A global mental health crisis? Really? (Patreon)

[This is a transcript with links to references.]

I’ve read that we have a mental health crisis. When I say “we”, I don’t mean that physicists are depressed because they still don’t understand quantum mechanics. Though there’s that. I mean, we, on this planet, supposedly have a mental health crisis. Though if you take a closer look at the headlines, most of them seem to be about the United States.

So do we really have a global mental health crisis? Or is it an American thing? Or is it maybe not a thing at all? Does it have something to do with COVID? And if not, then what’s going on? That’s what we’ll talk about today.

Let’s jump right in and see what the data say.

The Global Burden of Disease is a web interface maintained at the University of Washington in Seattle. It should not be confused with the local burden of disease, which is more commonly known as kindergarten.

This web interface collects and lets you display health data from all over the world. At the moment, it covers the years from 1990 to 2019, so it ends before COVID.

To get an idea for what was going on before the pandemic, we can search this database for mental disorders that are a cause of death and injury, globally, and here we get the result.

This is the incidence rate, that is, cases per 100,000 people. As you can see, it’s been pretty much stable over the past decades. Don’t get confused by this axis, it doesn’t start at zero. We can change this here. As you can see, the line is pretty much flat.

Ok, there’s no mental health crisis, thanks for watching.

Wait, I have to talk at least for 8 minutes otherwise I can’t put an ad break in the middle. Luckily there’s a few more things to say.

Let’s look at this a little closer. First of all, the lines are flat not because there’s been an increase in some regions and a decrease in others. The level of mental health problems has been almost flat in all regions of the world.

The most pronounced trends you can see are that in Latin America, there’s been a mild increase. And in North America, there’s been a rather noticeable increase in the late 1990s that, however, tapered off. If you look at a closer breakdown you see that this happened in the United States, whereas in Canada, at the same time, there was actually a dip.

The reason this increase in mental health problems in the USA and Latin America barely shows up in the global average is that compared to Asia, the total number of people there isn’t all that high.

Another interesting thing you learn from this database is that the higher the income level, the lower the mental health. Must be tough to be a billionaire. Also, while the prevalence of mental health problems is somewhat higher among women, the difference to men is not large.

According to a study that appeared last year , the most common mental health disorders among both men and women are depressive disorders and anxiety disorders. However, among women eating disorders are more common, whereas ADHD and autism spectrum disorders are more common among men.

You might say that maybe looking at causes of death and injury is a bit narrow, as there is more to mental health than physical damage. But looking at documented damage circumvents the problem that, especially in the western world, diagnosis and treatment of mental health conditions has become more widespread, and the cases on record might increase because of that, rather than because of changes in mental health.

For example, the number of people on antidepressants in the European Union has steadily increased in the past decades, which this website claims is a sign of a mental health crisis. Turns out that the European country with the largest per capita consumption of antidepressants is Iceland. I guess sitting on a volcanic island that scratches on the arctic circle isn’t for everyone. But the overall reason for the increase in antidepressant use is probably not so much that people in Europe are actually getting more depressed, it’s just that depression is increasingly recognized as an illness, and that more medications are available to treat it.

Also, as we saw in an earlier video, the prevalence of conditions like ADHD and Autism Spectrum Disorder has sharply risen because of better screening. Screening for depression has also increased in the past ten years, especially in the US, and funding for mental health studies has increased, too. On top of that, mental health conditions are much more openly discussed today than they were 30 years ago, and this might also raise the appearance that they’re becoming more common.

Still this doesn’t mean it’s all good. One way to see that something odd is indeed going on in the United States is to look at suicide rates. They were on the rise there already in pre-pandemic times, whereas they’ve been dropping in Europe. Actually, they have been dropping in most of the world. But it’s not just the US though where suicides are on the rise. In Brazil, too, things aren’t going all that well.

Okay, but all of this was before COVID. What happened during and after the pandemic?

A meta-review from last year found that during the COVID pandemic, suicide rates did not exceed expectations from pre-pandemic times in 33 countries for which there was data available.

When it comes to mental health problems in general, according to a fairly recent study the world made it through to COVID pandemic reasonably well. This one is a meta-analysis of 137 studies that compared general mental health, anxiety symptoms, and depression symptoms assessed right before COVID and up until April 2022.

The authors didn’t find changes for general mental health or anxiety symptoms, but depression symptoms worsened just a tiny bit. They conclude that “rather than a mental health crisis, at a population level there has been a high level of resilience during covid-19, and changes in general mental health, anxiety symptoms, and depression symptoms have been minimal to small with no changes detected in most analyses.”

What they mean is that while many studies found significant mental health impacts at the beginning of the pandemic, by mid-2022, most people had bounced back to their previous level of mental health. At least those who were still alive.

However, this study averaged over the entire globe, and all age groups, and that doesn’t tell the whole story.

According to a series of surveys conducted by the analysis firm Gallup, the incidence of depression in the United States has increased with the onset of the COVID pandemic and it still hasn’t returned to pre-pandemic levels. The US Census Bureau has also kept track of depression and anxiety before, during, and after the pandemic and reports the same thing: while levels have been dropping since the height of the pandemic, they’re still elevated. In this figure the green line is the pre-pandemic level from 2019.

If you look somewhat closer at the details, it becomes apparent that this isn’t a general American thing, but affects young people in particular. And it isn’t a new trend.

Earlier this year, the Center for Disease Control in the United States released the Annual Perspective reportfor 2020 and 2021, so that’s data from right at the onset of the pandemic. They found that the suicide rate for adults in their early 20s was the highest in more than 50 years. But this trend was apparent in the data already before the pandemic. Reports of depression among young people in the United States have also significantly risen in the past decade. The COVID pandemic didn’t help.

It isn’t an exclusively American phenomenon. Also in the UK, the number of children referred to mental health specialists has increasedfor the past decade or more. The same has been seen in several other countries, for example Australia and New Zealand. Though in those countries, the increase luckily doesn’t reflect in an increase in suicides.

Keep in mind that one has to interpret numbers for referrals and diagnoses with some caution, because they might have more to do with the treatment and general acceptance of mental health disorders, rather than their actual prevalence.

The depression trend affects young Americans of both genders, but girls are more affected. Earlier this year, the CDC released a trend report showing this gender gap for high school students. While girls have always reported more mental health problems, the gap has been widening. There has also been an increase in suicide attempts, though luckily not a huge one. The largest increase in suicide rates in the US has been in the age groups of 20-24 and 25-34.

Something is clearly going on, but what?

There’s no one-size fits all answer since every country has its own challenges. For example, remember the puzzling increase of suicide rates in Brazil? According to a 2022 review, most of the cases are either unmarried men or people with mental health disorders. Suicide rates among them are strongly associated with unemployment and economic deprivation.

What’s with the United States? In a paper from 2020, a group of neuroscientists from the United States and Spain considered the opioid epidemic as a possible explanation. On the one hand, opioid overdoses in the United States have increased exponentially in tandem with suicide rates since approximately 1999. On the other hand, the largest increase in suicides is among young adults, and those are actually less likely to use opioids. So, if the two are related, it’s an indirect cause. One could speculate that maybe young people are affected by the problems of their parents’ generation, but there’s no evidence for that.

Another factor that has been considered to explain what’s happening in the United States is access to guns. But firearm ownership has actually seen a mildly decreasing trend over the past decades. So it seems unlikely to be a cause for an increase in mental health problems.

Another possible cause is a failure of the health system. According to Mitch Prinstein, the chief science officer of the American Psychological Association, one factor in rising suicide rates in younger age groups is the “remarkable weakening of our mental health response system,” as he said in an interview with The New York Times. Though this doesn’t explain why it affects young people in particular.

Climate change is also a potential cause of psychological problems, both directly and indirectly. For one thing, that’s because climate change increases the risk of people to be exposed to extreme weather events such as floods or droughts, which understandably causes distress. And then there’s the general problem of living in a world that’s going to hell in a handbasket. It’d make sense that this affects younger people more than older ones, because they’re the ones who’ll have to sort out this mess.

Psychologists have reported a number of climate-related mental health conditions which go by names such as climate change anxiety, environmental distress , or ecological grief. However, it seems implausible that these would have a big impact in the United States in particular, and less so in other parts of the world. I mean, it’s not like Americans are all that well-known for their environmental consciousness.

And then there’s the American psychologist Jonathan Haidt who notes that the increase in mental health problems coincides with the popularization of smartphones and social media. Now, a correlation is not a causation, but it isn’t hard to see how social media that reward users for being popular and visually attractive can be a source of distress, especially for young people, and especially for girls.

This argument isn’t generally accepted among psychologists though. Some studies have found a link between social media use and mental health problems, others have not. And as we saw in our earlier episode on the good and bad of social media, it isn’t all that clear which way the causation goes. Maybe young people with mental health problems are more likely to use social media rather than the other way round?

Be that as it may, the US congress is in the process of passing laws that regulate the use of social media for children and adolescents.

Ok, so, do we have a mental health crisis? Well, some of us do. There’s been a significant increase in suicide rates among young adults in the United States for the past decade. Mental health is deteriorating generally among young people in the United States and some other countries too, and it especially affects teenage girls. There might be several reasons for this, but one issue that has attracted psychologists’ attention is the increased use of social media. There’s a lot of research on that, which I have a personal interest in because I have two children who will soon get their first smartphones. If you want us to look closer into the link between social media use and mental health of young people, please let us know in the comments.