Worsening mental health issues for adults and youth have been widely reported following the COVID-19 pandemic. But in the 10 years prior, rates of childhood mental health concerns rose by about 40%, and by 2018 suicide was the second leading cause of death for youth ages 10-24. The pandemic dramatically exacerbated the growing crisis, leading pediatric health experts to declare a national state of emergency in children’s mental health in October 2021.
Today, record numbers of kids and teens have soaring rates of depression, anxiety, trauma, loneliness, and suicidality. “If we weren’t already doing a lot of mental health care before the pandemic, we certainly are now,” said Dr. Angela Kade Goepferd, pediatrician and chief education officer at Children’s Minnesota. Dr. Goepferd also hosts the Talking Pediatrics podcast, where they discussed youth mental health and how clinicians can help in the episode, “The Impact of Anxiety and Stress on Kids and Families” with Dr. Sara Gonzales Rodriguez, pediatric psychologist at Children’s Minnesota.
Stress vs. worry vs. anxiety
It’s helpful to level set with some definitions: stress, worry and anxiety share many of the same emotional and physical responses, but there are also differences. Knowing which one a child or teen is dealing with will determine the best way to proceed with their care.
- Stress is almost always linked to a specific external stressor that’s identifiable, like a homework deadline or speaking in front of people. It can trigger a rapid heart rate, sweaty palms and shallow breathing, which typically decrease when the stressor goes away.
- Worry is like stress, but symptoms tend to stay in the mind, causing repetitive or obsessive thoughts about negative things that could go wrong. Worry can help our brains process problems and lead to a resolution, so it’s not always a bad thing.
- Anxiety is typically experienced in the mind and body and it’s normal for anyone to feel anxious occasionally. However, anxiety becomes a disorder when feelings of stress and worry are excessive, difficult to control, and persistent to the point they interfere with the ability to get through a normal day.
“Something becomes a disorder when it’s impacting functioning – whether that be sleeping, eating, attending school, leaving home, making friends, and all those things that can make our day to day enjoyable and happy,” said Dr. Gonzales Rodriguez.
Destigmatize mental health
Anxiety is one of the most common childhood psychiatric disorders. Yet for decades, mental health has been viewed negatively or less important than physical health, resulting in untreated anxiety, depression and other mental health conditions in youth and adults that could otherwise be successfully managed.
Primary care pediatricians and other health care providers are uniquely positioned to help address mental health in kids because they are often in long-term relationships with families for many years. They can draw on these relationships with hesitant parents and caregivers to help destigmatize mental health care.
“The biggest myth is that talking about anxiety may make the child more anxious,” said Dr. Gonzales Rodriguez. “If we can give words and meaning to what the child is experiencing then they have a better understanding of what’s going on with them. It can reduce the shame of why [they’re] feeling this way.”
The wellbeing of a person includes both emotional and physical components, so equating the two for hesitant caregivers is an important message and critical for reducing stigma. “In the same way we would give medicine if it were a physical diagnosis, [for mental health care] we can offer relaxation strategies or different coping tools to normalize a common experience and as a way to regulate our full emotional wellbeing,” said Dr. Gonzales Rodriguez. “If as providers and clinicians we can start linking the mind-body connection, we’re going to have a lot more success talking about mental health.”
Functionality is biggest clue for extra support need
Some kids and teens (and adults) are able to cope with their worrying intrinsically or by using skills they’ve learned. If someone is successfully coping with their stress, worry or anxiety then it’s probably manageable without needing extra support.
However, when a person’s daily functioning is impacted, it’s time to shift the conversation. A child or teen might not directly point out a worry or fear, but through conversations with the family, the health care provider could learn that the child’s eating patterns are off, they’re withdrawn or not interacting with others, sleep is interrupted by nightmares or insomnia, or appetite is increased or decreased. Ultimately, they are not functioning at 100% and these could be big clues leading to the need for mental health care.
Health care providers can be a critical link that identifies a mental health issue – that first presented as a physical problem – by keeping the mind-body connection part of the conversation. “Providing accurate information about what anxiety is and how it’s manifesting in their body, [like a stomachache or headache], is a fantastic thing to do. Talking about it doesn’t make it worse, and not talking about it doesn’t make it go away,” said Dr. Gonzales Rodriguez.
Listen to the podcast or read the transcript here.
Alexandra Rothstein