The mental health of high school students has largely worsened in the past decade, except between 2021 and 2023, when things improved slightly.

Those are among the findings of a new report by the Centers for Disease Control and Prevention, which features results from the latest Youth Risk Behavior Survey, conducted every two years.

"I don't think we are out of the woods by any means in terms of the crisis in youth mental health," says Kathleen Ethier, director of the CDC's Division of Adolescent and School Health.

"However, we're seeing some really promising small yet significant improvements in a couple of key places," she adds.

For example, between 2021 and 2023, overall reports of poor mental health went down.

"Slight positive change"

"When we look at the persistent sadness and hopelessness, we go from 42% down to 40%, which I realize is a small decrease, but it's statistically significant," notes Ethier.

And while girls and LGBTQ+ students are still more likely to report feelings of sadness and hopelessness, the share of girls reporting this went down from 57% in 2021 to 53% in 2023.

Similarly, the portion of Black students who said they had attempted suicide in the past year went down over that two-year period — from 14% to 10%. And the share of Black students who said they had made a suicide plan in the past year went down from 18% to 16%, and for Hispanic students that percentage went from 19% in 2021 to 16% in 2023.

"I am very heartened by the slight positive change," wrote Dr. Vera Feuer in an email. She is a child and adolescent psychiatrist and associate vice president of school mental health at Northwell Health.

And this is especially heartening when combined with the first-ever decline in the youth suicide rate in years, as illustrated by the most recent suicide data, she notes.

These "emerging positive trends" also stood out to psychologist Mary Alvord, founder of Alvord, Baker & Associates.

She also notes the decline in substance use over the past decade that's highlighted in the report. The percentage of students who reported drinking alcohol fell from 35% in 2013 to 22% in 2023, whereas reported marijuana use fell from 23% to 17% during that time. Students who reported ever misusing prescription opioids also fell between 2017 and 2023 — from 16% to 10%.

"Sometimes we just focus on what's getting worse, but I think we need to look at what has gotten better," she says, because that can provide important insights into solutions that are working.

"For me, building hope, building a sense of what works is really critical," says Alvord.

A national conversation

In fact, the most recent improvements are likely due to recent efforts to address teen mental health, notes the CDC's Ethier, even though the report doesn't investigate potential causes behind changes in trends.

"This is the first time that we've been having a national conversation about young people's mental health," adds Ethier. "And at the federal level, at the state level, at the local level, there has been this real effort to make sure that young people have access to the services that they need."

Schools across the U.S. have put more resources into addressing student mental health needs since the COVID-19 pandemic, she notes.

And "we've fielded questions and concerns from parents who, I think, are really making a concerted effort to attend to the mental health of their children and their teenagers."

Some of this is playing out in fewer kids going to hospitals for mental health emergencies, notes Feuer. "We do see lower numbers at the hospital services, and families are coming to help before crises happen in our school programs," wrote Feuer. "So I am hopeful that we are indeed heading in the right direction."

Violence and rape

But some troubling trends were also revealed by the report. For example, reports of violence experienced in schools went up, including being threatened or injured with a weapon at school. There was also a rise in students missing school due to safety concerns. And female and LGBTQ+ students were more likely to report this.

The research also found that 2 out of 10 girls reported experiencing sexual violence, and 1 in 10 said they had been forced to have sex.

"It's very difficult to read about the sexual violence and also just the feeling like they're not safe in schools," says Alvord, the psychologist. "One of the schools we were working at [in Washington, D.C.] said that they had shutdowns several times a month because of threats of violence."

Schools across the country are reporting similar disruptions since the pandemic, notes the CDC's Ethier.

"I think young people came back from the pandemic having been isolated from each other. And so part of what we're seeing is kind of young people acting out."

That "acting out" and aggression can come from "an inability to kind of negotiate around anger issues," she adds.

But proven efforts that address student mental health in schools — such as improving mental health literacy, teaching students healthy coping strategies and supporting teachers' mental health — can also address school violence, says Ethier.

So can students' sense of connectedness at school. "Helping young people feel that others in their school care about them and care about their well-being, which we know is an incredibly important protective factor," says Ethier.

If you or someone you know may be considering suicide or be in crisis, call or text 988 to reach the 988 Suicide & Crisis Lifeline.

Copyright 2024 NPR