The National Research Council and Institute of Medicine reports that 1 in 5 adolescents in the United States suffers from a diagnosable mental health disorder. The impacts of such illnesses can have serious effects: depression, social anxiety, strained relationships, and suicide.

We’ve combed through data from three government sources to explore the who, what, where, and why of teenage mental health, beginning with an overview of how many young people feel sad and suicidal in a single year.

Exploring Teen Feelings and Actions

The latest data from the Centers for Disease Control’s (CDC) High School Youth Risk Behavior Survey show that among 100 randomly selected 14- to 18-year-olds, 30 say that they felt sad or hopeless for two weeks straight, and that it was bad enough to stop them from doing some of their usual activities. That’s equal to 4.7 million teenagers across the country. More shocking is that 17 out of 100 say they seriously considered killing themselves at some point in the past year (2.1 million), and just over half that number actually attempted to do so. And, what’s more distressing, is that 469,000 9th- to 12th-graders made suicide attempts that were serious enough to cause injury that required medical treatment.

The number of teenagers who make life-threatening suicide attempts is thankfully a small fraction of all attempts, but the fatal rate has been creeping up over the last few years.

Suicide Rates Over Time

The graph above also uses data from the CDC, but it comes from its Underlying Cause of Death database, which tracks fatalities in the United States through the analysis of death certificates. We’ve pulled data for individual ages ranging from 11- to 19-years-old, across a 15-year period (starting in 1999).

The graph shows that suicides increase as children get older. In fact, in 2014, the rate more than triples from the ages of 11 to 13; It almost doubles from ages 13 to 15, and again from 15 to 19. In 2014, suicide was the second leading cause of teenage fatalities in the United States, accounting for 7.3 deaths per 100,000 lives. This number is up 14% from 1999, when it was 6.4.

The suicide rate among teenagers also differs significantly by race and gender.

Comparing Race and Gender

The chart above combines the CDC mortality data with responses to the most recent High School Youth Risk Behavior Survey, which in 2013 included answers from 13,633 9th- to 12th-graders on topics like drug use, physical activity, sexual behaviors, and unintentional violence and injury (which included questions specifically related to feelings of sadness and thoughts of suicide). It revealed that female students were roughly twice as likely as male students to have seriously considered killing themselves in the last 12 months (22.5% versus 11.6%).

However, when we introduce fatal suicide data, the numbers flip: male youths kill themselves at three times the rate of female youths (9.6 versus 2.7 per 100,000). These figures mirror rates in the adult population, which show that adult men commit suicide four times as often as adult women. Again, this is despite women being twice as likely to suffer from depression or harbor suicidal thoughts.

Researchers have proposed at least two explanations for this gender difference. One is that men often express their depression in different ways to women, including “anger attacks/aggression, irritability, substance abuse, and risk-taking behaviors.” Another is that men use more destructive methods to kill themselves than women, like hanging and firearms. Women are more likely to use poison (including prescription medications), which has a higher survivability rate.

Among the gender and race categories, female American Indians/Alaska Natives stand out, as they are part of the only female category that has a higher suicide rate than black and Asian males (7.5 per 100,000 versus 5.8 and 5.3 respectively). However, it’s male American Indians/Alaska Natives who have the highest suicide rate of all teenage groups, at 18.7. This rate is 3.5 times higher than Asian/Pacific Islander males, and approaching double the rate of white males (10.5).

The reason for this massive difference is that suicides in Native communities follow a very different pattern than the rest of the population. In general, suicide is most common among middle-aged and white individuals; within the Native American community, 40% of suicides involve people aged 15 to 24. One contributing factor appears to be a lack of mental health resources in Native tribal communities. Given that mental illness plays a part in 9 out of 10 suicides, this is a critical deficiency.

Rates Across the United States

Using combined CDC data from 2009 to 2013, we can also compare teenagers’ suicidal thoughts and attempts by state. Among the states that participated in the biennial survey, the percentage of 9th- to 12th-graders who felt sad or hopeless for two weeks in a row ranged from a low of 22.7% in Wisconsin to a high of 35% in Arizona.

Many of the same states appear in the five highest and five lowest lists across all four categories above, with Louisiana ranking highest for teenagers who attempted suicide (including attempts that did and did not result in injury) despite being only 10th highest for “Seriously Considered Suicide.”

Another interesting difference appears when we compare the states with the highest rates of teenage suicidal thoughts (as seen above) with the states that have the highest rates of fatal teenage suicides. Comparing ages shows that South Dakota had the highest suicide rate among 9th- to 12th-graders, followed by Wyoming, North Dakota, Montana, and Alaska.

It’s time to examine some of the causes of depression and anxiety that lead to negative feelings and actions. One among them: bullying.

Online and In-Person Bullying

Across the United States, 14.8% of 9th- to 12th-graders in 2013 said they had been electronically bullied in the past 12 months (through email, chat rooms, instant messages, websites, or texting). The prevalence of electronic bullying was 2.5 times higher for female students than male students (21% versus 8.5%), with the biggest individual difference seen in the 10th Grade, where it was 3 times higher for female students. There were also some significant differences across states. Mississippi showed the lowest rate of electronic bullying, at 11.9%; Maine was the highest, at 20.6%.

Female students were also far more likely to report being bullied in person on school property than male students (23.7% versus 15.6%). Montana had the highest overall rate in the nation, at 26.3%; Florida had the lowest, at 15.7%.

A study published in the British Medical Journal in 2015 provided further evidence for the fact that bullying actually has serious and long-lasting effects on victims, including a twofold increase in the odds of developing depression.

Fifteen percent of the 13-year-olds in the study who said they were frequently bullied reported being depressed five years later. Researcher Lucy Bowes commented: “This means that the more frequent the peer victimization, the greater the likelihood was that a child went on to develop depression at 18 years. With this type of study, we can never be certain about causality, but we believe our findings provide strong evidence that being bullied may lead to depression, with more frequent victimization increasing the odds of severe and persistent depression.”

Another form of peer victimization known to lead to depression is sexual and dating violence, and the CDC data allow us to quantify both.

Sexual and Dating Violence Among High Schoolers

The CDC defines sexual dating violence as being touched, kissed, or physically forced to have sex against your will by someone you are dating. Of the 73.9% of 9th- to 12th-grade students nationwide who dated someone during the 12 months before they were surveyed, 10.4% reported sexual dating violence. Female students reported the behavior at more than twice the rate of male students (14.4% versus 6.2%). Among races, Asian students had the highest rate of sexual dating violence. This percentage was nearly double the rate of black students (8.9%). At the state-level, Kansas had the lowest rate, at 7.8%; Hawaii had the highest, at 13.8%.

Physical dating violence – which is defined as being hit, slammed into something, or injured with an object by someone you are dating – was reported by almost the same percentage of students as sexual dating violence: 10.3%. White students had the lowest incidence of physical dating violence (as well as forced sexual intercourse), at 9.7%; Students of mixed race had the highest, at 11.8%. The state-level incidence rate of physical dating violence ranged from 7% in Utah to more than double that in Louisiana, at 14.8%.

These figures are important because sexual dating violence and physical dating violence in adulthood often have their roots in teenage years: a 2011 CDC survey found that “23% of females and 14% of males who ever experienced rape, physical violence, or stalking by an intimate partner, first experienced some form of partner violence between 11 and 17 years of age.”

A young person’s experiences in high school really can shape his or her future. During our research, we came across some additional data to illustrate this point, which are represented in the chart below.

Comparing Suicide Rates Throughout the Year

This chart is based on suicide data collected from 1980 to 2004, published in the Economics of Education Review in 2011. It compares the suicide rate of 14- to 18-year-olds (high schoolers) with 19- to 25-year-olds by the month of the year in which they killed themselves. The big result is that suicides among high schoolers are significantly lower in the summer (when they aren’t at school) than during the academic year.

The researchers who conducted the study factored out seasonal affective disorder (i.e. depression related to changes in the season) as the cause of the difference. Instead, they concluded that the most likely explanations are increased school-year stress, as well as the fact that students face a larger number of negative social interactions during the school year, especially with people they wouldn’t otherwise choose to be around, compared with during summer vacation.

The authors of the study point out that their findings are not meant to take away from the obvious benefits of schooling, but instead contribute to the debate over the length of the school year, which has grown longer in recent years. And a longer year may mean more negative social interactions for students.

To get a clear picture of mental health issues among adolescents, we examined the reasons they gave for seeking treatment.

Reasons Behind Mental Health Treatment

In 2014, approximately 70,000 randomly selected individuals across the United States were surveyed on their drug use and mental health; 38.1% of respondents who experienced a major depressive episode said they had received treatment for depression in the past 12 months. We filtered them down to only those aged 12 to 17 and ranked the reasons they received their most recent mental health treatment.

The table above, which includes 12 non-mutually exclusive categories, shows that feeling depressed is the most common reason adolescents receive mental health treatment; female students are 1.5 times more likely than males to select this reason, followed by suicidal thoughts, and then feeling afraid or tense. Female students are more likely than male students to select 10 of the 12 reasons, the exceptions being “broke rules and acted out” and “had trouble controlling anger.”

The reasons most biased toward female students are “had problems with friends” and “eating problems.”

Arguably, the simplest way to quickly assess how happy a person is at any given time is to ask them if they enjoy life. The University of Michigan includes this question on its yearly survey Monitoring the Future (MTF), alongside dozens of other questions on topics like drugs, social life, education, and interpersonal relationships. We used the “I enjoy life” question as a control in nine other behavioral comparisons to see how those who answered “yes” differed from those who said “no.”

Comparing Various Behaviors With Enjoyment of Life

Asking 8th- and 10th-graders if they “enjoy life as much as anyone else” isn’t a strict measurement of their mental health or depressive tendencies; however, it was enough to highlight some significant behavioral differences between those who said they did enjoy life and those who said they did not.

For instance, 4.3% of 8th- and 10th-graders who agreed that they enjoyed life ran away from home at least once in the past 12 months. That figure was nearly four times higher for those who disagreed with the statement.

The “disagree” group was also more than twice as likely to have stolen something worth $50 or more in the past year and 2.5 times as likely to say they expected to start smoking in the next 12 months. Additionally, their sleep quality, exercise routine, and daily fruit and vegetable consumption was comparatively different than that of the “agree” group.

Some of these differences echo existing findings. Through an analysis of 10,000 adolescents aged 16 to 18, researchers at the University of California, Berkeley concluded that “… the less adolescents sleep due to sleeping problems, the higher their risk of becoming depressed.” Running away from home is also a well-known symptom of teen depression and considered a strong warning sign that a young person is depressed or suicidal.

We’ve seen how many teenagers feel depressed, what proportion of them consider suicide, and what number tragically take their own lives. The final question is how many receive treatment for their mental health issues?

Mental Health Treatments Among Genders and Races

Data from the Behavioral Health Barometer 2015 show that the majority of 12- to 17-year-olds who suffered a major depressive episode in 2014 did not receive any treatment for their problem. There was no statistically significant difference between the rate at which male and female youths received treatment, but there were differences between races.

White youths were most likely to receive treatment (46.1%), followed by black youths (40.6%), and then Hispanic youths (33.1%). Across both genders and all races, 41.2% of adolescents aged 12 to 17 with a past-year major depressive episode (1.1 million in total) received treatment for their depression.

Conclusion

We’ve seen that each year more than 2.5 million young people between the ages of 12 and 17 have a major depressive episode in which they feel depressed for two or more weeks in a row. The potential outcomes of these periods of sadness and anxiety range from severe impairment to daily activities, to the tragedy of teen suicide. But the statistics also highlight opportunities to make a change, because out of five teen suicides, four are preceded by threats to harm oneself, and in up to half of cases, there is evidence of a prior attempt. Understanding the warning signs of teen depression, many of which we’ve seen above, and being ready to take action in the form of counseling, treatment, or medication, can therefore make all the difference.

If you are suffering from depression and would like to speak to someone who will listen to how you feel without lecturing you, and offer you support options to suit your situation, call at any time.

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Young and Numb: What the Latest Data Reveal About Teen Mental Health