Page 7 - Mecklenburg_Medicine_September-2019

Feature
The Kids Are Not Alright
By Gordon Hull, Director, Center for Professional and Applied Ethics, Associate Professor Philosophy
and Public Policy, UNC Charlotte
I t is undoubtedly some sort of discouraging sign of the times that
the mental health of our children does not make daily headlines.
The research is alarming. One study1 found that from 2007 to
2015, the number of ER visits by children for either attempted
or ideational suicide doubled, with children ages 5-11 comprising
the largest subgroup. Another 2 noted a 28 percent overall increase
in psychiatric ER visits by youth between 2011 and 2015, with a 54
percent rise among adolescents. African-American and Hispanic
patients saw much sharper rises. Suicide-related visits more than
doubled during the period,
Should we blame and less than 1 in 6 of all of
screens? I’m a parent; these patients saw a mental
health professional during
I know that the rise the visit, despite its being
of screens is really
for psychiatric reasons. Yet,
another survey3 of more
important to childhood than 500,000 individuals
now in a way that concluded that rates of
major depressive episode
it wasn’t even 10 increased by more than 50
years ago. percent in both adolescents
(ages 12-17) and young
adults (ages 18-25). jamapediatrics.2019.0464.
The final survey, by Jean
Twenge et al., is of interest because it discovers both a cohort effect and
speculates about causality. For cohort, they note that Baby Boomers,
Millennials and iGen (born in the 1990s) had significantly higher rates
than those in between, and find that the data “suggest that cultural trends
in the last 10 years may have had a larger effect on mood disorders and
suicide-related outcomes among younger people compared to older
people.” Particularly vulnerable seem to be upper-income white women
and girls. What’s going on here? A huge increase happened from
2011 to 2017, and the economy was strong then. Alcohol and drug use
was mostly unchanged from earlier periods. Opioids are an unlikely
explanation because its victims tend to be older, and self-reporting also is
unlikely because of the strength of the cohort effect.
Twenge et al. speculate that a significant cause is electronic media: It
is during the study period that both electronic media use rose and the
cohort in question experienced a spike in mental health issues. They
also cite a number of studies suggesting a correlation between screen
time and depression, and other disorders. Should we blame screens?
I’m a parent; I know that the rise of screens is really important to
childhood now in a way that it wasn’t even 10 years ago.
As an academic discipline, Science and Technology Studies teaches
that the meaning of the use of a technology can only be understood in
specific social contexts. Failing to look at contexts risks blaming the
technology or adopting a determinism in which the technology has
all the agency. It seems to me that’s a risk here. First, as Twenge et al.
acknowledge, kids also use social media for social support. There’s a
long-running debate on whether or not Facebook use makes individuals
lonely. The empirical literature on these points is mixed. Second, screens
already were prevalent by 2010. According to Pew,4 at the end of 2009,
78 percent of 18- to 29-year-olds reported social media use. By January
2018, it was 88 percent. That’s an increase, but not a huge one. The
much more dramatic rise5 is in smartphone use, and young adults, lower
income and non-white users were more likely to rely on their phones for
broadband Internet. In short, there is a lot of context-specific information
to tease out here, including what kinds of screens are used by whom.
Third, schools wholeheartedly embraced technology during
this time. High schoolers tote Chromebooks and do a lot of
their work online now, and anxious checking of PowerSchool is
normal. Homework culture is deeply entrenched6 in upper-middle
class high schools, and teens report both very high workloads and
decreased interactions with family and friends — the exact things
screens are supposed to take away, and in the same more affluent
demographic. More generally, even though there has been economic
growth, it is widely acknowledged to be uneven, and teens report high
levels of anxiety about economic precarity, college admissions and
costs, and so forth. In other words, there are larger sociological forces at
play, and these interact with the adoption of screens.
None of this is to dismiss the real concern about kids and screens. It is
to emphatically point to the alarming rise in mental health issues among
young people, and to urge caution in interpreting how we got here.
Reference:
1“Suicidal Attempts and Ideation Among Children and Adolescents
in US Emergency Departments, 2007-2015;” Brett Burstein, MDCM,
PhD, MPH; Holly Agostino, MDCM; Brian Greenfield, MD; Author
Affiliations; JAMA Pediatr. 2019;173(6):598-600. doi:10.1001/
2“Trends in Psychiatric Emergency Department Visits Among
Youth and Young Adults in the US;” Luther G. Kalb, Emma K. Stapp,
Elizabeth D. Ballard, Calliope Holingue, Amy Keefer, Anne Riley;
American Academy of Pediatrics, 2019.
3“Age, Period, and Cohort Trends in Mood Disorder Indicators and
Suicide-Related Outcomes in a Nationally Representative Dataset,
2005–2017;” Jean M. Twenge, A. Bell Cooper, Thomas E. Joiner, Mary
E. Duffy, Sarah G. Binau. Journal of Abnormal Psychology, 2019; DOI:
10.1037/abn0000410.
4Social Media Fact Sheet, PEW Research Center; www.pewinternet.
org/fact-sheet/social-media/.
5Mobile Fact Sheet, PEW Research Center; www.pewinternet.org/
fact-sheet/mobile/.
6“Nonacademic Effects of Homework in Privileged, High-Performing
High Schools;” Mollie Galloway, Jerusha Conner, Denise Pope; The
Journal of Experimental Education Vol. 81, 2014, Issue 4.
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