OCMH Senior Research Analyst Amy Marsman spotlights recent articles, resources, and research findings impacting youth mental health.
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Adolescent Mental Health Theme Issue – Adolescent Suicide, Eating Disorders, and the Role of Systems in Mental Health
In 2023, driven by the rise in adolescent mental health issues and heightened concerns following the pandemic, an ongoing theme issue in JAMA Pediatrics was launched. JAMA published 62 articles as this special theme comes to a close. The corresponding editorial highlights some key insights, including critical advancements in our understanding of adolescent mental health, challenges to existing practices through synthesis of the underlying evidence, and representation of research across a variety of settings and countries. Research focused on suicide, eating disorders, and systems that support adolescent mental health are reviewed.
Majority of Teens Use Chatbots, Some Daily, Some for Companionship
Pew Research found that roughly two-thirds of teens report using chatbots, including 28% who do so daily. The survey research also includes usage of social media platforms by demographic groups. ChatGPT (59%) is by far the most widely used chatbot.
In related research, Common Sense Media found that nearly three in four teens have used AI companions, and half use them regularly. A third of teens have chosen AI companions over humans for serious conversations, and a quarter have shared personal information with these platforms. Common Sense Media maintains that the peril of AI companions outweighs the potential – at least in their current form – and they recommend that no one under 18 should use these platforms.
In response to mounting public scrutiny over the effects of AI chatbots on children, Character AI announced in late November that it would begin removing the ability of users under age 18 to chat with AI-generated characters.
Childhood Predictability and Unpredictability
A research team has been examining early life predictability and found it shapes neurodevelopment and mental health trajectories. The researchers found that unpredictability – inconsistent routines, unstable finances, or frequent moves – can disrupt brain development and increase risks for both mental and physical health issues, sometimes even more strongly than traditional ACEs. Other analyses found unpredictability was associated with depression, anxiety, and impulsivity. In collaboration with community partners, one researcher helped implement unpredictability screenings for more than 100,000 children in Orange County, CA along with exploring policies that promote predictability.
Behavioral health spending spikes to 40% of all children's health expenditures
In this cross-sectional study, U.S. pediatric behavioral health expenditures totaled $41.8 billion, with $2.9 billion in out-of-pocket expenditures in 2022. The proportion of total pediatric medical expenditures directed to behavioral health increased from 22.4% in 2011 to 40.2% in 2022, essentially doubling in a decade.
Laughter Yoga Intervention and the Impacts on Children with Disabilities
This study was a pilot randomized controlled trial of adolescents ages 10-19 years with intellectual or developmental disabilities. The group that engaged in laughter yoga showed significant reductions in anxiety and loneliness compared with the control group. While a larger-scale trial is warranted to confirm the effects, health educators may consider integrating a laughter yoga intervention into school health programs to enhance the mental wellbeing of students with intellectual or developmental disabilities.
Large Majority of Families with a Young Child with a Disability Report Elevated Levels of Economic Hardship and Emotional Distress
RAPID, a survey that began in 2020, measures material hardship as difficulty in the last month paying for one or more basic needs, including food, housing, utilities, child care, and healthcare. Consistent access to basic needs is key to a stable home environment and economic well-being that supports overall family well-being and the healthy development of young children. This fact sheet digs into the experiences of families with a young child with a disability, using data gathered between April 2020 and August 2025 from parents across the country. Nearly 7 in 10 families with a child with a disability (68%) reported difficulty meeting one or more basic needs. The most common areas of hardship was food – with nearly half (48%) reporting hardship.
Cash Transfers in the Perinatal Period Reduced Infant Maltreatment
Infants are most vulnerable to child maltreatment, which may be due in part to economic instability during the perinatal period. In 2024, Rx Kids was launched in Flint, Michigan, achieving near universal participation, and providing every expectant mother with unconditional cash transfers during pregnancy and infancy. In this study, researchers compared changes in allegations of maltreatment within the first six months of life in Flint before and after implementation of Rx Kids relative to the corresponding change in control cities without the program. They found the program led to a significant reduction in allegations of maltreatment among infants.
After implementation of Rx Kids, the maltreatment allegation rate dropped from 21.7% to 15.5% in Flint, falling below the maltreatment allegation rate of 20.6% among the control cities. Rx Kids was associated with a statistically significant decrease in the maltreatment allegation rate, corresponding to a 32% decrease relative to the pre-intervention period.
These findings provide important evidence about the role of economic stability in preventing child welfare system involvement, while solidifying the literature on evidence-based policy options.
Child Maltreatment Referrals Continue to Rise – but Substantiations Fall
Recent Child Trends analyses of the National Child Abuse and Neglect Data System (NCANDS) show that the number of referrals made to child welfare agencies for child maltreatment continued to climb in 2023, the most recent year of available data. Both the number and the rate of referrals for maltreatment have risen since 2021. Although the number of referrals has increased over the past two years, the number of substantiated cases has been decreasing. In 2022, “screened out” referrals outpaced “screened in” referrals for the first time since the pandemic began, a gap that widened further in 2023.
Professionals made over 70 percent of “screened in” referrals in 2023, with law enforcement and school personnel accounting for over half of these reports. Increases in “screened out” referrals may highlight a need for additional professional training on mandated reporting protocols and decision making to help determine when alternative supports outside of maltreatment reporting might be appropriate.
In Wisconsin, the 2023 rate of referrals per 1,000 children to a child welfare agency was 58.3, much higher than the national average of 49.9. However, the percent of kids who were found to be victims of maltreatment was 12% in Wisconsin, which is lower than the national average of 16%. These data and other child welfare indicators are included in the Child Welfare Data Interactive, a data tool that allows users to examine state and national child welfare data on entries into foster care, child maltreatment, kinship caregiving, permanency, and older youth in foster care.
Preliminary Suicide Data Released
Preliminary CDC mortality data show the U.S. suicide rate dropped slightly last year from some of the highest levels ever reported. According to the provisional data, the overall suicide rate fell to 14.4 per 100,000 people in 2024, down from 14.7 per 100,000 in 2023. However, when comparing the same time period for youth, there was no significant change in the suicide rate: ages 5-14 years (1.2 to 1.2) and ages 15-24 years (13.5 to 13.2). Rates also vary by race. Other data on Native American youth suicidality show high rates of suicidal thoughts for both youth ages 12-17 and young adults ages 18-25 (the highest rate among racial groups).
Experts caution that suicide is complicated and that suicide attempts can be driven by a range of factors. Contributors include higher rates of depression, limited availability of mental health services, and the availability of guns.
Preliminary Validity for a Brief Screener for Suicidal Thoughts and Behaviors in Children Under Age 8
Suicidal thoughts and behaviors (STBs) can occur in children as young as preschool age, yet there are few tools to identify those at risk. This study assessed a new 4-item caregiver-report screener for suicide risk in 80 children aged 4 to 7, comparing results to clinical diagnostic interviews. The screener showed high specificity (98%) and good sensitivity (85%), meaning positive screens should be taken seriously as indicators of STB risk. If further validated, this tool could help clinicians identify young children at risk for suicide to ensure they receive appropriate support and intervention.
Care Following Hospitalization for Suicidal Adolescents: Evaluating ASAP and BRITE
This randomized clinical trial examined the efficacy of brief intervention and/or a safety plan phone application for suicide prevention after discharge. A total of 240 youth ages 12 to 17 who were hospitalized at two inpatient psychiatric facilities for suicidal thoughts or behaviors were randomly assigned to one of four treatment conditions: a brief intervention (As Safe As Possible, ASAP), a safety planning phone app (BRITE), their combination, or treatment as usual and followed over six months post-hospitalization. Findings indicate ASAP, BRITE, and their combination are equally effective at decreasing risk for suicidal events over 6 months posthospital discharge. Lower rehospitalization rates were associated with ASAP, whereas BRITE was associated with lower risk of suicide attempt over follow-up among those hospitalized for attempt.
Recently updated with nationwide county-level data, PLACES is an interactive map that provides model-based estimates of a variety of health measures among the U.S. adult population. PLACES is an expansion of the 500 Cities Project. The interactive mapping application allows users to view and analyze health outcomes, prevention measures, health risk behaviors, disabilities, social needs, and social determinants of health. It includes data on a wide range of topics covering physical health, food insecurity, loneliness, social emotional support, health insurance coverage, depression, sleep, and more. The data sources used to generate these estimates include the Behavioral Risk Factor Surveillance System (BRFSS), the American Community Survey (ACS) estimates, and the U.S. Census.
Increasing Emotional Distress Among Those Providing Child Care to Young Children
Those who care for young children, in homes and in centers, provide critical support for families and for overall child development. Yet despite the complexity and importance of their work, these essential workers face serious challenges, including chronically low wages, high stress, and limited professional support. In this fact sheet, data collected between February 2021 and March 2025 are reported and focus on providers’ economic and emotional well-being. The sample includes center-based teachers and directors, home-based providers, family, friend, and neighbor providers, and nannies. The survey data consistently show emotional distress is prevalent among child providers, and the most recent data reveal 84% of providers experienced emotional distress.
Head Start Is a Model for Supporting Child and Family Mental Health
Recent research has shown that children bear the brunt of a “chain reaction of hardship.” Material deprivation, such as struggling to afford food, utilities, and other basic necessities, causes emotional distress in parents and caregivers, including higher levels of stress, anxiety, and depression. These disturbances are, in turn, associated with higher rates of distress in their young children, which can have longer-term impacts on their cognitive, motor, language, and social-emotional development.
In June 2025, more than one-third of parents reported experiencing at least one form of material hardship, and by August 2025, that number rose to 56 percent. Child care precarity – uncertainty associated with being able to find or afford reliable child care – is associated with parental anxiety and distress, which, in turn, has negative impacts on children’s mental well-being.
Head Start is a program for low-income families that offers home visiting, mental health support, and early intervention services, alongside high-quality early education. This article argues that amid a pronounced youth mental health crisis, Head Start stands out as an effective model for supporting the mental health needs of children and their families because of its multigenerational approach – and ought to be fully funded.
Cash Transfers, Economic Stability, Housing, and Maternal Mental Health
National data show that poverty spikes to its highest level perinatally as income drops and expenses rise in the period before a child is born. Because household income plummets before birth and generally remains low until the child reaches the age of one year – a time of profound neurodevelopmental consequences – and given the fact that families with babies and toddlers are the most at-risk age group for eviction, a team of researchers and clinicians in Michigan launched a cash transfer program.
Their first study of the Rx Kids program – an unconditional cash transfer program for prenatal moms and infants in Flint, Michigan – had multiple statistically significant results, including improved maternal mental health and reduced housing instability. (See related article on Rx Kids in the Child Welfare section of this newsletter.)
See related Institute for Research on Policy podcast detailing the program and findings and Rx Kids Impact page and published papers, including an article in The Lancet on child cash benefits and child health.
Rates of Permanency Remain Low Among Older Youth in Foster Care
New Child Trends analysis of data from the Adoption and Foster Care Analysis and Reporting System (AFCARS) finds that only 62% of older youth ages 14-21 exited foster care to legal permanency in 2023; the comparable figure for children ages 13 and under was 98 percent. Legal permanency includes reunification with the child’s family of origin, adoption, guardianship, or living with a relative. Permanency should be the first goal for all children and young people in foster care, as it ensures that they have a legal connection to family as they transition into adulthood and prevents them from aging out of foster care without support.
Wisconsin Family Keys
Nationally, 10% of children enter foster care simply because their families cannot access or maintain affordable housing. According to the Wisconsin Department of Children and Families (DCF), during the 2020 statewide pandemic-related eviction moratorium, Wisconsin saw a 33% reduction in the number of children being removed from their parents due to housing instability. The data showed that when families have stable housing, children are less likely to enter out-of-home care. DCF launched Wisconsin Family Keys, a pilot in three counties, to prevent child removals due to housing instability. Reporting shows that Marathon County saved $381,000 in foster care costs, and after covering rent costs for participating families, the county had a net savings of $250,000. La Crosse County also reported it was more cost effective to address housing than to pay for foster care. Aside from the cost efficiencies, the program is far less traumatizing, which means less childhood adversity and better mental health for affected children.
New Impact Report from the Wisconsin Office of School Safety
The 2024-2025 OSS Impact Report highlights the progress and documents the impact of the Office of School Safety (OSS) initiatives throughout the state. The report covers the Speak Up, Speak Out (SUSO) tipline, which had a 32% increase from the year prior, crisis response and recovery, behavioral threat assessment and management, grants to schools, training on best practices, and comprehensive school safety guidance. This summary will be of interest to those working on psychological safety, violence prevention, emergency readiness, crisis, and trauma-sensitive schools.
Coming Out and Suicide Risk
A new American Academy of Pediatrics blog discusses The Most Dangerous Year: Suicide Risk When Youth Come Out. Though it is well recognized that those who identify as sexual minority (SM) are at higher risk for suicide, the timing of when this risk is particularly high is not well studied. In the accompanying study, researchers looked specifically at the period during which a SM is “coming out,” or revealing their sexual identity, as this is a time that can be fraught with anxiety, fears of rejection and discrimination, and changed relationships with family and friends.
More than half (55%) of respondents reported a suicide plan, more than one third (38%) reported suicide intention, and one quarter (24%) reported a suicide attempt. Disclosure to a family member was associated with a 10-percentage point increase in the likelihood of both first suicide intention and first suicide plan, and a 6-percentage point increase in the likelihood of first suicide attempt.
As most SMs come out during adolescence, this is particularly relevant information for pediatricians and others who work with adolescents and young adults. These data highlight the importance of maintaining contact with SM patients as they go through the period of coming out, as this is a time of increased psychological vulnerability.
Study Finds 31% Lower Odds of Suicide Attempts When Pronouns are Respected
The use and respect of one’s pronouns are essential components of gender identity expression and affirmation for transgender and nonbinary (TGNB) young people. Research from The Trevor Project found TGNB young people whose pronouns were respected had lower rates of past-year suicide attempts (11%) compared to those whose pronouns were not respected (17%), being associated with 31% lower odds of a past-year suicide attempt.
Their brief examines pronoun usage and pronoun respect among TGNB young people.
Large Increase in Psychiatric Diagnoses in Primary Care
This analysis found that during 2005-2019, the proportion of primary care physician visits addressing mental health increased by 44.7%. Psychiatric diagnoses increased by 65.9% in visits with adolescents ages 13–17 and 30.9% in visits with children ages 4–12. The increase in psychiatric diagnoses was driven by anxiety disorders. The increased demand for mental health care among children and adolescents highlights the need for rigorous mental health training for pediatricians.
New Report: Social Connection in America
Despite the importance of social connection, the U.S. lacks consistent, long term, nationally representative data on this fundamental need. The Social Connection in America survey aims to fill that gap. The survey is designed to track the state of social connection across the U.S. over 25 years. Led by Dr. Julianne Holt-Lunstad, the survey will collect rigorous data to provide a scientific foundation for social connection and clarify the urgent risks that loneliness, isolation, and disconnection pose to the American public. The first report from the 2025 survey is now available.
Findings from the inaugural Social Connection in America survey show that American neighborhoods and communities play a powerful role in building social connection.
- 72% of respondents feel a sense of belonging where they live
- 58% say they live in places where neighbors are willing to help one another
Yet, the survey also reveals that disengagement is the norm, and it’s contributing to widespread social isolation. The majority of respondents said they never participate in clubs/organizations, take action with neighbors, volunteer for organizations, or attend religious services.
Loneliness in Adolescence
Loneliness, though often mistaken for social isolation, is a distinct experience that affects individuals across the lifespan and is especially salient during adolescence. This developmental stage involves profound changes in identity, cognition, and social relationships, which can heighten vulnerability to loneliness. Drawing on global research, this paper highlights the widespread prevalence of adolescent loneliness, with variation shaped by cultural and societal factors. Loneliness in adolescence is associated with a range of negative outcomes, including depression, anxiety, social anhedonia, and increased health risks.
The researchers explored developmental transitions, shifting relational dynamics, and broader social environments’ contributions to the experiences of disconnection. They highlight that persistent loneliness may become maladaptive, reinforcing withdrawal through negative expectations and creating self-sustaining cycles of social disconnection.
The review further examines intervention strategies aimed at reducing loneliness (including those that enhance social and emotional skills, strengthen supportive relationships, and address maladaptive cognitions) and differentiates between transient and chronic loneliness.
Youth Overdose Deaths in Wisconsin
According to state data, unintentional injury is a leading cause of death for young people in Wisconsin. Between 2016 and 2023, there were 640 deaths due to unintentional drug overdoses. Half of the deaths occurred in the person’s home. For those with hospital records, half (52%) received a mental health diagnosis, most commonly for mood disorders (38%) or anxiety disorders (38%).
Overdose death records among young people indicate that the risk of overdose death varies by age (40% were 23 or 24 years) and race. Overdose deaths among American Indian youth were four times higher than white youth, while Black youth were three times higher than white youth.
OCMH Research and Data Resources
Key Facts in Youth Mental Health:
https://children.wi.gov/Pages/ResearchData/KeyFacts.aspx
Fact Sheets: https://children.wi.gov/Pages/ResearchData/FactSheets.aspx
Data Sources: https://children.wi.gov/Pages/Resources/DataSources.aspx
Research News in Youth Mental Health: https://children.wi.gov/Pages/OCMHNewsletters.aspx
Youth Mental Health Initiatives: https://children.wi.gov/Pages/Resources/ChildrensInitiatives.aspx
Please do not reply directly to this email message. To contact OCMH, email OCMH@wisconsin.gov
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