"While young people are generally physically healthy, they are psychiatrically vulnerable." Dr. Richard Friedman wrote in a New York Times opinion piece in January.

The psychiatrist warned even then that there was already an "epidemic of teen depression and suicide" that was largely being overlooked and under-supported. He cited evidence from the Centers for Disease Control and Prevention (CDC) that, after declining for almost 20 years, the suicide rate among Americans aged 10 to 24 had jumped 56 percent between 2007 and 2017. Suicide has been, and is still, the second leading cause of death, after accidents, for that same age range, the CDC reported.

Shutdowns and other responses to the coronavirus pandemic since Friedman's article have exacerbated the already precarious situation of youth mental health and well-being.

A CDC survey on mental health in June found symptoms of anxiety and depression "up sharply," NPR reported. 11% of respondents said they had "seriously considered" suicide in the past 30 days; among 18 to 34-year-olds, that number more than doubled to 25%. The news report offered up uncertainty about the future and the state of the world, educational and daily routine disruptions, and isolation from peers and caring adults as potential factors.

Teenagers crave structure, Mendi Baron, founder of Ignite Treatment Centers, told KNPR's State of Nevada. Without it, their mood and mental health suffer, she said.

According to the CDC, many have experienced increased grief and loss due to the "drastic changes to daily routines and ways of life that usually bring us comfort and a feeling of stability." How adolescents experience and process this grief is similar and different than in children and adults, the center said.

"Adolescents may experience significant changes in their sleep patterns, isolate themselves more, frequently appear irritable or frustrated, withdraw from usual activities, or engage more frequently with technology," the CDC said. "It is important for parents or caregivers to engage with their adolescents over their grief to promote healthy coping and acceptance. Parents may also need to obtain mental health services for the adolescent and family to deal with grief."

Teens are also "hardwired to be social," Baron told the KNPR's State of Nevada. Caroline Edgeworth, a high school student and co-founder of Hope Means Nevada, told KNPR that school closures had "dramatically hurt" her and her friends because of lost time together and with their sports teams.

"It was kind of my escape from home and now I'm stuck at home," she said, reported KNPR.

Lisa Damour, an adolescent psychologist, agreed.

"Teenagers are in a developmental space where it is critically important that they have regular contact with their peers and are able to develop close and ongoing relationships with adults outside the home, such as their teachers, their coaches, their advisers," she told NPR. "And I worry very much about what it means for that to be disrupted by the pandemic."

Spending more time at home due to quarantine also increases another major factor in youth suicides: increased access to lethal weapons.

NPR reported that gun ownership in a particular state was the single strongest predictor of youth suicide rates in the state. A 2019 study found that for each 10 percent increase in household gun ownership, the suicide rate for 10- to 19-year-olds increases by more than 25 percent in that state, NPR reported.

Gun sales also doubled between March and June, the report stated, with 40% of the 10 million new guns sold during that time being to new gun owners. It's a "red flag" because firearms are used in over half of youth suicides, NPR reported.

Not having guns in the home or keeping them safely locked away is especially important with adolescents having to stay home due to the pandemic because "teens are impulsive," Damour told NPR.

These factors are causing some experts to push for schools to reopen, including CDC Director Dr. Robert R. Redfield, reported ABC News. The American Academy of Child and Adolescent Psychiatry (AACAP) and American Psychiatric Association (APA) generally support the CDC's push to reopen schools for the sake of children's mental and developmental health, but not where coronavirus is circulating, ABC reported.

"Whether we are sending students back for in-person school or not, we need to put emphasis on providing mental health support," child and adolescent psychiatrist Dr. Avanti Bergquist, elected school board member and distinguished fellow of AACAP, told ABC.

Parents, caregivers and teachers can keep these tips in mind to help kids and teens struggling during the pandemic:

• Educate parents and teachers to recognize depression in young people and learn the warning signs of suicide, like sudden behavior changes, talking or writing about suicide, and giving away prized possessions, Friedman wrote in the New York Times.
• Talk to kids. Check-in regularly. If a teen talks about hurting themselves or disappearing, ask directly, "Is that something you think you might really do or you think about doing? Or are you just letting me know that you're very upset right now?," Damour told NPR. Importantly, listen with compassion and without dismissing what they are saying.
• Listen. The Chicago Tribune reported on the importance of being heard. Ask students how they are doing, and listen with an open mind. The World Economic Forum stressed fostering relationships and creating an open-dialogue about wellness and feelings. "The stronger the connections are, the more opportunities they'll have to address something before it becomes untenable," said Nadjeh Awadallah, director of a Chicago INSPIRE program, reported the Tribune.
• Acknowledge grief and loss. The CDC suggested outlets to process and express grief such as music, art, writing, gardening and other creative activities.
• Look out for anger as an indicator. "In teenagers, uniquely, depression can take the form of irritability," Damour said, reported NPR. "That depression in teenagers sometimes looks like a prickly porcupine. Everybody rubs them the wrong way. And that is easy to miss because sometimes we'll just dismiss that as being a snarky teenager."
• Foster strong coping skills, also suggested the Tribune. Awadallah suggested meditation, conversation and other means of self-regulation and centering. Being reflective and able to calm yourself down is an important self-care component that everyone, including adults, should practice, Awadallah told the Tribune. For these pandemic times and beyond, there are online resources and even phone apps specifically catering to teens to boost their mindfulness and mental and emotional well-being.
• Develop new rituals to replace lost ones. The CDC suggested those that live together to play board games or exercise together outdoors. Those isolated can play virtual games together online.
• Encourage safe outlets. Look for safe sports, work or volunteer opportunities that allow teens to have social time and contact with other caring adults, Damour told NPR.
• Use tele-therapy. Damour noted that therapy over video chat has worked "surprisingly well" with adolescents, NPR reported.

Finally, "one of the most important things to know about grief is that there isn't a quick fix," licensed therapist Jody Baumstein told Children's Healthcare of Atlanta Strong4Life. "The only way to truly deal with grief is to acknowledge it, feel it and work through it."

If you or someone you know is showing warning sides of suicide risk, reach out to the National Suicide Prevention Lifeline at 1-800-273-TALK or at suicidepreventionlifeline.org. The Crisis Text Line is available by texting TALK to 741741.