Mental health experts worry that not participating will make it more difficult to track behaviors signaling poor mental health
As the pandemic worsened the mental health crisis among America’s young people, a small group of states, including Colorado, quietly withdrew from the nation’s largest public effort to track concerning behaviors in high school students.
Colorado, Florida, and Idaho will not participate in a key part of the Centers for Disease Control and Prevention’s (CDC) Youth Risk Behavior surveys that reach more than 80,000 students. Over the past 30 years, the state-level surveys, conducted anonymously during each odd-numbered year, have helped elucidate the mental health stressors and safety risks for high school students.
Each state has its own rationale for opting out, but their withdrawal — when suicides and feelings of hopelessness are up — has caught the attention of school psychologists and federal and state health officials.
Some questions on the CDC surveys — which can also ask students about their sexual orientation, gender identity, sexual activity and drug use — clash with laws that have been passed in conservative states. The intense political attention on teachers and school curriculums has led to a reluctance among educators to have students participate in what were once considered routine mental health assessments, some experts worry.
The reduction in the number of states that participate in the state-level CDC survey will make it harder for those states to track the conditions and behaviors that signal poor mental health, like depression, drug and alcohol misuse and suicidal ideation, experts said.
“Having that kind of data allows us to say ‘do this, not that’ in really important ways,” said Kathleen Ethier, director of the CDC’s Division of Adolescent and School Health, which oversees the series of health surveys known as the Youth Risk Behavior Surveillance System. “For any state to lose the ability to have that data and use that data to understand what’s happening with young people in their state is an enormous loss.”
The CDC developed the Youth Risk Behavior Surveillance System in 1990 to track the leading causes of death and injury among young people. It is made up of a nationally representative poll of students in grades nine through 12 and separate state and local school district-level questionnaires. The questions focus on behaviors that lead to unintentional injuries, violence, sexually transmitted infections, pregnancy, drug and alcohol misuse, physical inactivity and more.
Part of what makes the survey a powerful tool is the diversity of information collected, said Norín Dollard, a senior analyst with the Florida Policy Institute, a nonprofit research and advocacy group. “It allows for the analysis of data by subgroups, including LGBTQ+ youth, so that the needs of these students, who are at a greater risk of depression, suicide, and substance abuse than their peers, are understood and can be supported by schools and community providers,” said Dollard, who is also director of Florida Kids Count, part of a national network of nonprofit programs focused on children in the U.S.
The CDC is still processing the 2021 data and has not released the results because of pandemic-related delays, said Paul Fulton, an agency spokesperson. Trends from the 2009 to 2019 national surveys showed that the mental health of young people had deteriorated over the previous decade. “So, we started planning,” Ethier said. “When the pandemic hit, we were able to say, ‘Here are the things you should be looking out for.’”
Nearly half of parents who responded to a recent KFF/CNN mental health survey said the pandemic had negatively impacted their child’s mental health. Most said they were worried that issues like self-harm and loneliness stemming from the pandemic may affect teenagers.
However, the CDC’s survey has shortcomings, said health officials from some states that pulled back from it. Not all high schools are included, for example.
That was the case in Colorado, which decided not to participate next year, said Emily Fine, school and youth survey manager at the Colorado Department of Public Health and Environment. Instead, she said, the state will focus on improving a separate study called Healthy Kids Colorado, which includes questions similar to those in the CDC survey and Colorado-specific questions. The Colorado survey, which has been running for about a decade, covers about 100,000 students across the state — nearly 100 times the number that participated in the CDC’s state-level survey in 2019. Fine said the state-run option is more beneficial because schools receive their own results.
Whatever the rationale, youth mental health advocates call opting out shortsighted and potentially harmful as the exodus erodes the national data collection. The pandemic exacerbated mental health stress for all high school students, especially those who are members of marginalized communities.
With data showing that students need more mental health services, opting out of the state-level surveys now may do more harm than good, said Franci Crepeau-Hobson, a professor of school psychology at the University of Colorado-Denver, who has used the national youth risk behavior data to analyze trends. “It’s going to make it more difficult to really get a handle on what’s happening nationally,” she said.