answers on sensitive and taboo topics, the sources of which are not always reliable. This is where they learn to turn cough medicine into a substance to get high and where they look up and find specific ways to kill themselves, often with step-by-step instructions and even videos. Still the most frequently misused substances in this age group are alcohol and marijuana, the effects of which are detrimental to the developing adolescent brain.8,9 In 2018, marijuana use among middle and high school students remained steady, but the number of teens in eighth and tenth grades who said they used it daily increased.10 Teens vape it, roll it, smoke it in pipes, cook it into baked goods, and often migrate to waxy-looking globs of high-THC concentrates known as hashish oil extracts, commonly referred to as dabs, wax, shatter, or crumble.
The problem is that parents and students are ill-informed about the detrimental effects and not only consider marijuana and derivatives as harmless but as a viable option to help kids with anxiety and sleep. Compared with conventional marijuana, hashish oil extracts may be associated with a greater risk of psychosis.11 Laura Stack is the mother of Johnny Stack, who killed himself as a result of high-concentrate THC-induced psychosis. Prior to using high-THC concentrates Johnny had not experienced psychosis, but as his use escalated so did his hallucinations about the FBI and mob pursuing him. After his death, Laura founded Johnny's Ambassadors (JohnnysAmbassadors.org), with a mission to educate parents and teens about the dangers of high-THC marijuana on adolescent brain development, mental illness, and suicide. Laura states, “Using cannabis at a young age, less than 15 to 18 years old, increases the risk of developing a psychotic disorder. Risk is dose dependent and increases with greater frequency of use and with higher potency THC.”12
Substance misuse, from the stimulants students take for “improving” their SAT scores to the pot they smoke to quiet anxiety, and even the opiates prescribed after athletic injury, combined with impulsivity in this age group, increases risk for suicide. However, school administrators rarely want to talk about substance misuse for fear of being labeled a school with a drug problem—yet another head-in-the-sand approach that has had devastating consequences on our youth. If we don't educate kids, drug dealers and disreputable Internet resources will fill that void.
Of course, other unhealthy coping strategies have also flourished, such as non-suicidal self-harm (e.g. cutting), eating disorders, gambling, retail therapy (buying stuff to feel better), pornography, and promiscuity.
So how can you tell who might be feeling unwell emotionally? Keep an eye out for the kids who are always going to the school nurse with complaints of headaches and stomachaches, who struggle with concentration and motivation or fall asleep in class. A drop in grades or a no-care attitude from a student who used to engage are signs that something isn't right. Other behaviors we don't always associate with depression, anxiety, and other mental illnesses include outbursts of anger, irritability, and aggression such as fighting and bullying. In the past, and sometimes even now, educators label these kids as being lazy, mean, or combative when in fact they are merely acting in response to how they are feeling.
Teen Depression
What does it look like when friends are feeling really down?
Showing up in sweatpants and messy hair—a sign that something might be wrong.
If a person is isolating themselves from a group.
Source: Signs of Suicide Youth Focus Group.
The Impact of Increased Screen Time
Studies have found that spending less than two hours per day of recreational screen time such as browsing the Internet playing games, watching videos, and using social media was associated with higher levels of life satisfaction and optimism, and lower levels of anxiety and depressive symptoms, especially among girls.13 While there is not enough definitive data specific to remote learning and its impact on student mental health, we do know that high levels of screen time do have an negative impact on a student's mental health.14
During the pandemic, calls to suicide hotlines went up 47% nationwide in June 2020 in the US, with some crisis lines experiencing a 300% increase.15 So it's not farfetched to assume that young people were not insulated from the emotional turmoil triggered by the pandemic, including parental job loss and income instability, and being stuck in a toxic home environment, along with the uncertainty and lack of connectedness of not attending school in person and seeing their peers. During online learning, spotting kids at risk and weeding them out for additional support or assessment became a challenge for educators as schools struggled to adapt quickly to a new digital delivery platform for teaching.
“The kids who were the highest risk were not on the Zoom sessions with their faces in class. Many of them tended to either miss class, sleep through class, or not have a picture in class. So it was very hard for us to find the high-risk kids, which is why our school counseling team sent out a survey. We send it out twice a semester and before the start of the year we were able to weed out the kids who were higher on the scale of showing that they were having more depressive and anxiety symptoms. The kids filled it out and there was a scale of how they were doing during COVID-19, how they were doing during remote learning, and we'd send it out a few times. It's always so important that the school counseling team, either guidance counselors, social workers, whomever is communicating with all the students, to be able to assess who is the most high risk. And honestly, as we know, the kids who are the most high risk are not calling us and saying, ‘Hey, I need some help.’ At our school, those kids tend to be on the sidelines, who we don't know. So if they're answering these surveys it's actually helpful, especially for the boys. Because again, boys are not calling their friends and saying, you know, ‘I'm feeling really sad today. Yeah, I'm feeling depressed, today.’”
Jessica Chock-Goldman, LCSW (She/Her/Hers), Doctoral Candidate, School Social Worker, Stuyvesant High School in Manhattan, New York
NOTE A copy of the survey mentioned can be found in Chapter 12, “Quizzes, Worksheets, Handouts, Guides, and Scripts.” Worksheet 3: Student Wellness Surveys features one for distance learning and one for in-classroom learning.
Co-occurring Disorders
Suicide in teens is often linked to the presence of mental health disorders, which can co-occur and further increase risk:
Major Depressive Disorder
Conduct Disorder
Substance Use Disorders
Eating Disorders
Generalized Anxiety Disorders
Schizophrenia
Bipolar Disorder
Source: More Than Sad Presentation from the American Foundation
