In the past few years, the mental health of adolescents has become a major theme in research and public debate. New research on Australian data now shows that almost three-quarters of adolescents experience clinically significant depression or anxiety symptoms, with most being chronic.
From the press release:
Almost three quarters of adolescents in Australia experience clinically significant depression or anxiety symptoms, with most being chronic, according to a new study. And preventive strategies outside our clinics are urgently required to address this considerable public health problem facing the nation.
The research, led by Murdoch Children’s Research Institute (MCRI) and published in The Lancet Psychiatry, found mental health problems were frequently chronic with 64 per cent reporting symptoms three or more times across their adolescent years.
MCRI Dr Ellie Robson said the rate and recurrence of depression and anxiety symptoms were concerning given mental health problems during adolescence had serious consequences across the lifespan.
“These are striking findings, particularly given how many young people experienced symptoms over multiple years of the study and how much depression and anxiety symptoms can affect young people’s functioning and can have long-lasting negative health outcomes,” she said.
For the study 1,239 children from Melbourne enrolled in the Child to Adult Transition Study (CATS) had their symptoms of anxiety and depression tracked every year from 10 to 18 years of age.
Girls were at increased risk with 84 per cent compared to 61 per cent of boys having depression or anxiety symptoms at least once during adolescence. Girls were also more likely to have a chronic course at 72 per cent and 49 per cent, respectively.
The onset of anxiety and depression symptoms increased at times that coincided with educational stress such as the primary to secondary school transition, exam periods and the end of compulsory education. Three quarters of participants who struggled with mental health problems during the COVID-19 years already had symptoms, highlighting factors beyond the pandemic stressors.
MCRI Professor Susan Sawyer said that despite growing concerns about adolescent mental health, until the CATS, few studies had comprehensively charted the course of common mental disorders across this key life stage.
“To our knowledge, this longitudinal study shows the highest cumulative incidence of clinically significant symptoms of common mental disorders that has ever been reported across adolescence from any country,” she said.
“This high incidence of common mental health problems suggests that even the most well-resourced country would struggle to provide adequate treatment if every young person sought help. Beyond clinical care, we urgently need to fund, develop and evaluate preventive strategies that aim to reduce the onset and chronicity of depression and anxiety.”
Dr Robson said; “Adolescents today are growing up in a distinctly different psychosocial landscape than earlier generations, one that is characterised by greater mental health literacy, reduced stigma, and at times the glamorisation of mental health problems. Given this context, our next step will be to explore what impact these reported symptoms have on the functioning and health outcomes of contemporary adolescents.”
GenV, tracking the health and wellbeing of Victorians, from birth to old age, will also provide invaluable insights into the health challenges faced by our young people including mental health problems.
One of the world’s largest-ever birth and parent cohort studies, GenV has seen almost 50,000 babies (over 100,000 newborns, mothers and fathers) sign up. Recruitment for children born in 2021-2022 is still open. Learn more on the GenV website.
Researchers from The Royal Children’s Hospital, the University of Melbourne, Deakin University and the University of Bristol also contributed to the findings.
Abstract of the study:
Background
Adolescent mental health appears to be in crisis, yet few studies have comprehensively charted the course of common mental disorders (CMDs; depression and anxiety) across this key life stage. We aimed to describe the course of CMD symptoms in adolescence by summarising annual prevalence, cumulative incidence, and course for depression and anxiety, both separately and as comorbid CMDs, by sex assigned at birth in a contemporary Australian cohort.
Methods
The Child to Adult Transition Study (CATS) was established in 2012 to form a representative cohort of adolescents in Melbourne, VIC, Australia. 43 schools were recruited using a stratified sampling approach, and all 2289 students aged 8–9 years were invited to participate. 1239 (54·1%) students obtained parental written informed consent and were followed up annually from 2012 to 2019 for a total of ten waves. Data from waves 3–10 (ages 10 to 18 years) were used for the current study and analysed to describe the course of symptoms of CMDs across adolescence. Primary measures of interest were clinically relevant depressive symptoms, clinically relevant anxiety symptoms, and any CMD (clinically relevant depressive or anxiety symptoms) at waves 3–10. A secondary measure of interest was comorbid CMDs (concurrent reporting of clinically significant anxiety and depressive symptoms) at waves 3–10. Depressive symptoms in the past 2 weeks were self-reported using the 13-item validated Short Mood and Feelings Questionnaire (SMFQ) at each wave, with a threshold score of 12 or more indicating clinically relevant symptoms. Anxiety symptoms in the past two weeks were self-reported using an 8-item shortened version of the Spence Children’s Anxiety Scale (SCAS) at each wave, with a threshold score of 11 or higher indicating clinically relevant symptoms. The course of CMDs was described using annual prevalence, cumulative incidence for depression and anxiety, separately and combined. Missing data were handled via multiple imputation. An author with lived experience was involved in the research and writing process.
Findings
Of the 1239 adolescents who participated in the study, 667 (53·8%) were female and 572 (46·2%) were male. 769 (62·1%) of 1239 were classified as socioeconomically advantaged, 675 (66·4%) of the 1016 with available data had a mother whose highest level of education was vocational or tertiary, and 579 (70·7%) of the 819 participants with ethnicity data identified as Anglo-Celtic or European. Overall, incidence of any clinically significant CMD symptoms during adolescence was 74% (95% CI 70–77; 84% [81–88] for females and 61% [55–66] for males). Independently, incidences of clinically significant depressive symptoms and anxiety symptoms were 65% (62–68) and 58% (55–62), respectively. Incidence of comorbid CMD was 48% (45–52). The estimated mean ages of first report in adolescence for both sexes were 14·1 years (95% CI 13·9–14·4) and 13·6 years (3·3–13·9) for depressive and anxiety symptoms, respectively. Of those who reached the threshold score for any CMD between ages 10 and 18 years, over half had a chronic (three or more waves) course (depression 54% [49–60]; anxiety 52% [47–58]), and a third met criteria for full remission at any subsequent wave (depression 30% [25–35]; anxiety 33% [27–39]). Females were consistently estimated to have a worse course of adolescent CMDs compared with males (eg, 64% [58–70] of females had a chronic course of depressive symptoms vs 37% [26–48] of males).
Interpretation
In this contemporary multi-wave cohort study, almost three-quarters of adolescents reported CMD symptoms. The likelihood of chronicity of CMD symptoms (ie, recurrence) was high. Universal responses are urgently required to address this considerable public health problem.