A woman sitting on the floor in front of a couchWHO data show that young people aged 18-29 are 30% to 80% more likely to report symptoms of depression or anxiety than adults. What are the primary reasons for this, and how have these trends evolved?
There’s a landmark study from 2007 that used epidemiological surveys from around the world and showed that about 75% of mental disorders have their onset before adulthood. There’s also a more recent study that says that half of the mental health conditions are already there before the age of 18, and two-thirds before the age of 25. So, it is part of the epidemiology of mental disorders that they start very early in the life course, opposite to many other non-communicable diseases that we study.
This is quite a relevant feature and, I think, also a reason for us to pay much attention to youth in terms of their mental health.
Additionally, the second part is that there was a potential rising trend in mental distress already before COVID-19. So, this increase didn’t start only with the pandemic. But then, the pandemic changed how we live and how care is provided in an abrupt way. During a certain period, it increased many risk factors for poor mental health and decreased a lot of what we call the protective factors. That definitely had an impact on the population’s mental health, particularly on young people.
The last point that we haven’t discussed yet is that even within youth, we have a lot of variation. We have groups in circumstances that are more vulnerable: for instance people of low socioeconomic status and minoritised groups such as low-income or low-education groups, particular ethnicities, and people who identify as LGBTQ+.
All of them are at a higher risk of poor mental health, particularly when considering depression and anxiety. They need to have dedicated attention to understanding what’s going on with their mental health. The OECD is currently working on a piece on understanding and addressing mental health inequalities that will be published later this year.
According to the World Happiness Report, older adults (aged 60 and older) feel more socially supported and less lonely than younger generations despite having less frequent actual interactions. What do you think contributes to this sense of loneliness among the youth?
Francisca Vargas Lopes: There’s a part that is related to the life course for example when discussing the transition into adulthood: this period of transition can be challenging for mental wellbeing. The transition can be a lonely experience, and it has probably been like that since ever. However, different generations have perceived it differently.
There are also different types of loneliness. One aspect certainly relates to people’s expectations and desires. So, this sense of increased loneliness we are referring to, could be connected to how people perceive themselves according to their expectations of meaningful relationships. For instance, it might be the case that youngsters would expect more links in real life, due to the reality they face and what they see through social media.
That said, in the last few decades, we can say that we all live more lonely lives. Households have become smaller; we have less connection to our neighbours and live busier lives with less time for bonding opportunities.
I should note this is because we are discussing the context of high-income European countries. We have a very different reality when discussing low and middle-income countries. It’s a bit outside of our scope because at OECD we mostly look at our member countries, but it’s relevant to point out that it would be quite a different reality.
This European Parliament’s study shows that digitalisation has brought many benefits and opportunities to society but has also created some risks, including digital addiction, attention-retention disorders, loneliness and exposure to dangerous and illegal content. What should be done to mitigate the adverse side effects of digitalisation on young people’s mental health?
Francisca Vargas Lopes: As our work is really grounded on evidence, I think it’s important to mention that evidence is still a bit mixed about all the effects of digitalisation on mental health. There’s still room to try to understand better what is driving all these changes.
However, increasing evidence shows that reducing screen time, and often this is time spent on social media, seems to have a positive effect on mental well-being. There are several ways of incentivising people to reduce screen time, but also, what’s critical is what you do with the acquired time.
We still don’t fully understand all the mechanisms behind the use of new technologies in terms of increasing the risk of poor mental health or decreasing mental well-being, but some of these might be connected to what else you are not doing when you not on your phone or the computer, for example physical activity or sleeping.
So, it is important for countries to work on approaches to mitigate the risk of excessive screen time, and namely the use of social media and the impact on mental health. We know that there are specific harms that we should have policies against, like harassment and cyberbullying. Countries need to implement interventions, for example in schools, together with parents, to try to tackle these realities.
Reducing screen time somehow impacts all of these, but it is not enough furthermore, it would be best if there were also incentives for time to be used with what we call the protective factors. This is not only for youth but for the whole population.
How have events like the COVID-19 pandemic and geopolitical tensions affected young Europeans’ mental health?
Francisca Vargas Lopes: There is a set of crises that somehow impact our mental health. This is nothing new; we’ve always known that. We’ve known this from previous wars. We have known this from natural disasters and from economic crises. Now we know this from the pandemic.
I think what is important is paying attention to how the set of ongoing crises seems to perpetuate some of the intensified risk factors and how this is impact impacting youth. Additionally, the fact that we live in a more than ever globalised world where information is very easily accessible to youth and sometimes hard to judge its truthfulness might also have an impact.
What preventive steps can we take to improve mental resilience among young people?
Francisca Vargas Lopes: First of all, it’s good to distinguish between the promotion of mental health, which would mostly fit the objective of improving resilience and prevention of mental ill-health, and mental disorders. At the same time, they are closely related, and some interventions could combine both.
However, there are still different aspects to take into account when designing promotion and prevention interventions, and both fields are really important. Gladly, I think, mostly after the pandemic, countries are increasing their investment efforts to employ these.
In 2015, many years before the pandemic, the OECD developed a set of recommendations on integrating mental health with work and skills policy that were adopted by ministries of health and labour in all OECD countries. The core outcome is the need for a cross-sectoral approach to mental health, and the acknowledgment that, healthcare system responses are not enough; governments need to implement policies that are both promoting and preventing mental health conditions in schools, workplaces, social and youth support services.
Every five years, we monitor OECD countries’ progress towards implementing this Recommendation; the first assessment was conducted in 2021. The good news is that we saw some real progress regarding youth and education policies, already prior to the pandemic. Most countries have increased their efforts to train better, for example, teachers or school counsellors, to identify youngsters with mental health problems.
There has also been implementation of universal and selective preventive interventions, such as monitoring and improving the school climate or improving students’ social-emotional learning skills. Linked to this body of work, the OECD’s New Benchmark for Mental Health Systems, published in 2021, also established that good promotion and prevention policies should:
- reduce the rate of suicide;
- ensure mental health literacy;
- make schools mental health-friendly environments that build resilience;
- ensure that workplaces foster good mental health;
- enable front line actors to recognise and respond to mental distress;
- and make it easy for individuals to seek help.
Finally, you also need to have dedicated measures to act on groups in the most vulnerable circumstances. Even within minoritised groups, you have different situations that require specifically designed interventions.
For example, if we’re discussing ethnicity, or indigeneity, which is also relevant for many OECD countries, you might need culturally and linguistically appropriate interventions; you need to understand the situations of stigma and discrimination these people have been through.
Additionally, suppose you are discussing people who identify as LGBTQ+. In that case, it is crucial to consider that the types of experiences they go through, including discrimination and those linked to disclosure of identity, are very different from those with a heteronormative sexual orientation, and this might place them at higher risk of poor mental health. These different drivers of mental health call for targeted action for these groups.