What Teens Think About Depression, Anxiety, and TikTok

Mental illness—particularly depressive and anxiety disorders—is on the rise in children and teenagers, with rates doubling (by some estimates) in the past four years. The explanations for this increase have included the effects of the COVID-19 pandemic, widespread racism and social injustice, war, climate change, rampant disinformation, and the ever-encroaching effects of social media. There is much to be learned from journal articles, books, and podcasts on these topics, but not everyone’s voice is heard through those outlets. What if we just ask Gen Z teens themselves?

Gen Z Wellness

On February 25 of this year, the Teen Advisory Group of the Friends of the Semel Institute at UCLA sponsored an all-day “Generation Z Wellness Summit” focused on the experiences of young people with depression, bipolar disorder, anxiety, substance abuse, and eating disorders. The Friends of Semel group (Vicky Goodman, Founder and President; Wendy Kelman, Executive Director) has a long history of supporting research and educational programs for people with mental illness and their families, with the aims of raising public awareness, erasing stigma, and supporting innovative treatments. I am a UCLA medical school faculty member directing a treatment program for teens with mood disorders and their families, so attending the Summit was of considerable interest to me.

With the unifying theme of “We’re all in this together” and over 600 people in attendance on a Sunday morning, the conference speakers talked about their struggles with mental health. These well-spoken teens and young adults emphasized the importance of interpersonal connectedness, being open about one’s distress, and finding community—whether in person or online.

All of the speakers acknowledged the important role that family support and psychological or psychiatric treatment played in their recovery—in fact, several called out their parents in the audience, without whom, they said, they would not be alive. What surprised me most was the degree to which social media had provided the interpersonal supports that were absent during and following the pandemic. Social media has become the boogeyman that adults blame for all behavioral or emotional problems in youth. As one young man reminded us, “Don’t believe everything you read.”

A more nuanced view is reflected in reviews of the nascent research literature (e.g., Valkenburg, Meier & Beyens, 2022; Nesi, 2020). A consensus report from the National Academies of Sciences, Engineering, and Medicine (Galea and Buckley, 2014) concluded that any causal link between social media use and teen mental health problems cannot be established from the existing (largely cross-sectional) research.

The effects of social media on adolescents’ depression or anxiety differ depending on what kinds of content teens seek and how they interact with this content over time. Simple measures such as “screen time” (even though easily available) do not distinguish whether the child is streaming movies, watching pornographic videos, doing homework, or engaging in meaningful dialogue with communities that share their interests or identities. The latter would appear to be salutary, especially for isolated or marginalized youth.

In one panel, speakers emphasized personal agency in navigating social media: “You have to tell Instagram or TikTok or Facebook what you want, ask questions of it, talk back to it. It’s your responsibility to make it your own,” explained one of the teen speakers. Disclosing personal details, several pointed out, may connect you with a community that understands you. If you are feeling depressed and ostracized, look for an online community that shares your personal characteristics (e.g., your sexual orientation, gender identity, race, ethnicity, or mental health status), and other communities for different interests, even if it means setting up different profiles for each community.

A panel on drug and alcohol abuse was eye-opening. Two young people, one of whom had become a recording artist, talked about how they had come through years of addiction with the help of friends, family members, and mental health professionals. Interestingly, psychiatric medications and rehab facilities were mentioned only in passing. As UCLA professor Timothy Fong put it, “Addiction is often driven by loneliness and lack of community. The antidote is connection.”

Lili Rinehart, an actress who has been very public about her personal journey through depression, anxiety, and body dysmorphia, had an inspiring conversation with the chair of the UCLA Psychiatry Department, Helena Hansen, M.D. Lili described an early warning sign of depression: being in social situations where you should be having fun but you’re not. Use these and other internal signs of distress to ask for help, she said, cautioning against withholding important information from your therapist because you find it shameful. If you aren’t feeling comfortable with your mental health providers, speak up and tell them what you need, which may be different from what they’re offering, she emphasized. She closed with “Don’t be afraid to share online because people will respond. You will be building a community. It’s a powerful experience to be surrounded by people who understand you and have been there.”

Social Media Essential Reads

The Impact of Social Media Scrolling on Brain Development

The Rise of Disinformation Entrepreneurs

In a panel on relationships and communication, singer/songwriter SkyDxddy spoke about the importance of protecting your personal boundaries in close relationships. She pointed out that many women are trained to be nice and not make others disappointed or uncomfortable. She modeled for the audience how to say no to a person who wants to exploit you. “Tell people what you do and don’t want… don’t tolerate relationships where your boundaries aren’t respected, where you give and give and don’t get back what you need.” I thought of the many advantages of teen participation in social skill groups, where behaviors such as limit-setting can be practiced with peers. Perhaps certain social media sites can serve the same group support function for youth.

Molly Kawahata, a climate change activist, strategist, and public speaker who was a former climate advisor to the Obama White House, spoke about hope and empowerment. A person with bipolar II disorder, Molly encouraged young people to not fall prey to the stigma of mental illness. “Learn to reframe the narrative—others’ perceptions don’t have to dictate your story,” she said, expressing her pride at having lived through multiple depressive and hypomanic episodes. After she left the White House, she continued her work on climate change and became an alpine ice climber. She attributed her successes to having known the extremes of high and low moods. She advised attendees to “Embrace your full journey with its ups and downs. Lean into the discomfort.”

I found much to agree with in Ms. Kawahata’s approach, with a few caveats. First, although empowering to the individual, there are also risks that young people take when publicly disclosing their disorder and celebrating their journey towards wellness. They may have their story eviscerated by an anonymous “troll” who feasts on humiliating others, or they may have to explain their disclosures later when applying for jobs. In my experience in working with teens with depression, there can be a thin line between leaning into one’s discomfort and ruminating on it – having repetitive cycles of negative thinking that contribute to depressed mood.

A Shattering of Myths

Generation Z is often described negatively in the press. We’ve heard that they are misguided youth who have grown up in the worst era for education, personal growth, health, environmental safety, social injustice, and economic freedom. We hear that they are addicted to their phones, live inside video games, and can barely hold a conversation. This conference certainly dispelled those stereotypes for me. I heard nothing but compassion, thoughtfulness, and empathy for others. Participants spoke of how their generation has used social media to connect with one another when personal contact was impossible. They are teaching the rest of us the value of being open about one’s struggles, owning one’s identity, and challenging pain through community.

In the words of Coretta Scott King, “Struggle is a never-ending process. Freedom is never really won, you earn it and win it in every generation.”