Is Your Teen or Young Adult Child Depressed?

Hard transitions, high expectations

The transition from high school to college can be particularly tricky to navigate. “There can be many sources of pressure during this developmental period, including meeting educational and occupational goals and becoming financially independent from one’s parents,” says Autumn Kujawa, assistant professor of psychology and human development at Vanderbilt University.

Adding to the anxiety, some teens and young adults fear that they’re never going to be as well-off as their parents were. “The job market is competitive and tough,” says Steinberg, who also points to the increased competitiveness of college admissions as a stressor for high-achieving high schoolers. “Colleges have not expanded their freshman classes in proportion to the increase in people applying to go to college,” he notes. “There’s this sense that you don’t just have to be excellent, you have to be perfect. That is a standard that no one can live up to.” 

And prevailing parenting styles may affect young people’s ability to cope. There are well-intentioned parents who want to protect their kids from everything harmful, for example. “We’ve heard about helicopter parenting — now there’s snowplow parenting, where some parents will try to clear any stressor or hiccup out of their child’s way,” says Bennett.

“While that may be well-intentioned,” she adds, “it prevents the child from ever learning how to appropriately cope with stress, hardship and failure — things that are a normal part of life. When they become adults and when they encounter something challenging — their first job or going away to school — they don’t have the skills they need to cope with the normal ups and downs of life. It’s hard, as a parent, to know whether we should be pushing our children to face things that are hard and stressful, and when we should be supporting or protecting them.”

Identifying young people at risk

Beth Syverson’s son, Joey, attempted to kill himself when he was 15. He tried to hang himself in his closet, using a belt from his leather jacket. It wasn’t the first time. “As a child, he was just delightful,” recalls Syverson. “He was doing OK in school — not a super-duper scholar, but getting B’s and C’s. He was really good at baseball, a great musician, and played guitar and drums. From where I stood, he seemed popular and a fun kid to be around. I would just pat myself on the back and tell myself that I was such a good parent. Look at him!”

When he became a teenager, Joey turned sullen, “the kind of kid you’d see on a TV sitcom,” says Syverson. “He slept a lot and started not talking to me as much. I thought, ‘Hey, this is what teenagers do.’ But there was way more that I just didn’t know.”

After Joey was hospitalized, he opened up, confessing to Syverson that he was getting bullied relentlessly at school about having two moms and the fact that’s he’s Asian. (Syverson adopted Joey from Japan.) “I had no idea,” she said. “He just took it and never said a word to me.” It also became clear that Joey was thinking some really dark, disturbing thoughts. “Not only was he constantly thinking about death — he idealized death,” says Syverson. “We found out from the blood work that he had been using drugs. Partly because of the psychedelics, he felt like he could see the other side and wanted to go there, because it was peaceful and beautiful and everyone loved him there. That’s what prompted the suicide attempts. In my sweet boy’s head were the darkest, scariest thoughts imaginable. We felt blindsided.”

As Syverson learned, figuring out which teenagers and young adults are most vulnerable to mental health problems can be tricky. Many don’t feel comfortable asking for help — for a number of reasons.

Take the recent surge in suicides among NCAA athletes, for instance. Since March, five have died by suicide. While they conveyed confidence on the field, in reality they were struggling, notes Bonnie Nagel, a professor of psychiatry and behavioral neuroscience at Oregon Health & Science University. With such high achievers, she says, “the expectation is that they’re fine all the time, because why wouldn’t they be? They’re popular, they’re athletes, they’re smart. But they are probably less inclined to seek out help because of expectations that have been placed upon them.”

Some troubled teens and young adults are reluctant to confide in their parents because they don’t want to upset them or cause them further stress (many adults are struggling with their own anxieties and depression, of course). “A phrase I get often with teens I work with: ‘I didn’t want to be a burden,’” says Zullo.

There’s also the stigma and shame that’s still associated with mental illness, which U.S. Surgeon General Murthy is now working to combat with the Dare to Share campaign, in which celebrities and others who’ve experienced depression and other mental health issues share their stories to encourage kids to speak up about their struggles.

While depression can be expressed in different ways, common signs include:

• A loss of interest in activities the child previously enjoyed
• New risky or dangerous behavior
• Trouble at school, particularly if the child is normally a good student
• Spending more time alone than usual
• Withdrawing from activities the child once loved
• Changes in eating or sleeping habits
• Changes in mood, including an increased tendency toward anger

First steps

Most parents would want their children to feel comfortable enough to ask for help when they’re hurting. Make it clear that you are present and open to discussing difficult subjects, says Nagel. “Have conversations with your kids, and create space for them to come forward. Be inquisitive without peppering with questions.” Start a conversation off with a simple, “How was your day?” Try not to multitask (put away your smartphone) while you’re interacting to make it clear that you’re there for them.

If you suspect there’s a problem your child isn’t revealing, dig (a bit) deeper without forcing the issue. “Start a conversation with something open-ended like, ‘You seem kind of down lately. Is there anything you want to talk about?’” suggests Steinberg. “Don’t make it confrontational, but do make it known that you have noticed.”

Finding professional help

These days, it might be wise to start looking for a good therapist the moment you suspect your child may need one. “We’ve always had a shortage of mental health providers, and the pandemic has made it that much worse,” Lynn Linde, a counselor and chief knowledge and learning officer at the American Counseling Association (ACA), told AARP.

But don’t give up. If your child is in high school, you can ask your pediatrician or primary care physician (PCP) for mental health referrals. “Your primary care office has a list of behavioral health specialists in your network,” says Caitlin Nevins, director of psychological services for McLean Hospital’s College Mental Health Program, in Massachusetts. “If this is a PCP that has worked with your child, they will have some understanding of them and figure out who might be a good fit.”

If your child’s primary care doctor can’t recommend a mental health provider, reach out to your friends for suggestions. (You may be surprised by how many have children who are receiving mental health care.) You can also try Psychology Today’s Find a Therapist, the American Psychological Association (APA) Psychologist Locator or Zencare (a therapist database). Type in your zip code and you’ll find a list of professionals near you. Refine your search by clicking on treatment methods (cognitive behavioral therapy [CBT], for instance), specialties, qualifications, years in practice or cost per session.

Persistence is huge, says Gigi Peterkin, a Philadelphia-based mom, who said it took about six months of cold-calling therapists just to get her teenage daughter “J” evaluated for depression. Her advice: “Be assertive. I said to so many therapists who were trying to give me the brush-off, ‘My child is in crisis. If you cannot help me, suggest somebody who can — give me a place to go. Who do you recommend?’ I got a lot of referrals and even got some callbacks.”

Let your child know that they can interview the therapists and choose the one they feel most comfortable with. “Offer choices — but don’t dictate,” says Patricia Daza, a senior psychologist and the director of Psychology Services at Menninger Clinic. “Work collaboratively so they feel like they’re part of the solution.” (If your child is away at college, reach out to the counseling center. “They have an ongoing list of providers nearby who frequently work with their students,” says Nevins.)

Another option: Consider alternatives to one-on-one therapy, such as group therapy. “Those often have much faster availability,” says Nevins. “It gets the patient into a setting where there’s a lot of validation of other young adults who are working through issues as well. It feels more like a community.”

Staying involved in your child’s care

Be aware that if they are 18 or older, your child will need to sign a waiver to allow your involvement. It can be extremely frustrating if they exclude you. (The fact that you’re the one paying for the services doesn’t give you any more right to be informed about their medical status.) But still try to talk openly with them about your concerns and to assist with things such as setting up appointments. “Just because you aren’t involved in their care doesn’t mean you can’t help them seek care or seek care in their behalf,” says Nagel.

“Once an emerging adult turns 18, I have to request that they give me permission to speak with their parents,” says Bennett. “Parents are a wealth of information in learning how that child lives and functions, and it’s important for parents to learn not every private thing about their child but how to understand and support them, without being over-involved. It’s a fine line that parents are being asked to manage. Sometimes they don’t want their parents involved, so I try to talk to them about what boundaries we can put in place, so it feels comfortable for everyone involved.”

And, Steinberg emphasizes, if your child is considering taking their own life or you suspect they are a danger to others — no matter their age — it’s no longer a question of your rights as a parent. You have an obligation to intervene.