Teen Girls ‘Engulfed’ in Violence and Trauma, CDC Finds

Photo for The Washington Post by Caitlin O’Hara
Students gather for a vigil in Chandler, Ariz., in September to remember teens who have died by suicide.

Updates with comments from high school senior girl who founded Arizona student mental health group, CDC’s chief medical officer and former leader of national school psychologists group

Teen girls across the United States are “engulfed in a growing wave of violence and trauma,” according to federal researchers who released data Monday showing increases in rape and sexual violence, as well as record levels of feeling sad or hopeless.

Nearly 1 in 3 high school girls reported in 2021 that they seriously considered suicide – up nearly 60 percent from a decade ago – according to new findings from the Centers for Disease Control and Prevention. Almost 15 percent of teen girls said they were forced to have sex, an increase of 27 percent over two years and the first increase since the CDC began tracking it.

“If you think about every 10 teen girls that you know, at least one and possibly more has been raped, and that is the highest level we’ve ever seen,” said Kathleen Ethier, director of the CDC’s Division of Adolescent and School Health who said the rise of sexual violence almost certainly contributed to the glaring spike of depressive symptoms. “We are really alarmed,” she said.

Ethier said it’s important to determine who is perpetrating the violence, which the survey did not address, and how it can be stopped.

Almost 3 in 5 teenage girls reported feeling so persistently sad or hopeless almost every day for at least two weeks in a row during the previous year that they stopped regular activities – a figure that was double the share of boys and the highest in a decade, CDC data showed.

Girls fared worse on other measures, too, with higher rates of alcohol and drug use than boys and higher levels of being electronically bullied, according to the 89-page report. Thirteen percent had attempted suicide during the past year, compared with 7 percent of boys.

Sharon Hoover, a professor of child and adolescent psychiatry at the University of Maryland’s School of Medicine and co-director of the National Center for School Mental Health, said she was struck by “the magnitude of the increases and the gender difference.”

Hoover and others pointed out it is unclear whether the data is influenced by other factors – if girls were more aware of depressive symptoms than boys, for instance, or more inclined to report them – or whether girls are simply far worse off.

Richard Weissbourd, a psychologist and senior lecturer at Harvard’s Graduate School of Education, said there is probably not a single cause to explain the data but rather interacting causes that vary by race, ethnicity, class, culture and access to mental health resources.

Even so, he said, “girls are more likely to respond to pain in the world by internalizing conflict and stress and fear, and boys are more likely to translate those feelings into anger and aggression,” he said. Boys are more likely to “mask depression,” he said, while girls may be more vulnerable to social media and “a culture obsessed with attractiveness and body image.”

CDC researchers said schools could be a lifeline as students struggle, pointing to studies showing better mental health outcomes for students who felt connected to their schools.

The pandemic took a heavy toll on adolescents, who already struggled with depression, anxiety and thoughts of suicide before it began. Many were cooped up at home for months. They continue to grapple with social media pressures, academic strain and family turmoil. Some lost parents and other relatives to covid-19. “These data make it clear that young people in the U.S. are collectively experiencing a level of distress that calls on us to act,” the report said.

In 2021, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry and the Children’s Hospital Association together declared “a national state of emergency” in children’s mental health. A year later, the organizations sounded the alarm again.

The isolation and stress of pandemic lockdowns were followed by a rise in domestic violence – and may have also driven an increase in the sexual assault of teen girls, said Heather Hlavka, an associate professor of criminology and law studies at Marquette University with expertise in sexual violence.

CDC data do not suggest where the assaults happened or who perpetrators are, but Hlavka said it could be a combination of peer violence, dating violence and violence in the home – and should be a target for more research. “It’s really important to disentangle the relationships between the perpetrators and the victim-survivors to better understand the reasons why,” she said.

CDC researchers have kept an eye on data about forced sex for a long time, Ethier said. Now, “we see this increase from 11 percent to 14 percent of teenage girls saying that they’d been raped just between 2019 and 2021 – and that’s extremely concerning,” she said.

The CDC analysis is based on data collected in fall 2021 from the Youth Risk Behavior Survey, taken by a nationally representative sample of students in public and private high schools. The results released Monday, derived from more than 17,200 responses, are the first since the pandemic began. The survey is done every two years, and Monday’s report showed trends that spanned from 2011 to 2021.

The findings about hopelessness and sadness among girls are true to the school experiences of high school senior Riana Alexander, 17, who founded the organization Arizona Students for Mental Health. As a group, girls tend to struggle more openly, she said, while boys “tend to struggle in silence.” The sexual violence figures did not startle her either, she said. “I’ve yet to meet a teenage girl who has not had something disgusting said or done to her by a man,” she said.

Lesbian, gay, bisexual and questioning students were significantly more likely to experience violence, including rape, than their heterosexual peers. They were also more likely to be electronically bullied and to report persistent sadness or hopelessness. Twenty-two percent had attempted suicide during the past year. (The survey did not have a question about gender identity, so the analysis did not include transgender students; future versions of the survey are expected to include the question.)

“These data show a distressing picture,” said Debra Houry, the CDC’s chief medical officer, speaking at briefing Monday. “America’s teen girls are engulfed in a growing wave of sadness, violence and trauma.”

That was not completely a surprise for Laurie McGarry Klose, past president of the National Association of School Psychologists. The first thing that came to mind about the rise in depressive symptoms, she said, was “this is the hard data that shows what we have known anecdotally for the last couple of years.”

Teens were hit hard by the isolation and disruption of the pandemic, but many were also shaken by a series of high-profile cases of racial injustice, Klose said – as they simultaneously navigated personal and family difficulties. “It was trauma after trauma, especially for kids of color,” she said.

The report showed disparities by race and ethnicity. Black and Hispanic students were more likely than White and Asian students to avoid school because of safety concerns, a finding the authors said suggested exposure to violence in the community or at school. Black students were more likely to attempt suicide than Asian, Hispanic or White students. White students were more likely to experience sexual violence than Asian, Black and Hispanic students, and they were the only group to see an increase in it.

American Indian or Alaska Native high school students were more likely than other groups to have been raped.

The report also spotlighted some positive findings: Students reported less alcohol and drug use. Over the last decade, fewer students reported ever having sex, currently having sex or having had four or more partners during their lifetime.

Though usage was significantly down over a decade, girls were more likely than boys to have consumed alcohol and used marijuana during the past 30 days. They also were more likely to have recently vaped or ever used illicit drugs such as cocaine, heroin, inhalants, meth and hallucinogens.

Girls were almost twice as likely as boys to be electronically bullied through texting and social media. The targets of bullying were more likely to be White, American Indian or Alaska Native, or LGBQ+.

In its report, the CDC steered attention to the nation’s schools, saying activities there can make a profound difference in the lives of teens. It recommended improved access to mental health services, more classroom management training for teachers, school clubs that foster gay-straight alliances, high-quality health education and enforcement of anti-harassment policies.

Ideally, schools would take on multiple initiatives: “The more of these things you do, the better the impact in the school environment,” Ethier said.

Research shows that those who feel close to people at school have a significantly lower prevalence of serious thoughts of suicide and feelings of persistent sadness or hopelessness. “Our research has shown that young people who feel more connected in their schools do better, both while they are adolescents and up to 20 years later,” Ethier said.

Those least likely to feel connected to school included girls, students of color and LGBQ+ students, according to the data.

Emily Ozer, a professor at the University of California at Berkeley School of Public Health, recommended more mental health services in schools and even small ways to relieve student stress – whether it’s greeting each student by name as they enter class, responding to an absence with a caring inquiry, or giving the occasional homework pass. Student well-being is also linked to the mental health of teachers and other adults in the building, and they, too, need to be supported, she said.

“It takes a lot to be there for students,” Ozer said, “especially distressed students.”

Strikingly 86 percent of students reported high parental monitoring, defined as parents or other adults in the family knowing most of the time where teens are going and who they are with – also considered a protective factor. Nearly 90 percent of girls reported it, compared with 84 percent of boys.