Documentary ANXIOUS NATION Explores The Rise In Anxiety In Children

Like adults, children feel worried from time to time. It’s normal. But when a child’s anxiety interferes with his or her school, home or social life, it’s time for professional help. The moving documentary, Anxious Nation, delves into the increased rates of anxiety among children and adolescents, and appeals for the urgent need for compassionate and science-based treatment and care. After attending a screening at the Palm Springs International Film Festival, I spoke with filmmakers and cast members about the mental illness epidemic among some of society’s most vulnerable individuals.

“We must start treating mental health the same way we treat physical health,” declares producer and NY Times best-selling author, Laura Morton, who is featured in the film along with her daughter, Sevey. “In an ideal world, we would have mental health professionals in every pediatrician’s office.”

The case for integrating mental health (MH) care into general medical care has been made for several years now. It’s easy to see why. According to the National Institute of Mental Health (NIMH), nearly 1 in 5 or 53 million U.S. adults lives with a mental illness. In addition, 20% of primary care visits include at least one mental health indication (e.g. depression, counseling, etc.) Despite its prevalence, mental health services were received by less than half (46.2%) of those carrying a MH diagnosis in the past year – and this varied significantly by race (more on this later).

Bringing Anxious Nation to the screen was an cardinal call to action for executive producer and entrepreneur, Kathy Ireland. “There are so many elements which contribute to the gut-wrenching pandemic of anxiety, and it’s critical that families realize that they are not alone in this fight,” states the fashion designer and former supermodel. “We cannot look away.”

Anxiety, Children & Covid-19

Anxiety and depression – two of the most commonly diagnosed mental disorders in children, along with ADHD and behavioral problems – have been increasing among children aged six to 17 since 2003. It’s hard to pinpoint one specific cause but several factors may contribute: from perceived pressure to excel in school and bullying (including cyberbullying) to overuse of social media and disruptions in learning caused by a global infectious disease crisis known as Covid-19. Anxious Nation clearly addressed the pandemic’s harmful impact: “COVID has fueled a mental health epidemic. Everyone is feeling the pressure of this epidemic.”

“We are definitely seeing an increase in teen anxiety,” describes Stephen Delisi, MD, psychiatrist and faculty at the Hazelden Betty Ford Foundation. “The school disruptions at the peak of the pandemic have created deficits in many students’ academic progress. This is causing extreme anxiety for students trying to catch up.”

“Kids Today Are Spoiled”

A common complaint by older generations about Gen Z (ages 11 to 26) is that they’re too coddled and entitled. While many parents do confess that their children are more spoiled than they were as kids, the burgeoning anxiety experienced by children and teens is very real.

“Accusing teenagers of being spoiled, entitled or coddled lets adults off the hook,” explains Lynn Lyons, LICSW, who was featured in the film. “Adults need to take their portion of responsibility for that behavior. When we experience teens as spoiled, entitled and coddled, I think what we are often seeing is a lack of emotional literacy and nuanced emotional management.”

Every older generation thinks the younger generation is spoiled and entitled, according to Academy Award-winning documentary filmmaker, director and writer, Vanessa Roth. “We need to raise and support kids in a way that gives them all the resources they need at home, at school and in the community. They need a strong sense of self, opportunities that give them a sense of purpose and tools to help them navigate through their anxiety.”

Child and adolescent psychiatrist, Candida Fink, MD, firmly believes that we need to teach adults to believe kids when they tell us how they feel. “Even if we don’t get it,” says Dr. Fink, “That’s how we can make needed life changes as well as seek treatment. If we just say, ‘you have nothing to worry about, you’ll be fine,’ we are missing the chance to identify anxiety and treat it.”

Racial Disparities in Mental Health Care

The film addresses disproportionate access to mental health care experienced by non-white children and young adults. In one scene, Golden Globe-winning actress and founder of the Boris Lawrence Henson Foundation, Taraji P. Henson, summarizes the sad reality faced by her community: “Black people have been told to pray our problems away.” NIMH reports that 51.8% of white individuals received MH services compared to 37.1% of Black and only 20.8% of Asian individuals. Research shows that Black youth rates of using any MH services decreased between 2010 and 2017 while it increased among white youth. In addition, white youth were twice as likely to use psychotropic medications compared to their Hispanic counterparts.

Explanations vary but likely include higher rates of stigma regarding mental illness in communities of color, as well as longstanding, systemic racism and discrimination among healthcare professionals. Some solutions are simple while others will require detailed planning. I believe medical and nursing schools and residency training programs need to teach the importance of equity, appropriate language and structural barriers to care. Hospitals also need to train staff about cultural sensitivity and break down barriers to high-quality care within their marble walls. Public health departments need to proactively create and implement community-based programs in partnership with members of minoritized groups.

What About Treatment?

So, how do we get anxious kids the help they need and deserve? One approach targets disinformation. “Right now, children and teens have unprecedented access to information about their mental health, much of which is not only inaccurate, but counterproductive,” says Lyons. “Both medical professionals and the media have a responsibility to report and disseminate correct information.”

Another big spider in the childhood anxiety cobweb? Social media. The film depicted one girl who spent over ten hours a day on TikTok: “The validation is so satisfying. But it’s temporary.” In addition to increased rates of depression and anxiety among adolescents, social media also impairs sleep: teens who visited social media platforms daily were 19% more likely to get inadequate sleep. Parents need to limit screen time, particularly before bedtime.

Perhaps the most impactful mental health intervention involves schools. Anxious Nation reported outrageous waiting periods: “The average wait time for an initial intake at school is 3 to 6 weeks. Not even treatment! Yet if you have a rash, the pharmacy will have steroid cream waiting that same day.” But teachers shouldn’t be expected to become ad hoc psychologists.

“We need more mental health professionals in schools proactively assessing and identifying students who are struggling, and then provide evidence-based interventions like CBT and mindfulness,” urges Dr. Delisi. He points out research showing that mindfulness-based stress reduction was as effective as escitalopram (“Lexapro”) for anxiety. Resiliency skills should also be a core part of student health and well-being. Students with severe anxiety may need more rapid and equitable access to professional MH treatment.

Academic demands are also a “huge part of childhood anxiety,” according to Dr. Fink, “and have been climbing for decades. Suicide deaths in kids increase during the school year.” While rare in children under 10 years of age, the American Academy of Pediatrics reports a marked increase in suicide death rates during adolescence and young adulthood, tripling between 2007 and 2017 among children 10 to 14 years of age.

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As a physician who’s cared for many patients with mental illness and as a member of the South Asian community where mental health is rarely discussed, Anxious Nation resonated with me personally and professionally. We need to openly and nonjudgmentally talk about our psychological health just as we do our physical health – particularly with children and teenagers. They are our future, but they need a LOT of guidance and support. I know I did (and still do). Go see this film, and reach out to the resources on their website. If you or someone you know needs urgent attention, call or text the National Suicide Prevention Lifeline at 988.