Young people who struggle mentally face far greater risks of serious outcomes in the years that follow
A large Danish study of nearly 68,000 young people shows that poor mental well-being during upper secondary and vocational school years is closely linked to a much higher risk of subsequent mental illness, self-harm, alcohol and drug misuse, violence, and suicide attempts.
The study, carried out by researchers at the National Institute of Public Health, has just been published in the scientific journal The Lancet Regional Health. It is based on survey responses from almost 68,000 students aged 15–19, collected in 2014 from schools across Denmark. The students were asked about their mental health and well-being, and based on these responses the researchers identified four overall groups with varying levels of mental well-being:
- Green group: young people who thrive, report high quality of life, strong self-esteem, good relationships with friends and parents, and who rarely feel stressed or lonely.
- Red group: young people who struggle on most measures, and often feel sad, lonely, and stressed.
- Yellow and orange groups: young people who fall in between these two extremes.
The study draws on WHO’s definition of mental health, which has two dimensions: one concerns how people feel about their lives – whether they experience joy, quality of life, and well-being – and the other concerns how they function in daily life, such as managing everyday tasks and maintaining relationships with others.
Into the early adult years
The researchers followed the young people for the next eight years – until they were 23–27 years old – and linked their survey responses with nationwide registers covering, among other things, mental illness, self-harm and suicide attempts, hospital contacts related to alcohol or drugs, emergency visits due to violence, and all-cause mortality.
The results showed that the young people’s own perception of their mental well-being in their teenage years was closely tied to how their lives unfolded afterwards. Those who reported poor well-being faced a much higher risk of mental illness and self-harm throughout the entire follow-up period – not just later in adulthood.
Professor Janne Tolstrup, who led the study, explains:
“We find that young people’s own assessment of their mental well-being strongly predicts how things turn out for them. For example, in the red group, almost one in five later received a psychiatric diagnosis, compared with only four percent in the green group.”
The risk of self-harm and suicidal behavior was also dramatically higher in the red group – more than ten times higher compared with the green group.
The study further revealed that poor well-being is closely linked to young people’s family and social circumstances. Those reporting poor well-being more often had parents with financial difficulties, mental illness, or alcohol problems.
Tolstrup emphasizes that the study only included young people who were enrolled in education – a relatively resourceful group. Even so, the links between poor mental well-being and adverse outcomes were strikingly clear.
“The important point is that we can actually identify who is thriving and who is not – and that poor mental well-being in youth has consequences for many years to come. We must take young people seriously when they say they are not doing well,” she says.
The study is supported by TrygFonden.
Contact: Professor Janne Tolstrup, e-mail: jest@sdu.dk, tel.: +45 2076 4819, National Institute of Public Health, University of Southern Denmark.