group of high school teens standing and smiling

The Youth Risk Behavior Survey: Mental Health Among High School Students (2023)

Every two years, the Centers for Disease Control (CDC) publishes a report called the Youth Risk Behavior Survey (YRBS) which, among other things, asks questions about the current mental health status of high school students. Researchers collect data with the well-established the Youth Risk Behavior Surveillance System (YRBSS). The YRBSS records, analyzes, and catalogues information on risky behavior among youth and young adults. The goal of the surveillance system is to understand the prevalence and frequency of behaviors that threaten the health and wellbeing of youth, adolescents, and young adults.

The YRBSS monitors the following categories:

  • Behaviors that can cause injury
  • Violent behavior or behavior that can lead to violence
  • Behavior related to sexual activity
  • Use of substances, including alcohol, drugs, and tobacco
  • Mental health, including depressive symptoms and suicidality

The information the YRBSS collects helps everyone involved in the lives of youth, adolescents, and young adults understand the risks they face and the behaviors they engage in that either increase or reduce risk.

For the 2023 Youth Risk Behavior Survey (2023 YRBS), published in March 2023, researchers received completed surveys from over 13,000 high school students around the country. The 2023 YRBS includes something unique for the YRBS: an analysis of trends in adolescent mental health over ten years, from 2011 to 2021.

Ten-Year Trends in Mental Health Among High School Students: 2011-2021

To determine rates of mental health issues and suicidality, YRBS researchers asked questions related to the following topics/feelings/behaviors:

  • Feelings of sadness or hopelessness
    • These questions serve as a non-intimidating way to gauge prevalence and frequency of depressive symptoms
    • Researchers worded questions carefully to avoid any stigma or self-consciousness among respondents
  • Self-perception of overall mental health:
    • Poor, average, good
  • Suicidal ideation
  • Suicide plans
  • Suicide attempts

We know why this information is important to us and to our patients: it allows us to provide better treatment so they can heal and grow. Treatment is essential for adolescents – or anyone – diagnosed with a clinical mental health disorder. In the words of the study authors:

“Poor mental health is associated with a host of health risks, both during adolescence and into adulthood, while suicidality not only places the life of the adolescent at risk but is also a marker for experience with trauma and other mental health issues.”

Poor mental health also causes severe disruption in the lives of people diagnosed with a clinical mental health disorder. It can impair relationships, inhibit academic achievement, and reduce overall wellbeing and life satisfaction.

The 2023 YRBS: Mental Health Among High School Students

Persistent Feelings of Sadness or Hopelessness During the Past Year
  • By Year:
    • 2011: 28.5%
    • 2013: 29.9%
    • 2015: 29.9%
    • 2017: 31.5%
    • 2019: 36%
    • 2021: 42%
  • By Sex:
    • Total: 42%
    • Male: 29%
    • Female: 57%
  • By race/ethnicity:
    • American Indian or Alaska Native: 40%
    • Asian: 35%
    • Black: 39%
    • Hispanic: 46%
    • Native Hawaiian or Pacific Islander: 39%
    • White: 41%
    • Multiracial: 49%
  • By Sexual identity*:
    • Heterosexual: 35%
    • LGBQ+: 69%
*The 2023 YRBS did not include survey questions on trans identity, but only lesbian, gay, bisexual, and questioning identities*

This data explains why, over the past several years, we see articles with headlines declaring our teenagers are in the midst of a genuine mental health crisis, and it has accelerated over the past five years in particular. Between 2011 and 2017, rates of feeling sad and hopeless increased by 10 percent, while rates of feeling and hopeless increased 10 percent between 2017 and 2021. In addition, we should note the striking disparity between males and females: in 2021, females reported feeling sad and hopeless at almost double the rate of males. That’s significant – and cause for alarm. Also, LGBQ+ high school students reported feeling sad and hopeless at twice the rate of their heterosexual peers. That’s significant, as well, and cause for alarm: we now know we need to offer additional support and care to both girls and LGBQ+ high school students.

It’s valuable to understand the raw numbers attached to these percentages, too. There are roughly 25 million people between ages 13-18 in the U.S. Therefore, when we do the math on the top-level number – 42 percent of teens report feelings of sadness or hopelessness – we learn that around 10.5 million teens reported feeling sad and hopeless, and around 1.4 million LGBQ+ teens reported feeling sad and hopeless during 2021. That’s something we can work to improve for these specific demographic groups, and for all teenagers.

The 2023 YRBS: Mental Health Among High School Students (Continued)

Poor Mental Health in the Past Year (Ten-year trend data not available)
  • By Sex:
    • Total: 29%
    • Male: 18%
    • Female: 41%
  • By race/ethnicity:
    • American Indian or Alaska Native: 31%
    • Asian: 23%
    • Black: 26%
    • Hispanic: 30%
    • Native Hawaiian or Pacific Islander: 20%
    • White: 30%
    • Multiracial: 33%
  • By Sexual identity:
    • Heterosexual: 22%
    • LGBQ+: 52%

Here again we see significant differences between females and males, differences between LGBQ+ students and heterosexual students, and significant differences between both groups and the national average. Girls reported poor mental health at over twice the rate of boys, and almost twice the national average. LGBQ+ students reported poor mental health at almost two and half times the rate of their heterosexual peers. This reaffirms what we observe above: we need to prioritize mental health support for adolescent girls and LGBQ+ adolescents.

In terms of real numbers – as we reported for the last data set – these prevalence rates tell us that close to ten million teen females reported poor mental health, and close to a million LGBQ+ teens reported poor mental health in 2021. With regards to mental health among high school students, there are two groups we need to focus on, without reducing our attention to others: female and LGBQ+ teens.

Seriously Considered Attempting Suicide in the Past Year

  • By Year:
    • 2011: 17%
    • 2013: 17.7%
    • 2015: 17.2%
    • 2017: 17.6%
    • 2019: 18.8%
    • 2021: 22%
  • By Sex:
    • Total: 22%
    • Male: 14%
    • Female: 30%
  • By race/ethnicity:
    • American Indian or Alaska Native: 27%
    • Asian: 18%
    • Black: 22%
    • Hispanic: 22%
    • Native Hawaiian or Pacific Islander: 21%
    • White: 23%
    • Multiracial: 24%
  • By Sexual identity:
    • Heterosexual: 15%
    • LGBQ+: 45%

There’s a distinct theme emerging from these data sets: females and LGBQ+ teens report higher rates in virtually every metric we examine. Between 2011 and 2021, the overall rates for seriously considering suicide increased 22 percent, with the national rate in 2021 at 22 percent. That’s around 5.5 million teens, total. However, the rate among females is twice the rate for males, and the rate for LGBQ+ teens is three times the rate for their heterosexual peers. In raw numbers, that works out to around 3.75 million females and close to a million LGBQ+ teens who seriously considered suicide in 2021.

Made a Suicide Plan in the Past Year

  • By Year:
    • 2011: 13.6%
    • 2013: 14.6%
    • 2015: 13.6%
    • 2017: 15.7%
    • 2019: 15.7%
    • 2021: 18%
  • By Sex:
    • Total: 18%
    • Male: 12%
    • Female: 24%
  • By race/ethnicity:
    • American Indian or Alaska Native: 22%
    • Asian: 17%
    • Black: 18%
    • Hispanic: 19%
    • Native Hawaiian or Pacific Islander: 20%
    • White: 17%
    • Multiracial: 20%
  • By Sexual identity:
    • Heterosexual: 12%
    • LGBQ+: 37%

We’ll discuss these figures alongside our discussion of the next data set, because the trend we see is consistent, and persists across the next data set as well.

Attempted Suicide in the Past Year

  • By Year:
    • 2011: 8%
    • 2013: 8.6%
    • 2015: 7.4%
    • 2017: 8.9%
    • 2019: 8.9%
    • 2021: 10%
  • By Sex:
    • Total: 10%
    • Male: 7%
    • Female: 13%
  • By race/ethnicity:
    • American Indian or Alaska Native: 16%
    • Asian: 6%
    • Black: 14%
    • Hispanic: 11%
    • Native Hawaiian or Pacific Islander: 10%
    • White: 9%
    • Multiracial: 12%
  • By Sexual identity:
    • Heterosexual: 6%
    • LGBQ+: 22%

These figures confirm the trend we identified above: females and LGBQ+ teens are in a genuine mental health crisis. The rates at which females made a plan to commit suicide and attempted suicide are both twice the rate of males, and significantly greater than the national average. The figures for LGBQ+ teens are even more striking: compared to their heterosexual peers, LGBQ+ teens made a plan to commit suicide and attempted suicide at three times the rate of their heterosexual peers. That makes our mission clear: when an adolescent female asks for support, or a LGBQ+ adolescent asks for support, we need to listen to their needs and offer them the most effective, comprehensive, evidence-based treatment we can.

How Can We Use This Information to Help Teens?

Across almost all measures, females and LGBQ+ adolescents report problems at higher rates than males, including:

  • Mental health:
    • Feeling sad and hopeless
  • Suicidal thoughts and behaviors:
    • Making a suicide plan
    • Attempting suicide

These differences are not small: they’re genuine cause for alarm. That leads us to a critical question: what factors may protect students – and females in particular – from the negative trends reported in all the areas above?

The editors of the YRBS indicate two primary protective factors that can help youth thrive on mental, physical, psychological and emotional levels: feeling connected to peers and teachers at school and parental monitoring. In data from the YRBS we did not share above, both females and LGBQ+ teens reported feeling less connected to peers and teacher at school than their heterosexual peers. That means we need to help them feel more connected to at school, which can improve their overall mental wellness, and reduce the high rates of negative mental health we report above.

In order to help all our teens – include those most at risk – the authors of the 2023 YRBS identify the following three key strategies to improve overall health and wellbeing for young people.

Youth in 2023: Three Ways to Improve Adolescent Health and Wellbeing

  1. Foster school connectedness. This is essential for LGBQ+ students and female students who report feeling the least connected to peers and teachers at school. To improve school connectedness, schools can:
    • Begin social and emotional learning (SEL) in grade school and middle school
    • Train teachers in effective, evidence-based SEL models
    • Train teachers in effective, evidence-based classroom management strategies
    • Increase inclusivity for LGBTQIA+ youth
    • Increase inclusivity for BIPOC youth
  2. Improve access to school based social services, and improve efforts to connect families to community-based services. To do this, schools can:
    • Provide behavioral and mental health support directly
    • Connect students and families to local resources for behavioral and mental health support
    • Train staff and students about how to access on-site support or support services in the community
  3. Improve general health education at all grade levels. Health education for students should be:
    • Grounded in science
    • Medically accurateDevelopmentally appropriate
    • Culturally sensitive
    • LGBTQIA+ inclusive

We can all support the move toward taking these concrete action steps, whether we work in schools or not. As parents and members of the community, we can advocate for the inclusion of all the programs above in school curriculum, starting as early as possible. We know that children who learn to talk openly and honestly about their feelings and emotions increase their chances at achieving optimal mental health as adolescents and adults.

The Role of Parents

With regards to the second protective factor for youth mental health – parental monitoring – we offer this practical advice for parents: avoid the impulse to manage every moment of every day, but make a real effort to know where your teen is, what they’re doing, and who they’re doing it with at all times. That way, if problems arise, you know where to look. It’s a delicate balance, but it’s important. Your teen needs the freedom to become themselves, and parents need to know what’s going on in their lives so they can help them avoid the pitfalls and missteps common in adolescence and become the best possible version of themselves.

How to Find Support: Online Resources for Families

To find help, call or email us here at BACA, or consult one of these online resources: