Teenage angst has been glorified in many a song, movie and book, from Hip Hip Hurray to The Breakfast Club, from The Beatles to Bieber. But when certain behaviours become profound or more than the ordinary, it can be cause for concern. Teen mental health is coming under the spotlight, in a constantly connected world that demands higher academic and social standards. Here are the most common teenage mental health problems — and how parents can help.

Stress and anxiety in teens

Stress and anxiety in teens, though related and often used interchangeably, are slightly different states of mind. Stress is a response to a particular situation, such as a class deadline, social or health problem, whereas anxiety is more general and usually stems from fear, often irrational. For instance, failing an exam can cause teen stress, but a fear of failing all future exams is a form of anxiety. Together, stress and anxiety are the most common teenage mental health issues.

While genetics play a role, biological and neurological factors predispose teenagers to higher stress and anxiety than adults. For instance, the hormone THP, released in response to stress, has a calming effect in adults – but in teens, it has the reverse effect, stirring up additional feelings of stress.

Another stress hormone, cortisol, is present at higher levels in mid-to-late teens, especially girls, than in adults. This means your teen is a little stressed all the time – just from being a teen. Add academic and social pressures, however trivial, and cortisol levels can surge even higher.

A 2014 review of 19 studies conducted across 12 countries found that teenagers today are experiencing more depression and anxiety than they did a decade or more ago. Teenage girls, especially, had a much higher rate, with 30 to 50% experiencing symptoms of anxiety or depression.

The implications of this for teen mental health are profound. Teen stress and anxiety can interfere with learning and memory. Studies conducted on the brains of stressed rats found fewer synapses and weak response in the hippocampus, the part of the brain critical to learning and memory.

It’s a vicious cycle. Stress and anxiety in teens can inhibit learning — yet academic difficulty is a top source of teen stress, says Dr Ajit Bhide, head of the psychiatry department at Bangalore’s St. Martha’s Hospital. Many young adults are unable to cope with the pressure to perform and excel, even when that pressure is more in their perception than reality. Pressure to constantly update possessions and skills and to be romantically involved also wear at teen mental health, he says. Finally, teens can be stressed by the need to assert themselves, often through rebellious behaviour that can prompt conflict — which creates more stress.

Unchecked, teen stress and anxiety can lead kids to seek unhealthy coping mechanisms, contributing to other teen mental health issues like anorexia, panic disorder, obsessive compulsive disorder, substance abuse and more.

The good news is that parental involvement can go a long way toward stress management for teens.

“Parents need to be sensitive to the young person’s rapidly changing world and perceptions of it,” Dr Bhide says. “Being friendly is more important rather than actually trying to be a friend. Most young people deep down do feel the need for guidance and authority, but this should be subtle rather than dictatorial.”

Parents should be willing to see their teen’s point of view without launching into lectures, he says, and to respect their personal space and time within healthy limits. This helps keep communication open and allows teens to confide. Physical exercise and participating in activities they enjoy or excel also support teen mental health. But if none of the above helps, says Dr Bhide, consult a psychiatrist or a professional counselor.

Teen depression

According to the World Health Organization, most teens experience a depressive episode at some point. For some, the depression may linger, intensify and be accompanied by suicidal thoughts; suicide is the leading cause of death among Southeast Asian, which includes Indian, 15- to 29-year-olds.

Family history plays a large role in teen depression, but emotional neglect, physical or emotional abuse, or the death of a loved one can cause it, too. Teen mental health is also very sensitive to negative criticism and bullying – online or in person – making today’s Like-obsessed young adults especially vulnerable; a recent review established a consistent relationship between cyberbulling and teen depression.

Withdrawn behavior, often seen as less socialising, morose and moody responses, and disinterest in favored activities are often the initial signs of teen depression.

“A ‘Who cares?’ attitude could also be a mask for a depression,” Dr Bhide says. “Sleep and appetite disturbances, tearfulness or heightened irritability are other warning signs if they are prolonged or profound or both.”

The good news is that teen depression comes with warning signs. They may be overt – statements like “Don’t worry, you won’t have to break your head over me too long now,” are cause for concern, says Dr Bhide – or they could be more subtle. Parents should be mindful of any radical or prolonged changes in their teen’s behaviour, reach out and keep communication open — and be prepared for a slow process.

“Rapport needs to be established over months if not years,” Dr. Bhide says. However, if depressed teens still seem out of reach, he says, parents should seek professional help and guidance in the form of counselling.

Teen mental illness

Teen mental illnesses, while less common than the states of mind above, do affect some kids. In fact, adolescence is the period when some mental illnesses first emerge.

For instance, the onset of schizophrenia, a disorder of the brain wherein the person is unable to tell what is real from imaginary, commonly occurs in the late teens and early 20s, when the prefrontal cortex forms connections with the rest of the brain. While many genes are associated with the illness, scientists believe schizophrenia is caused by an interplay of genetic and environmental factors (such as exposure to certain viruses, malnutrition and others). Symptoms include disinterest in socializing, isolation, a gradual deterioration in social functioning, psychosis, an unexplained drop in grades, withdrawal from extracurricular activities, paranoia or suspicion.

Teen mental illness may also take the form of bipolar disorder, which also often surfaces in adolescence; studies have found that 20 to 60% of adults with bipolar disorder had their first symptoms before age 20. It is a mood disorder caused by a biochemical imbalance in the brain.

Genetic and environment factors, life events and relationships can all trigger the illness, which causes moods and energy levels to swing between extreme highs and lows; it differs in teenagers in that high, or manic, episodes are less frequent, while mixed episodes — when both mania and depression occur simultaneously – are more frequent. Irritability, aggressive behavior, sexual disinhibition, other disorders like Attention Deficit Hyperactivity Disorder (ADHD), substance abuse, and conduct and anxiety disorders may also be symptoms.

Teen mental illness requires the intervention of a medical psychiatrist and/or a clinical psychologist, who can assess and diagnose the illness and provide comprehensive care, says Dr Ashlesha Bagadia, a Bangalore-based psychiatrist. Parents can help teens struggling with mental illness by scheduling an appointment with one of these professionals.

Adolescence is a time when considerable mental, physical and biological change takes place. The good news is that most teens emerge from this period as healthy, positive adults. Stay connected and communicative, be sensitive to teen mental health needs, be vigilant, and seek advice or counseling if you or your teen need it.