The question of whether recent rises in the way some young people act in order to seek help with anxiety and depression reflect a true increase in the number of individuals actually experiencing such difficulties has been frequently discussed.

The picture has been muddied by the fact that studies have not used comparable measures over time. Indeed, earlier evidence of a trend towards poorer mental health has been called into question. But now a team from Cardiff University and the Institute of Psychiatry, London, have surmounted this methodological hurdle and provided new evidence for substantial increases in adolescent emotional problems in England over recent decades.

The researchers, led by Stephan Collishaw, compared nationally representative samples of 16-17 year-olds living in England over a 20 year period. Surveys were completed by over 4,000 young people and 7,000 parents in 1986 and by over 700 teenagers and 700 parents in 2006.

Adolescents completed the Malaise Inventory and 12-item General Health Questionnaire, while parents filled out the Rutter-A scale. Critically, the measures used were the same in both years.

The increases in emotional problems identified were especially marked for girls, with the greatest increases affecting worry, irritability and fatigue. Other symptoms that increased significantly were sleep disturbance, panic, and feeling worn out and under strain.

Reports by both parents and young people showed the same broad trend for girls, but while reports by parents indicated an increase in emotional difficulties for boys, these were not apparent in the reports by the boys themselves.

But whenever data of this kind is published a common question that arises is whether the level of problems has really increased, or whether parents and teenagers today are just more aware of these issues and, therefore, more frank in reporting them. Collishaw and his colleagues argue that if the issue was greater frankness the effect would be seen across all outcomes. This was not the case, suggesting that the trends are “real”.

But if the trends are real, are they still heading in the same direction? And what is the direction: are the trends linear or non-linear? The research does not provide an answer to either question, but evidence from other studies suggests that the mental health problems of young people in the UK may have levelled off or even started to reverse.

Nonetheless, it is no time for complacency. Only a minority of young people with even a serious mental health problem receive a specialist service. Moreover, treatment choices, remain controversial, particularly in relation to the use of anti-depressants with young people.

The study therefore raises significant concerns for policy makers and practitioners dedicated to improving the well-being of young people with mental health difficulties. But the implications are perhaps more far-reaching than they first appear. There is growing evidence of strong links between having a mental health disorder in adolescence and being similarly affected in adulthood. The consequence is that rates of affective disorders in adulthood seem to be increasing. So as the cohort of young people considered in this study ages, we can expect to see further increases in adult mental health problems.

And to compound the problem, parent anxiety and depression are among the strongest predictors of child and adolescent disorders, raising the prospect of a vicious circle: increased problems for one generation leading to increased problems for the next.

While it is important to get treatment right, improved prevention and early intervention will be key to forestalling increases in problems in future generations.

As for the causes of the trends observed, the research team struggles to come up with answers. They could find no difference by social status or family type and concluded that changes in family structure and ethnic composition could not be held accountable, either. All of this underlines the urgent need for research to identify the underlying factors contributing to the trends observed.

Reference:
Collishaw, S., Maughan, B. ,Natarajan, L. & Pickles, A. (2010) ‘Trends in adolescent emotional problems in England: a comparison of two national cohorts twenty years apart’, Journal of Child Psychology and Psychiatry 51 (8), 885-894.