The mental health of US children and adolescents is in crisis. This narrative review takes a fresh look at current epidemiologic data—with a focus on mood disorders, suicidality, and substance use among youth aged 1 to 19 years—and reviews demographic and geographic risk factors, potential contributors to the crisis, and interventions available to communities, clinicians, and policymakers. The data are worrying. In 2023, almost 40% of high school students were reporting persistent sadness or hopelessness, 18% had experienced major depression, and 10% had attempted suicide. The suicide rate at ages 10 to 19 years increased by 85.3% between 2007 and 2017. Deaths from drug overdoses at ages 15 to 19 years surged during the COVID-19 pandemic, largely because of fentanyl.

Mood disorders, substance use, and suicidal behaviors are more common among lesbian, gay, bisexual, transgender, queer (LGBTQ+; especially transgender) youth; rural and American Indian/Alaska Native youth; and those who have experienced poverty, disabilities, or involvement with foster care or juvenile justice systems. Female youth exhibit greater morbidity rates from mood disorders, suicidal ideation, and substance use, but male youth are more likely to die of suicide and drug overdose. Potential contributors to the crisis include decreased social connections; school-related stress; access to lethal agents (eg, firearms), smartphones, and social media; cyberbullying; racism and homophobia; and inadequate access to behavioral health care. Primary, secondary, and tertiary preventive interventions may offer solutions, but the supporting evidence is uneven. Although the crisis calls for greater investment in research, training, and support for youth, the federal government is currently defunding research and eliminating programs.

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