Anxious Times…and Getting Worse

Article compiled from various items, written by G. Cooper in “The Clinician’s Digest,” in Pychotherapy Networker magazine, adapted and reprinted with permission, copyright, Psychotherapy Network, Inc.

 

Even before the terrorist attacks of 9/11, researchers had warned that depression and anxiety among Americans were at serious levels. A 1999 study by Columbia University psychologist Suniya Luthar, for example, jarred suburban complacency by finding that 10th graders in an affluent suburb had significantly higher levels of depression, anxiety and substance use—including hard drugs—than inner-city sophomores, a population long thought to be suffering from escalated levels of trauma.

A metanalysis of studies involving 12,000 ages 9 to 17, conducted between 1954 and 1981, as well as 40,000 college students studied between 1952-1993 finds worse news about anxiety: the levels of anxiety have risen sharply in the last 50 years.

The metanalysis, by psychologist Jean Twenge, reported in the December, 2000 Journal of Personality and Social Psychology, finds that the average score for American children in 1981 on self-reported anxiety measures was higher than those for children psychiatrically hospitalized in the 1950’s. Although that finding is more than 20 years old, the factors apparently responsible for this anxiety epidemic have either remained stable or intensified in the last few decades. Her study buttresses a report released in January, 2001 by the U.S. Surgeon General, which estimates that 1 in 10 children and adolescents suffer from mental illness severe enough to cause impairment. (The report also estimates that only 1 in 5 of these children receive needed treatment).

Twenge argues that the broad social trends are as responsible for anxiety among children as are genetics and family dynamics combined. According to her review, anxiety levels rise and fall in rough tandem with “perceived overall threats,” such as fears, nuclear war, violent crimes, or AIDS and with “social connectedness,” measured by such statistics as divorce rates, birth rates and the number of single-person households. “Until people feel both safe and connected to each other,” says Twenge, “anxiety is likely to remain high.”

Twenge’s study came before 9/11, the war on terror and global warming altered the zeitgeist. It’s safe to say that anxiety has gotten worse. A national survey taken between September 14 and September 16, 2001—just after the World Trade Center attack—showed that anxiety among Americans had reached unprecedented levels. For the survey, which was reported in the November 15, 2001 New England Journal of Medicine, respondents were asked to rate their experience of various symptoms of anxiety, such as disturbing memories, difficulty concentrating, sleeping problems and increased irritability, on a scale of one to five. Forty-four percent rated their experience of at least one of the symptoms as “substantial” (4 or 5 on the scale), and 46 percent rated their experience of at least one symptom as “moderate” (2 or 3).

Adults also reported that 35 percent of their children were suffering from elevated stress levels. Parents who felt substantial anxiety were more than twice as likely to report higher stress in their children. It’s unclear how much of that represents the contagion of stress and how much parental projection.

Mark Shuster, the lead researcher and professor of pediatrics and public health, describes the survey as a snapshot, but a month later there was evidence that stress and anxiety levels were still high—and perhaps even higher. On October 14, 2001, The Washington Post reported that in the month after the attacks on the World Trade Center and the Pentagon, prescriptions for anti-anxiety medications increased nationwide. Prescriptions for Ativan and its generic rose by 6.3 percent, with much of the increase occurring in Washington, DC (16 percent) and New York City (19 percent). Prescriptions for Valium and its generic increased 14 percent in Washington, DC, 8 percent in New York, and 3 percent nationally.

Stress and anxiety increased sharply on college campuses as well. An article in the November 13, 2001 Boston Globe reported that requests for mental health services on Boston-area campuses soared once the shock of the September 11 attacks wore off. At Harvard, service requests increased from 400 per week to 600 per week—an unprecedented number. At Boston College the average waiting time to see a campus psychologist jumped from the usual three days to two weeks.

British psychologist Simon Wessley, an expert in stress and chronic fatigue syndrome, predicts that the high stress levels will continue. Writing in the October 30, 2001 British Medical Journal, Wessley says, “The general level of malaise may remain high for years, exacerbating pre-existing psychiatric disorders and further heightening the risk of mass sociogenic illness.”

A later study by Luthar, in the September/October 2002 journal Child Development, looks at affluent seventh graders and finds that 14 percent of the girls have depression and stress scores above the clinical cutoff level. That’s twice the national norm for seventh grade girls. One in five of the girls in the study has clinically significant anxiety, also several points above the national norm. The boys in the study fared no better: they were three times as likely to use alcohol or drugs than the average boy that age.

Luthar finds two factors most frequently associated with depression, anxiety and substance use: emotional and physical isolation from parents, and pressure—both external and internal—to achieve. Interestingly, such achievement pressures have no significant correlation with grades.

These findings are all the more significant because another study on adolescent anxiety has found that highly anxious students were seven times as likely to exhibit anger, two to three times as likely to smoke, and almost twice as likely to drink alcohol than their less anxious peers. The study, conducted by Barbara Henker, a psychologist at the University of California at Los Angeles, also found that highly anxious students were 11 times more likely to report sadness, interacted less with peers in person or on the phone, and spent less time on entertaining activities.

The study, reported in the June, 2002 Journal of the Academy of Child and Adolescent Psychiatry, found that anxious students spent more time on achievement-oriented activities, a finding that echoes Luthar’s research. When these students did interact with friends or family, they felt significantly better, suggesting that such teens need to socialize more.

Despite her findings on the impact of parental absence on their children’s anxiety levels, Luthar is quick to defend affluent parents against charges that they’re pursuing their careers at their kids’ expense. “I’ve never talked to a parent who doesn’t care deeply about their children,” she says. Affluent parents, she believes, trying to raise their children in the best environments, become trapped into working long hours just to meet the high costs and long commutes that are part of where they live.