The statistics are staggering. Right now, about 22 percent of teenagers exhibit multiple symptoms of depression, double the number of just a generation ago. Meanwhile, teenage suicide has spiked nearly 20 percent, according to the Centers for Disease Control and Prevention, from 1,386 deaths in 2010 to 1,769 in 2015—a rise driven by a doubling of the suicide rate among teenage girls ages 15 to 19 between 2007 and 2015 (the suicide rate among teen boys also increased 30 percent during the same period). Even five years ago, I believed that most depression in teenagers was a sign of psychiatric disease. I don’t believe that any longer.
There is no biological explanation for the extraordinary upsurge we’ve seen in teen depression and anxiety. Instead, I’ve come to conclude that most of it is caused by increased engagement with smartphones, digital technology, and social media. Together, they are triggering what the nonprofit Culture Reframed calls a new “public health crisis of the digital age.” And we are letting it happen. The average adolescent sends about three thousand text messages a month, which works out to about one hundred every day. These numbers do not even include messaging on such social media platforms as Snapchat or Instagram, which is likely equal or even more frequent. This constant interaction often goes on long past midnight. And since many adolescents sleep with their phones, they might well be awakened early by friends texting or chatting.
Although causality can’t be proven, the association is certainly there. The heightened depression we’re seeing is highest in adolescents who use digital technology three or more hours per day (and that data is self-reported, probably not capturing the true rates, which are likely higher). The more depressed adolescents are, the more they use social media; the more they use social media, the more depressed they are. It’s a vicious cycle.
In a survey in the U.K. of some 1,500 teens and young adults, the respondents reported increased depression and anxiety symptoms after using four of the five main social media networks, in order from worst to best: Instagram, Snapchat, Facebook, and Twitter. The fifth, YouTube, was the only network associated with overall positive mental health outcomes in teenagers—everything else lowered their sense of well-being and mental health.
Teens realize there is a problem with social media, but they can’t be expected to provide the solutions. Biologically, adolescents are pseudo-adults, physically as large as adults and sexually mature. Yet their brains are only half-developed, with about a decade left of development in parts of the brain like the frontal lobe, which controls impulsivity and judgment. Add in social norms, and you’ve got a dangerous mix.
In the U.S. and other Western cultures, adolescent rebellion is accepted, and even supported to some degree. The thinking is that experimentation with sex, drugs, and alcohol can lead to more mature decisions later. Estimates suggest that by the end of high school, about 40 percent of adolescents have used marijuana, about 50 percent have had sexual intercourse, and 60 percent have used alcohol. But just because something has become more culturally permissible doesn’t mean it is safe.
Studies show that exposure to marijuana before age sixteen is associated with long-term cognitive impairment years later. Likewise, youth culture is becoming dangerously hypersexualized. Today, about fifteen percent of young people are reported to have four or more sexual partners before age eighteen. Sexting has become rampant—estimates suggest about one in five adolescents do it—even though it is illegal.
About one-third of all Internet activity involves pornography, and much of social media directs teenagers toward a hypersexual culture. It is changing how adolescent boys and girls understand sex, influencing boys to demand pornlike sex, and causing girls to allow it. Almost three-quarters of Snapchat photos are selfies, mostly by teen girls and young women, often in sexualized poses. Such new cultural norms lead to lowered self-esteem and anxiety and depression related to how one’s body looks, or how successfully one conforms to an overly sexualized culture, driven by huge corporations.
Like the tobacco industry, digital technology companies look away and deny the harms caused by social media and smartphones. Too many parents look away, too. They can’t afford to any longer.
I am a clinical psychiatrist who specializes in depression and bipolar illness, but I am also a father seeking potential solutions. I believe smartphones should be treated like alcohol, something that is best managed in adulthood with limitations beforehand. (I argue the same approach holds for marijuana usage and for sexual activity.) Parents need to be supportive but also exercise more control over their children in their middle adolescence years, especially from ages fourteen to sixteen. Delaying smartphone use until thirteen or older and social media use until sixteen or older can help.
Parents should set new standards and demonstrate control of their own smartphone and social media usage. Kids learn by example, and unfortunately, some surveys show that social media use in adults in their thirties and forties is like usage among teenagers. Parents of teenagers with anxiety, mood swings, or depression of any kind ought to institute strict restrictions on digital technology—better yet, such social media activity should be stopped altogether. If not ended completely, less than two hours daily should be the goal, and overnight usage should be prohibited.
I also encourage individual psychotherapy as soon as possible for adolescents with depression or mood swings, which can help them make the changes needed in their use of digital technology, and in exploring their attitudes toward drugs and sexuality. Psychotherapists can serve as important allies to parents in their struggle to help Generation Z safely navigate a brave new world.
School of Medicine professor Nassir Ghaemi is the director of the Mood Disorder Clinic and the Psychopharmacology Consultation Clinic at Tufts Medical Center.