Vital Signs: From the Surgeon General’s office to the box office, addressing teen mental health

CATHY WURZER: This is Minnesota Now. I'm Cathy Wurzer. It's time for our segment, Vital Signs. Each month we talk about topics that are important to your health and take a deep dive into medical news or what's top of mind at the doctor's office. Joining us is Dr. Jon Hallberg, a family medicine physician at Mill City Clinic in Minneapolis and a professor at the University of Minnesota Medical School. Welcome back.

JON HALLBERG: Thank you, Cathy.

CATHY WURZER: I think we should start with news that Surgeon General Murthy is calling for a warning label on social media platforms, saying that social media is associated with all kinds of mental health harms for teens. When you heard that, what did you think?

JON HALLBERG: Well, I totally get where he's coming from. I really admire a lot of what he's doing as the surgeon general. He is, by far, one of the most out there, active, even activist surgeon generals we've had. So I really admire what he's doing.

But when I heard this, I got to say, there's a little bit of a skeptical voice in my mind that's thinking like, is that really going to make a difference? Anyway, I appreciate what he's trying to do, but I'm just not sure that it's going to change anything or turn the dial.

CATHY WURZER: I'm wondering, in your practice, if you see teens coming in and they are dealing with depression and anxiety because they feel like they need to compare themselves to what they see on social media or they're being attacked perhaps by others on social media. I don't know. What do you see out there?

JON HALLBERG: Oh, yeah, they're missing out. Right. It's FOMO, Fear Of Missing Out. It's so multilayered. And it's just simply the amount of time that people are spending on their phones and tablets and computers-- mostly phones. Something like 4.8 hours a day is spent on social media platforms. Without doing any research, it just sounds like that's a bad idea.

CATHY WURZER: Right.

JON HALLBERG: Just on the surface of it, it's just like that is a ton of time. And Cathy, what did we do when we were teens when we didn't spend 4.8 hours a day on social media? It's amazing.

CATHY WURZER: I was on the phone.

JON HALLBERG: Well, yeah, on the phone. Maybe we're--

CATHY WURZER: Traditional phone, rotary dial.

JON HALLBERG: --watching television, sneaking, Gilligan's Island in after school or something. But yes, mean, I think that when young people come in and they've got anxiety and/or depression, this is often part of the conversation. But it's so difficult to put your finger on exactly what the problem is. And I think that's why there's some pushback with this, too.

It's like, OK, is social media really the enemy for adolescents? There's more and more evidence that it is. But I think that there's-- still, there's just so many things going on, so many factors that are making lives difficult for our adolescents.

CATHY WURZER: What was interesting to me, when he made the announcement, was he spoke directly to you, doctors, and other health care professionals, saying, "doctors, nurses, and other clinicians should raise the issue of social media with kids and parents and guide them toward safer practices." You already have a lot to talk about in your practice with every patient. What are you telling kids and parents?

JON HALLBERG: Oh. So, yeah, one of the questions is, how much time do you spend? And even with young, young kids, we ask families like, how much screen time is your child, your infant spending in front of the television? And it's so easy to have shows be babysitters. We've all done that with kids. And I did that in the '90s and early 2000s with my kids.

When young people are older and they're coming in often by themselves for their visits, we'll talk about this as well. So I think we're already doing it. But there's only so much time in a visit you can spend on this and offering that kind of guidance. And frankly, to an adolescent, I probably come across as, OK. Boomer.

[LAUGHTER]

So that doesn't help. So it's tricky.

CATHY WURZER: I'm sure that's right. It is. It can be really tricky. Do you think there should be a warning label on social media?

JON HALLBERG: Well, so they're using the example of like, look what happened in 1965 when they put the label on cigarettes about use of this product may be hazardous to your health. And they cite that and say that ever since then, there's been a decline in tobacco use. So that's great.

I just got back from Europe, and I was struck by how many cigarette boxes I saw on the sidewalk that had pictures of cancerous lungs, really graphic photographs. That has not been successful in the United States. Those pictures are not on the boxes, but these were empty boxes, by the way. So people, even with those labels, were still smoking.

So I don't know, honestly, how effective that would be. It would be a reminder, but I don't know. I'm just a little bit skeptical that it's really going to make a difference.

CATHY WURZER: And of course, as humans, you never think it's going to happen to you.

JON HALLBERG: Right.

CATHY WURZER: I'm bulletproof, in a sense.

JON HALLBERG: Well, and it's also like you put up a guardrail or rule, and then and someone wants to-- I'm a rule breaker. I want to-- sorry, I'm not going to pay attention to that. Or because it's on there, I'm going to do that. Human nature's funny that way.

CATHY WURZER: Let's continue talking about this same vein, in a sense, social and emotional health of kids. The movie Inside Out 2 is out. We have to play a trailer.

[AUDIO PLAYBACK]

- Hello. I'm Anxiety. Where can I put my stuff?

- A new emotion!

- Oh, I'm sorry! We wanted to make such a good first impression.

- Ah, ah, ah, what do you mean "we?"

- Ugh!

- I'm Envy.

- Oh, oh, at your hair.

- Oh, yeah, not happening.

- That's Ennui.

- On what?

- It's what you would call the boredom.

- What's your name, big fella?

- That's Embarrassment.

- Welcome to headquarters, Embarrassment. We're doing a fit? Nope. Oh. Nope. Going high. Oh. You got a real sweaty palm there, buddy.

[END PLAYBACK]

CATHY WURZER: (LAUGHING) I do have to see this. This is Riley, the main character. Riley's becoming a teenager, so, of course, that's an emotional minefield right there. So are the emotions, are they characterized in this film?

JON HALLBERG: They are. I saw the original Inside Out back in 2015 when it came out, and I thought it was so brilliant, just such a creative way of visualizing emotions. And now, of course, with the-- Riley's got hormones kicking in, and it changes everything and where she is in life. And so now introducing things like anxiety, something that often young kids don't really think about much, but become a huge issue in adolescence.

CATHY WURZER: Let me ask you this. OK. I don't have kids. I'm just going to say that off the top here. And I don't have a lot of kids in my life. However, my friends do. And they keep talking about really having struggles with their children who are anxious, who are really trying to navigate anxiety and depression. Are we seeing more of that nowadays?

JON HALLBERG: We are. And I think that this is-- it goes back to our social media conversation. What is it? Why was there sort of this inflection in the late aughts with more and more-- everything from suicidal behavior and thinking to hopelessness and anxiety. And something's happened. And so it's always been there.

I think that we have to remind ourselves that anxiety, we think back to psychology classes in high school or college, and, there's a whole fight-or-flight response. And it's easy to say that, well, obviously anxiety exists to-- it's like self-preservation, right? We should be a little bit anxious about stepping to the edge of a cliff. That should make you feel a little anxious.

We're designed to preserve ourselves and to step back. And anxiety, at its simplest, is just a major, major misreading of that. It's pathologizing it. It's making it super, super uncomfortable. And this movie was so brilliant about it, is that it makes anxiety-- it's one of our emotions.

And it's not the enemy. It's just an emotion. And so something happens, though, when it goes from being that, to being so overwhelming that you can't function or you're having panic attacks and you just literally don't want to leave your house for fear of it happening to you in public or in some other place. So it's really complicated.

CATHY WURZER: Do you help your younger patients with a mixture of maybe, say, medication and therapy, suggest going to therapy for some of those?

JON HALLBERG: Oh, always, yeah. And this is true for adults, too. Many times we might want to even start more fundamental than that and even start with some blood work, just making sure that a calcium level's not too high or that a thyroid level's not overactive or too high. Just, initially just to get a base, just make sure we're not missing something there that's truly a physiologic thing that we can affect. And then talking to a therapist, talking to a counselor, almost always a first place to start, super effective, super helpful.

And yes, there are times when medication can be useful as well. Medications can typically fall into two camps. You've got the kind you take every day to try and sort of reset neurochemistry. People would be on that for six months to a year or longer perhaps. And then sometimes even medication that can be used very immediately.

Like when you're having a panic attack, you can take something right now, potentially. And use of medications has become so much more common in adolescence. That is something that has absolutely gone up. And I know many people are alarmed by that or frustrated by that. But it's one category of tools that we turn to.

CATHY WURZER: It is nice, though, to see a movie that's-- seems like it's an entertaining teaching tool when it comes to helping kids understand their emotions.

JON HALLBERG: Yeah, I'm really optimistic that a movie like this, with such broad appeal, produced by Pixar, can create a certain degree of comfort and making the viewers realize that, hey, I never thought of anxiety this way before. It's not necessarily a friend exactly, but it's just part of who we are. And it's a normal emotion in certain contexts. And I'm hoping that this sparks some really, really good conversations with parents and their teens after seeing it.

CATHY WURZER: It was a good conversation today, as always. Thanks for coming in.

JON HALLBERG: Oh, my pleasure. Thank you, Cathy.

CATHY WURZER: Dr. Jon Hallberg is a family medicine physician at Mill City Clinic and a professor at the University of Minnesota Medical School.