There’s a Mental-Health Crisis Among American Children. Why?

Unfortunately, that means letting go of the popular notion that a return to “normal” for children — in-​person schooling, no more masks — will reverse those trends. In fact, such measures may compound the stress many students already feel, says Lisa Fortuna, the U.C.S.F. chief of psychiatry at Zuckerberg San Francisco General Hospital. And an estimated 200,000 children in the U.S. who lost a parent or guardian to Covid-19 may need additional support. Screening for depression and anxiety at schools and pediatricians’ offices will be crucial, because the symptoms associated with those conditions are easier to manage and do less damage when addressed early. For adolescents, substance abuse, eating disorders and thoughts of suicide can be complications of both anxiety and depression.

In preadolescent children, Fortuna says, depression may reveal itself as touchiness and irritability rather than sadness. For all ages, a withdrawal from routine activities is a warning sign, as is excessive worry. Symptoms vary greatly, but in general, depressed girls may become withdrawn, whereas boys may fight or act out, incurring the label of behavior problem rather than, say, mood disorder. “Clinically, I’m seeing a lot of young men presenting with depressive symptoms,” Fortuna says. That’s despite the decrease in male visits to the E.R. that the C.D.C. found. “They are still there,” she says. “They might not be as loudly presenting.”

Opening a dialogue with children about how they are feeling and listening without judgment are critical. “I would encourage parents to talk to kids and ask them, ‘Are you feeling sad?’” says Anita Everett, director of the Center for Mental Health Services at the Substance Abuse and Mental Health Services Administration. “We encourage people to also ask about suicide,” she adds. Doing so won’t plant the idea. If there’s a problem, don’t ignore it and hope it will go away. “Some sort of path forward is important,” Everett says.

That path may well be arduous. A recent survey in Annals of Family Medicine found that 85 percent of primary-care practices are having difficulty accessing evidence-based mental-health care for children. Nationally, Fortuna says, some children are waiting six months to a year for help. She suggests first seeking advice from a primary-care doctor or school counselor. The SAMHSA website includes a treatment locator, and churches and other community groups can be valuable resources. Everett urges caregivers to ensure that weapons, especially guns, and medications and other dangerous substances are well secured in any home where a child will be. And, she says, parents should look for support for themselves. Perhaps it’s helpful — as well as tragic — to know that finding others whose children are struggling, and who are struggling themselves, won’t be difficult.

If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK). You can find a list of additional resources at SpeakingOfSuicide.com/resources.

Kim Tingley is a contributing writer for the magazine.