Dr. Nick Allen: Teen mental health

[0:00:21]

NICK ALLEN: My name is Nick Allen. I’m a professor of clinical psychology at the University of Oregon, and I study mental health in young people. And by that, I mean teenagers and young adults. I’m particularly interested in prevention of problems like depression, anxiety, self-harm and suicide.

[0:00:51]

NICK ALLEN: One of the most powerful factors is stress in interpersonal relationships, and this can occur either in family relationships, it can occur in peer relationships, or it can occur in romantic relationships, particularly associated with breakups and things like that. So, whenever a young person is going through interpersonal stress of that type, there is a risk, an increased risk, that they will experience a mental health problem. There are also some factors that have to do with things that occur earlier in life. So, for example, experiences of trauma and stress early in life can also place people at risk. There are some aspects of development that can also predict risk for mental health problems. Some of the factors are associated with how early someone goes through puberty, and then there are also some personality types that are more at risk for mental health problems, particularly young people who are—have a more anxious type of personality or who might be more introverted and socially shy.

[0:02:17]

NICK ALLEN: Teenagers are going through a phase of life where they’re starting to deal with things more independently. And part of that is that they are starting to actually not share as much about their interpersonal—their personal experiences with adults and other people as much as they would have when they were a child. So, this can be—although this is a very normal developmental process and does lead to greater independence, over time, it can be quite difficult for adults and other caregivers and people in young people’s lives who want to be able to check in because often the young person will not feel comfortable or not want to share everything that’s going on with them. Some of it they want to keep private. So, the critical issue is to actually build on your relationship with the young person so that it’s the kind of relationship that they will feel comfortable to come to you when they are ready and when they need to. That’s a better approach than trying to emphasize checking in on them in a kind of assertive or what they might experience is an intrusive way. So, I would say the critical thing is to build that kind of relationship that’s open, that’s accepting, that’s affectionate and that the young person knows that if they really do need to ask you some critical questions, that you’re the kind of person who would be open to discussing it with them.

Having said that, you should also look for those opportunities to talk to your—the young person in your life when it’s possible. And there are some opportunities that might not be interesting. For example, I have a couple of colleagues who talk about the concept of car therapy, which is the idea that sometimes when you’re on a driving trip with your adolescent in the car, it’s a good time to kind of check in quickly. And they may feel more comfortable in that environment because it’s not—you’re not sitting there looking directly at each other. And they also have some sense of when it’s going to end. You know, they have a sense that it’s not going to last forever. And so that’s an example of a context where checking in with a young person might actually be more successful than if you try to do it at another context, like the dinner table, for example.

[0:04:49]

NICK ALLEN: So, there’s a number of warning signs that I think can help us understand the difference between a young person who’s having some emotional ups and downs, which are pretty normal for young people, versus someone who’s experiencing the early signs of a more serious set of problems. One thing that I would emphasize is if the young person’s mood is very flat and down, and that that’s true across all circumstances—so not just when they’re around you, but also when they’re around their friends, school and at home—if it’s a pretty consistent sort of flatness and down mood, then that’s more concerning than the occasional down mood, which might be a little bit more normal.

A second thing that I would look out for is if there are disturbances to things like sleep and appetite. That can often be a sign that there’s a more serious difficulty. A very negative attitude about yourself and about your future—so someone who’s very negative and persistently negative about themselves, about the world around them and about their future prospects—is an important cognitive thing that I think can be most serious. And then finally, you know, any suicidal ideas and feelings, which can be in terms of things like, you know, people thinking about killing themselves, but it can also be something a little less dramatic, like someone’s feeling that life’s not worth living or that there’s no future for them. So, those kinds of signs also should provide more concern and are good signs that someone could benefit from receiving some explicit mental health care and support.

[0:06:49]

NICK ALLEN: Sometimes young people are ready to say yes, that they want to also get that kind of support. And sometimes they’re not. So, you know, I think one thing is to make them aware of all the different ways that they can access that kind of support through online means, through, you know, at school, through health care, and that there’s a lot of different ways in which they can access that. Some young people would be much more comfortable having a telehealth appointment than they would with an in-real-life appointment. So, really making them aware that there’s a wide range of different ways that they can get mental health support and care.

And also, I think the other thing is to destigmatize these problems and to talk to people about the fact that everyone pretty much has mental health challenges in their life. It’s a very normal thing. It’s part of being human and that there’s—and that this is an aspect of their health care that they should prioritize, just like they would an aspect of their physical health care. And so giving young people that kind of de-stigmatizing message that this is a very valid thing to get support for is also a really important step.

[0:08:04]

NICK ALLEN: So, anything that has an influence on the young person feeling less hopeful, less optimistic about their future is likely to feed into problems like depression and anxiety and ultimately to problems like suicide and self-harm. And so we have a number of, you know, changes that are occurring into society where young people might not feel as confident that their prospects are going to be really positive. This can be related to worries about economic—their economic future. It could be related to worries about racism. It can be related to worries about democracy, war. It can be related to worries about the climate crisis. So, all of those are factors that are—you know, could feed into this sense that I have that my future is positive.

And then there’s also some factors such as social media, which is a mixed bag of things that can be good and not so good. But one of the things that social media does is it actually increases a young person’s exposure to social interactions. And if those are good social interactions, that could be a very positive experience. But if you’re experiencing things like bullying, ostracism, fear of missing out and other kinds of negative experiences, then the online environment will have often the effect of giving you a higher dose of those experiences, and that could also contribute to some of the problems that we’re talking about here.

[0:09:47]

NICK ALLEN: One of the fundamental tasks of adolescence in particular is learning about social relationships and building up social relationships with people in your peer group and romantic relationships and sexual relationships and all that kind of stuff. And the lockdown periods, and the periods where people couldn’t go to school in person, really did disrupt that thing which was such an important aspect of normal development for people who are in the teenage and young adult years. So, I think that’s going to result in some stressors, which are also going to contribute to a higher rate of problems like anxiety and depression.