An age of uncertainty: mental health in young people

Young people face a world with multiple crises and much uncertainty. A person born in 2006 will have gone through the great recession and the subsequent austerity measures, a pandemic with disrupted schooling and social isolation, a cost-of-living crisis, war in Europe, and a world coming to terms with the magnitude of climate change. There have been many tumultuous times in history, but evidence on the mental wellbeing of young people during those periods is scant. How should we think about the mental health of young people during an age of such uncertainty? In their Seminar on Depression in Young People in this week's issue, Anita Thapar and colleagues identify the importance of viewing mental ill health as a spectrum. At one end is a “mood state in the context of normative mood fluctuations” that do not meet full diagnostic criteria but impact quality of life and can be risk factors for depressive disorders in later life. At the other end is a heterogeneous cluster of symptoms that can constitute depressive or mood disorders (including anxiety). Prevalence across the spectrum has risen sharply in the past decade, even before COVID-19, and particularly in young women. Most mental disorders are rare during childhood and become more prevalent in adolescence, a stage that lasts up to age 24 years. Although prevalence estimates vary, the peak incidence appears to be at age 17–19 years in high-income countries. Some estimates suggest that globally, one in three to five children or adolescents have an anxiety disorder at some point. The prevalence of suicidal ideation, planning, and attempts is still relatively low in adolescents, but together they represented the fourth leading cause of death for adolescents between age 15–19 years globally in 2019. A recent systematic review and meta-analysis published in The Lancet Psychiatry estimated a pooled prevalence of 7·5% (95% CI 5·9–9·6) for suicidal ideation in children younger than 12 years. The picture is undoubtedly concerning. It also presents both medical and societal challenges. Medically, for severe disorders in children and adolescents, there are few treatment trials to guide clinicians, and a serious lack of access to services means too many people go without proper support or treatment. At the less severe end of the spectrum, to what degree is an increase in the burden of mental ill health in young people a normal response to a set of abnormal circumstances? It is easy to see how feelings of unhappiness, worthlessness, or fear of going out in young people could be reasonable responses to more than 2 years of social isolation during the pandemic, particularly when that social isolation occurred during adolescence—a time crucial in developing young adults. Peer support, physically being with each other, and learning from each other's social cues and behaviours are critical to future mental wellbeing. One report indicates that young people in Europe were more likely than older age groups to “experience job loss, financial insecurity, and mental health problems. They reported reduced life satisfaction and mental wellbeing associated with the stay-at-home requirements and school closures.” Anxiety about climate change is also a factor. In a survey of 10 000 children across ten countries, feeling sad, anxious, angry, powerless, helpless, and guilty were all emotions reported by more than 50% of respondents. When the future of all living things is in danger, it is difficult not to feel depressed. Such responses cut across unhelpful generational stereotypes about wokeness or a sensitive and coddled generation. These are appropriate reactions to a vision of a better future in jeopardy. This week, The Lancet launches the second adolescent health and wellbeing Commission, tasked with ensuring “that today's adolescents have the means to address the unique challenges of their generation”. The recent increases in the burden of mental ill health in young people are sending an important signal. Mental health issues in children and adolescents are neither unusual nor unexpected—the response needs to be shaped accordingly. Improved treatments and better, more accessible services are clearly needed, but the need goes beyond the health service. Schools, for example, instead of being centres for academic achievement, should become places that cultivate mental wellbeing. Governments and policy makers must also act by centring their efforts on the concerns of young people. It is the systems in which young people live and interact, from families to communities, that are the key to mental wellbeing. It is here that young people can be supported to lay the foundations for healthier futures. For more on anxiety in young people see Seminar Lancet 2021; 397: 914–27For the Eurofound report see https://www.eurofound.europa.eu/publications/report/2021/impact-of-covid-19-on-young-people-in-the-eu#:~:text=COVID%2D19%20pandemic.-,Young%20people%20were%20more%20likely%20than%20older%20groups%20to%20experience,home%20requirements%20and%20school%20closures For more on anxiety in young people see Seminar Lancet 2021; 397: 914–27 For the Eurofound report see https://www.eurofound.europa.eu/publications/report/2021/impact-of-covid-19-on-young-people-in-the-eu#:~:text=COVID%2D19%20pandemic.-,Young%20people%20were%20more%20likely%20than%20older%20groups%20to%20experience,home%20requirements%20and%20school%20closures Realising transformative change in adolescent health and wellbeing: a second Lancet CommissionThe 2016 Lancet Commission on Adolescent Health and Wellbeing1 brought global attention to the transformational potential of the world's 10–24-year-olds to reap a triple dividend of benefits for adolescents now, as they matured into adulthood, and later still for their children. In an accompanying Comment, the UN Secretary-General identified adolescents as “the world's greatest untapped resource”.2 Full-Text PDF Depression in young peopleDepression rates in young people have risen sharply in the past decade, especially in females, which is of concern because adolescence is a period of rapid social, emotional, and cognitive development and key life transitions. Adverse outcomes associated with depression in young people include depression recurrence; the onset of other psychiatric disorders; and wider, protracted impairments in interpersonal, social, educational, and occupational functioning. Thus, prevention and early intervention for depression in young people are priorities. Full-Text PDF Prevalence of suicidal ideation and self-harm behaviours in children aged 12 years and younger: a systematic review and meta-analysisA high number of children in the general population can experience suicidal ideation and self-harm behaviours, thus underlining the need for more research on childhood suicide, including developmentally appropriate preventive strategies, such as youth-nominated support teams or dialectical behavioural therapy. Full-Text PDF Climate anxiety in children and young people and their beliefs about government responses to climate change: a global surveyClimate anxiety and dissatisfaction with government responses are widespread in children and young people in countries across the world and impact their daily functioning. A perceived failure by governments to respond to the climate crisis is associated with increased distress. There is an urgent need for further research into the emotional impact of climate change on children and young people and for governments to validate their distress by taking urgent action on climate change. Full-Text PDF Open AccessSupporting every school to become a foundation for healthy livesAs a setting where children and adolescents live and learn, linked to the family and embedded within the wider community, schools have an important influence on every student's health. Many health interventions have used schools as a platform, often for standalone programmatic initiatives to reduce health risks, and sometimes for more comprehensive approaches, but the interventions, uptake, and sustainability are generally disappointing. Evidence shows that, to improve health and to reduce inequality, all students must attend school from a young age and for as long as possible, and their educational success therein must be maximised. Full-Text PDF