Facing intense academic demands and ever-present peer comparisons through social media, an increasing number of Iowa high school students grapple with mental health issues and enduring problems previous generations seldom confronted, an IowaWatch High School Journalism Project has found.

Michelle Kim, a graduating Iowa City West High member of the Class of 2017, describes going through depressive periods as “drowning” and says healing sometimes is more complicated than just coming up for air.

“And then it gets to that point where I don’t care anymore,” she said. “I don’t care about my social life; I don’t care about my grades. It’s just a cycle of sadness.”

School counselors and student advocates say they are seeing an increased number of students coping with mental health problems, and a state survey shows the number of 11th graders, especially females, contemplating suicide and experiencing depression and anxiety are creeping up.

“I see more and more mental health issues and social/emotional problems and deficiencies,” Derek Ziesmer, the guidance counselor at Forest City High School in northern Iowa, said.

ABOUT THIS STORY Student journalists at three Iowa high schools spent late winter and early spring 2017 researching and writing this report under the direction of IowaWatch’s Julia Davis and Stephen J. Berry. Berry also did reporting and writing for the report. Team members and their schools were: Mina Takahashi – Iowa City High School

Fenna Semken – Iowa City West High School

Taylor Shelfo – Iowa City West High School

Clare Rolinger – Cedar Falls High School

Sophia Schillinger – Cedar Falls High School Special thanks to journalism teachers Sara Whittaker, Iowa City West High School; Brian Winkel, Cedar Falls High School; and Jonathan Rogers, Iowa City High. The IowaWatch High School Journalism Project was funded, in part, with a grant that the Iowa Center for Public Affairs Journalism-IowaWatch was grateful to receive from the Community Foundation of Johnson County. Lyle Muller/IowaWatch

Ziesmer said students also face more technological distractions, including social media, that previous generations didn’t confront.

At West High School in Iowa City, Jamie Schneider, the student and family advocate for six years with a background in social work, sees 200 to 300 students a year. On busy days, she sees “two or three students per class period.”

Often, teens taking part in surveys report stress levels higher than what adults report.

And other experts point to increased access to drugs and academic pressures.

The results of these pressures show up in the numbers.

In Iowa, 17 percent of 11th graders reported having seriously thought about killing themselves in the previous 12 months, an increase of nearly 2 percent since 2012, according to the Public Health Department’s Iowa Youth Survey of students in grades 6, 8 and 11.

Twenty-two percent of those 11th graders with suicidal thoughts were females, and 13 percent of them made plans to do it. Seven percent tried, up 5 percent since 2012; and 2 percent required treatment afterwards.

It’s not just an Iowa problem. Mental health problems like depression and anxiety affect one in five children, according to the Centers for Disease Control.

The IowaWatch High School Journalism Project also found:

High school students overscheduling their day, which can lead to anxiety and depression;

Many struggling with mental health problems feeling misunderstood by peers;

Social media impacting students’ self-esteem and overall mental health;

Resources to address mental health issues varying by school, with most are stretched thin.

State Department of Education officials agree school counselors and teachers play the key role at the school level in helping students with mental problems due to anxiety and depression.

Even as the need for mental health services have been increasing, the number of counselors has remained generally flat since the turn of the century, dropping slightly to 1,187 full-time counselors in 2013-14 from 1,194 in 2000-01, according the Iowa Department of Education’s Bureau of Information and Analysis .

Depression produces sadness, loss of interest in usual activities, decreases a person’s ability to function at work or home and can cause a variety of emotional and physical problems, according to the American Psychiatric Association. It differs from normal sadness, grief or “the blues” if the symptoms last for two weeks or more. Its causes include biochemistry, genetics, personality of anxiety disorder include genetics, brain chemistry, personality, and life events.

Nationally, a Center for Disease Control studies show the problem has been getting worse. It’s Mental Health Surveillance Among Children, 2005-2011, said 13 percent to 20 percent experience a mental disorder in any given year, and surveillance covering 1994–2011 showed these conditions have been increasing. Suicide, often resulting from interaction of mental disorders and other factors, was the second leading cause of death among children ages 12 to 17 in 2010.

In IowaWatch’s High School Journalism Project, IowaWatch worked with student reporters at Cedar Falls High School and at Iowa City’s West High and City High. They examined reports and statistics and interviewed outside experts and students, teachers and school counselors in their own schools and at Belle Plaine and Forest City high schools.

The 2016 Iowa Youth Survey indicates the problems these students discussed are common statewide.

OVERBOOKED AND OVERSTRESSED

Academic pressures are a major cause of stress. The importance of becoming competitive for top-ranked colleges and for scholarships needed to mitigate skyrocketing tuitions pressure students into advanced classes and participation in multiple extracurricular activities.

The 2016 Iowa Student Survey found 62 percent of Iowa’s 11th graders spend more than three hours a week on extra-curricular activities, with 29 percent spending nine or more.

Colleen Davis, an English teacher at City High School said in a story for this project and published by The Little Hawk, the school newspaper, and later The Gazette (Cedar Rapids, IA) that many kids feel overloaded with advanced classes, such as Advanced Placement and honors courses.

Amanda Aaburg, one of the students interviewed for the story, said depression would blunt her desire to keep school commitments. She once stayed home from school for two months, and faced getting kicked out of school before she forced herself to return.

“I could not get myself to school,” she said. “I just felt so bad all the time.”

A 2013 survey of teens and adults by the American Psychological Association found 30 percent of teens reported sadness or depression from stress, and 31 percent felt overwhelmed and that their stress had increased in the past year. During the school year, teens reported stress levels higher than what adults reported in the survey.

Students feeling overbooked was a prevalent theme in the IowaWatch interviews.

One Cedar Falls senior graduating this year made a major sacrifice in her school extra-curricular life to find relief. Ellie Haan had been a track team runner throughout high school, even going to the state championships as a junior.

Submitted photo, used with permission

But, she no longer enjoyed doing it. Each track meet and practice were filled with anxiety and stress. She feared she would let her team down or disappoint her two sisters, who had been good at track before her. While Haan was not clinically diagnosed with anxiety, she decided to take action: she quit and later joined the golf team.

“Track almost made me sick because of how nervous I was,” Haan said. “I’m happy I quit, because it’s been a big stress taken off my shoulders.”

She drew an important lesson from the experience – don’t take on an anxiety-causing activity merely to please others.

“If you do something, do it for your own reasons,” Haan said. “Don’t quit for somebody else and don’t continue doing something for somebody else.”

Cedar Falls High School golf coach Megan Youngkent supported Haan’s decision.

“Adaptability is a life skill,” she said, “and the fact that Ellie took it upon herself to quit track for her mental health is key to how adaptable she’ll be as an adult.”

FEELING ALONE AMONG MANY



Students frequently describe a self-perpetuating cycle of issues that feed off each other, creating a lonely downward spiral that sweeps through their social life, classroom work and friendships.

“This year alone I have heard more students in my school talk about suicide or self harming themselves than the previous seven years I have been a principal,” Belle Plaine High School Principal Todd Werner said. “I think a lot of that is due to more exposure through social media and places where kids interact with other kids from all over. They’re more aware of it and talking about it more, so I think they are having those feelings.”

Often, students who have not experienced mental health problems can’t understand the behavior of those who have, said Kim, the West High graduating senior.

When depressive episodes strike, she feels like “I just drown. It’s quick for people to pick me up and pull me out of the water, but it’s also quick for me to drown into the water and just stay there, and drown for a really, really long time,” she said.

Kim said one of the hardest challenges is self-imposed pressure to measure up to others’ expectations combined with making good grades.

“You have to worry about grades, because you want to go to college, and being friendly with your teachers and your friends,” she said. “You don’t want to let them down. Maybe your friends are super smart, and you need to be up to their standards, or you don’t want to be a bad friend.”

“It’s a cycle of trying not to let anyone down, but then you do let them down, but then you get sad about that. You got to have everything happy, and it’s got to be happyville and stuff, but that doesn’t work if you have depression,” she said.

“I faked a lot of my happiness,” Kim said. “I smiled everywhere I went, but inside I was kind of dying.

Like Kim, another West High School student, Adriana Schafer, found that friends didn’t understand how her behavior was affected by her problems. Schafer, a junior in the 2016-17 school year, said some friends misinterpret her social anxiety; they think she doesn’t enjoy their company when, in reality she is going through an anxiety attack.

“Sometimes I get so anxious talking to people; it’s like I’m not actually hanging out with my friends,” she said. “I’m just stressing about what I’m saying. It’s so emotionally draining.”

In another parallel with Kim, Schafer’s anxiety affected class attendance and her relationship with teachers. She would get anxious and sometimes skip class, which then created more anxiety about attending future classes.

“I missed Spanish for a whole week, because I didn’t want to face my teacher asking where I was.”

Like Ellie Haan did in Cedar Falls, Schafer took action to help herself. In 2014, she started Behind the Mask, a group that meets regularly about struggling with mental illness.

“In Behind the Mask, we all talk about (mental health problems) like it’s no big deal. It’s nice to talk to people who understand what you’re going through and our stories can relate,” she said.

Another West High 2016-17 junior, Calla Gabaldon, also struggled to prevent her mental illness from limiting her academic potentiality. Gabaldon said she had “different severities of different disorders my entire life,” with obsessive compulsive disorder being the most severe.

“I have a hard time being in large classes, which is a problem because the Iowa City high schools are overflowing,” she said. “It’s hard to get the grades I want, despite my high intellect and perfect scores on work I do for school, because I tend to miss classes because of my mental health…”

Gabaldon, Schafer and Kim are not alone.

In Iowa, 35 percent 11th grade females met the clinical definition of depression during the previous 12 months (up 8 percent since 2012), as did 16 percent of 11th grade males, the Iowa Youth Surveys of 2016 and 2012 found.

THE ROLE OF SOCIAL MEDIA



Social media and other technology separates today’s teens from previous generations. It surrounds their daily lives, and that level of interaction adversely affects mental health, students and experts say.

“I think technology plays a huge piece in how this generation’s mental health issues are different from their parents’ generation,” Ziesmer, the Forest City guidance counselor, said. They engage with smart phones, video games, computers, tablets, “and look to social media for validation and happiness.”

He said he’s seen the effects of social media firsthand on the students who come see him every day.

Nicole Skaar, school psychologist for Belle Plaine High School, said students connecting with friends via social media sites such as Facebook, Instagram and Twitter inadvertently can end up comparing how they perceive their own life with how they perceive others’ lives.

“I think everybody compares everyone to each others lives,” Skaar, also assistant professor of educational psychology and foundations at the University of Northern Iowa, said. But this can lead to mental health difficulties, she said.

Janice Lane, chief executive officer of Children & Families of Iowa, an organization in Des Moines that offers services to families and children in crisis, said she believes social media is good in that it gives teens with similar interests or struggles a chance to connect.

But social media has a downside. Digital depictions don’t always reflect reality when students compare themselves to others online. That creates stress for those feeling pressured to meet or surpass unrealistic standards of happiness and success, Lane said.

Aaberg said social media greatly influenced her self-perceptions and contributed to anxiety and depression.

“Social media makes it so I have no confidence,” she said. I wish I had a life like theirs where I wasn’t like this all the time. I want to get to the point where there is a lot of happiness and good times.

“I just don’t want to be in hell all the time,” Aaberg said.

ADDRESSING THE PROBLEM

What resources do schools employ to assist these students? The answer varies from school to school.

Some have full-time therapists dedicated to individual schools. Others depend on itinerant therapists. Some teach teachers to recognize students suffering mental health issues, while others do not.

A study in Health Affairs journal on use of children’s mental health service says no matter what services they provide, schools play a vital role in treating adolescents. “Research suggests that schools may function as the de facto mental health system for children and adolescents,” it said.

Lyle Muller/IowaWatch

Barb Anderson, an Iowa Department of Education consultant administering a federally funded training project, said students generally first seek help through guidance counselors and teachers.

At the statewide level, the Department of Education, through a $1.9 million annual grant that goes through October 2019, has been working through the area education agencies to train instructors to train teachers, bus drivers, and members of the community in identifying and helping students needing help, Anderson said. As of March, the program had trained and certified 85 instructors who have trained over 2,000 adults spread over a broad cross-section of the state, she said.

“The feedback has been positive,” Anderson said.

But, still many students aren’t getting help. Ziesmer said teachers at Forest City receive training through a program called Youth Mental Health First Aid that included instruction on recognizing students dealing with mental health problems and on how to help. “Basically, anything that sticks out they refer to me or the principal.”

But even with training teachers, Ziesmer is not satisfied, saying, “There is not enough accessible support for students in need.” He said more laws and regulations are needed, mandating mental health professionals in schools for large and small districts.

He said, “There have been many times when a student needed help, but didn’t have transportation, proper insurance or parent/guardian help to get services.”

Although Iowa City’s West High provides counseling, Kim said, “Some teachers don’t know how to deal with kids who think about suicide or depression or any other mental health issue.”

Gabaldon, the West High junior, said, “If teachers learn more about teens and what they go through – the symptoms, effects, how to help – it could make a huge difference in a lot of lives.”

Gabaldon said she considers herself one of the lucky ones because she got help.

“High school is hard on even the most perfect and happy kids, and mental illness added to high school can be a very rough time when you can’t get what you need,” she said.

Julia Davis, an IowaWatch spring 2017 intern from the University of Iowa School of Journalism and Mass Communication supervised the student reporters and assisted with the writing.

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This IowaWatch story was republished by The Gazette (Cedar Rapids, IA), Des Moines Register and Iowa City Press-Citizen under IowaWatch’s mission of sharing stories with media partners.