Ever since February, when the Centers for Disease Control and Prevention shared its survey data on teen girls' skyrocketing anxiety, sadness and suicidal thoughts, the focus has been on what might be causing this level of suffering. But there's an answer in the data, staring us right in the face.

According to the 2021 Youth Risk Behavior Survey Data, nearly 3 in 5 U.S. teen girls (57%) felt persistently sad or hopeless in 2021. That's the highest level reported over the past decade and nearly twice what boys reported. Thirty percent of teen girls said they have seriously considered dying by suicide -- a percentage that's risen by nearly 60% over the past 10 years.

It's useful to note that this survey was taken while there were still significant disruptions in teens' lives from the pandemic. But let's explore some of the other factors involved.

To find out what might be driving this rise in mental health troubles, especially for teenage girls, I turned to two experts on the St. Louis Regional Suicide Prevention Coalition. Liz Sale, research associate professor for the Missouri Institute of Mental Health at the University of Missouri-St. Louis, studies and tracks suicide data in the state. Elizabeth Makulec is the executive director for Kids Under Twenty One, a nonprofit that works to improve the emotional well-being of young people.

Research has documented that frequent social media use has a detrimental effect on teen mental health, particularly for girls. Makulec pointed out that while social media also offers some positive aspects, like exposure to new ideas and connection with others, it carries risks like deteriorating self-esteem and bullying.

"I can't tell you the number of times that social media comes up as an issue," Sale said in agreement. Parents often don't even realize that their young children can access sites without their knowledge.

Other factors that Makulec and Sale agree have made adolescence more challenging: increased competitiveness, pressure and schedule demands on high school students; stress and anxiety among caregivers, parents and teachers; and awareness of bleak social and political realities, such as school shootings and climate change.

"There's an overwhelming uncertainty of what the world is going to look like when (a young person) becomes an adult," Makulec said. "There's a lot of uncertainty, ugliness and hatefulness going on, and there's only so much that people can tolerate."

Teaching children at all ages how to cope with difficult feelings and challenging circumstances has to be a fundamental part of education. Learning coping skills should start at the youngest possible ages, building on that knowledge and training as children grow, they said. Young people have become more comfortable talking about mental health and can learn strategies that become a part of their everyday wellness.

There were two other statistics in the survey data that immediately jumped out at me:

-- Nearly 1 in 5 teen girls (18%) said they had experienced sexual violence in the past year -- up 20% since 2017, when the CDC started monitoring this.

-- About 1 in 7 teen girls (14%) reported having been forced to have sex -- up 27% since 2019, when the CDC began monitoring this.

Some of these increases may be attributable to a growing willingness to talk about sexual violence, but these are unacceptably high levels, regardless. Consider that in a classroom of 20 girls, two have reported being raped.

It makes sense that a population experiencing rising levels of violence and trauma would report higher levels of anxiety and sadness.

"Any time you don't feel safe, feel you may be victimized, it causes you to be on edge and fearful," Makulec explained. Remaining hyperattentive or hypervigilant in an effort to keep oneself safe from sexual violence feeds a cycle of anxiety.

The solutions to address this issue go beyond teaching coping skills.

Unlike the internal work required by girls to build resilience, reducing their exposure to sexual violence demands external work -- from parents, educators, school administrators and law enforcement. From boys and men.

If parents and schools fail to educate boys about what consent looks like, boys will instead pick up cues from a toxic culture: politicians who brag about grabbing women's crotches, YouTube influencers who spout a hatred of women, and porn that fetishizes violence and degradation.

Too many parents are in denial about these messages their sons are constantly given. And too many educators are dismissive of the threats, harassment and violence girls say they've experienced.

If we are truly concerned about girls' mental health, we have to look outside their internal emotional world and also fix the broken real world.

A longtime conservative reader sent me an intriguing question recently.

He asked: Is it safe to take your kids to a Cardinals ballgame?

I've been thinking a lot lately about what places are safe. Recently, my husband and I were trying to find a restaurant in St. Charles County that we had never visited before. The GPS directions led us down a wrong street, and my husband pulled into a driveway to turn the car around.

"This is what got that girl killed in New York," I told him. Twenty-year-old Kaylin Gillis was shot to death on April 15 for pulling into the wrong driveway in upstate New York. There have been times when I've turned around in an unknown driveway, but I'll think twice about doing that now.

The shooting in New York happened within days of a teenage cheerleader in Texas landing in an ICU: She and a friend were both shot when the friend accidentally tried to enter the wrong car in a grocery store parking lot. That news followed the headlines about Ralph Yarl, a 16-year-old in Kansas City, who was shot in the head for ringing the doorbell at the wrong house.

That same week, 6-year-old Kinsley White and her parents were shot by a North Carolina neighbor who was upset that a basketball rolled into his yard, and a man from Springfield, Missouri, held a gun to a grocery store worker's throat because the meat department was closed and he wanted steak.

It's undeniable that we live in a culture of fear. But I don't think these were the incidents the reader who wrote to me was thinking of.

There's been a steady increase in gun violence in the downtown St. Louis area during the past 15 years, according to University of Missouri-St. Louis researcher Bobby Boxerman. And while the number of homicides in the city has been lower the past two years than it was in 2020, a man was shot and killed at Seventh and Market streets just a couple of weeks ago.

So many of us are afraid of becoming victims of violence in this country -- albeit for different reasons. My reader is afraid of the people he might encounter going to the ballpark in the city; I'm afraid of getting lost in the ultra-conservative part of St. Charles County he lives in. He's an older white man; I'm a middle-aged brown woman.

The through line is that we all know, regardless of political beliefs, that America is a particularly violent place. We disagree on why that is, and the media content we consume reinforces what we already believe.

Missouri Republicans have passed legislation making it easier for anyone to obtain a firearm at any time and bypass a background check. We're one of 27 states that now allow people to carry hidden, loaded handguns in public without a mandatory background check or safety training. Now, Republican lawmakers want to let people carry guns into churches and on public transportation.

Missouri is among the states with the highest rates of gun violence. And let's be honest: Is anyone surprised?

State Rep. Peter Merideth has repeatedly pointed out the hypocrisy of Republicans who rail about crime in St. Louis but keep rejecting efforts to actually address the issue. They've voted against: allowing St. Louis police to take away a person's guns if they have been deemed a high risk to themselves or others; allowing local police to work with federal law enforcement to reduce gun violence; and allowing municipalities to prohibit minors from carrying loaded guns in public.

Merideth proposed that last measure just two weeks ago, and every Republican representative rejected it. Makes you question how real their fear of attending baseball games is.

Our country has let guns become the No. 1 cause of death for kids and teens -- despite knowing there are laws that could prevent many of those deaths.

But it's our perceptions that shape our fears.

I asked a friend who lives in the city if she felt it was safe to take her children to a ballgame.

"I'm going to keep living my life," she said. "I'm not hiding in a cul-de-sac in fear."

I think this is the approach most American parents have taken. We have no choice but to send our children to school, where the chances of getting shot are higher than at Busch Stadium.

We take them to ballgames; we let them visit their friends and participate in school activities.

And we pray they don't get shot for knocking on the wrong door.

A week before her big race, Bonnie Cochran Bence was mentally and physically ready to run.

Then, a driver rear-ended her car.

As any runner knows, an injury before a race can sideline even the most prepared athlete. And this wasn't just any race: Bence had been training for the Boston Marathon, where the best runners from around the world gather to compete.

Then again, Bence isn't just any runner. She's a 78-year-old retired teacher from Creve Coeur, Missouri, who ran her very first race in her early 60s and has run 33 marathons since.

This year's Boston Marathon was going to be her 16th consecutive trip to the prestigious race, but the car accident put that in jeopardy. She was sore the day after it happened, but otherwise unhurt. She decided she would swim every day, plus continue with her yoga practice, to try to heal her body in the few days before the big race.

"I'm going to go, and I really want to finish, but I will accept what happens on the 26.2 (mile) journey," she said when I spoke to her six days before the race.

It's this type of persistence, grit and attitude that has helped Bence run so far for so long later in life. She started racing by accident. In 2005, her four adult children -- three sons and a daughter -- planned to run a relay together in St. Louis. Her daughter had to drop out at the last minute, and her son asked Bence if she would step in and take her place.

"She tough, and she's athletic," said her son Rob, now 44. "We had a feeling she would be down for it."

She was indeed, and she had a great time running with her sons.

"It was the first time I ever ran a true race. I was running through Forest Park, and the crowd was yelling, 'Go, mom, go!'" she said.

Their family team did well, and her son Chris, now 42, suggested she run a half-marathon. He made a training plan for her, which she followed diligently, and the pair ran the St. Jude half-marathon in Memphis together.

After that race, Chris said that if she could double the distance while keeping the pace of her half-marathon, she could qualify for Boston. She started training again, this time adding a lot of cross-training through swimming and yoga.

The next year, in 2008, she qualified for and ran her first Boston Marathon. Since then, she's been a regular fixture on the route. There have been high points over the years -- running it with her son; placing third in her age group at age 70 -- along with low ones. In 2013, she was a couple of miles from the finish when a bomb killed three people and injured hundreds.

Through it all, she keeps putting one foot in front of the other.

Bence, who was born in St. Louis, lost her mother to ovarian cancer when she was 5 years old. Her father, Bob Cochran, was left to raise three children by himself. He was an accomplished golfer who played in several Masters tournaments and inspired her interest in athletics from a young age.

She graduated from high school at Visitation Academy, then entered the convent, where she stayed for 7 1/2 years.

"I found out it wasn't for me," she said.

She got married at age 30 and ended up teaching for 45 years. She dedicated herself to her teaching career -- often getting up early and staying up late to prepare for her classes. Chris said his mom puts the same effort into all her endeavors as she does with running.

"She pushes herself to be great in all phases of life," he said. "And she has an extremely high pain tolerance."

When she stopped qualifying for Boston through the time requirements, Bence began fundraising for the Special Olympics to get into the race. Her children say they are "super proud" of her.

On April 17, just a week after a car accident, she ran through rain and puddles to finish another 26.2 miles in Boston.

"Your story can have a happy ending!" she texted me that evening.

Like she has so many times before, she waved and blew kisses to the cheering crowd as she crossed the finish line.

Her sweet 16th Boston was in the books.