The ‘big 5’ most common mental health struggles among youth today

Youth mental health has become an increasingly urgent concern in recent years, with rising rates of anxiety, insomnia, substance use, depression, and eating disorders. As young people navigate the pressures of academic performance, social relationships, and identity development, many express a desire to protect their mental health from issues like depression, anxiety, or burnout.

But with a growing wave of mental health challenges, Cheryl L. Green, MD, a child and adolescent psychiatrist, says that today’s youth are facing significant pressures that are impacting their emotional well-being like never before.

“The National Library of Medicine finds that anxiety disorders affect nearly 30% of young people, followed closely by insomnia, substance abuse, depression, and eating disorders,” Green said. “These areas form the core of the mental health crisis currently affecting youth and young adults.”

Additionally, while the term "youth" can vary in definition, it generally refers to individuals in the developmental stages between childhood and full adulthood. According to Green, youth can be understood in three broad categories: tweens, teens, and transitional-age youth.

• Tweens are older children on the cusp of adolescence, typically around ages 10 to 12.

• Teens span roughly ages 13 to 17, a period marked by rapid emotional, social, and cognitive development.

• Transitional-age youth refers to those between 18 and 25 years old, a period of transition into adulthood. Despite being legally considered adults, this age range is still supported under child and adolescent psychiatry due to the ongoing brain development they experience.

To better understand the mental health challenges among youth, Green breaks down the following below. 

1. Anxiety

The term anxiety is often used casually, but there is a distinct difference between occasionally feeling anxious and having a diagnosable anxiety disorder.

“An anxiety disorder is characterized by persistent anxiety that occurs most days of the week and for a significant portion of the day,” Green says. “It’s not just about feeling nervous before a test or stressed during a tough week. It’s an ongoing state of heightened anxiety that interferes with daily life.”

To meet the criteria for a clinical diagnosis, anxiety must present physical symptoms, including: 

• Racing heart

• Shortness of breath

• Lump in the throat

• Butterflies in the stomach

• Bodily tension

Clinicians also look for at least three of “C-FIRMS” symptoms:

• Concentration difficulties

• Fatigue

• Irritability

• Restlessness

• Muscle tension

• Sleep disturbances

Common causes of anxiety

Academic pressure and social expectations are two of the most dominant sources of anxiety in youth. Additionally, approximately 1 in 5 students report being bullied for not meeting social norms.

“Most girls, and roughly a third of boys, experience some form of bullying,” Green says. “This constant social scrutiny, coupled with body image issues and peer pressure, contributes to a persistent sense of inadequacy and anxiety.”

As youth transition into young adulthood, the sources of anxiety shift toward financial stress and the struggle for independence, many young people worry about how long they’ll need to live with their parents, whether they can find a stable job, and how soon they’ll be able to afford a life of their own. 

2. Insomnia

Insomnia is a surprisingly common mental health concern among youth, though it often goes unrecognized.

“It’s not just about trouble sleeping,” Green emphasizes. “Insomnia is an issue that affects nearly a third of young people, often amplifying other mental health struggles such as anxiety and depression.”

The three forms of insomnia include early, middle, and late insomnia:

• Early insomnia is when a person struggles to fall asleep.

• Middle insomnia happens when sleep is frequently disrupted during the night.

• Late insomnia, which is more common among those with depression, is when someone wakes up very early and cannot return to sleep.

Youth who suffer from insomnia can feel physically and mentally drained, more irritable, and less able to cope with daily stressors.

 “Insomnia makes every other mental health condition much worse,” Green emphasizes.

Common causes of insomnia

A high percentage of insomnia can be traced back to what Green refers to as sleep hygiene –– habits that promote a good night's sleep. 

Bad sleep hygiene that impacts insomnia can include:

• Using screens right before bed 

• Irregular sleep schedule 

• Napping too late in the day

• Sleeping in an environment that's too bright, noisy, or hot/cold

• Staying in bed too long in the morning after waking

3. Substance use

The use of alcohol, cannabis, and nicotine is one of the most pressing mental health challenges facing youth today. The following statistics underscore the severity of substance use in young adults: 

• Over 33% of 12 to 20-year-olds reported that they had at least one drink in their lives.

• 8.6% of 12 – 20-year-olds reported binge drinking in the past month.

• In 2022, 30.7% of high school 12th graders reported using cannabis in the past year. 6.3% reported using it in the past 30 days.

• In 2024, 3.5% of middle school students and 7.8% of high school students used e-cigarettes or vapes. 

Green points out that youth who use alcohol, cannabis, or nicotine are often at higher risk for anxiety, depression, and psychosis, and their developmental trajectory can be disrupted.

Common causes of substance use

Substance use disorders are often not just about experimentation or rebellion. Rather, it’s typically tied to underlying emotional and social issues. The most widely recognized causes are self-medication, loneliness, and peer pressure. 

• Self-Medication: Teens often turn to substances to cope with untreated mental health issues. Substance use becomes a short-term fix for emotional pain, but it often escalates into a long-term problem.

• Loneliness: Green says that when youth feel disconnected or isolated, substances can become a coping strategy, offering a sense of escape or numbness.

• Peer pressure: In some social groups, substance use is the main activity, making it hard to say no without becoming isolated. 

4. Depression 

According to Green, 21% of adolescents meet the criteria for clinical depression, but when surveyed, a staggering 53% of high school girls report persistent sadness or hopelessness.

The diagnostic criteria for clinical depression, referred to as SIGECAPS, is as follows:

• Sleep disturbances 

• Irritability 

• Guilt or hopelessness

• Energy loss

• Concentration problems

• Appetite changes

• Psychomotor changes 

• Suicidal thoughts or behaviors

Common causes of depression

According to Sigmund Freud and Erik Erikson, depression is often due to two major contributors: love and work.

“These areas are central to one’s sense of identity and fulfillment, and when they experience significant stress, whether in romantic relationships, family, or financial difficulties, depression can arise,” Green says. 

Additionally, the influence of social media has introduced new complexities in understanding depression. An informal diagnosis known as social media dependency suggests that the more time an individual spends on social media, the higher their risk of depression. 

5. Eating disorders

Eating disorders are widespread but often underdiagnosed conditions among both girls and boys. For girls, restrictive eating behaviors are nearly universal during mental health intakes. These patterns may manifest as:

• Restricting food intake

• Binge eating in response to restriction

• Over-exercising to control weight or shape

With boys, the issue is typically tied to body goals such as a desire to reduce fat and build muscle, often through extreme workouts or restrictive diets. 

Common causes of eating disorders