Being young is getting worse, but we are not sure why, or what it means

May 8, 2024
Close Up Of Teenagers With Mobile Phone Vaping and Drinking Alcohol In Park

Ill health, perhaps especially mental ill health, is generally seen as a personal issue, requiring diagnosis and treatment. But at the population level, mental health problems have a profound message for our societies and their futures. We need to pay it more heed.

A new international review has concluded that rates of emotional problems such as depression and anxiety have increased among adolescents in many countries over the past four decades, and outcomes for those with problems have worsened.

Their review says studies (mostly in rich countries) suggest that the trends are associated with increases in parents’ emotional problems, young people’s efforts to control weight and eating disorders, school-related stress, and a rise in family poverty and social inequality. It says the rise of digital media in the last few decades has been one of the biggest changes in young people’s lives, but the implications for trends in mental health remain unclear (although recent scientific and media reports are emphasising the role of smart phones and social media).

Other trends are likely to have mitigated against even steeper rises in youth emotional problems, the review says, including improvements in substance use and a possible reduction in child abuse and neglect. It concludes that improving young people’s mental health is a major societal challenge, but much more needs to be done to understand the connections between social change and trends in youth mental health.

I recently discussed this topic in an essay published In the US magazine Salon, before this review was published. This article draws on that essay.

Young people best reflect the characteristics of our times because they are growing up in them. Their health is an important predictor of future population health because many of the attitudes and behaviours – and even the illnesses – that determine adult health have their origins in early life. About 75% of mental-health problems begin before age 25. While some of these disorders are minor and transient, other problems can be severe and recur throughout life. In Australia, the 2020-21 National Survey of Mental Health and Wellbeing found almost 40% of people aged 16-24 experienced a mental-health disorder in the previous year.

US research shows increases in poor mental health in younger age groups such as adolescents and college students are now extending up the age scale to adults in their prime (aged 26-49). Similarly, a recent Australian study notes population-level trends in mental health have been falling in developed nations for many years, especially among young people. The study found that the decline in mental health over a 20-year period was largely driven by young adults born in the 1990s, and to a lesser extent those born in the 1980s. It says the evidence suggest that declines in mental health among young people may not spontaneously recover or disappear.

I began researching young people’s changing world for the Australian Commission for the Future in the 1980s, suggesting in a report that rising rates of youth suicide, crime, and drug use (there was no evidence on mental health trends back then) were linked to increasing family conflict and breakdown, youth unemployment, child poverty, education pressures and – a novel dimension – concerns about the world’s future.

At the time nuclear war was a prominent fear, as it is again now with the heightened tensions between the West and Russia and China. There is also today more awareness of the spectre of catastrophic climate change, which is not only a future threat but our lived reality. The new review states there is currently insufficient evidence on links between trends in youth mental health and exposure to a range of traumatic experiences including war, natural disasters, and pandemics. Again, however, the rise of ‘eco-anxiety’, especially due to climate change, is a growing topic of research.

Since the 1980s, my focus has been on the effects of cultural change. For example, rising materialism and individualism are defining characteristics of modern Western culture. Both have conferred benefits to people, including to their health and wellbeing. However, there is growing evidence of diminishing benefits and rising costs. The costs include a heightened sense of risk, uncertainty and insecurity; a lack of clear frames of reference; a rise in personal expectations, coupled with a perception that the onus of success lies with the individual, despite the continuing importance of social disadvantage and privilege; a surfeit or excess of freedom and choice, which is experienced as a threat or tyranny; and a shift from intrinsic to extrinsic values and goals, with more emphasis placed on success, status and popularity.

This cultural change is not just a matter of greater vanity, selfishness and greed (although many people express concerns about these traits). It is something deeply existential and relational, about how people think of life and how they see themselves in relation to others and the world, and this profoundly affects their wellbeing.

On this topic, the international review says studies investigating the role of broader cultural factors such as changes in globalisation, individualism or materialism were not found, but are likely to be shaping societies in profound ways that may have affected rates of youth emotional problems (citing my work).

It is not surprising, given the complexities of social changes and their effects, that the patterns and trends in young people’s wellbeing remain to be explained, as the review cited above notes. It is a contentious topic, marked by contradictory and ambiguous evidence and disciplinary and conceptual differences. Each stream of evidence can be challenged or open to other interpretations: for example, reported increases might result from a greater willingness to admit to problems or mistakes in recall; high prevalence and professional concerns have been attributed to increased diagnosis and the ‘medicalisation’ of normal human emotions.

The new review discusses the ‘prevalence inflation hypothesis’, which argues that improved recognition and more accurate reporting of mental health problems may have led to over-interpretation, where people label milder and more transient forms of stress as mental illness, resulting in a self-fulfilling prophecy. It cites evidence that challenges this view.

Notwithstanding this debate, there is a strong case to review the usual narrative that describes young people’s health and defines what is done about it. How societies address social problems and challenges depends on how these are represented or framed. Changing the representation, or story, of young people’s health and wellbeing would have the immediate effect of underscoring the need to expand and improve healthcare services, which dominate current policy considerations. I consider other political responses in the Salon essay.

However, the most important application of this perspective may be in the contribution it can make to a much broader political and public debate about the lives we want to lead, the societies we want to live in, and the futures we want to create. This debate is intensifying, but health research plays only a limited part in it.

A wider, more comprehensive, view of health would contribute to a better understanding of human progress and development, and of health as a social dynamic: a cause of social changes and developments, not only a consequence, through effects on population resilience, morale and vitality. This effect may well influence how well humanity responds to global threats such as climate change.

The health of young people should be a focal point in the larger contest of social narratives. They should, by definition, be the main beneficiaries of progress; conversely, they will pay the greatest price of any long-term economic, social, cultural or environmental decline and degradation. If young people’s health and wellbeing are not improving, it is hard to argue that life overall is getting better.

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