Mental Health in Teens: 10 Risk & Protective Factors

According to the Anxiety & Depression Society of America (n.d.), 31.9% of adolescents have anxiety-related disorders.

The age at which mental health disorders most commonly begin to manifest worldwide is 14 (Solmi et al. (2022).

Why is mental health in teens so fragile? Are there known risks we can identify early to protect against them? Who is at the highest risk, and why? What skills can we build in teenagers to protect their mental health as they grow up?

To answer these questions, we look at our biology and behavior and how these are inextricably linked by our experiences. To protect and support mental health in teens, we need to think developmentally, know about the brain, and pay attention to experience.

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Understanding the Teenage Brain

We often think of infancy as the period of life when our brains are most sensitive to our experiences. But a second period of heightened neuroplasticity occurs during adolescence.

Changes in the structure, function, and connectivity within the brain, along with the onset of puberty and an increase in sensation-seeking behavior are why adolescence is often described as a time of both vulnerability and opportunity (Dahl, 2004; Sisk & Gee, 2022).

Ecobiodevelopmental model of human health

The ecobiodevelopmental (EBD) framework explains how interactions between our biology and our environment can increase the risk of future mental health problems, or protect and promote wellness (Shonkoff et al., 2012).

There are three dimensions to the EBD model: ecology, biology, and development.

1. Ecology
   Ecology is our environment. It refers to the things that happen to us. Our ecology can be our nutritional environment, neighborhood and school environment, family, friends, and teachers. When we think of “nurture,” ecology is what we often have in mind.
2. Biology
   Biology refers to our genome, physiology, and brain function. When we think of “nature,” biology is often what we have in mind.
3. Development
   Development refers to the complex and cumulative interactions between our ecology (nurture) and our biology (nature) over time.

Advances in research: Epigenetics and developmental neuroscience

Scientific advancement in the fields of epigenetics and developmental neuroscience is making headway to identify potential mechanisms that explain health outcomes driven by gene–environment–development interactions (Boyce et al., 2020).

1. Epigenetics

Epigenetic processes explain how our ecology gets embedded in our biology at the molecular level.

For example, environmental experiences such as stress early in life may turn genes on or off, influence their strength, and modify the way our cells function, which may influence how our bodies respond to stress (Tyrka et al., 2012).

2. Developmental neuroscience

A second way experiences get embedded into our biology is through their ability to change the structure and function of our brain.

Research in developmental neuroscience shows that environmental adversity, such as toxic stress early in life, can alter the number of neurons, the strength of their connections, and the speed at which they communicate. Each of these alterations has consequences for behavior, learning, and health outcomes later in life (Garner & Saul, 2018).

4 Hallmarks of adolescent brain development related to mental health

Developmental neuroscience points to a few key changes in the teenage brain that make adolescence a vulnerable period for the onset of mental health challenges.

1. Critical period

Adolescence is considered a neurobiologically critical period — a strict time period when the brain and experience interact to shape cognitive development (Larsen & Luna, 2018).

Disruptions to critical period processes may explain the onset of mental health pathology during adolescence.

2. Cortical development

The cerebral cortex, the outermost part of the brain, consists of billions of neurons, which undergo significant reorganization and optimization during adolescence (Norbon et al., 2021).

The timing of these changes may be a risk factor for adolescent mental health (Ferschmann et al., 2022).

3. Increased activation in “reward” centers of the brain

Adolescents experience heightened reward-related neural activation compared to adults and young children (Vijayakumar et al., 2018).

Reward sensitivity is related to mental health in teens (Cardoso Melo et al., 2022).

4. Puberty-related brain changes and social development

The onset of puberty initiates a cascading relationship with neurodevelopment (i.e., the brain structure and function) and psychosocial processes, which include peer relations and self-perception related to mental health (Pfeifer & Allen, 2021; Vijayakumar et al., 2018).

What Causes the Onset of Mental Health Disorders?

Age 14 is the peak age of onset of any mental health disorder globally (Solmi et al., 2022).

Roughly half of teens (48.4%) experience the onset of any mental health disorder before their 18th birthday (Solmi et al., 2022). What explains this robust finding between mental health disorders and adolescence?

According to research done by Guyer et al. (2016) and Pfeifer & Allen (2021), adolescents will experience several factors that can be drivers of change, but also potential risks to adolescent mental health.

These include:

• Biologically based change related to puberty: hormones, physical changes, neurodevelopment
• Psychosocial change: peer and family relationships
• Changes in affect and cognition: emotional reactivity and self-concept

The timing of puberty is related to mental health risks. Early puberty in girls is associated with increased rates of depressive disorders, eating disorders, substance disorders, and disruptive behavior disorders (Graber, 2013).

In boys, early maturation is a risk factor for both internalizing and externalizing symptoms (Hoyt et al., 2020), whereas late maturation is related to increased risk for conduct and substance disorders (Graber, 2013).

To explain both early and late maturers, the maturational deviance hypothesis predicts increased psychosocial stress related to looking different than peers of the same age (Van Rijn et al., 2023).

Early maturers specifically are faced with additional stressors such as feelings of sexual attraction, parental expectations, and peer relationships, without the resources to support them as an “on-time” maturer would have (Mendle et al., 2010).

3 Psychosocial Influences on Teenagers’ Mental Health

Gene–environment–development models show that the dance between puberty, neurodevelopment, and psychosocial changes specific to adolescence are drivers of mental health risk and resilience (Pfeifer & Allen, 2021).

Family dynamics

Parent–child interactions across childhood and adolescence influence both parent and teen mental health. Every parent has different attitudes that guide their parenting and interactions with their children.

Parenting styles with high levels of parental warmth and support that allow for adolescent autonomy are associated with more positive mental health behaviors (Azman et al., 2021; Gorostiaga et al., 2019).

Authoritarian and neglectful parenting styles with high demands, harsh control, and low emotional support are associated with internalizing and externalizing symptoms in adolescents (Azman et al., 2021; Gorostiaga et al., 2019).

Peer relationships

Friendship quality, peer acceptance, peer rejection, and peer victimization are key aspects of peer functioning associated with various mental health disorders and wellbeing (Chiu et al., 2021).

A meta-analysis of longitudinal studies of peer functioning and adolescent mental health found that teens who experience higher levels of friendship quality experience lower levels of social anxiety over time (Chiu et al., 2021).

The effects were largest, however, for peer victimization with repeated experiences of aggression from peers, which was more strongly associated with future social anxiety compared to all other measures of peer functioning (Chiu et al., 2021).

Social network studies where teens are asked to identify peers from school who they consider friends are useful tools for understanding individual teens within their social context. Teens with poor mental health tend to be friends with those who also have mental health problems (Baggio et al., 2017).

Teens with externalizing symptoms tend to be rated as popular, and teens with depression tend to be rated as socially withdrawn (Long et al., 2020).

School environment

School climate includes feeling safe at school, social connectedness and relationships, school connectedness, and the academic environment (Long et al., 2021; Wang & Degol, 2016).

Feeling safe at school, feelings of belonging and inclusivity at school, and supportive relationships with teachers are related to better teen mental health, whereas academic and exam pressure are related to poorer mental health (Aldridge & McChesney, 2018; Long et al., 2021).

Psychosocial factors do not operate in isolation to affect adolescent mental health. School environment, peer relationships, and family dynamics work in concert to create a social context in which teens develop across time.

However, it is possible to develop interventions that target these psychosocial factors and improve the mental health in teens. Anti-bullying programs, social-emotional learning, and parenting skills programs are a few examples of mental health interventions that can help build resilience and positive mental health.

Known Disparities in the Mental Health of Teens

Disparities in mental health refer to inequities in access to mental health care or differences in mental health outcomes. Adolescents in gender, racial, economic, and other minority groups may experience mental health disparities (Hoffman et al., 2022).

Toxic stress, poverty, income inequality, psychosocial stressors such as bullying and a lack of family support, and structural barriers to care are plausible mechanisms for disparities.

Youth experiencing homelessness

Youth experiencing homelessness have higher rates of depression, anxiety, and post-traumatic stress disorder (Jain et al., 2022).

Youth experiencing homelessness with parents are more likely to consider suicide and three times more likely to have attempted suicide than housed peers (Perlman et al., 2014).

Racial and ethnic minority youth

Rates of mental and behavioral health conditions in racial and ethnic minorities are higher compared to those of their white peers; however, they are less likely to access care (Hoffman et al., 2022)

Black and Hispanic children with externalizing symptoms are less likely to receive care than white children, but they are more likely to be referred to emergency departments for these same symptoms (Hoffman et al., 2022).

Sexual and gender minority youth

Gender minority youths report higher rates of depression and self-injurious thoughts and behaviors than their sexual minority and heterosexual peers (Fox et al., 2020).

Compared to heterosexual cisgender peers, adolescents who identify as homosexual are three times as likely to attempt suicide, those who identify as bisexual are four times as likely, and those who identify as transgender are five times as likely to attempt suicide (Hoffman et al., 2022).

10 Risk and Protective Factors

Risk and protective factors may work in opposition and often have cumulative effects. Their impact may be stronger or weaker depending on when they occur (Masten, 2019).

A greater number of risk factors experienced continuously may increase the rate of mental health problems during adolescence (Wille et al., 2008).

1. Prenatal risk factors, including maternal stress, anxiety/depression, maternal obesity, maternal substance use, and intimate partner violence, may increase the risk of internalizing or externalizing behaviors in adolescents (Tien et al., 2020).
2. Early puberty, compared to same-age and same-sex peers, increases risk of internalizing and externalizing disorders (Ge & Natusaki, 2009).
3. Prior sleep disturbances increase the risk of developing the first episode of a mood or psychotic disorder during adolescence (Scott et al., 2021).
4. Use of alcohol, nicotine, and cannabis is related to increase in suicidal thoughts, depression, anxiety, and poor mental health in adolescents (Tervo-Clemmens et al., 2024).
5. Excessive social media use (more than three hours per day) doubled the risk of symptoms of depression and anxiety (Riehm et al., 2019).
6. During adolescence, higher levels of friendship quality can protect against later social anxiety, particularly in younger adolescents (Chiu, Clark & Leigh, 2021).
7. High self-esteem and adolescent beliefs about their own personal qualities protect against mental health problems in adolescents (Liu et al., 2021).
8. Higher levels of resilience protect against mental health problems in adolescents, including depression and anxiety (Mesman et al., 2021).
9. Supportive relationships with an adult at home, an adult at school, and supportive peer relationships have a cumulative protective effect on adolescent mental wellbeing (Butler et al., 2022).
10. Higher levels of self-compassion have a protective effect on psychological distress, particularly for younger adolescents (Marsh et al., 2018).

Resilience Interventions to Bolster Mental Health in Teens

Resilience interventions focus on building protective factors for the mental health of the teen and in the teenager’s environment (Llistosella et al., 2023; Zimmerman, 2013).

These protective factors include self-esteem, social-emotional skills, problem-solving skills, and coping skills and can be used with the family, in peer relationships, and in the community.

A meta-analysis reports the effectiveness of resilience-focused programs to increase resilience in children and teens when compared to control groups (Pinto et al., 2021).

Resilience programs differ in design in order to meet the needs of a specific group, community, or challenge.

1. Resilience in LGBTQ youth

LGBTQ youth with higher resilience have significantly lower odds of reporting a suicide attempt than those with lower resilience (The Trevor Project, 2022).

After participating in Mindful Self-Compassion for Teens, an eight-week program that focused on self-compassion, self-esteem, difficult emotions, and gratitude, transgender adolescents showed a decrease in depression and anxiety and an increase in self-compassion, mindfulness, and resilience (Bluth et al., 2023).

2. School-based intervention

Adolescents who took part in an eight-week school-based intervention of psychological counseling paired with outdoor exercise showed improved resilience, reduced anxiety and depression, and improved sleep compared to a control group (Zhang et al., 2021).

3. Family resilience intervention

These programs focus on building strengths-based family skills to cope with significant stressors and improving the capacity of a family to positively adapt to stressors.

The use of a family resilience framework within clinical and community-based teen interventions is recommended and has shown positive impact in a program designed to decrease gang involvement in teens (Walsh, 2021).

Useful Resources From PositivePsychology.com

On our blog, we have a variety of relatable articles as well as a handy selection of worksheets that can be used as interventions with teens to build resilience, self-compassion, and more.

Articles

• Are you counseling at-risk teens? In her blog post Youth Counseling: 17 Courses and Activities for Helping Teens, Dr. Tiffany Sauber Millacci describes evidence-based techniques and professional development certifications for fine-tuning your knowledge base.
• Teens experience change in every aspect of their lives, from their physical bodies to new friendships and strong emotions. Learn about the use of the biopsychosocial model to frame these complex processes in Dr. Melissa Madeson’s blog post, Biopsychosocial Model in Action: 12 Tips and Resources.
• As teens gain more autonomy in their day to day lives, their sleep often suffers. Learn positive sleep habits for teens in our blog post 20 Sleep Hygiene Tips and Worksheets for Kids & Teenagers.
• Relationships with friends and interactions with peers can be a trigger for big emotions that are hard to regulate. Teach teenagers how to recognize and manage their anger with our blog post Anger Management for Teens: Helpful Worksheets & Resources.

Worksheets

• Incorporate this Solution-Focused Resilience Template into your practice as a practical approach to building resilience in teens and young adults.
• Protective self-kindness and forgiveness skills can be built using this simple Letter of Self-Compassion activity that targets self-compassion toward unwelcome emotions.
• Often, family conflict boils down to the same problems being recycled. Build respectful parenting skills for handling repeated conflict with this worksheet about Seeing Family Conflict as a Problem to Solve.
• Guide teens in their search for authentic friendships that are supportive and protective of their mental health with this Friendship Expectations worksheet.

If you’re looking for more science-based ways to help others enhance their wellbeing, check out this signature collection of 17 validated positive psychology tools for practitioners. Use them to help others flourish and thrive.

A Take-Home Message

Although the teenage years are a time of vulnerability, they are also a time of great opportunity to build the kinds of skills and habits that can protect mental health.

The autonomy to get a driver’s license, land that first job, seek out a romantic relationship, or fight for a personal cause are opportunities to build resilience, improve self-esteem, practice relationship skills, control big emotions, and learn self-compassion. These are the tools that protect mental health as teens face the inevitable challenges of puberty and young adulthood.

As teachers, parents, therapists, caregivers, and neighbors, we need to rally around the teens in our lives and educate ourselves on how to support their mental health. This blog has a wealth of articles, worksheets, and tools to help you help them. Give teens the skills that will benefit them for a lifetime.

And remember, a single act or word of compassion may be the difference that matters.

We hope you enjoyed reading this article. Don’t forget to download our three Positive Psychology Exercises for free.