Colorado youth mental health found to have improved in first post-pandemic survey

Colorado high school students seem to be feeling better mentally, with the number reporting signs of poor mental health not only falling from its pandemic high, but in some cases hitting the lowest level since the state started surveying youth in 2013, though it also found youth don't always feel safe in school, and problems with body image are widespread.

The Healthy Kids Colorado survey found about 26% of high school students in 2023 reported they felt sad or hopeless enough to stop doing their usual activities over at least two weeks, a possible sign of depression. Students take the survey every two years, so last year's numbers were the first hard data on how youth are faring since the emergency phase of the pandemic ended.

While one in four students reporting possible depression is higher than anyone would want, it was an improvement not only over the height of the pandemic—when 40% of students said the same thing—but over the years before the disruption of 2020. The last time fewer students answered that question in the affirmative was 2013.

"We're very happy to see overall improvements in many areas. There have been dramatic changes in the right direction around indicators of mental health, suicide risk, and substance use," Jill Hunsaker Ryan, executive director of the Colorado Department of Public Health and Environment, said in a news release. "We're hopeful this is an indication of state and community investments in prevention programming and protective factors paying off."

As in previous years, some students were more likely to report stopping activities because of sadness or hopelessness:

• 55% of nonbinary students, versus 32% of female students and 18% of male students;
• 61% of transgender youth, versus 24% of cisgender youth; and
• 56% of students who identified as pansexual, versus 50% who were bisexual, 48% who were gay and 20% who were straight.

The percentages of students who reported attempting suicide, planning an attempt, or seriously considering it also hit their lowest levels since 2013. About 6% of students said they had made an attempt in the past year, 9% said they'd made a plan and 11% said they'd seriously considered suicide, with or without a plan.

Nonsuicidal self-harm also dropped: 13% of students reported harming themselves in some way, such as cutting, without the intention to die. In 2021, one in five students intentionally hurt themselves.

Colorado youth still have a large unmet need for outpatient mental health care, but the number who need more intensive care seems to be returning to its pre-pandemic pattern, said Lauren Gallanis, a pediatric psychologist at Children's Hospital Colorado. Typically, fewer children and teens need inpatient care during the summer, when they aren't experiencing the stress of school, and so far this year appears to follow that pattern, she said.

In May 2021, Children's declared a youth mental health "state of emergency" in response to an increase in young patients in crisis. Gallanis said she wasn't sure that the emergency is over, but the reduction in kids arriving with severe needs has made it easier to find inpatient care for those who need it. But options for kids who need outpatient care still remain sparse in comparison to the need, and inpatient resources could become strained again when students go back to school, she said.

"I feel like there's been a slight improvement in connecting youth to services. It's not where I'd like it to be," she said.

More than half of students who took the survey said their stress level was manageable most days, which was about four percentage points higher than in 2021. Still, 28% of students reported they had poor mental health for most of the previous month. The survey didn't ask those questions in pre-pandemic years.

Most youth also reported they had someone to talk to: three-quarters said they could go to an adult with a serious concern, and more than half said they could usually talk to a friend about their feelings. Both were slightly higher than in 2021.

If they were concerned about their own well-being or someone else's, 14% said they wouldn't tell anyone. Those who would tell someone said:

• 23% would call a crisis line,
• 29% would make an anonymous report to Safe2Tell or a comparable tipline,
• 37% would tell a friend,
• 54% would tell their parents or guardians, and
• 50% would tell another trusted adult.

Students could select multiple answers, so the numbers don't add up to 100%. The survey didn't ask that question in previous years, so no one can tell if students' perceptions that they can talk to someone are improving or worsening.

In recent years, young people have had more options to seek help for a mental health problem, and the culture has become more open to discussing emotional struggles, Gallanis said. For example, schools are increasing access to routine mental health interventions, youth can get free therapy sessions through the state's I Matter program and primary care doctors are more likely to screen for depression and anxiety before they become severe, she said.

"I think it would be pretty hard to disentangle that" and say one thing made the difference, she said.

Substance use also went down in the survey: fewer students reported using alcohol, cigarettes, or marijuana in the previous month than at any point since 2013. The percentage who reported recent vaping also fell to its lowest level since that question debuted in 2015.

The survey changed the wording on its questions, so the data doesn't allow the public to compare how many students used other drugs over time.

Not all of the news was good. One in 10 students reported not going to school because they felt unsafe, which, like in 2019 and 2021, was higher than in previous years.

In addition, students reported widespread dissatisfaction with their bodies. One in four students said they rarely or never felt confident about their bodies' appearances, and 23% said they had used unhealthy methods to control their weight, such as going a day or longer without eating, taking diet pills, or vomiting. The survey hadn't asked those questions before.

More than 120,000 students in 46 counties completed the survey, which made this year's the most comprehensive since it started in 2013, according to the state health department.

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