December 28, 2023
Cindy Lopez:
Welcome. My name is Cindy Lopez, the host of this CHC podcast, Voices of Compassion. We hope you find a little courage, feel connected and experience compassion every time you listen.
Recent statistics the Centers for Disease Control Prevention reveal a concerning surge in persistent feelings of sadness and hopelessness among our high school girls today. In just a decade, these numbers nearly doubled. So today’s episode, we talk with Dr. Katie Reeves, Health Researcher and Nurse Practitioner who specializes in the care of anxious, suicidal, and self-harming teens and their families. We explore the prevalence of health challenges among adolescent girls, from social pressures the influence of social and more. Listen now learn more about you do support our adolescent girls today. Welcome Katie. Can you just take a minute to tell us a little bit more about yourself?
Dr. Katie Reeves:
Thanks for having me Cindy. I’m a nurse practitioner by training. So I’ve worked in child adolescent psychiatry, and although I’ve worked with a whole range of ages, I specialize in working with teenage girls and young women, most of the time who are struggling with anxiety or depression or suicidal thoughts.
I’m also a full time researcher at UCSF, and most of my work is just focused on figuring out what we mean when we say we’re feeling anxious or depressed and really getting at the changes in that definition over time from moment to moment. So I might say I’m feeling anxious in one moment and I also might say it in another and have totally different mental health outcomes.
Dr. Katie Reeves:
This is not Katie’s first episode with us. So, she has, done other podcast episodes with us. You can find those in our Voices of Compassion Podcast series, but today we’re talking with Katie about mental health and girls specifically. So Katie, why mental health and why girls?
We all probably have been privy to the big change in the numbers. So all the stats that are kind of being thrown at us in the news all the time are really horrifying recently. So we’ve seen huge increases in rates of suicidal thoughts among teens, teen girls are up to 25%. So it’s one in four teen girls having reported seriously considering suicide in the previous year, and that’s up 6% from four years ago. So we know the last four years have had a lot of change. And then huge numbers of persistent sadness and hopelessness among teenage girls that’s much higher in girls than it is in boys and kind of trickling down into clinical spaces, just these huge increases in prevalence rates of a lot of mental health challenges.
Cindy Lopez:
Every day it seems like there’s some kind of a mental health headline and youth mental health specifically. And why is that? As we think about environmental factors and biological factors, I’m really interested to hear what your perspective is both as a practitioner and a researcher.
Dr. Katie Reeves:
I will definitely share both perspectives from the research and also from the clinical end of things. I think first it’s important to just acknowledge what our kids are experiencing when we say that over 50% of teenage girls have persistent feelings of hopelessness, that means that half of these teen communities, whether that’s at school or in an after school program or just among groups of friends, over half of these teen girls are feeling this way. So it’s a huge percentage and developmentally teens are all about their peers. So I know parents probably notice, but this is a time when it’s all about kind of emotionally separating from parents, pushing their boundaries and really engaging their peers and figuring out where do they fit in, who are they and so if we can kind of put ourselves in their shoes right now and think about what it would be like to go into peer settings where really there’s a perpetual feeling of sadness and how hard it might be to find supportive groups of friends or just like spaces where one might be able to feel comfortable and might feel welcomed. Um, so that’s also probably perpetuating a lot of these numbers and, you know, kind of gives us a different understanding of what this idea of contagion might be. So contagion has typically been discussed as, “I have friends that are feeling bad or feeling a certain way, and I see those thoughts, I use their language and I kind of perpetuate that later on in my life,” but this is giving it a different thought where, oh my gosh, if all of my friends are feeling really bad, it just genuinely kind of makes me feel bad too.
Cindy Lopez:
Culturally there is a shift with girls, with women as the woman’s role has changed over the years, right? It’s not all about, you know, families and being home. It is now about women who are amazing, powerful business leaders, right? I wonder if the doing it all expectation, how does that play into this conversation?
Dr. Katie Reeves:
Cindy, I think you’re referring to a girl boss, maybe. Yeah, I think this is a huge component of it. And so when we talk about the original question of why, like, why are these numbers changing? You are really clearly outlining that there are major cultural differences. And so environment and biology are two kind of high level factors contributing to change. And when we parse out what the environment means, our social and cultural environment is huge. So absolutely there is this cultural shift towards women having opportunities that we haven’t necessarily had in the past and being I guess like rewarded for a lot of the same success that men have had in the past. So being a boss is something that has really been a masculine identity and now women also can be a boss. I think what’s happening is we’re not shifting a lot of the kind of like menial and small cultural changes of gender among teenagers. So like, you know, girls still want to be pretty and that’s perpetuated, right? Like there is still this push to be pretty and to be prettier than other girls. And to especially not be crazy or hysterical, that’s another thing that I’m hearing a lot about in clinic is girls really being worried that they’re being too much. And so I think your question actually speaks to something that I see all the time, which is this intense tension between a desire to be more in charge and extroverted and a leader in the group and more like a CEO and also still kind of getting the backlash of you’re being too much. You’re being too needy. You’re being too emotional. You’re being too, too, too all the things. And there’s a lot of stress that I think these teenagers are feeling that maybe hasn’t been around as intensely, in kind of those distinct messages.
Cindy Lopez:
I’m also thinking about the girls who don’t fit that mold, who are not the extroverts, who really don’t want to be in the middle of everything or be the leader. They have different kinds of strengths. And this expectation now that women are all these things, but what about the girls who don’t feel like that’s necessarily them? I can imagine there is tension there and there is angst and for individual girls as they try to figure out and navigate their way.
Dr. Katie Reeves:
Yeah, there are great examples of this already. So, I mean, if you just kind of watch as I do sometimes what’s popular on social media, you can get samples of pushback to this girl boss identity and saying, “I don’t think that that fits me. I don’t want that.” And that actually is very humanizing. And I think that you’re pointing something out that we can all kind of relate to no matter what age you grew up in. There is one identity that is kind of held up. And then there’s this measure of whether or not you’re meeting that expectation. And so that kind of gives us all something to relate to.
I will speak to what I think is a little different now. Although people haven’t changed all that much, I think this is maybe more my opinion than it is scientific fact, the arena in which we grow up really has. And what I mean by that is kids are interacting now on the internet when maybe they are doing the same things, kind of having the same interactions with their peers, but they’re doing it with this entirely different medium. So some kids are always going to be mean and some kids are going to be nice, and sometimes kids are shy, and sometimes they’re not, and this is totally true in the age of social media, but the big difference between Instagram and the schoolyard is that there’s no supportive guidance on the internet. So on the schoolyard, although maybe the teacher doesn’t see one kid bullying another and maybe they don’t see them the first time, maybe they don’t see them the second time, maybe they don’t even see them the third time. Every kid on that schoolyard knows where to find that teacher. And when that kid, you know, ends up getting told on or…
Cindy Lopez:
Some kind of consequence or whatever.
Dr. Katie Reeves:
Exactly. They get pulled into the office, right? So they do get the attention. And then even more when they’re being pulled into the office when they’re, kind of getting that consequence, they are not being kicked off a platform. They’re being listened to they’re being supported maybe in an ideal playground world. So this doesn’t always happen, but ideally, even the bullies are cared for and taught how to be better and how to you know kind of get at whatever it is that’s bothering them so that they can interact with their peers more effectively. And that doesn’t exist right now for teenagers. The internet is kind of this Wild Wild West where not only do kids not feel that support, but there’s also this sense that nobody really knows how to give it to them. And so just putting boundaries on it doesn’t necessarily seem all that effective. It’s like making the playground just extremely small, but it still isn’t allowing for learning. And I would also just put a plug in for that part may not be specific to teen girls. In fact, I think all of us that are using social media and the internet kind of for the first time are struggling with this.
Mike:
CHC’s Voices of Compassion podcast is made possible by the generosity of people like you. To learn more about supporting CHC, go to chconline.org/donate. Also make sure to follow us on social media for more inspiring and educational content from CHC.
Cindy Lopez:
So Katie, you have been talking about this. I’m just wondering if there’s anything more you’d like to share about the unique challenges that girls face.
Dr. Katie Reeves:
Yeah, I think when we look at the numbers and the differences between boys and girls, and even men and women, because these trends tend to kind of follow into adulthood, there is something to be said about how some of the cultural differences that you mentioned change the outcomes that we see. So for example, we know that girls tend to have much higher rates of suicidal thoughts. So 25%, I mentioned earlier of teenage girls experience intensive suicidal thoughts compared to still a very high number, but more like 16-17% of boys that does not carry over in behavior. So, more boys actually die from suicide than girls, and more similar rates of injury associated with suicidal behavior happen among boys than girls.
And so we’re seeing this kind of evidence that maybe the quote unquote “problem” exists everywhere, but girls are actually taught to externalize emotions where I think boys tend to internalize. And so for these teenage girls there’s this anxiety that is rising and rising and rising and rising that in a clinical setting I can tell you that pretty consistently it’s coming from the tension between we’re told we need to externalize our emotions. We’re told we need to understand other people’s emotions, we attune really quickly, and then we’re told that’s too much. Often these thoughts of suicide in particular are a really good example of adults we get really scared when kids especially teenage girls tell us that they’re considering or thinking about wanting to die. It is objectively scary, right? We do not want our children to hurt themselves. We don’t want them to get hurt even on accident. So it is of course going to bring up intense feelings in the parent or the caregiver or even the clinician. And also, that fear that adults are having right now is then impacting those teens. So there’s more and more thoughts that are more and more scary. And then there’s more and more consequence to the teenager to express them. And it’s this vicious cycle that I think when teens are told don’t be so emotional, they try so hard not to be emotional, causing so much more anxiety. So that is something that I think is specific to teenage girls because this need or kind of this vicious cycle for wanting to express these big emotions and then feeling really scared to express the emotions because maybe no one will understand, that I think is perpetuating at a rate that is not necessarily happening in their counterparts in boys.
Cindy Lopez:
So, you talked about girls experiencing this increasing anxiety and some suicidal thought, all those things kind of going on beneath the surface so to speak. I’m wondering if you could describe some indicators that our listeners might see in girls struggling with their mental health in some way.
Dr. Katie Reeves:
This is one of the most challenging questions to answer in a time when over half of these kids are expressing kind of perpetual feelings of hopelessness because 10 years ago perpetual feelings of hopelessness would have been something I would say maybe on this list. And now if every single one of these kids is really struggling, when and where and why and how do you end up getting support and help? And so I think first of all, going back to the basics, something to ground us in is some mood that’s low, some depression is normal. Some anxiety is good. Imagine if we never felt anxious, we wouldn’t know to run away from a bear in the woods, you know. Some even existential thoughts about whether or not your life is happy and worth it, those are absolutely normal to have.
As we think about when to reach out for support, it becomes more and more important to understand how these emotions are impacting the goals of your kid and your family. And that’s when we can say, okay, it is so normal to feel really scared about the future of your life and your children’s lives when we’re constantly hearing about how the earth is on fire, right or we’re living through pandemics where you’re being told that life is going to look a certain way, and then you’re actually asked to stay inside. These are really, really legitimate fears. And so it might be totally reasonable and biologically important for your kids to be responding in a negative way. Mm hmm. Mm If that seems to be impacting the long term goal of growth or kind of meeting some kind of typical learning structure, so like if your kid’s not able to go to school on a regular basis because they’re so terrified of social interaction, that is really different than, you know, the kind of social awkwardness that I think we’re all feeling, trying to re-emerge from, you know, being inside during COVID. These are what we call functional impairments, which may or may not be the best term, but they are kind of where clinicians are feeling grounded in understanding the severity of any kind of mental health disorder. I think one more important note is there are two kinds of mental health concerns or at least this is how I classify them in my head. One is a very reasonable, but very intense and negative response to the world. So like we’re talking about, there’s a lot of really scary stuff going on. You might have a kid that is responding in a very typical, very appropriate and very healthy way, and they need support. Any kid that experiences trauma needs help to process that trauma so it doesn’t turn into some kind of illness later on.
Then, on the other hand, we have kids that we know have more of a biological kind of, in any environment, they’re going to experience more difficulties with their mental health. We do not have systematic ways to triage these two different mechanisms. They look very similar. If ever there are functional impairments that are causing concern, I always suggest to go reach out to a professional who is very attuned to the difference between those two so that they can then suggest treatment that is appropriate to the mechanism.
Cindy Lopez:
I’m thinking about adolescent development in general, that’s kind of unique in itself. So how does that adolescent development also play into this picture of girls and mental health?
Dr. Katie Reeves:
Well, we have psychological development that we’ve talked about and then we have this biological development. There’s been some good reports on the change in puberty, and the average age of puberty among girls, over the last10, 20 years. We have always seen a decrease in the average age of puberty over the last couple centuries. We are seeing the rate of change increase. So girls are starting puberty younger and younger and younger. And just to put some numbers on this the turn of the 20th century, we think the average age of puberty for teen girls was around 16 or 17 years old. When now we’re seeing the average age closer to 12 or 13 years old. And so that’s a big change in a hundred, 120 years. So we also know that this is not something that is seen across all teenage girls in all spaces evenly. So we know that girls in westernized countries tend to see earlier and earlier puberty than compared to the global average.
So these numbers make us think, well, what the heck is going on here? I think there’s a lot of people working on this in the scientific community and in psychiatry. So there will definitely be a lot of important science coming out. As of right now, we don’t have a very solid understanding. Some of those numbers indicate that this cultural and social change we’re discussing is definitely changing our biology. And I think that’s where we are making the biggest change in our understanding of teen girls. There’s this bi directional relationship between our biology and our environment. Our environment affects our biology just like our biology affects our environment.
Cindy Lopez:
Mm hmm. And, so you’ve given us this picture of girls and what they’re experiencing both environmentally, biologically. And we know that girls are being more impacted by mental health kinds of conditions.
So Katie, what kind of effective help and support can we give girls right now around these mental health kinds of concerns?
Dr. Katie Reeves:
This is the shining star question. First I will say that it does depend on your position and your relationship to those girls. I will speak mostly to parents. I think that parents can do what parents have always done best, which is to just love the living daylights out of your kid and as long as you’re doing that, your worry will benefit them. We also know that parents taking care of themselves is probably one of the best things they can do for their kids. And I am not saying that to just, you know, butter people up. I promise you that this is true. If you can, as a parent, figure out where your boundaries are, your limits are, so that you have the emotional capacity to really hear what your kids are saying that is going to benefit them more than anything.
First, it is really important to hear your kids. If you can listen a lot of the time as humans we try and correct right away, like if we hear our kids say, ” it was the worst day I’ve ever had in my entire life.” And we kind of remember a day from a month ago when they said that same thing, and you’re like, this isn’t even anywhere near as bad. Our instinct is to say, “well, what about that day a few weeks ago that was pretty bad too,” or “hey, it seems like everything’s fine. What are you talking about?” Right now, especially, more than ever, these kids, especially teenage girls, need to know that their feelings, their emotions are acceptable and are going to be taken seriously. And so when your kid comes home and says, this is the worst day I have ever had in my entire life, the best thing that you can do is to at least respond to that and validate the emotion and say, “well, that sounds horrible,” right, or, “oh my gosh, tell me more.” Even saying, well, that’s so surprising to me, that at least acknowledges that you hear that it is the worst instead of immediately rejecting it. I will also say it is fine to later bring up, “this doesn’t seem all that bad, right?” But the first thing you can do is acknowledge that you hear them, that will over time bring together the two realities that they’re experiencing and allow them to just calm down a little, right?
We talked about teen girls feeling really anxious because they’re being told their emotions are too much, but then they’re also being told to express their emotions. If you can validate their emotions without agreeing with them necessarily, you will be able to alleviate some of that anxiety as a parent without really doing much. The only way, as humans, we are able to validate our children, especially when they’re elevated is to make sure you have time to yourself. It is just impossible to constantly be validating the emotions of a teenager, especially a teenage girl, right? We know that there’s a lot going on. Teen girls are experiencing things for the first time in their life. You know, a heartbreak or even just a friend saying something mean may feel like the worst day of their life. And that is a big emotion to validate. So if parents are not taking space for themselves and getting their own validation and having their own time to do what they like, they’re not going to be able to emotionally take on the task of validating their teenagers. The next thing is, you know, reaching out. And I’ve said that for the last decade, and I just now more than ever believe that it is just so much harder and more complicated than it sounds. Who do you reach out to? And for what reasons? And when you do reach out? You know, you’ll be told to consider five different factors and, you know, if this, then this, and one person’s 800 dollars an hour and the next is 50 and the next is free. So which one and how do you measure all these things? I just want to validate that the system in which we discuss, treat and study mental health is just as confused as you are, and we love to say that the system is broken. I don’t know that it’s broken more than there’s just a lot going on. And we really have a lot of learning to do before it’s going to work well. Because of that, the best thing that you can do is to talk to as many people as possible and get as much information as possible before making your decisions. That becomes difficult when we’re faced with stigma. I think parents often come to me really nervous that there’s going to be some judgment. If their kid is saying I’m pissed off at my parents all the time and that’s having a negative outcome, going to another adult and saying my kids are really pissed off at me all the time, and I think it’s impacting them negatively, it’s really hard to do. So I would say, make sure you have space for yourself because all this stuff is going to be really difficult. Pushing past that worry of judgment is going to benefit your children. If you can talk to more people, you will get more information. If you talk to me in a psychiatric setting or other psychiatrists or people that are trying to you know, evaluate psychiatric needs, our tools are therapy and medications. So that’s probably the recommendation you’re going to get. If you go to a community center where they have, you know, support groups and they have after school activities, those are their tools and those are the recommendations that you’re probably going to get. One is not better than the other generally, but for every kid, there is the right treatment. And it does often include kind of an analysis of how expensive is it? How hard is it to get to and all the logistics that go into your day? Because those logistics also impact our mental health. So it’s really complicated, talk to your schools. Usually there’s a counselor, especially in the Bay Area. I’m a recovering teen girl from Palo Alto. So I remember being a student at Palo Alto and now I’m an adult in the Bay Area, and I can pretty much guarantee that there is someone on every campus that can at least address some kind of mental health concern. There are community centers and organizations, definitely reach out and look at those, even if they’re not necessarily advertising mental health assessments. There is usually somebody there that can offer that kind of support. Organizations like CHC are absolutely perfect for this thing; they were built for this, they work and function for exactly this, that is a kind of next step and it seems intense. I promise that providers are willing and able to respond at the volume of the kid, so it’s never too early if for some reason it seems that maybe the concern was bigger than the potential quote unquote “problem,” your provider will say that too. They will help you through that.
Cindy Lopez:
We have resources here and you can reach out to us at chconline.org. You’ll find all kinds of resources there. Reach out to our care team, which is careteam@chconline.org or call us at 650-688-3625. We do have people like Katie who can meet with you and talk about what’s going on and figure out what the best next steps are for you and for your daughter in this case. So Katie, as we wrap up this conversation, I’m wondering what you really want our listeners to hear from you today. What are the most important takeaways from today’s conversation?
Dr. Katie Reeves:
One of the best things that you can take away is they are facing all of these challenges, and they’re getting through it. Teenage girls are extraordinarily strong and resilient, and I think we have for a long time understood peers as weakness and teenage girls in 2023 are showing us that tears and emotions and wanting to go to therapy and being able to express ourselves and be vulnerable is incredibly strong. And if we can remind our kids in moments where they feel weak that they are actually strong and that their actions have shown that, that is going to be the most healing thing for them. It will also be extraordinarily healing for us. We need to remember that our teenage girls are gonna be okay. If we love them and we support them, they’re gonna be okay. And that is something that I think is hard to hold on to in these moments when things get really scary.
The last thing, and this will be a repeat, right now the mental health crisis, it is affecting everybody. And teenage girls are this group that are expressing kind of what I think everybody is feeling. The rates of suicidality have gone up a lot in teenage girls. They’ve gone up a huge amount in adults, from 3 percent before the pandemic to 11% in the middle of the pandemic, and so I don’t say the self care thing lightly, and I don’t say it in kind of a passive way. I don’t think taking a bubble bath will necessarily change your outcomes, but when we talk about accessing supports for your kids, the best thing that you can do on the car ride or, picking up your kid or whatever it is, the best thing that you can do is check in with yourself and say, do I need help right now? Do I need supports? Do I need my own therapist? And learning from our teenage girls and knowing that asking for that help is not weakness. It is in fact strength in every form. It is incredibly strong.
Cindy Lopez:
For all of us girls out there and all parents and teachers of girls and everyone, so many important things that you shared with us. And I think one that stays with me is what you just said there are daunting and statistics and headlines out there all the time, but there’s also resilience and all of the things that you can do to help your kids and students develop that resilience. And as Katie noted, self-care, it’s a place to start. Thank you Katie. Thank you to our listeners, and we hope that you’ll join us again next time.
Dr. Katie Reeves:
Thanks for having me, Cindy.
Cindy Lopez:
Visit us online at podcasts.chconline.org. Make sure to subscribe to Voices of Compassion so you never miss an episode, and we’d love it if you’d leave us a rating and review. Have a question? Send us an email or a voice memo at podcasts@chconline.org. We’re here for you when you need us.
