Recent studies cast doubt on whether large-scale mental health interventions are making young people better. Some even suggest they can have a negative effect.In recent years, mental health has become a central subject in childhood and adolescence. Teenagers narrate their psychiatric diagnosis and treatment on TikTok and Instagram. School systems, alarmed by rising levels of distress and self-harm, are introducing preventive coursework in emotional self-regulation and mindfulness.Now, some researchers warn that we are in danger of overdoing it. Mental health awareness campaigns, they argue, help some young people identify disorders that badly need treatment — but they have a negative effect on others, leading them to over-interpret their symptoms and see themselves as more troubled than they are.The researchers point to unexpected results in trials of school-based mental health interventions in the United Kingdom and Australia: Students who underwent training in the basics of mindfulness, cognitive behavioral therapy and dialectical behavior therapy did not emerge healthier than peers who did not participate, and some were worse off, at least for a while.And new research from the United States shows that among young people, “self-labeling” as having depression or anxiety is associated with poor coping skills, like avoidance or rumination.In a paper published last year, two research psychologists at the University of Oxford, Lucy Foulkes and Jack Andrews, coined the term “prevalence inflation” — driven by the reporting of mild or transient symptoms as mental health disorders — and suggested that awareness campaigns were contributing to it.“It’s creating this message that teenagers are vulnerable, they’re likely to have problems, and the solution is to outsource them to a professional,” said Dr. Foulkes, a Prudence Trust Research Fellow in Oxford’s department of experimental psychology, who has written two books on mental health and adolescence.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

A large study of “discordant twins,” in which only one suffered abuse or neglect, adds to evidence linking childhood trauma to adult illness.Twins are a bonanza for research psychologists. In a field perpetually seeking to tease out the effects of genetics, environment and life experience, they provide a natural controlled experiment as their paths diverge, subtly or dramatically, through adulthood.Take Dennis and Douglas. In high school, they were so alike that friends told them apart by the cars they drove, they told researchers in a study of twins in Virginia. Most of their childhood experiences were shared — except that Dennis endured an attempted molestation when he was 13.At 18, Douglas married his high school girlfriend. He raised three children and became deeply religious. Dennis cycled through short-term relationships and was twice divorced, plunging into bouts of despair after each split. By their 50s, Dennis had a history of major depression, and his brother did not.Why do twins, who share so many genetic and environmental inputs, diverge as adults in their experience of mental illness? On Wednesday, a team of researchers from the University of Iceland and Karolinska Institutet in Sweden reported new findings on the role played by childhood trauma.Their study of 25,252 adult twins in Sweden, published in JAMA Psychiatry, found that those who reported one or more trauma in childhood — physical or emotional neglect or abuse, rape, sexual abuse, hate crimes or witnessing domestic violence — were 2.4 times as likely to be diagnosed with a psychiatric illness as those who did not.If a person reported one or more of these experiences, the odds of being diagnosed with a mental illness climbed sharply, by 52 percent for each additional adverse experience. Among participants who reported three or more adverse experiences, nearly a quarter had a psychiatric diagnosis of depressive disorder, anxiety disorder, substance abuse disorder or stress disorder.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

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Alone with his mother for the first time in almost a year, Andrey Shevelyov had a question: Could he come home?She sat beside him and stroked his head. The hotel room had a sour, rancid smell, and clothes lay mounded in a corner. His fingernails were long and curved and ridged with dirt. In jail, they cut off his hair, which had been matted and infested with lice.Clean-shaven now, Andrey looked younger than his 31 years, like the gentle, artistic boy he had been before the psychosis took hold. “Zaichik,” his mother called him, a childhood nickname. Bunny rabbit. She pushed a strand of hair over his ear. He lay back on the bed and smiled, and a dimple appeared on his cheek.“I like living with you also,” said Olga Mintonye, but it was not an honest answer.Three years ago, when he stopped taking his antipsychotic medication, her son withdrew into delusions, erupting in unpredictable and menacing outbursts. Fearful of being evicted from their apartment, she and her husband, Sam, sought a no-contact order to keep Andrey away.Since then, he had lived in a tent, wandering Vancouver in ragged clothing and carrying machetes for protection. Twice, he had been in jail, ranting in his cell about the C.I.A. Three times, he was confined to psychiatric hospitals, where guards wrestled him down so he could be injected with antipsychotics.Now they were together in Room 117 in a budget hotel overlooking the interstate. The county had allotted $8,400 to house him temporarily, as part of an effort by the state to divert the stream of severely mentally ill people from the criminal justice system. It was enough to keep him in the Red Lion Inn for eight weeks.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? 

An Oxford researcher measured the effect of popular workplace mental health interventions, and discovered little to none.Employee mental health services have become a billion-dollar industry. New hires, once they have found the restrooms and enrolled in 401(k) plans, are presented with a panoply of digital wellness solutions, mindfulness seminars, massage classes, resilience workshops, coaching sessions and sleep apps.These programs are a point of pride for forward-thinking human resource departments, evidence that employers care about their workers. But a British researcher who analyzed survey responses from 46,336 workers at companies that offered such programs found that people who participated in them were no better off than colleagues who did not.The study, published this month in Industrial Relations Journal, considered the outcomes of 90 different interventions and found a single notable exception: Workers who were given the opportunity to do charity or volunteer work did seem to have improved well-being.Across the study’s large population, none of the other offerings — apps, coaching, relaxation classes, courses in time management or financial health — had any positive effect. Trainings on resilience and stress management actually appeared to have a negative effect.“It’s a fairly controversial finding, that these very popular programs were not effective,” said William J. Fleming, the author of the study and a fellow at Oxford University’s Wellbeing Research Center.Dr. Fleming’s analysis suggests that employers concerned about workers’ mental health would do better to focus on “core organizational practices” like schedules, pay and performance reviews.“If employees do want access to mindfulness apps and sleep programs and well-being apps, there is not anything wrong with that,” he said. “But if you’re seriously trying to drive employees well-being, then it has to be about working practices.”Dr. Fleming’s study is based on responses to the Britain’s Healthiest Workplace survey in 2017 and 2018 from workers at 233 organizations, with financial and insurance service workers, younger workers and women slightly overrepresented.The data captured workers at a single point in time, rather than tracking them before and after treatment. Using thousands of matched pairs from the same workplace, it compared well-being measures from workers who participated in wellness programs with those of their colleagues who did not.It is possible that there was selection bias, since workers who enroll in, say, a resilience training program may have lower well-being to begin with, Dr. Fleming said. To address that, he separately analyzed responses from workers with high pre-existing levels of work stress, comparing those who did and did not participate. But among this group, too, the survey answers suggested that the programs had no clear benefit.The findings call into question practices that have become commonplace across job sectors. But researchers said they came as no surprise.“Employers want to be seen as doing something, but they don’t want to look closely and change the way work is organized,” said Tony D. LaMontagne, a professor of work, health and well-being at Deakin University in Melbourne, Australia, who was not involved in the study.Workplace mental health interventions may send the message that “if you do these programs and you’re still feeling stressed, it must be you,” Mr. LaMontagne said. “People who don’t have a critical view might internalize that failure: ‘So I really am a loser.’”The corporate wellness services industry has ballooned in recent years, with thousands of vendors competing for billions of dollars in revenue. Companies invest in the interventions in hopes of saving money overall by improving worker health and productivity.Some research supports this expectation. A 2022 study tracking 1,132 workers in the United States who used Spring Health, a platform that connects employees with mental health services like therapy and medication management, found that 69.3 percent of participants showed improvement in their depression. Participants also missed fewer days of work and reported higher productivity.Adam Chekroud, a co-founder of Spring Health and an assistant professor of psychiatry at Yale, said Dr. Fleming’s study examined interventions that were “not highly credible” and measured well-being many months later. A blanket dismissal of workplace interventions, he said, risks “throwing the baby out with the bathwater.”“There is recent and highly credible data that things like mental health programs do improve all those metrics that he mentions,” Dr. Chekroud said. “That’s the baby you shouldn’t be throwing out.”There is also solid evidence that practices like mindfulness can have a positive effect. Controlled studies have consistently demonstrated lower stress and decreased anxiety and depression after mindfulness training.The lackluster benefits that Dr. Fleming found may reflect variations in offerings, said Larissa Bartlett, a researcher at the University of Tasmania who has designed and taught mindfulness programs. “Light-touch” interventions like apps, she added, are generally less effective than one-on-one or group trainings.Dr. Fleming’s study, she said, “misses most of these details, condensing intervention types into broad labels, engagement into yes/no, and dismissing the reports from intervention participants that they felt they benefited from the programs they did.”A key omission, she added, is longitudinal data showing whether participants experience improvement over time. The result is a “bird’s-eye view” of the well-being of participants that “skates over changes that may occur at the individual level,” she said.Dr. Fleming said that he was aware of the body of research supporting the treatments’ effectiveness, but that he had “never been as convinced by the very positive findings,” since the data comes from controlled trials in which the treatment is implemented very well, something that may not be the case in employer-provided programs.Dr. David Crepaz-Keay, the head of research and applied learning at the Mental Health Foundation in the United Kingdom, who has advised the World Health Organization and Public Health England on mental health initiatives, described Dr. Fleming’s data and analysis as “certainly more robust” than “most of the research that has created the consensus that employee assistance works.”

Traumatic memories had their own neural mechanism, brain scans showed, which may help explain their vivid and intrusive nature.At the root of post-traumatic stress disorder, or PTSD, is a memory that cannot be controlled. It may intrude on everyday activity, thrusting a person into the middle of a horrifying event, or surface as night terrors or flashbacks.Decades of treatment of military veterans and sexual assault survivors have left little doubt that traumatic memories function differently from other memories. A group of researchers at Yale University and the Icahn School of Medicine at Mount Sinai set out to find empirical evidence of those differences.The team conducted brain scans of 28 people with PTSD while they listened to recorded narrations of their own memories. Some of the recorded memories were neutral, some were simply “sad,” and some were traumatic.The brain scans found clear differences, the researchers reported in a paper published on Thursday in the journal Nature Neuroscience. The people listening to the sad memories, which often involved the death of a family member, showed consistently high engagement of the hippocampus, part of the brain that organizes and contextualizes memories.When the same people listened to their traumatic memories — of sexual assaults, fires, school shootings and terrorist attacks — the hippocampus was not involved.“What it tells us is that the brain is in a different state in the two memories,” said Daniela Schiller, a neuroscientist at the Icahn School of Medicine at Mount Sinai and one of the authors of the study. She noted that therapies for PTSD often sought to help people organize their memory so they can view it as distant from the present.“Now we find something that potentially can explain it in the brain,” she said. “The brain doesn’t look like it’s in a state of memory; it looks like it is a state of present experience.”Indeed, the authors conclude in the paper, “traumatic memories are not experienced as memories as such,” but as “fragments of prior events, subjugating the present moment.”The traumatic memories appeared to engage a different area of the brain — the posterior cingulate cortex, or P.C.C., which is usually involved in internally directed thought, like introspection or daydreaming. The more severe the person’s PTSD symptoms were, the more activity appeared in the P.C.C.What is striking about this finding is that the P.C.C. is not known as a memory region, but one that is engaged with “processing of internal experience,” Dr. Schiller said.The findings feed into a much debated question in the field of trauma: Should clinicians encourage people with PTSD to expose themselves to their most traumatic memories?In recent years, many Americans have embraced treatments such as prolonged exposure therapy and eye movement reprocessing and desensitization, or EMDR, which revisit traumatic memories in hopes of draining them of their destructive force. Ilan Harpaz-Rotem, an author of the paper, said the new findings suggested that revisiting the memory was a critical element of treatment.“You are helping the patient to construct a memory that can be organized and consolidated into the hippocampus,” said Dr. Harpaz-Rotem, a professor of psychiatry and psychology at Yale University.He described a case from his clinic: An Army medic was haunted by a fragmentary image from his past, of frantically bandaging a solder’s wound while under fire. In therapy, trying to “build a story, a coherent memory,” the clinician helped the medic fill in details around the edges of that scene, including a dead soldier who lay nearby, shooting in the background, and his own panicked use of too many bandages.Ideally, such treatments can help transform the traumatic memory into one that more closely resembles ordinary sad memories. “It’s like having a block in the right place,” he said. “If I can access a memory, I know it’s a memory. I know it’s not happening to me now.”Dr. Ruth Lanius, the director of PTSD research at the University of Western Ontario who was not involved in the study, described its findings as “seminal,” both because it establishes that traumatic memories have distinct pathways and because it indicates that key mechanisms for traumatic memory may involve less-examined areas of the brain. Much research into PTSD has focused on the amygdala, the stress detection center of the brain, and the hippocampus, she said. The posterior cingulate cortex is “really involved in the reliving of memories,” and in seeking self-relevance, which may explain why a sensory reminder may cause overwhelming fear or panic.“A soldier, if they hear fireworks, they may run and take cover,” Dr. Lanius said. “Traumatic memories are not remembered, they are relived and re-experienced.”Clinicians, she said, can use these findings to treat patients who “don’t feel that the trauma is over,” employing therapies that “bring on line context, so you know, ‘Oh, that happened in the past.’” She said researchers should explore therapies, like mindfulness, which are known to activate the parts of the brain known to provide context.If biological markers for PTSD can eventually be identified, it would be “a major scientific contribution,” settling differences within the field about what experiences constitute a trauma, said Brian Marx, deputy director of the Behavioral Science Division of the National Center for PTSD, who was not involved in the study.While most experts agree that motor vehicle accidents, sexual assaults or military combat are traumatic events, there is disagreement about whether experiences like racism or pandemic stress should be viewed as the basis for a PTSD diagnosis, he said.“It is one of the foundational questions of the field,” he said. “It is a debate we still wrestle with, because we don’t have an answer for it.”Dr. Marx called the new research “intriguing,” but not conclusive, noting that it did not include a comparison group of subjects without a PTSD diagnosis, specify how long ago the traumatic events took place, or specify whether the subjects had already received psychotherapy.And he said it was not likely to settle debates over whether PTSD treatments should include exposure to traumatic memories, since literature on treatment outcomes show that responses are highly individualized.“To say this is proof positive really ignores the reality that our treatments are imperfect,” he said. “They don’t work for everyone in the same way.”

Gunshots are the top cause of death for children and teenagers in the U.S. Fatal or not, the wounds reverberate through communities and the health care system.With each mass shooting, Americans look to one grim indicator — the number of dead — as a measure of the destructive impact. But damage left behind by gunshot wounds reverberates among survivors and families, sending mental health disorders soaring and shifting huge burdens onto the health care system, a new analysis of private health insurance claims shows.In 2020, gunshot wounds became the leading cause of death for children and adolescents in the United States. Though the government does not systematically track nonfatal gunshot wounds, existing evidence suggests that they are two to three times as common as fatal ones. These wounds can be especially catastrophic in children, whose bodies are so small that the amount of tissue destroyed is greater.“What comes after the gunshot is so often not talked about,” said Dr. Chana Sacks, co-director of the Gun Violence Prevention Center at Massachusetts General Hospital and an author of the new study, published on Monday in the journal Health Affairs. The study, which analyzed thousands of insurance claims, maps out lasting damage to families and communities.For families in which a child died of a gunshot wound, surviving family members experienced a sharp increase in psychiatric disorders, taking more psychiatric medications and making more visits to mental health professionals: Fathers had a 5.3-fold increase in treatment for psychiatric disorders in the year after the death; mothers had a 3.6-fold increase; and surviving siblings had a 2.3-fold increase.Children and teenagers who survive gunshot wounds become, as Dr. Sacks put it, “more like lifelong patients.” During the year after the injury, their medical costs rose by an average of $34,884, a 17-fold increase from baseline, driven by hospitalizations, emergency room visits and home health care, the study found.Children and adolescents who survived the most severe gunshot wounds, requiring treatment in an intensive care unit, struggled considerably. In that group, diagnoses of pain disorders increased 293 percent, and psychiatric disorders increased by 321 percent.The study examined medical records from 2,052 children who survived gunshots, 6,209 family members of children who survived, and 265 family members of children who died from gunshot wounds, comparing each with five controls. Because the study was based on private insurance claims, it did not reflect the experience of families who were uninsured or on public insurance.Rising costs linked to firearms injuries make it “increasingly an economic issue,” said Dr. Zirui Song, an associate professor at Harvard Medical School and co-author of the study. The prevalence of gunshot wounds has quadrupled over the last 12 years in the population covered by private insurance, he said.In a paper published last year in the Journal of the American Medical Association, Dr. Song calculated the annual cost of firearms injuries in lost wages and medical spending as $557 billion, or 2.6 percent of gross domestic product. The new study is the first to focus on the cost of nonfatal gunshot wounds, he said.“The cruel reality is that if one dies from a firearm injury, one is free to society — there’s no more health care spending, no more taxpayer dollars, no more resources used,” he said. “But actually surviving a firearm injury is quite expensive to society. The magnitude of that was previously not known.”National data on nonfatal gunshot wounds is “disturbingly unreliable,” but many survivors face long-term disability, said Dr. Megan Ranney, an emergency room physician and the dean of the Yale School of Public Health, who was not involved in the study.“It may be that they have been shot in the intestine, or through a major blood vessel, it could be a bullet has gone through their lung,” Dr. Ranney said. “It can also be that they’ve been shot through the head or the spine.”Trauma physicians have long observed the ripple effect of shootings on the health of family members and communities, she said, often because of repeated visits to the emergency room for nightmares, anxiety or depression, but “we’ve never been able to measure it.”Clementina Chery, a Boston woman whose 15-year-old son was fatally shot in crossfire in 1993, and who founded the Louis D. Brown Peace Institute, an organization to support families who have lost members to gun violence, said she had often seen survivors struggle with addictive behavior, job loss, suicidal or homicidal thoughts in the years after a young person dies.“In that immediate aftermath, I just felt that I was having an out-of-body experience,” Ms. Chery said. She turned to alcohol, she said — “a little wine here, a little wine there” — and found it difficult to leave her house. Her marriage ended. What finally woke her up, she said, was realizing that her younger children were starved of attention.“I literally was going through the motions,” she said. “I was not living. It was like, what do you call it, a mechanical robot.”The ripple effect of gunshot wounds is important because these injuries tend to be concentrated in specific communities, usually communities of color, where many young people know someone who has been shot, Dr. Sacks said.She traced her interest in the subject to the 2012 mass shooting at Sandy Hook Elementary School in Newtown, Conn., where the 7-year-old son of her cousin was one of 20 children killed. The child’s death “changed my life” and has continued to shape extended families and communities in the years that followed, she said.“We can’t think about this as a problem that starts and ends with the bullet going in and then the acute surgical care,” Dr. Sacks said. “Leaving the hospital is just the beginning of that family’s journey, and I think we need to treat it that way.”

At a time when teen suicide was seen as random and unpredictable, Dr. Shaffer, a psychiatrist, led investigations that proved that it was not.Dr. David Shaffer, a psychiatrist who spent decades studying children and teenagers who died by suicide, constructing a framework for screening and laying the groundwork for modern prevention efforts, died on Sunday in Mastic, N.Y., on Long Island. He was 87.His son, Dr. Charlie Shaffer, said the cause was respiratory failure from Alzheimer’s disease. For about six years, as the disease progressed, he had lived on the estate of the Vogue editor Anna Wintour, his former wife and the mother of two of his children.In the 1970s, when Dr. Shaffer was a young doctor, most people saw the suicide of a child or adolescent as a random and unpredictable act. Trained as an epidemiologist, he undertook an investigation known as a “psychological autopsy,” gathering detailed information from adult caregivers of 31 children who had died by suicide.The research yielded surprises. In more than a third of the cases, the suicide had occurred in the midst of what he called a “disciplinary crisis,” as the child awaited consequences. Many of the children were described, not as depressed, but as aggressive or impulsive.And there were clusters of suicides apparently driven by contagion. Dr. Shaffer realized this when he repeatedly spotted the name of one Welsh town in coroners’ reports, a light-bulb moment that he recalled with satisfaction many years later.“He liked the detective work,” Dr. Charlie Shaffer said. “That’s why he loved being an epidemiologist. He loved detective stories.”That investigation, and the others that Dr. Shaffer conducted in the years that followed, have helped identify clinical, neurological and behavioral characteristics linked to suicide.As the head of Columbia University’s vast and influential child psychiatry program, he developed clinical tools that are widely used today, such as the Diagnostic Interview Schedule for Children, or DISC-IV, an interview that assesses more than 30 common diagnoses.The prevention and screening programs that he championed decades ago are now commonplace. Looking back on his career in 2004, in Focus, the American Psychiatric Association’s clinical review journal, he recalled that, in his youth, society had regarded suicide as “a reasoned choice for those facing harsh circumstances” that “defied prediction and prevention.”The work of epidemiologists and social and cognitive psychologists had proved that mental illness is common. “Once the province of the author, poet, and philosopher, suicide is now squarely in clinical territory,” Dr. Shaffer added.Colleagues recalled him as an insatiable researcher, seeking out the families of young people who had died by suicide and trying to learn everything about them, in hopes of eventually finding ways to interrupt a chain of events that can lead to suicide.“He was fascinated by how people behaved, and why they behaved that way,” said Prudence Fisher, a research scientist at the New York State Psychiatric Institute in Manhattan who often accompanied him on these visits.The interviews often lasted four to six hours, she said, and the researchers were frequently the first people the families had spoken to about their child’s death; they “welcomed someone coming in to ask these questions,” Dr. Fisher added.Dr. Daniel Pine, who worked under Dr. Shaffer’s supervision at Columbia for 10 years, said Dr. Shaffer was “really drawn to the tragedy of it all.”“He was this really passionate guy, and tragedy wouldn’t make him necessarily turn away where other people might,” said Dr. Pine, the chief of the emotion and development branch at the National Institute of Mental Health. “They talk about people who run toward the danger — David was that kind of guy.”David Percy Shaffer was born in Johannesburg, South Africa, on April 20, 1936, to Joyce and Isaac Shaffer. His father, an immigrant from Lithuania, was a wealthy businessman who oversaw factories for multinational corporations.As a child, David was repelled by South Africa’s apartheid system, and when he left for boarding school in Switzerland as a teenager, he was drawn to left-wing causes, his son said. At one point, he was caught smuggling socialist pamphlets home to distribute to workers in his father’s factory.That rebellion was interrupted by the death of his father in a plane crash when David was 16.He felt at home in London, where he trained at the Great Ormond Street Hospital for Children and the Maudsley Hospital. He had an “English eccentricity and values to life,” Ms. Wintour said, hosting a revolving cast of houseguests and gathering large groups for elaborate meals, only to vanish as they sat down because he thought of something else he wanted to serve.“He was supremely eccentric,” Ms. Wintour said. “He didn’t follow the traditional rules of life in any way.”In England, he began working with Dr. Michael Rutter, who pioneered child psychiatry as a specialty. He viewed suicide as an untapped opportunity, an area where “people were not doing science, and he thought they should be and they could be,” his son said.When he relocated to the United States, in the 1970s, American psychiatry was dominated by the psychoanalytic model, in stark contrast to his own data-driven approach. Each new research finding on suicide “reinforced his desire to sort of push back against the psychoanalysts’ grip on psychiatry at the time,” his son said.Mr. Shaffer’s first marriage, to society caterer Serena Millington, ended in divorce in 1983. His marriage to Ms. Wintour ended in divorce in 1999.Dr. Shaffer with his second wife, Anna Wintour, the editor of Vogue magazine, at a party in 1990. They divorced in 1999, but he spent his last years living at her Long Island estate after he was diagnosed with Alzheimer’s disease.Ron Galella Collection, via Getty ImagesBoth marriages situated him at the edge of high-octane New York glamour not typical of academic psychiatrists. Colleagues recall that he and Ms. Wintour would buy multiple tables at galas supporting mental health causes, and that extra seats were filled with models.He traveled widely and unpredictably. “You know, he took us to Libya for Christmas,” said his daughter, Bee Carrozzini.In addition to her and his son Charlie, both from his marriage to Ms. Wintour, Dr. Shaffer is survived by two sons from his first marriage, Joe and Sam, and seven grandchildren.Dr. Shaffer was diagnosed with Alzheimer’s disease in 2015. In 2017, Ms. Wintour invited him to live full-time on her property in Mastic. “He was never good at arguing with me,” she said.At first, they played dominoes and read together, she said, but “toward the end, it was, you know, holding his hand and eating with him, and feeding him.”He had been living there for more than a year when his daughter was married at the house. Ms. Carrozzini recalled her friends’ wonder at the arrangement: “They turned to me and said, ‘That is the purest form of love, the way that your mom was taking care of your dad.’”If you are having thoughts of suicide, call or text 988 to reach the 988 Suicide and Crisis Lifeline or go to SpeakingOfSuicide.com/resources for a list of additional resources.

As young Americans turn to TikTok for information on mental health, the T.H. Chan School of Public Health at Harvard is building its own team of influencers.One day in February, an invitation from Harvard University arrived in the inbox of Rachel Havekost, a TikTok mental health influencer and part-time bartender in Seattle who likes to joke that her main qualification is 19 years of therapy.The same email arrived for Trey Tucker, a.k.a. @ruggedcounseling, a therapist from Chattanooga, Tenn., who discusses attachment styles on his TikTok account, sometimes while loading bales of hay onto the bed of a pickup truck.The invitations also made their way to Bryce Spencer-Jones, who talks his viewers through breakups while gazing tenderly into the camera, and to Kate Speer, who narrates her bouts of depression with wry humor, confiding that she has not brushed her teeth for days.Twenty-five recipients glanced over the emails, which invited them to collaborate with social scientists at the T.H. Chan School of Public Health at Harvard. They were not accustomed to being treated with respect by academia; several concluded that the letters were pranks or phishing attempts and deleted them.They did not know — how could they? — that a team of researchers had been observing them for weeks, winnowing down an army of mental health influencers into a few dozen heavyweights selected for their reach and quality.The surgeon general has described the mental health of young people in America as “the defining public health crisis of our time.” For this vulnerable, hard-to-reach population, social media serves as a primary source of information. And so, for a few months this spring, the influencers became part of a field experiment, in which social scientists attempted to inject evidence-based content into their feeds.

@kate__speer Calling all people pleasers! 🙃💁🏻♀️ #anxiety #peoplepleasingrecovery #peoplepleaser #peoplepleasing #peoplepleasingendsnow #recovery #mentalhealthhack #mentalhealthlifehack #ocd #exposuretherapy ♬ Good Vibes (Instrumental) – Ellen Once Again “People are looking for information, and the things that they are watching are TikTok and Instagram and YouTube,” said Amanda Yarnell, senior director of the Chan School’s Center for Health Communication. “Who are the media gatekeepers in those areas? Those are these creators. So we were looking at, how do we map onto that new reality?”The answer to that question became clear in August, when a van carrying a dozen influencers pulled up beside the campus of Harvard Medical School. Everything about the space, its Ionic columns and Latin mottos carved in granite, told the visitors that they had arrived at the high temple of the medical establishment.Each of the visitors resembled their audience: tattooed, in baseball caps or cowboy boots or chunky earrings that spelled the word LOVE. Some were psychologists or psychiatrists whose TikToks were a side gig. Others had built franchises by talking frankly about their own experiences with mental illness, describing eating disorders, selective mutism and suicide attempts.On the velvety Quad of the medical school, they looked like tourists or day-trippers. But together, across platforms, they commanded an audience of 10 million users.Step 1: The subjectsFrom left, screenshots of the TikTok feeds of Ms. Speer, Khalida Himes, Rachel Havekost and Dr. Patrice Berry.Samantha Chung, 30, who posts under the handle @simplifying.sam, could never explain to her mother what she did for a living.She is not a mental health clinician — until recently, she worked as a real estate agent. But two years ago, a TikTok video she made on “manifesting,” or using the mind to bring about desired change, attracted so much attention that she realized she could charge money for one-on-one coaching, and quit her day job.At first, Ms. Chung booked one-hour appointments for $90, but demand remained so high that she now offers counseling in three- and six-month “containers.” She sees no need to go to graduate school or get a license; her approach, as she puts it, “helps clients feel empowered rather than diagnosed.” She has a podcast, a book project and 813,000 followers on TikTok.This accomplishment, however, meant little to her parents, immigrants from Korea who had hoped she would become a doctor. “I really just thought of myself as someone who makes videos in their apartment,” Ms. Chung said.The work of an influencer can be isolating and draining, far from the sunlit glamour that many imagine. Ms. Havekost, 34, was struggling with whether she could even continue. After years of battling an eating disorder, she was feeling stable, which did not generate mental health content; that was one problem.

@rachelhavekost this is your sign🦋🥰. “dance it out” merch is now up on my website🌈💃🏼boogie over the 🔗in my bio or type rachelhavekost.com/merch in your browser🎯🍟! I love you all SO MUCH!!! #dancetoheal #danceitout #somatichealing #somaticshaking ♬ ILYAF (I love you always forever) – Donna Lewis & Digital Farm Animals The other problem was money. She is fastidious about endorsement deals, and still has to tend bar part time to make ends meet. “I’ve turned down an ice cream brand that wanted to pay me a lot of money to post a TikTok saying it was low sugar,” Ms. Havekost said. “That sucked, because I had to turn down my rent.”At Harvard, the influencers were treated like dignitaries, provided with branded merchandise and buffet lunches as they listened to lectures on air quality and health communication. From time to time, the lecturers broke into jargon, referring to multivariate regression models and the Bronfenbrenner model of behavior theory.During a break, Jaime Mahler, a licensed counselor from New York, remarked on this. In her videos, she prides herself on distilling complex clinical ideas into digestible nuggets. In this respect, she said, Harvard could learn a lot from TikTok.“She kept using the word ‘heuristics,’ and that was actually a genuine distraction for me,” Ms. Mahler said of one lecturer. “I remembered her telling me what it was in the beginning, and I didn’t want to Google it, and I kept getting distracted. I was like, Oh, she used it again.”But the main thing the guests wanted to express was gratitude. “I spent my 20s in a psychiatric ward trying to graduate from college,” said Ms. Speer, 36. “Walking into these rooms at Harvard and being held lovingly — honestly, it is nothing more than miraculous.”Ms. Chung was so inspired that she told the assembled crowd that she would now post as an activist. “I am walking out of this knowing the truth, which is that I am a public health leader,” she said. When Meng Meng Xu, one of the researchers on the Harvard team, heard that, she got goose bumps. This was exactly what she had been hoping for.Step 2: The field experimentAmanda Yarnell, senior director of the Chan School’s Center for Health Communication. “People are looking for information, and the things that they are watching are TikTok and Instagram and YouTube,” she said.Sarah Blesener for The New York TimesMany academics take a dim view of mental health TikTok, viewing it as a Wild West of unscientific advice and overgeneralization. Social media, researchers have found, often undermines established medical guidelines, warning viewers off evidence-based treatments like cognitive behavioral therapy or antidepressants, while boosting interest in risky, untested approaches like semen retention.TikTok, which has grappled with how to moderate such content, said recently that it would direct users searching for a range of conditions like depression or anxiety to information from the National Institute of Mental Health and the Cleveland Clinic.At their worst, researchers said, social media feeds can serve as a dark echo chamber, barraging vulnerable young people with messages about self-harm or eating disorders.“Your heart just sinks,” said Corey H. Basch, a professor of public health from William Paterson University who led a 2022 study analyzing 100 TikTok videos with the hashtag #mentalhealth.“If you’re feeling low and you have a dismal outlook, and for some reason that’s what you are drawn to, you will go down this rabbit hole,” she said. “And you could just sit there for hours watching videos of people who just want to die.”Ms. Basch doubted that content creators could prove to be useful partners for public health. “Influencers are in the business of making money for their content,” she said.Ms. Yarnell does not share this opinion. A chemist who pivoted to journalism, she found TikTok “a rich and exciting place” for scientists. She views influencers — she prefers the more respectful term “creators” — not as click-hungry amateurs but as independent media companies, making careful choices about partnerships and, at times, being motivated by altruism.In addition, she said, they are good at what they do. “They understand what their audience needs,” Ms. Yarnell said. “They’ve done a huge amount of storytelling that has allowed stigma to fall away. They have been a huge part of convincing people to talk about different mental health concerns. They are a perfect translation partner.”This is not the first time that Harvard’s public health experts have tried to hitch a ride with popular culture. In 1988, as part of a campaign to prevent traffic fatalities, researchers asked writers for prime-time television programs like “Cheers” and “L.A. Law” to write in references to “designated drivers,” a concept that was, at the time, entirely new to Americans. That effort was famously successful; by 1991, the phrase was so common that it appeared in Webster’s dictionary.

@latinxtherapy Insurances can be so unfair (at least in california) to #mentalhealth providers #latinxtherapy #directory ♬ original sound – shawty bae 🥥🫦 Inspired by this effort, Ms. Yarnell designed an experiment to determine whether influencers could be persuaded to disseminate more evidence-based information. First, her team developed a pool of 105 influencers who were both prominent and responsible: no diet-pill endorsements, no “five signs you have A.D.H.D.”The influencers would not be paid but, ideally, would be won over to the cause. Forty-two of them agreed to be part of the study and received digital tool kits organized into five “core themes”: difficulty accessing care, intergenerational trauma, mind-body links, the effect of racism on mental health and climate anxiety.A smaller group of 25 influencers also received lavish, in-person attention. They were invited to hourlong virtual forums, united on a group Slack channel and, finally, hosted at Harvard. But the core themes were what the researchers were watching. They would keep an eye on the influencers’ feeds and measure how much of Harvard’s material had ended up online.Step 3: This study is not without limitationsA month after the gathering, Ms. Havekost was once again feeling depleted. It wasn’t that she didn’t care about her duty as a public health leader — on the contrary, she said, “every time I post something now, I think about Harvard.”But she saw no simple way to integrate public health messages into her videos, which frequently feature her dancing uninhibitedly, or gazing at the viewer with an expression of unconditional love while text scrolls past. Her audience knows her communication style, she said; study citations wouldn’t feel any more authentic than cleavage enhancement.Mr. Tucker, back in Chattanooga, reached a similar conclusion. He has 1.1 million TikTok followers, so he knows which themes attract viewers. Trauma, anxiety, toxic relationships, narcissistic personalities, “those are the catnip, so to speak,” he said. “Basically, stuff that feeds the victim mentality.”He had tried a couple of videos based on Harvard research — for example, on the way the brain responds to the sound of water — but they had performed poorly with his audience, something he thought might be a function of the platform’s algorithm.“They are not really trying to help spread good research,” Mr. Tucker said. “They are trying to keep eyeballs engaged so they can keep watch times as long as possible and pass that onto advertisers.”It was different for Ms. Speer. After returning from Harvard, she received an email from S. Bryn Austin, a professor of social and behavioral sciences and a specialist in eating disorders, proposing that they collaborate on a campaign to prohibit the sale of weight-loss pills to minors in New York State.Ms. Speer was elated. She got to work putting together a sizzle reel and a grant proposal. As summer turned to fall, her life seemed to have turned a corner. “That’s what I want to do,” she said. “I want to do it for good, instead of, you know, for lip gloss.”Step 4: System-level effectsDr. Sasha Hamdani, a psychiatrist and TikTok creator, center, with Ifelola Ojuri, of YouTube Health, right, and Ms. Speer during a panel discussion in New York City.Sarah Blesener for The New York TimesLast week, in a conference room overlooking the Hudson River, Ms. Yarnell and one of her co-authors, Matt Motta, of Boston University, presented the results of the experiment.It had worked, they announced. The 42 influencers who received Harvard’s talking points were 3 percent more likely to post content on the core themes researchers had fed them. Although that may seem like a small effect, Dr. Motta said, each influencer had such a large audience that the additional content was viewed 800,000 times.These successes bore little resemblance to peer-reviewed studies. They looked like @drkojosarfo, a psychiatric nurse practitioner with 2.4 million followers, dancing in a galley kitchen alongside text on the mind-body link, or the user @latinxtherapy throwing shade on insurance companies while lip-syncing to the influencer Shawty Bae.The uptake seemed to be driven by the distribution of written materials, with no additional effect among subjects who had deep interactions with Harvard faculty. That was unexpected, Ms. Yarnell said, but it was good news, since digital tool kits are cheap and easy to scale.“It’s simpler than we thought,” she said. “These written materials are useful to creators.”But the biggest effect was something that did not show up in the data: the formation of new relationships. Seated beside Ms. Yarnell as she presented the experiment’s results were two of its subjects: Ms. Speer, with her service dog, Waffle, who is trained to paw at her when he smells elevated cortisol in her sweat, and Dr. Sasha Hamdani, a psychiatrist in Kansas who presents information on A.D.H.D. to the accompaniment of sea shanties.Contact had been made. In the audience, the Brooklyn-dad influencer Timm Chiusano was wondering about how to build his own partnership with Harvard’s School of Public Health. “I’m going to 1,000 percent download that tool kit as soon as I can,” he said.But who was boosting who? Ms. Mahler, who was promoting a new book on toxic relationships, sounded a little sad when she considered her partners in academia. “Harvard has this abundant knowledge base,” she said, “if they can just find a way of connecting to the people doing the digesting.”She had learned a great deal about scientists. In some cases, Ms. Mahler said, they spend 10 years on a research project, publish an article, “and maybe it gets picked up, but sometimes it never reaches the general public in a way that really changes the conversation.”“My heart kind of breaks for those people,” she said.

Applicants have challenged the Peace Corps practice of rescinding invitations to applicants on the basis of mental health conditions.Lea Iodice was thrilled to hear that the Peace Corps had accepted her application and was sending her to Senegal as a community health care worker. She shared the good news with her roommates, her family and her favorite professor and daydreamed about her last day at her job, managing a gym called SnapFitness.She was crushed, about a month later, to receive a letter from the Peace Corps Office of Medical Services saying that her offer was being rescinded because she was in treatment for anxiety. Though she had been in therapy to manage occasional panic attacks, she had never taken any psychiatric medication, been hospitalized or engaged in any kind of self-harm.“The reason for medical nonclearance is that you are currently diagnosed with an unspecified anxiety disorder,” read the letter, which appeared in her online application portal. “You indicated that your anxiety symptoms of increased heart rate and queasiness recur during periods of stress, which is likely to occur during service.”Searching online, Ms. Iodice discovered that her experience was not uncommon. For years, comparing notes under anonymous screen names, Peace Corps applicants have shared stories about being disqualified because of mental health history, including common disorders like depression and anxiety.The practice is the subject of a lawsuit filed this week in federal court, accusing the Peace Corps of discriminating against applicants with disabilities in violation of the Rehabilitation Act, which prohibits discrimination in programs receiving federal funds.The lawsuit, which is seeking class-action status from the U.S. District Court for the District of Columbia, includes accounts from nine people whose Peace Corps invitations were rescinded for mental health reasons. The suit alleges that those decisions were made without considering reasonable accommodations or making individualized assessments based on current medical knowledge.In a statement, a Peace Corps official said he could not comment on pending litigation, but added that “the health, safety and security of Volunteers are the Peace Corps’s top priority.”“The agency has a statutory responsibility to provide necessary and appropriate medical care for Volunteers during service,” said Jim Golden, acting associate director of the Office of Health Services, in a statement. “Many health conditions — including mental health care — that are easily managed in the U.S. may not be able to be addressed in the areas where Peace Corps Volunteers are assigned.”He said each candidate’s medical history is assessed individually to determine whether the agency can support the individual’s needs. The three plaintiffs in the lawsuit are not identified by name in the court filings. But other Peace Corps applicants described rescinded offers as a major blow at a vulnerable time in their lives, throwing post-college plans into doubt and forcing them to explain to family, friends and supporters that they had been rejected because of a mental health condition.“It was really heartbreaking to be dismissed like that,” said Ms. Iodice, now 26, who is not a party to the lawsuit. “It took a lot of processing to get over the initial feeling of unworthiness.”The Peace Corps medically screens accepted applicants before sending them overseas to ensure that they do not face health crises when they are in locations where specialized care may not be available. Similar screenings are used in the State Department and the military.But those policies are coming under pressure from legal activists. Early this year, the State Department agreed to pay $37.5 million to settle a class-action lawsuit, filed 16 years ago, challenging a hiring requirement that an applicant should be able to work in any State Department overseas post without the need for ongoing medical treatment.In recent years, the Peace Corps has deployed around 7,000 volunteers to more than 60 nations, according to recent figures from the Congressional Research Service. A review of the medical clearance system found that, in 2006, around 450 applicants were medically disqualified from serving.Carol Spahn, director of the Peace Corps.Michael Brochstein/Sipa USA, via Alamy Live News“I was shocked, at first, at how broad and antiquated some of these policies seem,” said Megan Schuller, legal director of the Bazelon Center for Mental Health Law, which, along with Bryan Schwartz Law, is representing the plaintiffs.One party to the lawsuit filed on Tuesday, Teresa, 22, who asked to be identified by her middle name out of concern that stigma would damage her employment prospects, had been accepted this past January for a volunteer position in Mexico working on climate change awareness.In March, before her planned departure, she was told that she had failed her medical clearance because of her history of treatment for anxiety and depression. She appealed the decision but was denied.Like many undergraduates, she had struggled during the isolation of the pandemic and attended therapy and took an antidepressant medication in 2020, never considering that these treatments might disqualify her from serving in the Peace Corps, she said.“There was part of me that thought, This can’t happen,” she said. “I do not know a single person throughout my whole college experience who didn’t struggle with their mental health.”The letter informing her of her nonclearance cited “active symptoms of anxiety, increased heart rate, inability to sit still, inability to say no,” all symptoms noted down by her therapist in 2021, she said. She spent the weeks around college graduation explaining, again and again, that she wouldn’t be going to Mexico after all.“It’s really humiliating to tell people that you got in and were then rejected because of your mental health,” said Teresa, who is now training to be a paralegal.Another party to the case, Anne, 34, who also asked to be identified by her middle name out of concern for stigma, was offered a Peace Corps position in Mongolia teaching at the university level.On her medical clearance forms, she shared that she had made two suicide attempts at age 15 and was hospitalized at the time, she said in an interview. Since then, however, she had lived abroad as an exchange student and worked for more than a decade as a public school English teacher with no recurrence of suicidal behavior.Her rejection letter, which arrived in November, said that she was assessed as a high risk for a recurrence of suicidal behavior. She scrambled to appeal the decision but was denied. “When you get a denial based on something from half your life ago, it feels like a punishment for being honest, and it feels like part of your past that you can’t escape,” said Anne, who teaches at a high school. “I was very upset. I was confused and trying to figure out how to do it — to save this dream.”Complaints over the policy have simmered for years in online forums and were the subject of a Change.org petition in 2019 and coverage this year in Worldview magazine, a news site for the National Peace Corps Association.Applicants are increasingly forthcoming in discussing their experiences with medical clearance, said Jade Fletcher-Getzlaff, 33, who outlined her own denial and successful appeal in a YouTube video in 2019. With each wave of deployments, she said, she receives between five and 10 inquiries from applicants who have been disqualified because of mental health conditions.“As more people are seeking therapy, and more openly talking about these issues, I think it may be coming up more often,” she said in an interview from Japan, where she now teaches, after serving as a Peace Corps volunteer in Cambodia.Rates of anxiety and depression among young U.S. adults have risen sharply in recent years. In 2020, a Centers for Disease Control and Prevention study found that 63 percent of adults aged 18 to 24 years reported mental health symptoms, compared with 31 percent of all adults. Young adults also expressed greater need for mental health treatment, with 41 percent of adults aged 19 to 25 reporting unmet needs, compared with 26 percent of all adults.Kirstine Schatz, 24, who is currently serving as a Peace Corps volunteer in Morocco, said she was initially denied a medical clearance because she took sertraline, a common antidepressant, for six months on the recommendation of her primary care physician. She discontinued the medication seven months before applying and never received any mental health diagnosis, she said, but she was informed that she was denied medical clearance because the stressful environment of the Peace Corps might trigger a relapse. Ms. Schatz appealed the decision, emphasizing that she had been off the medication and stable for six months, and the decision was overturned. She urged the agency to change its screening policy. “They are missing out on so many amazing people because of this archaic mind-set they have on mental health,” she said. “It’s 2023. They need to figure it out.”As for Ms. Iodice, she never appealed her initial rejection and is still at SnapFitness, where she is the general manager. She said she had no regrets about receiving therapy, even though it might have kept her from serving with the Peace Corps in Senegal.“If I had applied before I went to therapy, I could have gotten there, but I would have been a way worse worker, in my opinion,” she said. “In my perspective, I am a stronger person. I know myself better. I know how to cope.”