Colorado teenagers reported more depression last year than pre-pandemic, but that didn’t translate into more drug use or suicidal thoughts.

The Healthy Kids Colorado survey found the rate of youth reporting they stopped doing normal activities because of sadness or hopelessness for at least two weeks (a proxy for depression) increased from about 35% in 2019 to almost 40% in 2021.

The percentage of youth who contemplated suicide, planned it or attempted it didn’t change, though, and drug use went down, according to the survey.

“The story of resilience and, really, hope shines through,” said Emily Fine, school and youth survey manager for the Colorado Department of Public Health and Environment.

Every other year, middle and high school students take the Healthy Kids Colorado survey, with questions ranging from whether students wear seat belts to whether they’ve experienced violence from a boyfriend or girlfriend, if they have a supportive adult in their lives and how often they eat vegetables.

Some students took an abridged version focused on the effects of the pandemic in 2020, but it may not be comparable, since far fewer schools took part, and most of those that did were in rural areas.

In fall 2021, about 107,000 students from 340 schools in 51 of Colorado’s 64 counties participated. Most participants were back in their classrooms by then, so the results can be compared to previous years, Fine said.

Jessica Hawks, clinical child and adolescent psychologist and clinical director of the Pediatric Mental Health Institute at Children’s Hospital Colorado, said the data doesn’t fully represent youth mental health in the state, though.

One of the 13 counties in which no schools participated was El Paso County, which has the highest youth suicide rate in the state, she said.

“Without representative data from these 13 counties, the survey results are unable to capture the complete picture and likely represents an underestimate of the prevalence of suicidal planning and behaviors in our youth,” she said.

It also doesn’t capture mental health outcomes in younger children, since students don’t take the survey until middle school. While elementary-aged children have a far lower risk of suicide, crisis line calls increased more steeply in that age group than in teenagers, Hawks said.

The survey is confidential, so schools won’t know which students report struggling. The data can be used to figure out where youth are most at-risk, though.

A study using the 2019 survey found 21 schools in 19 counties where students reported high rates of planning suicide and also that they could easily access firearms. That’s a particularly risky combination, because suicide is often an impulsive act, said Ashley Brooks-Russell, one of the study’s co-authors and an associate professor at the Colorado School of Public Health.

If communities know young people face that particular danger, they can prioritize talking to parents about safe storage.

“Firearms are such lethal means that when kids have access to them, suicide attempts can be fatal,” she said.

It’s not entirely surprising that depression and suicidal thoughts didn’t rise in tandem, Fine said. While mental strain and suicidal thoughts can be connected, depression has risen every year since 2011, but the rate of suicidal thoughts has stayed about the same since 2015, she said.

“Suicide is such a complex issue,” she said. “There’s never just one reason.”

A question about self-injury not intended to result in death was new in 2021, so it’s not clear how that may have changed. About 20% of students reported they had harmed themselves in some way, such as cutting, but didn’t intend to die when they did.

Students were also asked about stress for the first time last fall, and about 53% thought their stress level was manageable most days.

Respondents were less likely to report they had recently used alcohol, tobacco, nicotine vaping products or marijuana than they were two years earlier. It’s possible that the reduction in substance use could still be an effect of the pandemic, if students weren’t holding gatherings where they would drink or use drugs, Fine said. The only way to know will be to see the numbers rebound in 2023, she said.

“It does speak to kind of this lingering social disruption for youth,” she said. “We’re interested to see if these trends continue.”

Students also were more likely to say it would be difficult to get alcohol, tobacco or marijuana, and they perceived frequent use as risky. The change was smallest for alcohol, but even then, the drops exceeded 10%. Generally, when young people think using a particular substance is riskier and that it would be harder for them to find, they’re less likely to try it, Fine said.

Respondents who identified as gay, lesbian, bisexual, transgender or nonbinary (meaning they don’t identify as male or female) were more likely to report using the substances the report asked about, experiencing depression and thinking about, planning or attempting suicide.

Female students also reported higher rates of suicide attempts, depression, non-suicidal self-harm, drinking alcohol and vaping. Multiracial students showed a higher risk for mental health struggles and substance use. The state’s categories for race and gender identity have changed since 2019, so it’s difficult to compare the most recent results to previous years.

The percentage of students reporting “protective factors,” such as having an adult they can go to for help and feeling they belong at school, stayed about the same compared to 2019, Fine said. The exception was participation in extracurricular activities, which fell. Young people who have support and clear rules in their lives are more resilient and less likely to experience multiple bad outcomes, including drug use, mental health problems and participating in violence, she said.

Youth of color and those who identify as LBGTQ are less likely to have protective factors in their lives, though. While about one in four respondents said they don’t have an adult to turn to, about one in three youth of color and LBGTQ youth said the same, Fine said. That’s not substantially different from previous years, she said.

“The disparities are usually pretty consistent,” she said.

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