Young people reported deteriorating mental health before covid-19—we need to take their concerns seriously

Life has changed enormously in Europe over the past two decades. The pace of change has probably been faster than at any time in human history. Digitalization, urbanization, globalization and climate change mean that we now live in a more complex and increasingly inter-connected Europe.

Young people are often the first to be exposed to and affected by change. They have formed the vanguard of the movement advocating to end climate change, for example, and are frequently among the first adopters of new technologies, particularly in the digital arena. It is essential that we seek to understand how monumental changes in the way we live our daily lives affect young people, physically and mentally, because they represent all of our futures.

For over 35 years now, WHO Europe has been documenting findings from the Health Behaviour in School-aged Children (HBSC), which is undertaken every four years, and charts trends in the health and social behaviours of 11-, 13- and 15-year olds. The latest and seventh report, Spotlight on adolescent health and well-being, contains findings from surveys taken in 2017 and 2018 of 227,441 young people in 45 countries in Europe and Canada.

Despite the many emerging social and economic pressures, the latest report found that most adolescents experience positive and supportive social relationships, relatively few health problems, and good overall health and wellbeing.

One area of concern, however, is that adolescent mental wellbeing has worsened in many countries between 2014 and 2018. One in four adolescents report feeling nervous, feeling irritable, or having difficulties getting to sleep every week, while mental wellbeing declines as children grow older, with girls particularly affected when compared with boys.

In around one third of countries, the report shows a rise in adolescents who feel pressured by schoolwork, and there has been a decline in young people reporting to like school, compared with 2014. In most countries school experience worsens with age, with school satisfaction and adolescents’ perception of support from teachers and classmates declining as schoolwork pressure increases.

There are substantial variations in mental well-being across countries. This indicates that cultural, policy and economic factors may play a role in fostering good mental well-being, and the reverse may be true in some other countries.

The latest study reflects the growing use of digital technology and its impact on the mental well-being of young people in Europe and Canada. Clearly, technology can have positive benefits, but it can also amplify vulnerabilities and introduce new threats such as cyberbullying, which disproportionately affects girls. Over one in 10 adolescents reported having been cyberbullied at least once in the previous couple of months.

As with findings in other areas of adolescent health, socio-economic factors play a significant role. Particularly in the area of social well-being, with adolescents from richer families reporting better communication with their parents and higher levels of family and peer support.

The latest HBSC report is published as Europe and the world is dealing with the most pernicious existential threat to our health and lives in generations, as covid-19 traverses the globe.  Since January, our attention has been focused on fighting the pandemic to save people’s lives, and recovering from the damage that has been done across the European Region will dominate economic and policy thinking for many months, if not many years ahead. The European Region has been particularly hard hit, accounting for 42% of all global cases and 55% of deaths attributed to covid-19.

While thankfully, children and young people appear to have escaped the direct effects of the virus, with relatively few suffering major symptoms, it has inevitably had consequences for their daily lives and wellbeing.

With widespread social restrictions and social lockdowns to suppress transmission of the virus, young people are finding their schooling interrupted, direct interaction with their peers curtailed, and access to sports and most leisure activities largely prohibited. For some, family life is becoming increasingly fraught, with rising financial pressures as employment uncertainty grows, and increasing levels of domestic violence, as doubt, separation and fear becomes part of daily existence.

The next HBSC study will be vital to understanding the additional impact of covid-19 on the mental health and overall wellbeing of young people, as it will feature findings from 2021/22, collected in the immediate wake of the pandemic.

The broad range of issues covered by the HBSC study, which give great insights into adolescents’ lives today, should also provide us with a useful baseline to measure the impact of covid-19 on adolescents when findings from the next study emerge. The data will enable us to measure how prolonged school closures and community lockdowns have affected young people’s social interactions, and physical and mental well-being.

I have no doubts that the young people living through these tragic times will recover; they are extremely resilient and practically minded and will adapt and cope with the great changes facing society, but some scars are bound to remain. How societies and governments respond to adolescents’ needs will echo for generations. Investing in young people by, for example, ensuring they have easy access to mental health services appropriate to their needs, will deliver a triple dividend: bringing health, social and economic gains to today’s adolescents, tomorrow’s adults and future generations.

Hans Henri P. Kluge, WHO Regional Director for Europe

Competing interests: None declared