Naomi Osaka was not doing well and she knew it.

The top-ranked women’s tennis player was feeling “huge waves of anxiety” about facing the press, so she decided not to appear at a post-match press conference at the French Open in May 2021, citing the need to “exercise self-care.”

Osaka was fined $15,000 and later decided to drop out of the tournament entirely.

Naomi Osaka | Getty Images

Two months later, Simone Biles — often considered the best gymnast on the planet — stunned the world by withdrawing from the team final competition in the 2020 Summer Olympics.

In the middle of a vault, she lost her sense of where she was in the air. “I have to put my pride aside,” she told reporters. “I have to do what’s right for me and focus on my mental health and not jeopardize my health and well-being.”

Simone Biles | Getty Images

How does Gen Z view mental health?

Gen Z is speaking up about their mental health, and they are not shy about it. The less positive news is that they are talking about it more because they are suffering more.

Every indicator of mental health and psychological well-being has become more negative among teens and young adults since 2012. My 2017 book, “iGen,” documented the first signs of these trends among teens, and they have only gotten worse since.

In February, the Centers for Disease Control and Prevention released data showing that nearly 1 in 3 high school girls considered suicide in 2021, a 60% increase since 2011. More girls also now report feeling so sad and hopeless they couldn’t engage in their normal activities for at least two weeks in the last year.

“I think there’s really no question what the data is telling us,” Dr. Kathleen Ethier, head of the CDC’s adolescent and school health program, told The New York Times in response to the report. “Young people are telling us they are in crisis.”

Although much of the discussion around these statistics centered on the pandemic, teen depression started to increase more than 10 years ago, around 2012. 

The trends are stunning in their consistency, breadth and size. Most involve what psychologists call internalizing disorders, such as depression or anxiety. Even when they do not rise to the level of disorders, these emotions are not pleasant — they involve feeling unhappy, dissatisfied with life and down on yourself. 

One precursor to these feelings is loneliness — the sense that one is isolated from others. Feeling close social connections to others is crucial for mental health, especially for young people. Gen Z teens are markedly more lonely than previous generations at the same age.

Loneliness among teens had been slowly declining or at least stable since the early 1990s, but after 2012 it suddenly shot upward. 

Carole Henaff for the Deseret News

Teens also became less satisfied with their lives and with themselves. The number of 12th graders who were not satisfied suddenly spiked after 2012, doubling in just eight years, after four decades of not changing much at all. This is strange timing, because the U.S. economy was doing progressively better between 2012 and early 2020, so if anything, teens should be more satisfied with their lives as economic circumstances improved.

Teens also began to show signs of depression and self-doubt. Starting around 2012, they became more likely to agree with statements like “I can’t do anything right” and “My life is not useful” and less likely to agree with “I enjoy life as much as anyone,” all classic symptoms of depression and low self-esteem. These were again sudden and large changes after several decades of only small shifts.

Singer Billie Eilish, who rose to fame after posting a song to SoundCloud at age 14, has captured Gen Z’s despair in her lyrics. “I’m thinkin’ about the things that are deadly,” she sings. “Like I wanna drown, like I wanna end me.”

Eilish had her finger on the pulse of the generational mood long before the rest of the culture. “At the beginning there were all these radio people that wouldn’t play me because I was too sad and no one was going to relate to it. (But) everybody has felt that,” she told Gayle King. “It’s of course really important to promote happiness and loving yourself and stuff, but a lot of people don’t love themselves.” 

Olivia Rodrigo also sings about her generation’s low mood (with a twist of slow-life strategy thrown in). “I’m so insecure, I think / That I’ll die before I drink,” she intones. She doesn’t stand up for herself, she confesses, she’s anxious and no one can help, and if one more person tells her to enjoy her youth, she’s going to cry. “I’m not cool and I’m not smart,” she admits in a song. “I can’t even parallel park.”

Is Gen Z prone to depression?

So far, these are worrying signs of low mood, but not definitive indications of a debilitating mental illness. Perhaps Gen Z is sad but not clinically depressed.

To find out, we can tap the National Survey on Drug Use and Health, a large, federally funded study that puts a premium on privacy and confidentiality. The study assesses depression using the criteria for major depressive disorder in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, the gold standard for diagnosing mental health issues. The criteria include experiencing depressed mood, insomnia, fatigue or markedly diminished pleasure in life every day for at least two weeks.

The result: The number of teens with clinical-level depression doubled between 2011 and 2020, with the increase in depression among young adults not far behind. 

Most tragic of all, the suicide rate for young people skyrocketed after 2007, exceeding the previous highs of the early 1990s. The teen suicide rate nearly doubled between 2007 and 2019, and the suicide rate for those in their early 20s jumped 41%.

Perhaps even more shocking, the suicide rate of 10- to 14-year-olds — most of whom are elementary and middle school students — tripled overall, and nearly quadrupled for girls.

Let that sink in: Twice as many teens were taking their own lives in 2019 than just 12 years before, and three times as many kids in fifth to eighth grade died at their own hands. 

There’s another reason why digital media is the most likely culprit for the rise in depression: it changed day-to-day life in a fundamental way.

These tragic outcomes cannot be explained by self-report issues, lessened stigma or more help-seeking. In fact, if more young people sought help for mental health issues, you’d expect the suicide rate would go down as they got the help they needed. Instead suicide rates have gone up, suggesting that more teens really are suffering from depression and other mental health issues.

The increase in mental health issues among teens and young adults is large, consistent and pervasive. Young people’s actions speak loudly: More are harming themselves, and more are dying by their own hands. Something clearly went wrong in the lives of teens around 2012, and among young adults soon after. The question is: What was it?

The link between smartphones and well-being

When these trends in youth mental health first began appearing in the early 2010s, I had no idea what might be causing them. It was difficult to think of a specific event that occurred around 2012 that reverberated throughout the decade. The economy had finally started to improve after the Great Recession. The traditional generational theory of major events would predict that depression would decline as the economy surged. Instead, it increased.

The rise in teen mental health issues was a mystery.

Then I came across a poll from Pew Research Center, and things began to fall into place. The poll graphed smartphone ownership in the U.S., which started in 2007 with the introduction of the iPhone and crossed 50% at the end of 2012 into the beginning of 2013. This was also around the time that social media use among teens went from optional to virtually mandatory — in 2009, only about half of teens used social media every day, but by 2012, 3 out of 4 did.

Among all the possibilities, the rise of these new technologies seemed the most likely culprit for the rise in teen depression, self-harm and suicide. This argument was initially controversial when I first made it in 2017 in “iGen” (an excerpt in The Atlantic was headlined “Have Smartphones Destroyed a Generation?”), but in the years since, no other plausible culprit has emerged. The very large and sudden changes in mental health and behavior between millennials and Gen Z are likely not a coincidence: They arose from the fastest adoption of any technology in human history.

One important note: I am not suggesting that digital media use is responsible for all cases of teen depression. Many factors influence whether a teen is depressed, including genetic predisposition, poverty, trauma, discrimination and bullying. Nor is every heavy social media user going to be depressed; only some are. (As Derek Thompson put it in The Atlantic, “Social media isn’t like rat poison, which is toxic to almost everyone. It’s more like alcohol: A mildly addictive substance that can enhance social situations but can also lead to dependency and depression among a minority of users.”) People are complex and there are many causes of mental health issues. 

That said, there’s no denying that teen depression and digital media use have increased in lockstep. Internet use, social media use and smartphone ownership rose as depression rose. The pattern of change by age groups also fits. Because adolescents adopted these technologies first and most completely, we would expect a technology-fueled increase in depression to hit adolescents first, young adults second and prime-age adults next. That’s exactly what happened.

Carole Henaff for the Deseret News

If the rise of digital media explains the increase in teen depression, similar patterns of change should appear in countries other than the U.S. that also adopted the technology of smartphones and social media around the same time. This is an argument often voiced by critics of this theory: If it’s the smartphone or social media, they asked, then where is the evidence from other countries?

The evidence has emerged, and it too is overwhelming. Self-harm, anxiety and depression have increased sharply among teens in the United Kingdom, Canada and Australia. Depression rates more than doubled among 13- to 16-year-olds in the United Kingdom, with the sharpest increases after 2010. 

What about other countries? The World Health Organization’s Health Behaviour in School-aged Children study has surveyed more than 600,000 13- and 15-year-olds in 50 countries since 2002, mostly in Europe. The project included a measure of psychological distress, including feeling nervous, being irritable or having trouble sleeping.

The number of teens with significant distress was unchanged or down between 2002 and 2010, but then jumped sharply between 2010 and 2018, especially among girls. The number of teens with high levels of distress increased in 38 out of 40 countries between 2010 and 2018. 

Still, it would be better to have a broader cross section of countries from more regions of the world. That type of data is hard to come by for teen mental health, but one dataset comes close: The Program for International Student Assessment (PISA) included a measure of loneliness at school since 2000. More than 1 million 15- and 16-year-olds in 37 countries were asked if they agreed with statements like “I feel lonely at school” and “I feel awkward and out of place at my school.”

The result? School loneliness among teens rose in 36 out of 37 countries around the world, with increases in loneliness in all regions. Those increases primarily appeared after 2012, exactly the same pattern as loneliness and depression among teens in the U.S. 

The number of teens experiencing a high degree of loneliness doubled in Europe, Latin America, and the English-speaking countries, and increased 65% in Asian countries. The only country where loneliness did not increase was South Korea; teen loneliness increased in Austria, Australia, Belgium, Brazil, Bulgaria, Canada, Chile, the Czech Republic, Denmark, Finland, France, Germany, Greece, Hong Kong, Hungary, Iceland, Indonesia, Ireland, Italy, Japan, Latvia, Luxembourg, Mexico, the Netherlands, New Zealand, Norway, Peru, Poland, Russia, Spain, Sweden, Switzerland, Thailand, the United Kingdom and the United States.

The smartphone led to a global rewiring of human social interaction — when most people own smartphones and use social media, everyone is impacted, whether they use these technologies or not.

Not only that, but the rise in loneliness across all of the countries tracked closely with the rise in teens’ smartphone access and internet time — but not with unemployment, income inequality, gross national product or family size. When smartphone access went up, particularly when 75% or more teens had a smartphone, more and more teens felt lonely at school.

How else does social media impact Gen Z relationships?

There’s another reason why digital media is the most likely culprit for the rise in depression: It changed day-to-day life in a fundamental way. While getting together in person or talking on the phone were the only communication choices for boomers and most Gen Xers when they were young, digital communication became the norm for Gen Z.

Instead of going to the movies or meeting up at parties, Gen Z was using Snapchat, Instagram and TikTok. By early 2020, nearly half of eighth graders spent three hours a day or more using social media. The average teen spent more than eight and a half hours a day with screen media in total in 2021, according to Common Sense Media.

As digital communication took over, in-person gatherings waned. Beginning in the 2000s and accelerating during the 2010s, teens started spending less and less time with each other in person — whether that was just hanging out, going to the mall, driving around or going to parties. By early 2020 (before the Covid-19 pandemic hit), eighth and 10th graders were going out with friends about a day a week less often than they had in the 1990s, when that age group was Gen Xers.

These were not small changes socially. College-bound high school students reported spending an hour a day less socializing and partying with friends than Gen Xers in the 1980s. And that was not because they were spending more time studying or on extracurricular activities — time spent on those activities was roughly the same in the 1980s and the 2010s among high school seniors. 

Young adults in 2019 — even before the pandemic — spent 25 minutes less a day socializing in person with others than those in 2012. That translates to three hours a week, 13 hours a month, and 152 hours a year less in the company of others. 

Smartphones and social media don’t just affect individuals; they affect groups. Smartphones are communication devices. Social media is social. These are not technologies that individual people use in isolation. The smartphone led to a global rewiring of human social interaction — when most people own smartphones and use social media, everyone is impacted, whether they use these technologies or not. It’s harder to strike up a casual conversation when everyone is staring down at a phone. It’s harder for friends to get together in person when the norm is to communicate online instead.

That’s especially true for Gen Z, where these technologies are used by the vast majority of their age-mates. Let’s say Sophia, 16, has chosen not to use social media. She thus escapes seeing Instagram influencers with flawless bodies and unattainable lives every day, doesn’t see the pictures from the parties she’s not invited to and has more time to get enough sleep. But she also feels left out because her friends and schoolmates are all on social media and she’s not. (As teens frequently tell me, they feel like they can’t win whether they’re on social media or not.) Plus, if Sophia wants to live like it’s 1988 and hang out with her friends in person, who will she get together with when her friends would rather post to social media?

This does not go away once teens head to college. “Gen Z are an incredibly isolated group of people,” wrote a Canadian college student recently. “There is hardly a sense of community on campus and it’s not hard to see why. Often I’ll arrive early to a lecture to find a room of 30+ students sitting together in complete silence, absorbed in their smartphones, afraid to speak and be heard by their peers. This leads to further isolation and a weakening of self-identity and confidence, something I know because I’ve experienced it.” Life with smartphones, author Sherry Turkle wrote, means “we are forever elsewhere.”

Considering group-level trends also helps answer the question of whether digital media use causes depression, or depression causes digital media use. Among individuals, it’s probably some of both. But at the group level, it’s much more likely that digital media became popular and depression followed. To make a case for depression causing digital media use at the group level, you’d have to argue that teen depression increased for a completely unknown reason and that that led people to start buying smartphones and using social media. That seems pretty unlikely.

Many of the increases in mental health issues are larger among girls than among boys. For example, the suicide rate for 15- to 19-year-old girls doubled between 2007 and 2019, while the increases for boys were about half that. Rates of clinical-level depression doubled among both teen girls and teen boys, but because the rate is higher for girls, the increase was 14 percentage points for girls and five percentage points for boys. Increases in loneliness, both in the U.S. and worldwide, were also larger for girls than for boys.

Given that the increases appear for both boys and girls but are larger for girls, the cause of the increase in depression is likely something that impacts both but has a larger impact on girls. Digital media fits that description perfectly. For example, while both boys and girls compare themselves to others on social media, girls are especially likely to compare their bodies to the perfect specimens they see online, and especially likely to receive comments about their bodies. “You can’t ever win on social media,” observed a teen girl interviewed by Facebook researchers. “If you’re curvy — you’re too busty. If you’re skinny — you’re too skinny. If you’re bigger — you’re too fat. It’s endless, and you just end up feeling worthless about yourself. I’m never going to have that body without surgery.” Instagram is, at essence, a platform where girls and young women post pictures of themselves and invite others to comment on them.

Even apart from body image, the social dynamics of girlhood — more focused on words, close friendships and popularity than boys — can be a perfect storm on social media. Popularity, which has always been important among teen girls, is now a number: How many followers do you have? How many likes did your post get? Girls also spend more time on social media than boys do: In 2021, 35% of 10th grade girls spent five or more hours a day using social media, compared to 20% of boys.

That may be another reason why the increase in mental health issues is particularly acute among girls: They spend more time on social media, and social media is more strongly linked to unhappiness and depression than other forms of digital media.

TV time is only weakly linked to unhappiness, and gaming (which is more popular among boys) is pretty much a wash until it reaches five hours a day. But unhappiness starts to trend upward after just an hour a day of social media use for girls. Two studies of U.K. teens show the same thing, with social media and internet time the most strongly linked to depression and self-harm behaviors, especially among girls, and gaming and watching TV/videos more weakly linked.

In other words: Not all screen time is created equal. Social media and internet time are the most strongly linked to self-harm and depression, and those links are more pronounced among girls. Electronic gaming and watching TV and videos may not play as big a role in mental health. So if digital media is the cause of the large increase in mental health issues among teens and young adults, solutions focusing on social media in particular might be the most effective at reducing the unacceptably high rates of depression, self-harm and suicide.

What can we do for Gen Z’s mental health?

So what’s the answer? Is there a solution?

Young activists like Emma Lembke, a student at Washington University, have founded movements encouraging young people to quit or limit social media (Lembke’s is called Log Off). Lembke joined Instagram when she was 12 and started spending six hours a day on it, “mindlessly scrolling, absorbing all of these unrealistic body standards. That down the line resulting in disordered eating,” she said. “It just became this horrific loop of going on ... Instagram, feeling worse about myself, but feeling as though I could not stop scrolling because it has this weird power over me.”

Lembke says her goal is more discussion of social media and mental health and more regulation to help make the platforms safer for teens. The organization wants teens “to be more comfortable talking about their experiences so that we can educate legislators to understand a Gen Z perspective, what we need from technology, what privacy concerns we’re having, what mental health concerns we’re having,” she said.

Not that long ago, it was common to see kids and teens playing pickup basketball at a neighborhood park, walking home from school and biking to each other’s houses. Now they are picked up in a car by their parents, and then go inside to play video games or watch videos on TikTok.

The cost of the digital age isn’t just mental — it’s physical. Around 2012, just as smartphones became common, the number of teens who said they rarely exercised increased, reaching all-time highs among both eighth graders and 12th graders by 2019. The number who rarely ate breakfast also started to trend up after two decades of declines. As we saw earlier, the number of teens who don’t sleep enough has also gone up, another unhealthy trend for both physical and mental health.

Perhaps due to lack of exercise and other unhealthy habits, the number of teens and young adults who were overweight increased sharply between 2012 and 2019. By 2016, more than 30% of American young adults were overweight. A full 1 out of 3 young adults in 2019 was not just overweight but clinically obese, up from 1 out of 3 as recently as 2014.

There is little doubt these figures are correct: They are from a CDC-run project that measures height and weight in a mobile lab, which produces considerably more precise and accurate data than self-reports (since it’s tempting to shave off a few pounds when reporting weight). This is not just a Gen Z issue, as the number of overweight and obese older adults also increased over this time. Still, it is stunning to see such a large number of the young considered overweight.

As Jonathan Haidt and I wrote in The New York Times in 2021, it’s not possible to go back in time and eliminate smartphones, and considering all the benefits of the technology, we probably wouldn’t want to. But teens are in crisis, and there are answers. 

For starters, kids already have a long period each day when they are not distracted by their devices: When they’re in school. Locking up phones during the school day allows kids to practice the lost art of paying full attention, especially to their teachers.

We can also delay entry into social media, ideally keeping it entirely out of elementary and middle schools. The platforms should — at a minimum — be held legally responsible for enforcing their stated minimum age of 13 and should be required to implement age and identity verification for all new accounts, as many other industries have done. We can also be mindful that this crisis, as the data suggests, affects us all. Being more compassionate of ourselves, and others, can make a huge difference.

“As an athlete, you’re kind of told to be strong and push through everything, but I think I learned that it’s better to regroup and adjust the feelings you have in that moment and you can come back stronger.”

When Osaka did return to the court, at the Tokyo Olympics, she said she was overwhelmed by the response from other athletes, who told her they understood and supported her. 

“I do hope that people can relate and understand it’s OK to not be OK, and it’s OK to talk about it,” she wrote that month in an essay for Time magazine. “There are people who can help, and there is usually light at the end of any tunnel.”  

Adapted from “Generations: The Real Differences between Gen Z, Millennials, Gen X, Boomers and Silents — and What They Mean for America’s Future” by Jean Twenge from Atria Books, an imprint of Simon & Schuster. Copyright 2023.

This story appears in the May issue of Deseret Magazine. Learn more about how to subscribe.