'Boys are disappearing' from mental health care, as signs of depression and anxiety go undetected

Teenage boys are drowning in just as much of the depression and anxiety that’s been well documented in girls. Experts warn that many young men struggling with their mental health are left undetected and without the help they need.

“We are right to be concerned about girls,” said Kathleen Ethier, director of the Division of Adolescent and School Health at the Centers for Disease Control and Prevention. “But I don’t ever want us to lose sight of the fact that boys aren’t doing well, either.”

Depression in boys may go unnoticed, Ethier and other experts said, because boys usually don’t show it through signs of melancholy typically found in girls.

“We have this very classic understanding of depression as being sad, being tearful, crying more, not eating as much and losing weight,” said Dr. Lauren Teverbaugh, pediatrician and child psychiatrist at Tulane University in New Orleans. “That’s just not how it looks for a lot of young boys.”

‘Boys are disappearing’

A recent study published in the journal Pediatrics found that while antidepressant prescriptions have risen dramatically for teenage girls and women in their 20s, the rate of such prescriptions for young men “declined abruptly during March 2020 and did not recover.”

Dr. Kao-Ping Chua, a pediatrician at the Susan B. Meister Child Health Evaluation and Research Center at the University of Michigan, led the study. He said that his finding that boys weren’t accessing antidepressant medications once the pandemic hit has been “perplexing.”

“In males, it’s theoretically possible that this reflects improved mental health, but I’m struggling with that explanation,” Chua said. “Given that everybody’s mental health got worse, I would have expected that boys’ antidepressant dispensing would have at least remained stable, not decrease.”

The more likely explanation in Chua’s experience as a pediatrician, he said, was that boys stopped engaging with the health care system overall during the pandemic, leading to an underdetection and, consequently, an undertreatment of mental health problems in young men.

“There was something happening to make male adolescents not come in for mental health,” Chua said. “They didn’t go to their doctors. They skipped physicals.”

“Boys are disappearing,” he said.

What does depression look like in boys?

Boys struggling with their mental health tend to show it with a shorter fuse: They’re easily irritated, frustrated or aggressive.

“A lot of times, parents who have boys with depression say that they’re walking on eggshells around them because they don’t know what would set them off,” said Dr. Mai Uchida, a pediatric psychiatrist and director of the Child Depression Program at Massachusetts General Hospital.

Parents, pediatricians and even psychiatrists may not pick up on mental health problems in boys, Uchida said, because “they don’t fit the stereotypical image of depression.”

Women have long been much more likely to be diagnosed with depression than men. But a 2013 study found that when “irritability” is considered a main symptom, the rate of depression actually equalized between the sexes: 30.6% of men and 33.3% of women.

In addition to irritability, depression symptoms in boys can include impulsivity, risk-taking behavior and being more argumentative than usual.

Dr. Willough Jenkins, a psychiatrist and the medical director of emergency and consultation liaison psychiatry at Rady Children’s Hospital in San Diego, blamed, in part, a societal normalization of teenage angst and irritability.

“There’s a myth that teenagers are supposed to be irritable, that they’re supposed to be cranky,” she said. “I think too many parents have heard that and think it’s normal behavior, when it’s really indicating that there could be a struggle.”

Evidence of mental health distress among teens — especially young girls — has been mounting for years. Covid-19 lockdowns worsened the situation.

In 2023, a sobering report from the CDC revealed that girls experienced unprecedented levels of sadness and hopelessness early in the pandemic.

The research might indicate that boys don’t require the same level of mental health care as girls. That’s not true, experts insist.

“Both boys and girls are struggling,” Jenkins said. “None of our young people are doing well in terms of their mental health.”

‘Anger caused by sadness’

Eighteen-year-old Noah Power, who lives in Yukon, Canada, said his struggles with anxiety and depression began when he was about 12 years old.

His mental health symptoms first took the form of headaches and crushing pressure in his chest. Over time, those symptoms developed into a “rush of anger that I couldn’t explain,” he said. “It was like anger caused by sadness.”

Power said that expressing himself through anger and irritability felt like a natural, healthy outlet.

“It can be a bit much, but for us, we feel like we’re doing something good for our own brain,” he said.

In addition to long-term psychotherapy and medication, Power has relied on physical outlets for his anxiety and depression. Running, he said, is key.

“Being able to run and run and run and get all of my energy out has been the most helpful thing for me,” Power said. “You sweat out all of your energy.”

Lockdowns led to fewer referrals

Teachers, coaches and other caregivers outside of the home are on the front lines of monitoring teen mental health, Tulane’s Teverbaugh said.

“Not only do they see that child, but they see other children their same age also experiencing some of the same environmental factors,” she said. “They’re a really good measure for being able to pick up on something that is beyond the norm.” Teverbaugh and other experts said that many referrals for boys seeking mental health treatment stem from behavioral issues in school.

When schools went remote and sports and other activities were canceled in 2020, those referrals decreased.

“We’re often not seeing [boys] in the office, because it’s just not being picked up as much in the community,” she said.

Advice for parents

Mass General’s Uchida — a mother of three young boys — encourages parents to permit sons to express their sadness and frustrations.

“We have to really allow them to feel that and hold their hand and appreciate that they are expressing that kind of emotion,” she said. “They’re going through a lot. We often forget to empathize with them.”

Power said that having a parent or caregiver calmly listen, even during verbal outbursts, is helpful. “What we really, really appreciate is the listening and being able to just vent,” he said. “Just getting it all out is a huge relief.”

And if teenage boys can’t find the words to express themselves, allow them other outlets.

“They may not use emotional language like, ‘I feel sad,’” Teverbaugh said. “But when they’re playing their video games together, or they’re on the basketball court just goofing around, that’s engagement. That’s social interaction. That’s them being able to feel connected.”

Power also credits online gaming as a coping skill. “It’s an easy way to talk to your friends and have a good time,” he said. “Face-to-face social pressure can be a lot, especially when you’re going through something and you don’t want to break down in front of the person.”

This article was originally published on NBCNews.com