Teenage distress is growing and becoming more "silent and invisible": 5 warning signs

We share this report from Heraldo de Aragón in which a guidance counselor, a child and adolescent psychologist, and a primary care physician and researcher from Zaragoza warn of the increase in mental health cases left by the pandemic and the lack of resources.

Emotional distress among teenagers increases by 11 points after the pandemic and becomes chronicmostly affecting young girls between 17 and 18 years old. These are figures from the latest HBSC study on healthy behaviors of school-aged youth, a WHO initiative supported by the Ministry of Health that shows how in recent years they have appeared new symptoms that do not manifest themselves through disruptive behaviors in the classroom. 

«Teenage distress is becoming increasingly silent and invisible. What we've seen especially since the pandemic, although it's a trend that predates it due to the influence of screens, is that Social interactions are less spontaneous, more measured. There is a greater record of events. what we say and do, And that's promoting a greater inward focus, a constant monitoring that isn't always positive.", warns Beatriz Lucea, a child and adolescent psychologist at Asapme.

At the Aragonese Association for Mental Health (Asapme), the demand for therapy from children and adolescents is "increasingly high," and it involves increasingly internalized problems. "We see that He doesn't want to get close to his classmates, but we don't know why; he locks himself in his room, but apparently everything is fine."Although afterwards he doesn't speak to us," this psychologist describes. 

This type of attitudeHe warns, they are only the "tip of the iceberg"because the resistance that teenagers put up when discussing certain topics makes it much harder to detect what's behind it.

Scientific evidence: a gender and age gap

According to the latest HBSC study, Emotional distress in adolescents has increased from 27,8% in 2018 to 38,5% in 2022 (an increase of almost 11 percentage points). Furthermore, it has also become clear that a gender gap exists: The impact is more pronounced among women, affecting 60,3% of girls aged 17 to 18, compared to 28,4% of men. of the same age. 

Isabel Tolosana, educational advisor at IES Pedro de LunaShe emphasizes that in girls this discomfort often goes unnoticed until abrupt and disproportionate reactions occur, usually due to an anxiety disorder with a major crisis.They are young people who do not engage in disruptive behavior in the classroom and that, furthermore, They have high standards for themselves. Therefore, their academic performance is usually good. Their teachers tell you: 'They sit there, in the back, they always seem to be smiling…', until at some point everything comes out. We need to know how to observe because there are a number of indicators that will help us to be alert to possible changes. "Or to have preventative conversations. The important thing here is to detect it as soon as possible so that they can ask for help," she argues.

Data indicates that new symptoms have emerged in recent years. In this regard, the professionals consulted warn that Pathologies no longer always manifest themselves through visible disruptive behaviors in the classroom. Currently predominates a profile of sustained emotional exhaustion characterized due to the increase in anxiety and somatization, the Chronic fatigue e insomnia, the high burden of self-demand,he silent school disengagement, And a "24/7" effect of digitizationwhere social validation depends on a hybrid coexistence that generates vulnerability to comparison and exclusion. 

«There is a more self-aware view, but it's not a positive approach. not for improvement, but for: everything I can't do right, everything I do wrongEverything I don't do like other people I see on screens… We focus on very high expectationsOn social media we show results, but not so much processes, and that is being related to low self-esteem, social anxiety, eating disorders, and this screen overuse"This highlights psychologist Beatriz Lucea, who focuses on a series of warning signs that can alert those around teenagers to some type of psychological distress." 

Indicators of distress in adolescents

• It appears older apathy and irritability.
• Loss of hobbies or interest in sports or hobbies that previously interested them and they are not replaced by anything else"Adolescence is a time of change, but when there is no search for something to replace the activity we left behind, we need to be alert," Lucea warns.
• Greater tendency towards isolation.
• Refuge in the screensnot because of addiction but turned into a form of quick emotional relief"When there is distress, cognitive resources are also limited. We see young people who are only able to swipe their finger, which is a very passive activity," explains this psychologist.
• Changes in their spontaneity in relationshipsthat they seek less contact with family.

For her part, Isabel Tolosana, guidance counselor at the IES Pedro de Luna, adds what she considers to be the most important. Other indicators to consider in the educational field to detect emotional distress in adolescence. 

• When they start to skipping class first thing in the morning.
• O They ask to go home because they are not feeling well. and you start to see a pattern (there may be a drop in academic performance or an abrupt "I can't take it anymore" crisis). 
• A disproportionate reaction the least expected day.
• Tiredness or sleepiness in class: can be resulting from excessive use of screens or simply "teenagers who don't sleep well because they're not well," he points out.

How to behave at home and at school

To address these types of situations in both the educational and family spheres, both professionals advocate for to foster a "family communication style" that allows for open discussion of emotionsFor this, they advise:

1. Encourage dialogue about emotions since we were kids.
2. Validate how they feel and take advantage of everyday conversations to do so. One barrier many parents encounter is: 'my child doesn't tell me anything, what am I going to validate there?' But in everyday life, this psychologist assures us, there are many opportunities to seek that dialogue.
3. The idea is not to solve everything for them, but to provide support for what they cannot achieve. "They need to be able to come home one day and say, 'I'm exhausted, I feel discouraged.' We need to foster in them the ability to accept discomfort, something we sometimes fail to achieve, and that's very dangerous. Often, when they come to us to talk about a problem, their perspective isn't that we solve it for them, but that we understand it," she points out.
4. Change the interrogation/accusation (that "why don't you tell people things") for speaking from experience and affectionresorting to messages such as: "I've noticed you've been sadder lately, I'm worried you might be having a hard time and I haven't realized it"; "Is there anything I can do to make you feel better?". 
5. Try to engage in dialogue and don't assume the answer will be "no".This advice is valid for both parents and teachers. "If you notice something, validate it, don't minimize it based on other people's opinions." There is a difference between offering help and being told no, and not offering it at all. Following this pattern, their sons and daughters or students are learning that when support is needed they will be there, otherwise that message might not get through," Lucea adds.
6. Guide them to ask for helpThis psychologist acknowledges that it's a difficult issue to address because it makes us feel vulnerable. "We need to normalize the fact that everyone goes through rough patches, and that's a sign that we're human and it's okay to admit that we sometimes suffer," she adds. 
7. If that atmosphere isn't present at home, turn to any teacher, counselor, or friend. that helps them to verbalize the emotional distress they are experiencing. 

Many factors behind the 'iceberg' and few coordinated resources

This increase in emotional distress among adolescents has a multifactorial component. Isabel Tolosana, educational advisor at IES Pedro de Luna, speaks of a structural change in which the pandemic acted as a "catalyst and accelerator" of something that was already latent: the increasing isolation of teenagers.

«There is much talk about loneliness in old age, but often there is great loneliness among young people as well.Either because during adolescence your circle of friends changes a lot, and if your interests don't evolve at the same pace you get left out of the group, or it stems from social media itself: because you're not connected, because they don't include you, or they don't give you that immediate validation. There may be loneliness that often leads to feelings of hopelessness«, warns this educational psychologist. 

Among other risk factors, Tolosana also mentions the economic factor -a very common stressor in the second year of high school, in families where it is not guaranteed that they can continue their studies-, the cultural uprooting of boys and girls "who have left their country and it seems we forget that they are going through a significant grieving process, which requires a lot of support"; also separations and divorces which sometimes generate "great emotional distress" because they are not always resolved in the most appropriate way, and others more extreme situations of violence in the family or school environment, where bullying has become "a brick in the backpack that the teenagers who suffer it will carry for a long time because of the pain and suffering it produces."

Currently, when the family authorizes direct communication between the school's Guidance Department and the assigned psychologist or psychiatrist, there are forms available to allow the school to refer the child and request medical intervention.Unless it is a case of suicidal ideation, in which case there is a specific protocol. which we complete and submit to pediatrics for referral to mental health, which What we do is prepare a report suspecting another type of disorder and encourage the family to contact Primary Care. "So that they can be referred. If we are dealing with a slightly more serious case, we refer them to the Emergency Room, but those are very extreme cases, which is not the norm," this counselor explains. 

For Tolosana, one way to address this increase in adolescent distress would be improve and generate new channels of coordination between educational and healthcare services. "That's a demand from society. There's a lack of resources in healthcare, in education, at the social level." The increase in cases is very, very large; we're talking about a total increase of 200 or 300%, without taking into account the eating disorders, which skyrocketed during the pandemicAt the center where I work, there are two counselors and we're in a better situation than in others, but It only gives you time to detect, not to interveneAnd so, attention is insufficient. Ideally, these children would have more resources available to them, and a more coordinated intervention"Tolosana argues."

The problem, in the doctor's opinion Rosa Magallón, the first female professor of Family Medicine in Spain and coordinator of the Primary Care Research Group in Aragon, is the limited accessibility that adolescents have with the health system and a Primary Care system that "abandons" the person in a very relevant age range in their lives: adolescence. 

«This is the stage where psychotic episodes, tobacco and marijuana use, sexist behavior, bullying, and unperceived loneliness begin.And paradoxically, if they experience emotional distress, they have no one to turn to at the health center. If they choose not to tell their families, which is common, the healthcare system's accessibility for adolescents is very limited. Either you set up an afternoon consultation service or they have to skip work to come see you."Magallón comments, proposing that public authorities establish a regulated system for a 'youth consultation' in educational centers that operated in the afternoon shift and were staffed by professionals who earned the trust of teenagers. 

She asserts that similar experiences have occurred in schools and institutes that have offered their services to minors to address mental health problems in coordination with doctors and residents.I myself have had the experience of two hours of free consultation per week, from 3:30 to 5:00 pm, and my teenagers have always known, because I have taken advantage of any visit for a cold. They would come with their parents to tell them he was there and that they could come whenever they needed to, without an appointment. What I was doing on my own is something that could be normalized. But we need to make it accessible to teenagers. "To access the healthcare system when they can because we are at a vital stage, not only of developing values ​​but also of developing pathologies, addictions, eating problems, etc.," claims this specialist, who has extensive experience in healthcare of more than 33 years at the Arrabal health center. 

Currently, as a researcher at the University of Zaragoza, she has several open lines of work that address unperceived loneliness in adolescents. One of these studies focuses on the consequences of screen addiction, which, she warns, we mistakenly focus solely on young people. "When I ask girls, 'How many hours do you spend on your phones?' many say, 'Less than my parents.' We don't realize that we're dealing with an addiction that develops in adolescence but is promoted by families, educators, and institutions themselves. Therefore," "We cannot stigmatize a population group when those responsible for that group are doing the same thing.", criticism.

On the other hand, Magallón also speaks of the influence of social changes on family models.We are seeing single-parent families with appalling working conditions, without a family support network wide. We call them: 'the children with the key hanging off their necks so they don't lose it' and the 'when you get there, heat up your dinner, I'll be there soon' kind of kids. Poor women, usually - she confesses. They are only children, single-parent families, small families, with few cousins, one or none. They grow up in isolation because they don't know or don't have a reference point in their extended family.Now there are children who celebrate Christmas at home with just three people. And how many get together for birthdays? They're alone and they don't even know it. That's the context we're dealing with, and There is a lot of this in adolescence because it is a social change that also generates emotional distress"This doctor comments, proposing several measures to address this epidemic of cases."

As an example, he gives the Stroke Code, a benchmark in Aragon for the treatment of strokeor the possibility of creating a school for parents within the Parent-Teacher Associations.Broad approaches are needed at the public health and coordination levels. It's unacceptable that the education system and primary care operate independently, leaving families completely adrift. We're so disconnected from one another. Families are floundering, and children are suffering. This needs to be addressed for what it is, a genuine epidemic that requires public health measures. And just as there is a truancy committee in schools, there needs to be a mental health committee. Just as there is a stroke code, if there is a serious risk in this area, action must be taken, and yet no action is taken."This concludes the professor, who participated this Monday, along with guidance counselor Isabel Tolosana and psychologist Beatriz Lucea, in the last talk of the V Cycle of Child and Adolescent Mental Health, organized by Asapme Aragón.

Source: Heraldo de Aragón