Schooling has a halo around it in society’s eyes, and halos tend to interfere with perception and judgment. Maybe that’s why nearly everyone, including journalists, whose job it should be to keep their eyes and minds open and report honestly to the public, continues to ignore the ever-growing evidence that school is a major cause of anxiety, depression, and even suicide in children and teens.

Every scintilla of evidence that social media may be contributing to the mental health crisis among young people gets blown up in the popular press (see here), while the overwhelming evidence for the role of the school is ignored. An exception is an August 2022 Scientific American article by Tyler Black, an emergency psychiatrist who works at a major children’s hospital,. Black shows clearly and starkly the temporal relationship between suicides and the school calendar.

I first became interested in the relationship between schooling and mental breakdowns in 2014, when a clinical psychologist who works with children told me that her business increases dramatically every fall when the school year begins and declines again in mid-to-late June when it ends. Her view was that children simply do better psychologically when school is not in session.

I wondered then whether I could find objective, published evidence for a relationship between mental breakdowns and the school calendar. I scoured the literature and found no research directly related to that topic, but I did find a graph, published online by one hospital, showing the month-to-month number of children’s emergency psychiatric visits to that hospital for every year from 2000 to 2013. The numbers were startling. The average rates of admissions were less than half as high during the school vacation months of July and August than they were during the months of full schooling. The online article made no mention of this striking and consistent relationship, but the data were clear. I published the data in a post on this blog, in August of 2014.

Four years later I conducted another search and found new research, and one older study that I had missed in the earlier search, confirming and extending what I had found for that single hospital. The research revealed that throughout the nation, suicides, as well as lesser mental health breakdowns for school-aged children and teens (but for no other age group), rise sharply at the beginning of every school year and then decline every summer. I summarized those findings in another post in May 2018. But now there are even more data. I begin with data presented in Black’s Scientific American article.

Children’s Risk of Suicide Increases on School Days

The subtitle here is the title of Black’s article. He showed graphically, using data from the Centers for Disease Control and Prevention’s Wonder database for the years 2000 to 2020, a tight relationship between the school calendar and suicides for school-aged children (under age 18). The data revealed that during school months, the suicide rate was consistently highest on Monday through Thursday, declined significantly on Friday, and was lowest on Saturday and Sunday.

His data also showed that, month by month over the 20-year period, the suicide rate was lowest in July, which is the only month that is fully vacation for nearly all schools; increased somewhat in August, when some children start school and most begin to anticipate school; increased much more in September, when most children are back in school; and by October was 43% higher than it was in July. The rate then remained about that high through the rest of the school year, except for a dip in December (when most children have a winter vacation), and finally declined sharply in June when summer vacation begins for most students.

His graphs show further that the relationship between month and suicide did not hold for young adults (age 18-30) beyond secondary school age. In fact, for them, the suicide rate was slightly higher in the summer months than during the rest of the year.

Other relatively new studies reveal a similar temporal relationship between school and suicide in other countries, including Germany, Finland, India, and Japan. The study in Japan encompassed a 40-year period, from 1974 to 2014, and revealed on average a roughly 40% jump in suicides at the start of each school year compared with the rate during summer break.

Suicides Declined When Schools Closed in the COVID Pandemic and Rose Again When In-Person Schooling Resumed

When COVID struck and U.S. schools closed in March of 2020, many pundits predicted that this disruption in children’s routines would be disastrous for their mental health. But at least three independent systematic surveys—one of which was conducted by the nonprofit organization Let Grow and which I published in the American Journal of Play—revealed that, on average, both parents and children themselves reported the children to be less anxious and depressed during at least the first three months of lock-down (when the surveys were conducted) than they had been before schools were closed. You can find my academic report of the Let Grow study and review of the other studies here (and my blog posts on the research here and here).

More recently, a research team headed by Benjamin Hansen of the National Bureau of Economic Research analyzed teen suicide data for the period before, during, and after pandemic school closures in the U.S. (published here). They found (in their words): “Teen suicides plummeted in March of 2020 when the COVID-19 pandemic began in the U.S. and remained low throughout the summer before rising in Fall 2020 when many K-12 schools returned to in-person instruction.”

These researchers also developed a method to determine the day when individual counties reopened schools and found a tight relationship between that timing and the rise in suicides. For counties that opened schools in early August, the rise in suicides began in August; for counties that opened schools in September, the rise in suicides began in September.

A drop in teen suicides during COVID school closures has also been reported in China. The pandemic started earlier there than in the U.S., so Chinese schools closed much earlier in the school year than U.S. schools and began reopening for in-person schooling around the same time in March that U.S. schools were closing. According to the report, the reopening was accompanied by a sharp increase in psychological distress and suicides among students.

Why Do Mental Health Breakdowns and Suicides Increase When School Is in Session?

The answer to this question is probably not simple and may differ substantially from case to case. Hansen and his team suggest that a major cause of the suicide increase is persistent bullying. As evidence, they cite studies showing that bullying occurs more in school than in other settings and that bullying appears to be the immediate trigger for at least some suicides. Black suggests a more multifaceted set of causes. The bullying may not come just from students but also from teachers or even from the way the school is structured. He writes: “[School] can be incredibly stressful because of bullying, health- and disability-related barriers, discrimination, lack of sleep and sometimes abuse.”

In a study of “Stress in America” conducted by the American Psychological Association in 2013, teenagers of school age were found to be more stressed, by their own reports, than people in any other age group, and 83% of them said school pressure was a significant source of their stress. This was much higher than any other reported source, including bullying. Moreover, teens who were surveyed during the school year reported twice as many instances of severe recent stress than did teens who were surveyed during the summer. The idea that the pressure and competitiveness of schoolwork itself is a major cause of psychological breakdown is reinforced by research showing that students in “high-achieving schools” suffer from such breakdowns at higher rates than do those in schools where the concern for high marks is less strong (see my summary of such research here).

What Can We Do About the Problem?

So far, the most common approach of schools in addressing the problem is to try to change the children, not the school. They have brought in therapists, paid for courses in “social-emotional learning,” recommended drugs, and counseled parents, but they have done little to change schooling itself to make it more student-friendly. In fact, most school changes have been in the opposite direction, which may help explain why rates of suicide have increased from year to year for school-aged kids. Black suggests it is time for schools to modify their own practices. Among his suggestions (quoted verbatim) are the following:

• “Reduce homework (preferably get rid of it). Some of the best educational science available shows that excessive homework is of limited benefit and in fact harms children’s health and well-being.”

• “Restore funding for playtime, music, and art in school and de-emphasize academic overload. Children need relaxation, comfort, beauty, fun, and play. Children who have opportunities for play and rest will learn more in their academics, and they will also be able to sustain their development as they grow.”

• “End ‘perfect attendance’ awards and goals. … We should all, from time to time, recognize when we are at our limit and need a break.” [My words: The suggestion here is that just as adults sometimes take mental health breaks from work, kids should be encouraged, not discouraged, in taking breaks from school when they feel the need.]

• “Start school later. How many more decades of research do we need to show that children need more sleep and that adolescents do better in school when the day starts later? It’s time to make serious structural changes in the early-morning wake-up times.” [Again, me: One of the reasons given by parents for their kids’ improved mental health during the COVID lockdown, in our survey, was that they were able to sleep later in the morning.]

• “Be nonjudgmental and respect children’s identities and identity formation. This is not a ‘woke’ concept. This is a caring, compassionate concept that works for all children all the time.”

• “Recognize and address child abuse within schools. There exist (and many readers may likely recall) teachers who are abusive, punitive, and cruel.”

To Black’s suggestions for modifying schools, I add this suggestion to parents: If your child truly, consistently, says he or she hates school, or if the bouts of anxiety or depressions are severe, take that seriously and do research on alternatives. Alternatives are far more available, even to families with low incomes, than most people realize.

As regular readers of this blog know, I have conducted and written about research studies of young people who opted out of public or conventional private schooling, often because of traumatic experiences there. They opted for homeschooling or for democratic alternative schooling, and in those settings restored themselves, discovered and pursued their interests, and went on to highly successful adult lives in the whole range of careers valued by our society. Some even reported to me that they believed their parents’ willingness to take them out of conventional schooling saved their lives, and I believe them.

Our societal view that forced, curriculum-based schooling is essential for success in today’s world is a societal myth. For a summary of evidence for that, see here and here.

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• Teens of overly-controlling parents are likely to circumvent the rules or withdraw emotionally, damaging the parent-child relationship.
• The less parents engage in a power struggle, the more likely teens are to relate from a place of maturity.
• Parents who are able to position themselves as trusted, credible advisors are more likely to have teens who take their advice.

Parents are under pressure. Mostly it comes from within. Many of us have internalized to some extent the idea that our children are an extension of ourselves. When our kids struggle, we feel the shame of having somehow failed. When they succeed, we bask in their glory, confident we must have done something right.

As a psychologist treating families whose teens and young adults struggle with mental health, substance use, and other behavioral concerns, I challenge that view. Parents cannot control how their kids turn out. Whether kids wind up earning a lot of money, developing depression, or summitting Mount Everest doesn’t reflect much on the competence of their caregivers.

Expectations about how they should dress and talk; whether we push them toward advanced classes or after-school jobs; whether we allow them to go out with friends on school nights or attend parties— your opinion about these issues matters mostly to the extent that your adolescent cares what you think. Therefore, the most important work of parenting an adolescent is not controlling your child’s path, but rather creating a relationship of trust and mutual respect.

Yet anyone who has recently interacted with a 15-year-old (or, ahem, a college student) recognizes that they are far from ready to take responsibility for major decisions. The prefrontal cortex, the part of the brain responsible for planning, risk estimation, and self-awareness, continues to develop through about age 25. Adolescents and young adults are much better off if there are trusted adults in their lives who can steer them away from a poorly considered tattoo, credit card, or romantic entanglement.

Adolescence and early adulthood are also a time of heightened risk for mental health problems. Young adults ages 18 to 25 have the highest prevalence of mental illness of any age group, and suicide is the fourth leading cause of death globally for adolescents. In this context, promoting self-sufficiency may seem riskier than keeping a close watch.

What, then, is a parent’s job? Teens are famously uninterested in heeding adults’ limits and advice, setting the stage for years of conflict. Insisting on control over adolescents’ behavior drains warmth and authenticity from the relationship, and they will often find a way to circumvent parents’ rules, or simply withdraw emotionally. If parents hope to influence adolescents’ decisions and monitor their safety, they need to find a way to be present, close, credible advisors—in short, the kind of people whose advice kids might actually want to hear.

Don’t worry: I want your teen to hear (and follow!) your advice. In my book, The School of Hard Talks: How to Have Real Conversations with Your (Almost Grown) Kids, I offer a vision and method for achieving that goal. By working closely with hundreds of families in a series of research studies, I developed a 5-step method for effective conversations on literally any topic.

The first step is to approach a hard talk by making a neutral, factual observation. “Your backpack smells like marijuana,” for instance. Then, stop talking. See how your teen or young adult responds and give them a chance to explain themselves.

The second step is to ask questions. Good questions don’t have one answer, invite a conversation, and are rooted in genuine curiosity. “What do your friends think about marijuana?” is a good question. “Did you know that marijuana stunts brain development and could be laced with fentanyl?” is less likely to lead to a productive conversation.

Step three is to use reflections. Repeat back what you heard and keep your own opinions on ice. For instance: “You feel like marijuana is harmless as long as you don’t smoke until after school.” It’s OK if your knuckles are glowing white from the effort of suppressing what you really want to say. You’re doing great.

At this point, teens might acknowledge that they do not in fact know everything, or that they have made some questionable decisions. The less you engage in a power struggle or a debate over who is right and who is wrong, the more likely teens are to relate from a place of maturity.

Once your teen has thoroughly expressed her perspective, it’s time to give your own view. Announce the pivot: “Can I tell you what I know about cannabis?” you might say, or more assertively, “I’d like you to consider my thoughts on this.” Then give your own perspective or advice. “Not only is consuming cannabis at your age illegal,” you might say, “but it could get you suspended from the swim team. Also, since you are getting it from a person you don’t know well, you have no idea what’s really in there. That’s incredibly dangerous. I don’t want you using it at all until you’re at least 18.”

The final step is the hardest: Acknowledge that you’re not in control. Let’s face it: Unless you’re going to follow your kid around 24/7, you can’t control their behavior. Your teen already knows this. Hearing you acknowledge it validates their sense of autonomy and appeals to the responsible side of their brain and personality. You can do this by asking, “So what do you think you’ll do?” or simply saying, “I can’t be there all the time, so I have to trust that you’ll use good judgment.”

Will my method guarantee that your teen won’t smoke again until she’s reached the age of legal majority? Of course not. You’re a parent, not a wizard. But by using this method, you can demonstrate that you’re safe to talk to, curious about your child’s perspective, and respectful of her judgment and autonomy. You lay the groundwork to keep figuring it out, day by day, together.

This excerpt is adapted from The School of Hard Talks: How to Have Real Conversations with Your (Almost Grown) Kids.

References

Kline, E. (2023). The School of Hard Talks: How to Have Real Conversations with Your (Almost Grown) Kids. Seattle: Sasquatch Books.

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Schools can offer a critical lifeline for students facing trauma

New trend data from CDC’s Youth Risk Behavior Survey (YRBS) reveal that teen girls and teens who identify as lesbian, gay, bisexual, and questioning (LGBQ+) are experiencing extremely high levels of mental distress, violence, and substance use. With the right programs and services in place, schools have the unique ability to help students thrive.

Collected in the fall of 2021, these data represent the first YRBS data collected since the start of the COVID-19 pandemic. CDC’s Youth Risk Behavior Surveillance System is the largest public health surveillance system in the United States. It has monitored multiple health-related behaviors among high school students since 1991. YRBS data are a critical first step to revealing, understanding, and addressing emerging threats to the health and well-being of the nation’s youth.

Teen Girls

According to the data, teen girls are confronting the highest levels of sexual violence, sadness, and hopelessness they have ever reported to YRBS.

Almost 1 in 5 teen girls experienced sexual violence in the past year—a 20% increase since 2017.[1]

Sexual Violence Among U.S. High School Students, By Sex, 2017-2021

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More than 1 in 10 teen girls reported they had ever been forced to have sex—up 27% since 2019 and the first increase since CDC began monitoring this measure.

Forced Sex Among U.S. High School Students, By Sex, 2011-2021

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Persistent Feelings of Sadness or Hopelessness Among U.S. High School Students, By Sex, 2011-2021

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3 in 5 girls felt persistently sad and hopeless, a marker for depressive symptoms, in 2021, up nearly 60% from 2011.

A combination of complex factors can place young people at high risk for suicide, depression, substance use disorder, poor academic performance, and other severe consequences.

More than 1 in 4 girls reported they seriously considered attempting suicide in 2021, up nearly 60% from 2011. More than 1 in 10 girls reported they attempted suicide in 2021, up 30% from a decade ago. Alcohol use is also higher among girls than boys.

Attempted Suicide Among U.S. High School Students, By Sex, 2011-2021

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Seriously Considered Attempting Suicide Among U.S. High School Students, By Sex, 2011-2021

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LGBQ+ Teens

A combination of complex factors can place LGBTQ+ youth at high risk for violence victimization, suicide risk, and other severe outcomes. In 2021^[1], lesbian, gay, bisexual, and questioning (LGBQ+) youth were substantially more likely to have experienced all forms of violence and had worse mental health outcomes than their heterosexual peers. The 2021 YRBS survey did not ask about gender identity, so data for transgender students are not available. Previous research has shown that transgender young people experience greater levels of violence, more stigma, and are more likely to have mental health problems and suicidal thoughts and behaviors than the rest of their peers.

In 2021, more than 1 in 10 LGBQ+ students did not go to school because of safety concerns; nearly 1 in 4 experienced sexual violence, and nearly 1 in 4 were bullied at school.

Experiences of Violence Among U.S. High School Students, By Sexual Identity, 2021

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In 2021, almost half of LGBQ+ students seriously considered attempting suicide, nearly 1 in 4 attempted suicide, and nearly 3 in 4 reported persistent feelings of sadness or hopelessness.

Mental Health Among U.S. High School Students, By Sexual Identity, 2021

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In 2021, 1 in 5 LGBQ+ students reported having ever used illicit drugs.

Substance Use Among U.S. High School Students, By Sexual Identity, 2021

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Three key strategies to improve youth health and well-being

Young people in the U.S. are collectively experiencing a level of distress that calls for action. This report focused on a select set of YRBS questions that represent leading indicators of health and well-being for young people—and that share a common set of factors that can be enabled through schools to protect young people from these threats.

While the primary goal of schools is academic learning, they also play a critical role in shaping mental, physical, and social growth. More than 95% of children and adolescents in the U.S. spend much of their daily lives in school, providing a considerable opportunity to foster the knowledge, skills and support needed to help prevent and reduce the negative impact of violence and other trauma and improve mental health. CDC has identified and supports a range of evidence-based activities that can make a profound difference in the lives of teens with a relatively small infusion of support to our schools.

Supporting schools in efforts to reverse these negative trends and ensure that youth have the support they need to be healthy and thrive will take time, partnership, and resources. Supporting schools in efforts to reverse these negative trends and ensure that youth have the support they need to be healthy and thrive will require partnership. The following actions can help ensure success. 

• Increasing the sense among all students that they are cared for, supported, and belong at school. The proven health benefits of this approach, called “school connectedness,” are well demonstrated and can last well beyond their teenage years. However, youth who are racial and ethnic minorities, experience racism, and who identify as LGBTQ+ often feel less connected at school. Effective programs include approaches like providing safe and trusted adults such as mentors or trained teachers and connecting teens to their peers and communities through clubs and community outreach. These programs help kids know they matter and are not alone.
• Increasing access to needed health services, including mental health and substance use prevention services, whether provided on-site or through connecting youth and families to community-based sources of care.
• Implementing quality health education that is medically accurate, developmentally appropriate, culturally and LGBTQ+ inclusive, and grounded in science can help prevent violence and reduce mental health challenges by equipping teens with essential knowledge and skills such as negotiating sexual consent, managing emotions, and recognizing and asking for the help they need.

CDC’s evidence-based What Works in Schools program has demonstrated impact on key health behaviors and experiences that affect the nation’s youth. The program supports school districts across the country in making school environments safer and more supportive—with a strong focus on improving school connectedness; connecting young people and their families to needed services; and implementing quality health education. Participating schools have seen improvements in a wide range of health behaviors, including sexual behaviors, substance use, and sexual violence.

Additional Resources

For the full report, visit CDC Youth Risk Behavior Survey, Data Summary & Trends Report, 2011-2021

For more information on suicide prevention, visit: www.cdc.gov/suicide.

988 Suicide Prevention
Contact the 988 Suicide & Crisis Lifeline if you are experiencing mental health-related distress or are worried about a loved one who may need crisis support. Call or text 988. Chat at 988lifeline.org. Connect with a trained crisis counselor. 988 is confidential, free, and available 24/7/365. Visit the 988 Suicide and Crisis Lifeline for more information at 988lifeline.org.

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