The rapid pace of modern life means the odd ignored text or angry outburst over an expensive bill can go unnoticed.
But subtle changes in a loved one could be a sign that your friend is struggling with mental health problems, according to Dr Thema Bryant, president of the American Psychological Association.
She said that everyone carries stress differently and explained seven signs that suggest you should check in on your friend — even if the changes seem innocuous.
Pictured above are seven warning signs that your friend may need your help. These are indicators and the list is by no means exhaustive
About 26 percent of Americans suffer from a mental health disorder, estimates suggest. But there are signs that this level may be rising nationwide.
Just this week the CDC reported suicide had become the second leading cause of death for under-35s.
They did not give a reason for this, but experts have previously blamed it on the economic and psychological fallout from the pandemic.
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Being slow to respond to texts
Dr Bryant told DailyMail.com one of the most common signs someone is struggling emotionally is when they start to close themselves off.
This can include simple signs such as taking longer to respond to texts or meeting up with friends less often.
‘If you haven’t heard from them for a while or if usually they are responsive but now they are not responding. [You can see] the change based on text frequency.’
She explained: ‘If they were usually someone where they responded within a day whereas now over a day has passed, or within an hour and now several hours have passed, that marks a change from what would have been your normal level of communication.’
People may self-isolate when they are depressed as a coping mechanism, allowing them to have more control over their lives, or because they are feeling overwhelmed.
Picking at skin, hair or nails
Another warning sign that all is not well could be regularly picking at skin, hair or nails.
Experts say the repetitive behavior is often driven by a sense of tension or anxiety that is relieved by picking.
Skin picking is a medically recognized condition, named dermatillomania. An estimated one in 20 people may have the condition at some point in their lives.
Dr Thema said people may start picking areas of their body because they ‘don’t have the word for naming their distress and so they are expressing it physically’.
Many people pick their bodies, but signs that someone is picking because of emotions may be that they do it without realizing or that it happens when they feel angry or stressed.
The picking may also end up causing cuts, bleeding or bruising, or someone may be picking at moles, freckles or spots to ‘smooth’ them out.
It can be tempting to overlook a downcast comment from a friend while you’re enjoying a coffee or a meal out.
But Dr Thema urged people to sit up and take notice of comments like ‘why would anyone hire me’.
She told DailyMail.com emotionally troubled friends may say something like, ‘Oh, why would anyone hire me’ or ‘No one wants to date me because I’m the worst’.
‘[It’s] when people indicate a sense of hopelessness or powerlessness, a feeling that things would never get better.
‘They might have also lost pleasure in things that they used to enjoy, but don’t anymore.’
Pets or children terrified of them
If someone’s child or pet appears to be frightened of them, this could actually suggest that they are struggling emotionally.
Dr Thema said that when people are stressed or feel like they’ve hit a dead end they tend to bottle up their emotions and then take them out on those closest to them.
‘Some may take out their frustration on other people or even on their pet,’ she told DailyMail.com.
‘Mistreating a pet or child may be because, let’s say, at work they are feeling powerless and stressed out and they come home and take out all that frustration on family members.
‘Someone’s dog or cat looking afraid in a way that doesn’t seem good [can also be a sign].’
She said that in many situations people will avoid saying anything, thinking to themselves ‘their family, their business’.
But if you are close enough with someone, it is worth pointing out that there is another way to handle what they are going through.
Sudden weight loss or weight gain
Dr Thema said a more common warning sign of mental health problems can be a sudden weight fluctuation.
Depressed people may start eating less because of negative emotions or a loss of interest in activities they enjoy.
Conversely, they may also eat more to cope with emotions and because they have become less active.
Are overbearing parents to blame for explosion in child mental problems?
Overbearing parents are driving an explosion in mental health problems among children, a study suggests.
A Florida research team found parents’ good intentions were depriving their children of essential time to play, roam and engage in activities independently.
In an analysis of 80 studies, researchers found children have been left with less independent playtime since the 1970s, corresponding with a sharp rise in depression and anxiety over that period.
Now, nine in ten school administrators now saying their students are battling moderate or severe mental health challenges.
Dr David Bjorklund, a psychologist at Florida Atlantic University, just north of Miami, who led the research, said: ‘Parents today are regularly subject to messages about the dangers that might befall unsupervised children and the value of high achievement in school.
‘But they hear little of the countervailing messages that if children are to grow up well-adjusted, they need ever-increasing opportunities for independent activity.
‘[This includes] self-directed play and meaningful contributions to family and community life, which are signs that they are trusted, responsible and capable.’
Dr Thema said: ‘I have had a number of people who lost weight when they were depressed and everyone kept complementing them, so it was really hard for them when they had all this positive affirmation.
‘At the same time, weight gain can be triggered by depression. So, instead of a response with compassion, it becomes a put-down, so really that person is already struggling and then they have more on top.’
Stacking up items at home could also be another sign someone is struggling emotionally, Dr Thema said.
This can include items that may give them comfort, security or a sense of control, like clothes, books or sentimental items.
Hoarding can be a coping mechanism for dealing with difficult emotions, Dr Thema said, or it may provide a sense of relief from negative feelings.
Suddenly snapping at small things
If a friend has a sudden angry outburst over small things like an expensive bill, it may be a sign they are struggling emotionally.
Dr Thema said you could spot an angry snap when someone appeared to have an out-of-proportion rage response to something relatively minor.
She said this could also include children taking too long to tie their shoelaces.
What should I do for a friend who is struggling?
If you have been reading the above and noted that one of your friends may need help, Dr Thema said there are several things you can do.
First of all, she said it was important to calmly check in on a friend without making assumptions.
She told DailyMail.com: ‘You could say, you know, “oh I usually hear from you and you didn’t respond so I just wanted to check in and see if everything is ok”,’ she said.
‘If it really is nothing and they have a busy day, they will just say that. If it’s nothing, the person will say I have this work day and that, you didn’t offend them you just asked.
‘But if it is a bit more serious, they may let you know.’
Should a friend indicate there is something more serious happening, then there are a number of things you can do.
This includes listening to their problems without judgment, being there for them and also offering acts of kindness.
Dr Thema said this could include buying a meal for them. For example, you could ring one day and say you are ordering in and also want to get them something because you know what a difficult time they are having.
If they have children, this could also include offering childcare, or if they have lost their job, this could be referring them for a new one.
What if this describes me?
If you have read the above and thought ‘oh god, that’s me’, Dr Thema said you shouldn’t panic.
‘If you notice you are stressed or potentially depressed or overwhelmed, I want to say the first step is the acknowledgment.
‘So many of us are so busy taking care of other people or our professional responsibilities, but just being aware of I’m exhausted, that’s the first step.’
Tips she offered to help with negative feelings included carving time out for yourself to relax during the day.
Other strategies include not working late into the night or being on social media late in the evening and keeping a consistent sleep schedule.
Exercise can also help to boost mood, she said, including doing it in a group as it gives you a chance to mix with others.