Mental health is a critical public health issue. The importance of good population mental health became even clearer during and after the COVID‑19 pandemic, when a sharp rise in mental distress highlighted the urgent need for broad, cross-sectoral action. This paper focusses on anxiety and depression, while other mental health issues, such as eating disorders, affect children and young people. Levels of mental distress, anxiety and depression remain elevated compared to pre‑pandemic levels. Depression and anxiety are the most common mental health conditions, with a significant burden of mild and moderate symptoms that too often go unrecognised and that, if untreated, can lead to more severe mental disorders. With the support of the European Commission, the OECD has been supporting countries in identifying and assessing candidate best practices for major public health threats, including mental ill-health. Building on this work and to support Poland’s presidency of the Council of the European Union (EU), this policy paper focuses on children and young adults and summarises relevant key findings of a forthcoming OECD publication on best practices for the prevention of mental ill-health and the promotion of good mental health (OECD, forthcoming[1]).
Promoting good mental health in children and young adults
Mental health conditions are common amongst children and adolescents. The latest available data suggest that, in 2022, about 6% of people of all ages in the EU/EEA suffered from anxiety disorders, and 5% suffered from depressive disorders (IHME, 2024[2]). Adolescents aged 15‑19 suffer the highest burden of anxiety disorders, and although rates of depression peak later in life, it still affects 4% of adolescents and young adults from age 15 onwards (Figure 1). The high prevalence rates led the 2024 Lancet Commission on youth mental health to identify mental illness as “the leading health and social issue impacting the lives and futures of young people for decades”, which has now entered “a dangerous phase” due to the steadily declining mental health of young adults (McGorry et al., 2024[3]).
Source: IHME (2024[2]), Institute for Health Metrics and Evaluation (IHME) at the University of Washington, www.healthdata.org (accessed on 18 October 2024).
There are strong signs that the mental well-being of children and young people has declined, especially since the COVID‑19 pandemic. Rates of multiple health complaints in children and adolescents, often taken as a general well-being proxy, have increased in all EU/EEA countries except Bulgaria (Figure 2). For example, between 2018 and 2022, the rate of “multiple health complaints” among 15‑year‑olds increased by +25% on average across EU/EEA countries. Data also indicate that girls generally demonstrate poorer mental well-being than boys, with a more pronounced deterioration over time. This evidence supports other statistics suggesting that rates of mental illness among those aged under 20 increased significantly by about +20% during the COVID‑19 pandemic (IHME, 2024[2]). While this paper focusses on EU/EAA countries, the trend of declining mental health among children and young people is a global phenomenon (McGorry et al., 2024[3]).
Note: Multiple health complaints refer to two or more symptoms for more than once a week in the previous six months, including: headache; stomach ache; backache; feeling low; feeling irritable or bad tempered; feeling nervous; difficulties in getting to sleep; and feeling dizzy.
Source: Health Behaviour in School-based Children (HBSC) Data Browser, https://data-browser.hbsc.org/.
Suicidal behaviour is the second leading cause of death among people aged 15‑29 across EU countries (Eurostat, 2024[4]). An OECD analysis of Eurostat data indicates that between 2011 and 2021, suicide deaths as a proportion of all deaths increased by 0.9 percentage points for those aged under 25, while it decreased by 0.3 percentage points for adults over 25. Up to a quarter of young people reported having had suicidal ideation during the COVID‑19 crisis, a proportion five times higher than pre‑pandemic levels (OECD/European Union, 2022[5]). Mental health disorders, as well as cyber-bullying, academic pressure and performance anxiety, interpersonal problems and access to lethal means are all risk factors for suicide among young people. National-level data confirms these worrying trends of suicidal behaviour and self-harm among young people. For example, in France between 2010‑19 and 2021‑22, the rate of hospitalisations for self-harm amongst adolescent girls rose by +71% for age 10‑14, +44% for age 15‑19, and +21% for age 20‑24 (Hazo et al., 2024[6]).
Mental ill-health in early life is not just a significant burden during childhood and adolescence – and a risk factor for suicide and self-harm – it also increases the likelihood of poor mental health in adulthood, affects educational outcomes, and makes young people’s transition into the labour market more difficult.
On average across EU countries, students indicating mental distress are 25% more likely to have repeated a grade although causality may run in both directions (OECD, 2021[7]). In some countries, this relationship is particularly pronounced; students indicating mental distress in Greece, Estonia, Denmark and Iceland are all at least 75% more likely to have repeated a grade. Young people with mental health conditions are in general less likely to reach a high level of education: only 25% of those with mental distress had achieved a tertiary education, compared with 32% for those not experiencing mental distress across EU countries (OECD, 2021[7]).