After she graduated from college, Lauren Smith struggled to find a sense of purpose.
The outgoing, goal-oriented psychology major moved back home to Batavia, Ill., without a job lined up or a career plan in place, and her mood, already low, spiraled downward. She was very sad all the time. She didn't want to eat or sleep. She shut out her friends and family.
"It's just a sense of despair and loneliness," Smith, 22, said of the depression that closed in on her in May.
"I kind of felt like nothing could ever work. I felt hopeless and useless."
Depression and related forms of psychological distress aren't just affecting teens. The rate of major depression among young adults, ages 18 to 25, rose 63% between 2009 and 2017, according to a national study published earlier this year in the Journal of Abnormal Psychology. In April, Northwestern Medicine Central DuPage Hospital responded to growing demand for services by starting a young adult track in its intensive outpatient mental health program.
At NAMI Chicago (local affiliate of the National Alliance on Mental Illness), executive director Alexa James reports an increase in young people calling the nonprofit's mental health helpline.
"We do need to recognize that there is a mental health crisis among adolescents and young adults," said Jean Twenge, co-author of the recent study in the Journal of Abnormal Psychology and author of the book "iGen: Why Today's Super-Connected Kids Are Growing Up Less Rebellious, More Tolerant, Less Happy – and Completely Unprepared for Adulthood."
"We need to think carefully about how our teens are living now and what might be contributing to these mental health issues."
A striking 13% of young adults – more than 1 in 10 – experienced major depression in the final year of Twenge's study.
Among the explanations suggested by researchers and mental health professionals: societal pressure to achieve at an early age, exposure to trauma and images of peers' success on social media, fewer face-to-face social interactions – and an accompanying increase in loneliness, less sleep and exercise due to factors such as smartphones, and even a reduction in stigma, which may make young people more likely to come forward and be counted.
Celebrities have become increasingly willing to discuss their mental health problems, with Selena Gomez speaking openly about her struggles with anxiety and depression.
Smith was first diagnosed with depression and anxiety at about age 13, but she was able to function well with the help of a therapist and a supportive family. At Batavia High School, where she was a cheerleader, she enjoyed spending time with friends and participated in choir and theater.
In college at Illinois State University, she majored in psychology, was active in her sorority and worked as a bartender.
A big goal for her – dating back to middle school – had been to graduate from college, and this past spring she was almost there. She participated in the graduation ceremony in May, despite still needing four credits to graduate, with the school allowing her to do the remaining coursework online.
Her psychology degree wouldn't open up many job opportunities if she didn't go on to get a master's degree, she said, but she knew that wasn't the right step for her. The problem was, she didn't know what the right step was.
"There's this sense of, 'What do I do now?' And I think a lot of kids my age are trying to figure that out."
At Central DuPage Hospital, behavioral health counselors Kelly Powell and Nea Cortez said that they're seeing more young people struggling with post-high school and post-college transitions.
"We noticed that it was a big struggle," said Powell. "We were noticing more and more people were either staying at home or coming back home because they were having trouble with the transition."
Smith said her depression got so bad that in June she spent a week as an in-patient in the psychiatric ward at Central DuPage Hospital, a difficult and surreal experience, she said, but one that put her on the right track. She had already been taking medication for depression, but her new psychiatrist prescribed an additional medication for anxiety that was very helpful.
"I can't stress (enough) the importance of seeing a psychiatrist, of medication," she said. "It's so needed. You need a positive attitude, but you also need the medication."
After she left in-patient care, she attended an intensive eight-week outpatient program that included the specialized young adult services added in April.
She learned coping techniques, did individual and group therapy, examined her core values, and worked to break down her big goals into more manageable parts. There was coaching focused on the particular needs of young people exiting school. Now she's sending out resumes for bartending and waitressing jobs, dating, planning to return to her coursework this winter and even painting again – a passion she gave up during her darkest days.
"Thanks to the (outpatient mental health) program, I would say that I'm totally better now," she said. "It's like a 360-degree turnaround. I just feel like I have this new sense of purpose and positive attitude about life."
Rates of major depression in young adults rose from 8.1% to 13.2% between 2005 and 2017, according to Twenge's study, while the rate in adolescents rose from 8.7% to 13.2%. Rates of serious psychological distress and suicidal behavior also increased for young adults, with less consistent and weaker increases in older adults (26 and over).
Smith believes that a big part of the explanation lies in the societal pressure to achieve academically and professionally.
"Every few years or so, the standard gets raised: You have to be this good. You have to have this amount of education. You either work your butt off and get a great GPA, or you're kind of just in that group of 'average.' And most of the people in that average group don't get those big, high-end jobs," she said.
James, the NAMI executive, said destigmatization may be freeing more people to seek help: "My hope is there's more mental health literacy."
Twenge doesn't think destigmatization is playing a major role in the increase in depression; she points out that people aren't just reporting depression at higher levels; they're attempting suicide at higher rates, a finding that reflects emergency room visits, not a willingness on the part of the individual to disclose an illness.
Twenge also questions the "societal pressure" explanation.
She said pressure to achieve has long been a factor in some small corners of society, but studies indicate that for the vast majority of young people, rising academic expectations aren't the issue. She said eighth graders actually spend less time on homework than in the 1990s, and high school seniors spend about the same amount of time on homework as they did in the 1990s.
Twenge said the most likely explanation is the rise of smartphones and social media.
The problem with smartphones and social media isn't just the activity itself; it's what screen time replaces, she said. Exercise is linked to lower rates of depression, as is spending time with other people face-to-face, she said, and not getting enough sleep is a major risk factor for mood disorders such as depression.
Teens and entering college students spend an hour less per day on face-to-face socializing than young people in the 1980s, and there has been a sharp increase in loneliness since the 1980s, according to a 2019 study co-authored by Twenge in the Journal of Social and Personal Relationships.
Smith said that she's a big advocate for mental health services, and she hopes her story encourages young people to seek the help they need.
Asked to describe her life now, she smiled: She's calm, she said.
"I've always been this racing-thought kind of person. I've always been like, 'We've got to do this! We've got to do that! What comes next?' For the first time in my life, I feel like I can sit down and breathe and feel like I can be grounded. I feel like I can be anyone I want to be, because I have that sense of calmness, that sense of reassurance."