within the community. Have ways of getting students the help they need. I think out at Stony Brook, for instance, I mean there’s a group out there that will send, take the kids who have a suicidal ideation to a place on campus that’s quiet, secure and private for an ambulance to come meet them. So, it’s not stigmatizing to the student. So, there’s different things that we have to do in that way. And Jed Foundation is just one of those places, and I’m on the Scientific Advisory Board, disclosure, that really helps colleges look through and see what is needed for their students.

[00:37:55]

MELISSA BESSAHA: And I can jump on that. Yeah, so the Jed Foundation campus at Stony Brook is one of those campus sites, there’s plenty across the country. They’re doing amazing work. Providing a lot of feedback for the universities. So, I would say that’s a great resource. Peers, there’s a lot of work and data that supports that peer interventions work. Great training for peers, recognizing need, who to contact for support, how to advocate bystander training as well. And these are all things I can speak of my own campus that they offer. I know many others that do. So, these are all things that have been found to work. Just providing that time, efficient training, hiring staff that can do this. We know the staff limitations on college campuses, there’s a great need but not enough staff. Sometimes long wait lists for seeking support and services. How do we support the staff to do the work that’s necessarily? We’re seeing the crisis. We know there’s a need. How do we get that information and that support across?

[00:38:52]

RICK WEISS: Great, OK. Question here from Kelly Gordon, Minnesota Public Radio News. I’m sure we’re still waiting for robust data, but how much of this was impacted and possibly even exacerbated by the pandemic? Anecdotally, young adults in particular those were late teens in 2020 seem to be experiencing extremely high levels of anxiety, depression and disengagement. I think Adrian, you had a graph that showed some increase there that seemed timed with the pandemic. What can we say about cause and effect there?

[00:39:28]

ADRIAN AGUILERA: I mean I would say the short answer is yes, right. I think we know that it’s, young adulthood is a developmentally sensitive period where there’s a lot of kind of biology happening where things are getting kind of more cemented put into place. And there’s a need for socialization and a variety of things that were missing during the pandemic. So, I think that we can all probably have a sense of how it impacted us. And I think all I can say is it likely impacted folks in those critical time periods that much more. Because it’s when they’re kind of starting to make sense of some of these things and they weren’t in places to be able to do so. But I’m sure my colleagues can add a bit more nuances.

[00:40:19]

RICK WEISS: Yeah, actually, I think those data were yours, Anne Marie, so I should toss to you as well.

[00:40:25]

ANNE MARIE ALBANO: Yeah, well the nuance and the data there, first of all, the data is still coming out because we’re studying that. The cohort of adolescence and young adults, school age kids and young adults. But what’s been shown first and foremost is that in an individual who has had COVID, and this is children, adolescence and young adults, if they had the virus, there’s a higher likelihood that they have mental health problems or they’re more at risk for it than individuals who had some sort of medical condition but that looked like COVID but wasn’t and those who were not affected at all. So we do have to be mindful of that. Second thing is that with the shutdowns and stuff, yes it shook up. There’s developmental milestones that these kids have to meet along the way all through high school, through college, of different types of skills. Cognitive, social, problem solving into personal and so forth. And they were kind of shut down a bit. And kids lost their sense of perception of control or the illusion of control that they have more freedoms and choices than they actually have. Whether it’s by parents or the way the systems are in colleges or the workforce. And so that shook them up and deskilled them a little. And there’s data coming out about that and also how to work with that. And as we heard from Adrian and such and also from Melissa, the youth who are more vulnerable, LGBTQ, immigrant kids, especially those who are first generation or dreamers, Native American youth and such, BIPOC kids, they are more vulnerable because they might have been isolated or alone in a school system. Then they were on Zoom and really out of the mix. So, those are the kids who are having more struggle now. But the sort of silver lining is most people recover from these kinds of pandemic-level traumas so to speak. But the other thing is that telehealth and telework, as Adrian said, is just like flourished. We figured out we can treat people this way. There’s nuances, but at least that’s there so we can try and direct folks to get help. Sorry for the long response.

[00:42:37]

RICK WEISS: That’s great, very useful. Why don’t we follow up on the telehealth theme here with a question from Kate Walters at KUOW Public Radio in Seattle. Beyond telehealth, what’s a change or innovation that you’ve seen in your field during the pandemic that you would like to see continued?

[00:42:58]

ADRIAN AGUILERA: That’s a great question. I think that telehealth is one thing. So, when we think about telehealth specifically, it’s taking what we were already doing and doing it over a video. And that’s great. But I think unfortunately that doesn’t use our resources as efficiently as we can, right. It’s still a, as my mentor would call it, a consumable resource. And so, we need to think about ways to blend technology with the limited workforce that we have in more efficient ways. So, that means doing a better job of triaging so that let’s say folks with more mild symptoms get maybe a lower dose of the treatment, of the live intervention. And maybe we can rely on technology and some of these automated tools. And as the need increases, apply more of let’s say the clinician or the more intensive interventions. And I think unfortunately, the way our systems are set up is that people get treatment based mostly on their resources, ability to pay, et cetera, versus based on their need, right. And until something fundamental changes, that’s going to continue to be a problem, and it’s going to continue to exacerbate the disparities.

[00:44:13]

RICK WEISS: Great. Any other thoughts on future innovations or promising innovations? Alright, we’ll move ahead with a question here from Nicholas Gerbis at KJZZ Public Radio in Phoenix. Have there been any changes in the DSM definitions of depression, anxiety, et cetera, that should inform our reporting on trends such as the uptick that Dr. Albano showed in one of her slides. Does any of that, should a reporter be careful about mentioning differences in definitions there?

[00:44:49]

ANNE MARIE ALBANO: I don’t think, and I just finished a review of the DSM anxiety disorders and such for a project we have, I don’t think there’s any changes in definitions that would make for more, finding more cases. I think the only thing in DSM 5 is that what should have been there before, you can be diagnosed with separation anxiety disorder if it occurred while it was in childhood. It persists through adulthood, and they used to say there was a cutoff at age 18. But nothing that I think would make more prevalence.

[00:45:30]

RICK WEISS: Okay. Thank you, Nicholas, for paying attention to details on that level. That’s a great question. From Michael Jones at Supercreator News. I’m curious to know what the role of public policy plays in making mental healthcare more accessible for young adults. What should policymakers know as they’re proposing legislation on these issues? And I think that could mean statewide, or it might mean federal. Anyone want to jump on that?

[00:46:01]

MELISSA BESSAHA: Yeah, I can take a stab or at least start the conversation. I mean looking at costs, the costs can be really astronomical. Insurance only goes so much. Sometimes it doesn’t even cover much. So looking at that, what is a, I mean the annual or average cost that kids are paying out of pocket or young adults, I know with Affordable Care Act expansion to dependents up to 26 have been a huge deal. So looking more into that. I know there’s some buzz of expanding that age. Should we expand that age? Is it necessary. I don’t know. I don’t have the answer to that. But I think looking at that data is important. What are the national level, state level, for that. So, I think there’s something there. I think it could be a creative idea. Any kind of maybe credit account. I’m not sure. I don’t have the answer. I do think that looking at cost is a good start. Clearly, there’s a need for this. And if money is a major issue that is in the way of accessing care, that’s a big problem in our country. What can we do about it?

[00:47:09]

RICK WEISS: What about who is certified or allowed to be doing the therapy? Is there an issue there as well that could be opened up with legislative or other kinds of action?

[00:47:23]

ADRIAN AGUILERA: I’ll just add, I think that’s a great point. One of the things that we’re seeing in order to improve access, so one is improving training of diverse providers, right. That’s kind of, there are some programs federally, and state levels I think expanding those is helpful. I think formalizing expanding peer-based programs or nonprofessional programs so that they can be reimbursed and be part of the care process. We just need more resources, both human and technological, etc. And then the last thing just getting in the door is really challenging. Even if you have insurance, if you, if somebody says I want help, it’s nearly impossible to know what to do next, right. And so we need to figure out some maybe common front door that then kind of gets us to where we need to be.

[00:48:22]

ANNE MARIE ALBANO: And I can just add too, when it comes to the workforce, there is now a larger workforce in that there’s many more master’s level people who are providing services. In fact, that’s the brunt of service providers. What we do want to make sure and ensure, and this happens, this needs to happen at the state level through licensing boards, is that there’s competency in people. I don’t care what level, M.D., Ph.D., M.S.W., M.A., competency in what they’re doing and training people in various programs to deliver evidence-based treatments. So that’s number one. And as you say, Adrian, to do it, have a more diverse workforce. But the other thing, just what can be done? I’ll step into it here. If I was an LGBTQ kid struggling with any kind of issue in certain states in this country, I’d be afraid to seek help. Because of the way that they are being so stigmatized and disenfranchised and so forth. And whether it’s with their healthcare provider or a counselor at school or whatever, I think a lot of kids are afraid to talk about who they are because of what is going on politically in this country. And that is, I’ll leave it there because I could go on for an hour or two or three.

[00:49:42]

RICK WEISS: A really important point. Melissa, were you about to add something to that?

[00:49:48]

MELISSA BESSAHA: Looking at the—100% agree with that—but looking at the workforce, even at the university level, there are definitely state level—and I speak for New York—initiatives for hiring a lot more diverse workforce for schools, elementary, K through 12. We, I would love to see something like that for the university systems across the country where we are seeing a lot of the shooting and the threats, the confusions, the identity development and crises, all these things are definitely, it’s a milestone age group developmental period. It’s looking at those types of initiatives could be great, really powerful as well.

[00:50:27]

RICK WEISS: OK. Question here from Alice Callahan, freelance reporter in Eugene, Oregon. Do the panelists have tips for reporters about how to evaluate the efficacy of digital health apps and interactive technologies? Is there concern that some of these technologies are unproven and could perhaps delay more evidence-based treatment?

[00:50:50]

ADRIAN AGUILERA: That’s a great question. I’ve put, I typed in some information in the answer. There’s a—so we definitely need to make sure that these apps are based in evidence. So, there’s two ways to do that. One is to actually test these programs to see if they are indeed working. And that happens variably to be honest. I think one thing that’s at least helpful is to know that they’re based in evidence-based practice. So, for example, many apps are using cognitive behavioral therapy exercises or content. So, that’s at least going to give us some level of confidence. I think the, so I mentioned One Mind Cyber Guide which is a resource to evaluate apps. Mindapps.org is another one. Where they also assess things like privacy, data security, things like that. In terms of delaying evidence-based treatment, I think that there’s tradeoffs. I think I personally would rather have people have some resources versus having none. It also may be the case where providing a resource like an app can be the beginning of the journey to start accessing mental health services, right. So oftentimes, this isn’t just a one and done thing. It’s maybe something that throughout our lives at different periods we need support. So I see this as fitting into the broader scheme of things.

[00:52:31]

RICK WEISS: So, just while we’re on the apps’ topic, I can’t help but intervene with a moderator’s question: Do any of you have thoughts about whether AI is going to be able to really kick in in a serious way, the more we read about GPT and so on. Is there a future where the therapist is often something mechanical?

[00:52:56]

ADRIAN AGUILERA: So, I’ll jump in given, it is related to some of my work. And so, I guess the short answer is yes, AI will be integrated in some way. I think will it completely take over a relationship that you have between the therapist and the client, that’s unlikely, right. Because we, there’s something real about a human connection. That being said, I think there are ways that AI can personalize, for example, what are the kind of interventions that a given individual might benefit from, right. And having a bunch of data behind us can help us make those decisions better. So, in an ideal world, we can kind of give people what they need most efficiently. That’s one way that we can use AI. In the kind of chat GPT world, maybe we can give folks the right information that they need between sessions, between care. Maybe before they’re going to get care, getting them ready. So, there are I think ways that we can utilize technology in very targeted ways that can be beneficial and keeps us away from kind of that scary place just interacting completely with machines and having no human connections.

[00:54:14]

RICK WEISS: Fascinating. Alright. I’ve got a question here—we’ve got room for one or two more questions before we start to wrap. But we’ve got a question from Vince Beiser at Wired magazine. How can parents, family, friends, encourage young people with anxiety and depression, especially teens, to seek help? Some practical advice that journalists might be able to pass along.

[00:54:41]

ANNE MARIE ALBANO: Well, if I can jump in, that’s like my whole program is the young adult program we call it LEAP, Launching Emerging Adolescents and Adults Program. And we do a lot of work with parents. My biggest wait list is for the parent group. And the first thing I ask them to do, because usually they’re like this. You need help. You need help. Get at it. And we ask them to just sit back and just listen. And you might just hear silence at first. But it’s okay, just listen. And the thing is to reflect back what your teen is saying to you. You’re really miserable and what’s happening here at school or work or whatever it might be. Or your young adult you’re really frustrated with. And then to ask them what do you think might help? What and how can we help you? So it’s about listening to them, reflecting to them and then seeing can you get them engaged. And if they say I just want you to leave me alone, we tell the parents, okay, I’m going to leave you alone for two weeks with the hope, or one week, whatever makes sense, with us watching what you do for yourself. At the end of that time, if you haven’t made some moves, then we’re going to talk again about how we can work together, and we have someone we want you to maybe talk to. And have the parents then have a trusted friend, a therapist or someone. But it has to engage the youth. It has to validate their feelings. They have to feel that they’re not being told or judged by the parent. And also, hold back, tell parents to hold back on telling stories of what it was like at their age, because nothing applies at this point anymore.

[00:56:15]

RICK WEISS: Fascinating. Anyone else on this?

[00:56:18]

MELISSA BESSAHA: Yeah, I agree with that 100%. Back in the day stories are great and all, but they don’t always apply to today’s age. But I would also add to that just recognizing the need. Asking how was your day, being part of the adventure of young adulthood or adolescence of today. And it changes. With technology a lot of things change. So, I think being part of the conversation, knowing what’s going on at school and work, just engaging. I think engagement is key here. And we do see that young adults do look at social supports for their, to meet their needs, informal social supports. So, looking at the informal, we know that it’s important to be engaged, contribute, ask meaningful conversation.

[00:57:04]

RICK WEISS: So reporters—I’m going to get to the last question or so in a moment. But I want to just mention before we get close to signing off that when you do sign off at the end of this briefing you wills see a prompt for a very short three-question questionnaire. We all hate polls and questionnaires, but we here really appreciate your opinions and advice about how these media briefings are doing, strengths and weaknesses. And we’d really appreciate it if you’d take that minute to give us feedback as you sign off today. I also want to encourage everyone to follow us on social media @RealSciLine, and our website at sciline.org. And at this point, at the end, towards the end of our briefing here, I just want to go around the horn one last time and ask each of our experts to wrap up with something that you just really want reporters to take home. If there’s one message you want to leave them with, if there’s one thing you want to make sure they get, this is often our opportunity to say in the most succinct way possible what’s really front of mind for you on this topic. Let’s go around and do that and leave that with our attendees today. And I’ll start with you, Anne Marie.

[00:58:10]

ANNE MARIE ALBANO: Yeah I think the thing that we want to bear in mind is young adults today are going through a time that’s never happened before in so many ways. I mean everything is changed, the way they communicate and we communicate. What gets presented to them 24/7. The challenges they have. So, I think we all have to step back and listen to them and be ready as adults in the room to flex and do things differently to meet them where they are. And I think that’s a big message for any of your special human interest stories and things like that for families. We’ve got to meet kids where they are. This means in our world we have to take our treatments not just on lying to meet them but into places where they hang. Into the schools, into community centers, into barbershops, you name it. We really have to take it into the community. And that way they’ll come.

[00:59:04]

RICK WEISS: Thanks. Melissa.

[00:59:07]

MELISSA BESSAHA: I would just say to lead it with science. We’re doing that today. So, asking experts, asking folks that are doing the work, even talking to your clinicians. They are in the fields, different staffers, social workers, teachers, community members. I think it’s important to hear it from all facets of what is going on with young adults today. Thank you.

[00:59:29]

RICK WEISS: And Adrian.

[00:59:31]

ADRIAN AGUILERA: I guess maybe the last thing is just, there really are no silver bullets, I think, to this challenge. I think we need comprehensive approaches. We talked about different type of treatment approaches, policy approaches, individual family. So, it really, it’s going to be a, it’s a multilevel problem that requires multilevel solutions.

[00:59:54]

RICK WEISS: Well, I want to offer my biggest thanks to all three of our professors here who have helped us get through this pretty complicated and really worrisome trend in society today. It’s been a very informative session, I think. Thanks to the reporters who are doing the work to cover this topic in a way, and I can tell from the questions being asked, I really appreciate this sort of motivation to not just tell the news but to help in some way in the telling of that news so important with an issue like this. Thank you all for your attention to this. Do check us out at sciline.org to see all the ways we can help you in your reporting. And we’ll see you at the next SciLine media briefing. So long.