Teen Mental Health and 988: What Published Guidance Supports

Key takeaways

• Persistent sadness or hopelessness: about 4 in 10 high school students, per CDC survey data
• Seriously considered suicide in the past year: about 1 in 5 high school students
• Most useful single change: Ask directly and calmly how your teen is feeling, and listen without rushing to fix things.
• Commonest mistake: Dismissing changes in mood or behavior as "just a phase".
• See a doctor if any of the signs under "When to speak to a doctor" below apply to you.

What it is

Emotional well-being in the teen years, and how to get help, including through the 988 Suicide & Crisis Lifeline. It sits within Teen Health. What follows are the published numbers, not the ones that get passed around.

The numbers, in one place

What helps

The advice below comes straight from the guidance cited at the foot of this page.

• Ask directly and calmly how your teen is feeling, and listen without rushing to fix things
• Ask about mental health at the yearly checkup; the doctor can screen and refer to a therapist
• Encourage regular sleep, activity and time with supportive friends and adults
• Store firearms locked and unloaded, with ammunition locked separately, and lock up medicines
• Save 988 in your phone and your teen's phone

What to avoid

A few of these are widely believed. That is precisely why they are here.

• Dismissing changes in mood or behavior as "just a phase"
• Promising to keep thoughts of suicide a secret
• Waiting for a crisis before reaching out for help

In depth

Adolescence is a period of rapid brain development, especially in areas that handle emotions, rewards and social relationships. The parts of the brain responsible for planning and impulse control mature later, into the mid-twenties. This mismatch helps explain why teens feel emotions intensely and are highly sensitive to peer acceptance. Most mental health conditions that last into adulthood first appear in childhood or the teen years, which makes this a crucial time to notice problems and get help.

Depression in teens does not always look like sadness. It can show up as irritability, anger, withdrawal from family, loss of interest in activities, physical complaints such as headaches, or falling grades. Anxiety may appear as constant worry, avoidance of school or social situations, panic attacks or trouble sleeping. Eating disorders, self-harm, substance use and ADHD are other common concerns, and many teens have more than one condition at the same time.

Getting help early matters, and effective treatments exist. Talking therapies, sometimes combined with medicine, help most teens with depression and anxiety. The 988 Suicide & Crisis Lifeline, available by call, text or chat at any hour, connects people in emotional distress or suicidal crisis to trained counselors. It is for teens themselves and for worried parents, friends and others who want advice about how to help someone.

Signs and symptoms

• Persistent sadness, irritability or hopelessness lasting two weeks or more
• Pulling away from friends, family or activities they used to enjoy
• Big changes in sleep, appetite or weight
• Falling grades, missing school or trouble concentrating
• Talking or posting about death, hopelessness or being a burden
• Self-harm such as cutting, or giving away belongings
• Increased use of alcohol, cannabis or other drugs

Causes and risk factors

• Family history of mental health conditions
• Bullying, including online, and social isolation
• Trauma, abuse, loss or major family stress
• Academic and social pressure
• Chronic illness, disability or ongoing pain
• Discrimination, including based on race, sexual orientation or gender identity
• Substance use and poor sleep

How it is checked

The USPSTF recommends screening for major depression in teens aged 12 to 18, which is often done at yearly checkups using a short questionnaire adapted for adolescents. Doctors also ask about anxiety, substance use, safety at home and school, and suicidal thoughts. Teens are usually given time to speak with the doctor alone, which helps them be more open; confidentiality is explained, including when safety concerns must be shared.

If screening suggests a problem, the doctor will ask more detailed questions, check for medical causes such as thyroid problems or anemia, and may refer to a mental health professional, such as a psychologist, psychiatrist, licensed counselor or clinical social worker, for full assessment. Schools may also offer counseling and can arrange support for learning.

Treatment and support options

Talking therapies

Cognitive behavioral therapy helps teens recognize and change unhelpful thought patterns and behaviors, and is effective for depression and anxiety. Interpersonal therapy focuses on relationships and conflicts. Dialectical behavior therapy teaches skills for managing intense emotions and is often used for self-harm. Family involvement is commonly part of treatment and can improve communication and support at home.

Medicine

For moderate to severe depression or anxiety, or when therapy alone is not enough, a doctor may suggest an antidepressant, often alongside therapy. The FDA requires a warning that antidepressants may increase suicidal thoughts in some young people, especially in the first weeks, so close follow-up is important. Families should report any worsening mood, agitation or new suicidal thoughts right away.

Safety planning

For teens with suicidal thoughts, a written safety plan, made with a clinician, lists warning signs, coping strategies, people to contact, professional supports and steps to make the environment safer. Reducing access to firearms, medicines and other means is one of the most effective ways to prevent suicide, because suicidal crises are often brief.

Crisis support through 988

Calling or texting 988, or chatting online, connects to a trained crisis counselor who listens, helps the person through the moment and connects them to local services when needed. Most contacts are resolved without emergency services. If someone is in immediate danger, has made an attempt or is seriously injured, call 911.

Prevention

• Have regular, low-pressure check-ins, such as during car rides or meals
• Protect sleep and encourage physical activity and time outdoors
• Help teens build connections with trusted adults beyond parents
• Model healthy ways of handling stress and asking for help
• Learn the warning signs of suicide and how to respond

Day to day

Supporting a teen with a mental health condition can be exhausting and worrying. It helps to remember that recovery is rarely a straight line; good weeks and hard weeks are normal. Focus on keeping communication open, helping your teen stick with treatment and maintaining routines such as sleep, meals and school as much as possible. Work with the school on accommodations if needed, such as extra time or a quiet place to go.

Parents and caregivers need support too. Talking with your own doctor, joining a family support group or getting counseling can help you cope. Siblings may also feel affected and benefit from attention and honest, age-appropriate explanations. If you are ever unsure whether a situation is a crisis, you can call or text 988 for guidance yourself.

For specific groups

LGBTQ+ teens

LGBTQ+ youth report higher rates of depression and suicidal thoughts, largely linked to stigma, rejection and bullying rather than their identity itself. Family acceptance and supportive schools are strongly protective. Affirming mental health care is available.

Teens with chronic illness

Living with conditions such as diabetes, asthma or chronic pain raises the risk of depression and anxiety. Mental health care can be integrated into their medical care, and treating mood can also help them manage their physical condition.

Teens who have experienced trauma

Abuse, violence, loss or other traumatic events can lead to post-traumatic stress, depression or behavior changes. Trauma-focused therapies are effective, and a doctor can help connect families to them.

Questions to ask your doctor

• Do my teen's symptoms suggest depression, anxiety or something else?
• Can you recommend a therapist, and what type of therapy would help most?
• Would medicine be helpful, and what should we watch for if it is started?
• How do we create a safety plan at home?
• What will you share with me from my teen's confidential conversations?
• What school supports should we ask for?

More questions, answered

Will asking about suicide put the idea in my teen's head?

No. Research shows that asking directly about suicidal thoughts does not increase risk, and it often brings relief and opens the door to help. Ask calmly and clearly, listen, and get help if the answer is yes.

What happens when someone calls 988?

A trained counselor answers, listens, asks about safety and helps the caller cope with the immediate situation. They can share resources and connect people to local crisis services. 988 is free and confidential, and most calls are resolved without police or emergency services.

How can I tell normal moodiness from depression?

Ordinary teen moods come and go and do not stop teens from functioning. Depression lasts most days for two weeks or more and affects school, friendships, sleep or interest in activities. If you are unsure, ask your teen's doctor for a screening.

Can a teen get mental health care without a parent?

Rules on consent and confidentiality for minors vary by state. In many states, teens can access some counseling on their own, and doctors try to protect a teen's privacy while involving parents when safety requires it. Ask the doctor or counselor how it works where you live.

Does insurance cover teen mental health care?

Most health plans, including Medicaid and CHIP, cover mental health services, and federal parity laws require many plans to cover them comparably to physical health care. Check your plan for in-network providers, and ask your teen's doctor or school for referrals.

What if my teen refuses help?

Keep talking, without forcing the issue, and let them know help is available whenever they are ready. You can seek advice from their doctor, a school counselor or 988 yourself. If there is any immediate danger, call 911.

Related topics

• The Evidence on Men and Mental Health, Without the Hype (Men's Health)
• What the Guidance Really Says About Child Mental Health (Children's Health)
• Supporting Someone Else: What the Evidence Actually Says (Mental Health)
• Loneliness and Aging: Sorting the Evidence From the Noise (Healthy Aging)

Where to go next

• The First Steps With Teen Mental Health and 988
• Answers to the Common Questions on Teen Mental Health and 988
• Teen Mental Health and 988 — the reference entry
• Teen Health: The Complete Guide
• Social Media and Teens: What the Evidence Actually Says
• Puberty: What Published Guidance Supports

When to speak to a doctor

See your doctor if a teen has low mood, anxiety, withdrawal, changes in eating or sleep, falling grades or self-harm that lasts two weeks or more. Call or text 988 for thoughts of suicide or emotional crisis, and call 911 if someone is in immediate danger, has taken an overdose or is injured.

Where this comes from

• CDC — Youth Risk Behavior Survey Data Summary & Trends
• US Preventive Services Task Force — Depression and Suicide Risk in Children and Adolescents: Screening
• 988 Suicide & Crisis Lifeline — Get Help

How this page was put together

Every figure, recommendation and warning above is taken from the guidance named in Where this comes from. Nothing on this page is inferred, summarized or generalized beyond what those bodies publish: where they give a number, it is their number, and where they are silent, so are we. Pages are rebuilt whenever the underlying record changes. Sign-off by a named clinician, where it has happened, is shown at the top of the page along with the date.

Medical disclaimer

This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to your doctor, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 911.