Marblehead Cares: Behavioral health challenges in adolescents and the role of hope

The month of May has been designated as Mental Health Awareness Month.  The goals for the month and throughout the year are to fight stigma, provide support, educate the public and advocate for policies that support the millions of people in the United States affected by mental illness.

The statistics speak for themselves:

— 1 in 5 youths struggle with a mental health illness.

— According to health insurance data from 41 million health records released by Blue    Cross and Blue Shield (2020), “Major depression is on the rise among Americans from all age groups but is rising fastest among teens and young adults.”

— 75%-80% of children and youth in need of mental health services do not receive them.

— According to a recent report from the Centers for Disease Control and Prevention (CDC) mental health among high school teens is worsening.

— Between 2019 and 2021, the percentage of high school teens experiencing persistent feelings of hopelessness and sadness increased from 37% to 42%, continuing a decade-long trend of declining mental health among young people.

—2021 CDC data shows a stark disparity in mental health for teenage girls and LGBQ+ students. Fifty-seven percent of female students and 69% of LGBQ+ students experienced persistent sadness or hopelessness. About 13% of female students and more than 20% of LGBQ+ students in 2021 had attempted suicide in the past year.

The top two mental health issues experienced by adolescents are anxiety and depression. Symptoms of anxiety include pounding or rapid heartbeat, shortness of breath, dizziness, sweating, numbness, and nausea. Symptoms of depression include sadness, hopelessness, loss of interest in hobbies/activities, low energy, lack of focus/concentration, appetite, or weight change.

We know that adolescence is a critical period of growth and transformation, characterized by physical, emotional, and cognitive changes. Teenagers encounter various challenges, including academic pressures, social expectations, identity formation, and peer influences. These challenges can impact their well-being and outlook on life.
Understanding the concept of hope and its role in the lives of teenagers is crucial for promoting their resilience and positive development. Hope is defined as “the belief that your future will be better than today and you have the power to make it so.” Hope is positively correlated with self-esteem, optimism, and life satisfaction. A lack of hope, or hopelessness, positively correlates with suicidality and suicide ideation. With suicide being the second-leading cause of death in adolescents, hope is incredibly relevant to adolescents’ lives.

Hope is more like a muscle than an emotion. It’s a cognitive skill, one that helps people reject the status quo and visualize a better way. If it were an equation, it would look something like: hope = goals + pathways/road map + agency/willpower.

Pathways refer to the ability to identify routes toward goals and to find new routes (problem-solve) around obstacles if necessary. Agency (willpower) is the ability to sustain motivation to move along these pathways.

Hope is a future-oriented pattern of thinking that involves the abilities to (a) set clear and challenging “stretch goals,” (b) develop the strategies or pathways to those goals, and (c) muster the necessary motivation to use those pathways to pursue objectives. All three hope components are necessary in order to successfully attain goals.

Research has demonstrated that promoting hope in adolescents is important for the following reasons:

— High-hope compared to low-hope adolescents are better able to cope with their failure experiences.

— When low-hope adolescents fail to achieve goals, they typically cannot create alternate pathways to go around obstacles.

— Adolescents with low hope are prone to give up, criticize their own abilities, and experience strong negative emotions.

— When adolescents with high hope fail to attain goals, they simply acknowledge that they did not try hard enough or that they did not have access to the most useful pathways.

— Instead of becoming stuck criticizing themselves, high-hope adolescents get busy finding solutions.

— High-hope compared to low-hope adolescents achieve superior outcomes across a range of performance and mental health indices.

— Having hope is vital for the successful transition from adolescence to satisfying adult roles.

The good news is – Hope can be taught! Follow these steps:

  • Introduce the concept of hope and discuss it with your adolescents. For a list of hopefulness questions for children ages 8 to 16 track down the Children’s Hope Scale, and for adolescents/adults 16+ search for the Adult Hope Scale.
  • Discuss and identify your child’s goals. If they struggle to articulate their goals help them develop personally relevant goals. Think SMART goals: specific, measurable, achievable, realistic, and time-bound.
  • Remember to start with doable goals. Frame goals to facilitate success. Achieving a goal is motivating and sets the course for continued goal achievement.
  • List and discuss potential pathways toward goal achievement.
  • Have your child identify/describe their sources of motivation to achieve their goals.
  • Identify and list obstacles they believe might get in their way & problem-solve solutions to these obstacles.
  • Create a visual map so that your child can see his/her goals on paper.
  • Remember to discuss “Plan B.” We always have the ability to re-goal.

A greater sense of hope is associated with better physical health and behavioral health outcomes on indicators such as fewer chronic conditions, lower risk of cancer, fewer sleep problems, and higher psychological well-being such as increased positive affect, life satisfaction, purpose in life, lower psychological distress, and better social well-being.By understanding the role of hope and how to promote hope in teenage development, you can effectively support and empower adolescents in navigating the challenges they face and assist in cultivating their positive futures.

Marblehead Cares is a monthly column written by the Marblehead Mental Health Task Force.

Mark Libon, Ph.D., LMHC, LMFT, LADC1
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Melissa Kaplowitch, Ph.D., LMHC
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