The past twenty-five years have witnessed two dramatic changes in adolescent mental health in the United States.The first, a dramatic decrease in a wide range of adolescent externalizing behaviors, has been fortuitous. Rates of adolescent rule- and norm-breaking behaviors have plummeted, and not just by a little. Rates of teen pregnancy, for example, have declined by over 75% (MaddowZimet & Kost, 2021), and rates of alcohol abuse by more than 50% (National Institute on alcohol abuse and alcoholism, 2023). Juvenile arrest rates have declined by over 70% (OJJDP, 2024). Notably, these improvements occurred in spite of considerable social upheaval across this period, including the terror attacks of 9/ 11, multiple school shootings, the wars in Iraq and Afghanistan, and the Great Recession. They are a testament to Cicchetti’s(2016) description of the construct of resilience, and should debunk the notion that “things are worse than they’ve ever been.”
At the same time, a countervailing trend makes clear that all is not well. In the ten years leading up to the onset of Covid, youth rates of depression soared by over 60% (Keyes et al., 2019). This appears to reflect much more than just increased willingness to acknowledge depressive symptoms, as rates of admissions to hospital emergency departments following suicide attempts have gone up by similar levels(Kalbetal., 2019). Data are still coming in, but all evidence suggests the Covid pandemic has only increased these rates (Barendse et al., 2023). Anxiety disorders are not as precisely tracked, but evidence suggests these have skyrocketed as well (Twenge et al., 2022). Looking at youth social development more globally we see that overall life satisfaction levels among juveniles have also fallen precipitously (Marquez & Long, 2021).
The critical importance of peer connections
One of the biggest keys to understanding the changing nature of adolescent psychopathology may be recognizing both the central role of peer relationships in adolescent development as well as the extent to which these relationships have recently changed in problematic ways. Adolescents have long been scoffed at for treating peer relationships as matters of life and death, and the intensity of adolescent peer influences has often been viewed as a source of concern. Yet, as data continue to come in, it increasingly appears that the teens approach may have been right all along: Adolescent peer relationships appear fundamentally linked to long-term mental andphysical health inways that make teens’“life and death” perspective on them appear unsettlingly realistic. Understanding the normal developmental drive to connect with peers in adolescence appears essential to understanding the pathological results that follow when this drive is thwarted (Cicchetti, 1993).
As much as peer influences may be feared, the great bulk of accumulating evidence now suggests that it is the lack of strong connections to others that may currently be the more potent shortand long-term risk factor for psychopathology. Unfortunately, our youth are clearly suffering from a lack of connection. Rates of adolescent loneliness appear to have skyrocketed over the past twenty years (Twenge et al., 2021) and are not only high, but higher than for any other age cohort (Shovestul et al., 2020), an effect which the pandemic only seems to have exacerbated (Cigna Corporation, 2021). Even prior to the pandemic, adolescents had begun spending significantly less time in in-person interactions with their friends (Twenge et al., 2019). Understanding adolescent psychopathology in the current era requires attending closely to the meaning of these changes.
In adulthood, social relationships are now recognized as being as fundamental to survival as food, water, and shelter (HoltLunstad, 2023). Lack of social connection is linked to everything from depression and anxiety to stroke risk, dementia, respiratory illness, and even early mortality (Cohen, 2021; Mann et al., 2022; Valtorta et al., 2016). Our own recent data suggest that these findings are at least equally relevant to adolescents.
Reconsidering the role of peer influence
Recognizing just how critical peer bonds are to adolescent development suggests a need to also reconsider the strong negative connotation the field has attached to the phenomena of peer influence in adolescence. This paper makes three assertions in this regard: First, our field has been making a version of the same mistake often made by parents in looking to peer influence to explain concerning behavior that is best understood at a different level of analysis. Second, we need to more consistently recognize the symmetrical nature of peer influences: They can be directed either toward or away from maladaptive behaviors. Finally, we must recognize the degree to which being influenced by one’s peers is fundamentally isomorphic with becoming well-socialized and adapting to larger social norms– a process that is critical to a successful adulthood. Each will be covered in turn below.