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THE STATUS
OF GIRLS IN
NORTH CAROLINA

Contact Information
General Information:
Amie Hess
(919) 760-8016
hessamie@meredith.edu

Press Contact:
Melyssa Allen, News Director
(919) 760-8455
allenme@meredith.edu

Mental health is an increasing part of the national conversation. In North Carolina, schools from elementary through college have initiatives to address the mental health and emotional well-being of youth.1 Though pushes to take mental health as seriously as physical health began prior to the global pandemic, since COVID-19 efforts to support the mental health of young people have increased substantially.2 These efforts are critical, as rates of depression and isolation appear to be rising among North Carolina youth. Almost half of high school and middle school girls in North Carolina report feelings of depression, and almost one-third of high school girls have thought seriously about suicide.3 College students across the country are experiencing mental health struggles at unprecedented levels since the onset of the pandemic.4 Locally, the North Carolina State University student community experienced seven deaths by suicide in the 2022-23 academic year. The Governor’s office pledged increased investment in student mental health across all levels of the public education system as part of a plan to expand and support North Carolina’s behavioral health system.5

Table of Contents

Depression

Youth across the country are reporting significantly higher rates of depression than prior to the pandemic. In 2021, 42% of high school aged youth in the United States reported sustained feelings of depression. At both the national level and in North Carolina, girls report depression-like symptoms at substantially higher levels than boys.  

Figure 1: Percentage of high school girls feeling sad/hopeless for two or more continuous weeks by region, 2019 and 2021

Source: CDC, Youth Risk Behavior Survey, 2021 and 2019

No Data Found

Teen girls across the nation are struggling with their mental health.6 In North Carolina 55% of high school girls report prolonged periods of depression-related symptoms. This is a significant increase at both the state and national level from the data reported immediately prior to the onset of the pandemic.  

Figure 2. Percentage of North Carolina high school students feeling sad/hopeless for two or more continuous weeks, 2011-2021

Source: CDC, Youth Risk Behavior Survey, 2011, 2013, 2015, 2017, 2019 and 2021

No Data Found

During the previous decade, the percentage of high schoolers in North Carolina reporting feelings of depression has increased steadily, spiking in 2021 as the nation was just starting to understand the full social, emotional and physical impacts of the pandemic. High school girls are more likely than their male peers to experience depression–a consistent and persistent finding both in North Carolina and nationally.7

Figure 3. Percentage of North Carolina middle school students feeling sad/hopeless for two or more continuous weeks, 2011-2021

Source: Adapted from North Carolina Department of Public Instruction, Youth Risk Behavior Survey, 2011, 2013, 2017, 2019 and 2021

No Data Found

The trends among middle school students mirror those of high schoolers in North Carolina. As with their high school counterparts, rates of depression spike in 2021 among middle school girls. With almost half of middle school girls in North Carolina reporting a sustained bout of hopelessness, they are twice as likely to experience symptoms of depression as middle school boys. 

Figure 4. Rates of hopelessness among North Carolina middle and high school girls by grade level, 2019 and 2021

Source: CDC, Youth Risk Behavior Survey, 2019 and 2021

No Data Found

Looking specifically at reported rates of depression by grade level in the pre-pandemic year and the first reported year after the onset of the pandemic, there is not one clear pattern. The data in 2019 is consistent with previous years, with reported rates of depression-like experiences peaking between 8th and 10th grades. The most recent data from 2021 do not follow that same pattern, with 6th grade girls reporting much higher rates of mental health struggles than in previous years. Girls in all grade levels experienced rates of depression-like feelings at rates higher than 2021–with the exception of 9th grade in which the rates in both years are the same. 

Figure 5: Depression among high school and middle school girls by race, 2021

Source: CDC: Youth Risk Behavior Survey, 2021

No Data Found

Middle school girls who are multiracial, Latinx, and Black report feelings of hopelessness at significantly higher rates than their White peers. There is less variation by race/ethnicity among high school girls. 

Suicide

In 2021, North Carolina had a relatively low rate of death by suicide at 13.2 per 100,000, with the 9th lowest rate among the states.8 However, North Carolina is seeing a peak in suicide-related deaths among youth between 10 and 17 years olds.9 Boys in both North Carolina and nationally are significantly more likely than girls to die by suicide, while girls are significantly more likely to report suicide ideation and suicide attempts.10 In 2021, more than 1 in 5 high school students in North Carolina seriously considered attempting suicide.11

Figure 6. Percentage of North Carolina high schoolers who have seriously considered suicide, 2011-2021

Source: CDC, Youth Risk Behavior Survey, 2011, 2013, 2015, 2017, 2019 and 2021

No Data Found

Over the past decade, girls in North Carolina have consistently experienced thoughts of suicide at a higher rate than boys. Both girls and boys show increased considerations of suicide throughout the decade. However, the likelihood of suicide ideation has doubled among high schools girls in North Carolina between 2011 and 2021. 

Figure 7. Percentage of North Carolina middle schoolers who have seriously considered suicide, 2011-202112

Source: CDC, Youth Risk Behavior Survey, 2011, 2013, 2017, 2019 and 2021

No Data Found

Rates of suicide ideation are also high among both middle school girls in North Carolina, with a similar gap between middle school girls and boys as with high school youth. Middle school girls have had consistently high rates over the past decade, ranging between 25% to 31% of girls reporting serious considerations of suicide. 

Figure 8. Suicide-related behaviors among North Carolina youth by gender, 2021

No Data Found

Teen women, in particular, report high rates of hopelessness and extreme sadness. For some, this leads to thoughts of suicide. For both girls and boys in North Carolina middle and high schools this is the most common type of suicide-related behavior. Among girls, one in five report having moved from serious consideration of suicide to making a specific plan. The number of youth that move from planning to action and make an attempted suicide drops substantially, though high school girls are significantly more likely to report an attempt than high school boys. There is no statistical difference between boys and girls at the middle school level. However, it is important to note that young men are more than twice as likely to die by suicide. Rates of death by suicide among youth in North Carolina was 15.4 per 100,000 for males aged 15-19 and 5.0 per 100,000 for females aged 15-19 in 2020.13 As noted earlier, this gender difference holds across all ages, both in North Carolina and nationally.14

Figure 9. Suicide-related behaviors among North Carolina girls by grade level, 2021

Source: CDC, Youth Risk Behavior Survey, 2021

No Data Found

Early adolescence–between 8th and 10th grades–is a critical time for girls in many areas of development, including mental health. There are observable peaks across all suicide-related behaviors in both 8th and 10th grades, suggesting this period is critical for observation, support and intervention. 

Figure 10. Suicide-related behaviors among North Carolina high school girls by race/ethnicity, 2021 

Source: CDC, Youth Risk Behavior Survey, 2021

No Data Found

In 2021, girls in all racial and ethnic groups in North Carolina experienced serious thoughts of suicide. Girls who identify as White and multiracial experienced these thoughts and reported making a plan to attempt suicide at rates higher than their Latinx and Black peers. Over one in three multiracial and White young women report serious suicide ideation, and over one quarter actually made a plan. Black and multiracial young women in North Carolina are the most likely to report making an attempt at suicide. In reviewing the data since 2017, there is no clear pattern by racial/ethnic group among high school girls in North Carolina in suicide-related behaviors, with the important exception that girls identifying as multiracial exhibit consistently suicide ideation.15

Figure 11: Suicide-related behaviors among North Carolina middle school girls by race/ethnicity, 2021

Source: CDC: Youth Risk Behavior Survey, 2021

No Data Found

Among North Carolina’s middle school girls in 2021, Black, Latinx, and multiracial girls report serious forms of suicide ideation at rates higher than White and Asian girls. When considering the data suicide-related behaviors among both  high school and middle school girls by race/ethnicity there is no one clear pattern. But, what is clear is that all girls, but especially racialized girls, need increased mental and emotional health support systems. 

Figure 12. Suicide-related behaviors among North Carolina high school girls by sexual identity, 2021

Source: CDC: Youth Risk Behavior Survey, 2021

No Data Found

Girls who identify as lesbian, gay or bisexual (LGB-identified) or those who indicate they are unsure or questioning their sexuality are at elevated risk for suicide ideation relative to their heterosexual peers. LGB-identified and questioning young women in North Carolina are twice as likely to have made a suicide plan and more then three times more likely to have made a suicide attempt as heterosexually-identified young women. See LGBTQ Youth section for more information on the mental and emotional health of North Carolina’s queer-identified youth [this should be hyperlinked].

NC Project AWARE/ACTIVE

North Carolina’s Project AWARE (Advancing Wellness and Resiliency in Education) also known in some districts as Project ACTIVATE (Advancing wellness, Timely InterVentions, Awareness,Training and Education) is a promoted program designed to advocate for student’s mental health. The program is designed to provide comprehensive activities and supports to support mental health and emotional well-being among NC students by promoting mental health awareness, crisis prevention and early identification and intervention of struggling students . The program is currently being piloted in six NC school districts with a mix of state and federal funding. To expand the program, 6 local education agencies were chosen to begin using the project and with time, it will hopefully begin to expand state-wide; factors will depend on the student’s education and social risk factors. Learn more.

988 National Suicide and Crisis Lifeline

If you or a loved one are experiencing any mental distress and are in need of aid, whether it is for a life-threatening occasion or just to have someone to talk to, call or text 988. The national suicide and crisis lifeline is staffed 24/7.

Cause For Concern

Nationally, we have witnessed a concerning increase in depression and suicide rates, but North Carolina’s rates are catching up. Rates of both depression and suicide among North Carolina youth have been rapidly expanding. Girls are highly likely to experience depression, but they are also susceptible to fall into suicide ideation. As a community, we need to advocate for schools and other institutions to develop effective programs aimed at healing depression and suicide ideation. Schools, counselors, families, and friends, are large contributors to a child’s mental health; by developing healthy relationships and surrounding them with a positive environment, young adults may be able to receive the help they need and heal from their mental disturbances. 

Notes and References

1 There are many mental health and emotional well-being initiatives happening throughout our public education system, much of which is funded through the Governor’s Emergency Education Relief Fund (GEER). The University of North Carolina system has initiated a program to implement the Mental Health First Aid program at education institutions across the state, among other system-specific initiatives. The North Carolina Department of Public Instruction released the School Behavioral Health Action Plan in March 2023. The plan details the mental and emotional health crisis facing North Carolina’s youth and details strategies to increase behavioral health initiatives in our public schools. One of these initiatives, Project Activate, is detailed on this page.

2 For a comprehensive national review of youth mental health and recommendations for improving mental health support systems for youth, see Protecting Youth Mental Health: The U.S. Surgeon General’s Advisory, 2021. 

3 CDC, Youth Risk Behavior Survey, 2021. 

4 North Carolina Student Mental Health Task Force Report, February 2023. 

5 See report, Investing in Behavioral Health and Resilience: A comprehensive plan to strengthen North Carolina’s mental health and substance use disorder treatment system, March 2023. 

6 CDC, Youth Risk Behavior Survey, 2021.

7 CDC, Youth Risk Behavior Survey, 2021.

8 CDC, National Center for Health Statistics, Suicide Mortality by State 

9 North Carolina Child Fatality Task Force Annual Report, February 2023 

10 For North Carolina data on death by suicide by age and gender, see North Carolina Department of Public Health, NC Injury and Violence Prevension Branch, Suicide in North Carolina, 2020 and Suicide Among School-Aged Youth in North Carolina Ages 10-18, 2020.  For national-level data and discussion, see Garnett, Curtin and Stone. 2022. Suicide Mortality in the United States, 2000–2020, National Center for Health Statistics, CDC. 

11 The Centers for Disease Control (CDC) administers the Youth Risk Behavior Survey every two years nationally to middle and high school students. The survey collects a variety of measures of mental health and emotional well-being, including three items related to suicide measuring suicide-related thoughts, planning and attempts. See further documentation here for survey item questionnaire wording. 

12 The data from this item was not reported in the 2015 YRBS survey for North Carolina middle school students. 

13 North Carolina Department of Public Health, NC Injury and Violence Prevension Branch, Suicide Among School-Aged Youth in North Carolina Ages 10-18, 2020.  

14 Garnett, Curtin and Stone. 2022. Suicide Mortality in the United States, 2000–2020, National Center for Health Statistics, CDC. 

15 This data comes from the CDC YRBS data from 2017, 2019 and 2021. One caveat to note is that the category of multiracial includes the smallest number of respondents that was still sufficient to report analyzable data. Also note that Asian and Indigenous American girls did not have sufficient numbers among the high school sample in North Carolina to report data. 

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