14 March 2019

Alarming reports about increasing mental ill-health among adolescents may be seriously exaggerated. This is the conclusion of LiU researchers after studying replies from young people in a Swedish investigation.

Group of multicultural friends using smartphone outdoors - People hands addicted by mobile smart phone - Technology concept with connected men and women - Shallow depth of field on vintage filter tone Photo credit ViewApart“Young people struggle with the demands of everyday life. But this does not necessarily mean that they are suffering from mental ill-health”, says Anette Wickström, associate professor at the Department of Thematic Studies – Child Studies.
She leads a project to study, together with researcher colleague Sofia Kvist Lindholm, what may lie behind figures suggesting that mental ill-health among young people is increasing.

Biträdande professor Anette Wickström, TEMA Photo credit Anna Nilsen“Research reports and the media present an image of such an increase. But we often know too little about the reasons behind the problems the young people report, and what their answers mean”, says Anette Wickström.

The researchers have examined the responses given by pupils in an annual survey that is analysed by the Public Health Agency of Sweden, with questions formulated by the World Health Organization. The survey, which contains questions about physical and mental health, has been sent since 1985 to pupils in 42 western countries. The responses subsequently form the basis for several analyses of how young people are faring.

But do the analyses accurately reflect what young people say? This is the question that the LiU researchers are trying to answer. They have interviewed 41 pupils in Year 9, both individually and in groups, about some of the questions in the survey. In the survey, these questions are grouped into eight different types of symptom used to measure mental ill-health. They include, for example, whether in the past six months the respondent has had a headache, a stomach ache, been irritated or in a bad mood, or had difficulty falling asleep. The researchers have interviewed the respondents about what their answers mean.

“When we talk to the pupils a rather different picture emerges from that derived from the experts’ analyses. For instance, the young people might say that sure, they have a headache sometimes, or a stomach ache, but they point out that basically they feel pretty good. They also say that it’s difficult to fill out surveys like these, and that the responses they give can depend on how they’re feeling on the day. If they have quarrelled with a friend, for example, on the day that they completed the survey, they may feel that life is total rubbish. If they make up with the friend the next day – maybe their replies to the survey would differ.”

Anette Wickström and Sofia Kvist Lindholm believe that there is a risk that the replies are oversimplified, and that unjustified conclusions may be drawn from them. The mental ill-health that is reported may be many different things.

“Is your feeling of despondency a symptom of a depressive condition, or the result of doing badly on a school test? Does a stomach ache arise from mental ill-health, or are you feeling nervous about a presentation? We must find the problems behind the replies, rather than treating the respondents as a uniform group and concluding that ‘Young people are faring badly’.”
In their report, the researchers demonstrate that many everyday problems are related to school, physical matters, and relationships.

“If we conclude that all of the problems experienced by young people are the result of mental ill-health, when they are instead about relationships, everyday aspirations and the consequences of being human, we will end up with completely the wrong conclusions”, says Anette Wickström.

The results of their study demonstrate two clear trends. One is that ordinary difficulties in life risk being labelled as mental health problems – even if they are not. There is a risk that such problems are seen as medical problems.

“We risk that young people develop a negative view of themselves. That all forms of feelings of stress, despondency, nervousness and anxiety are interpreted as signs of ill-health. It’s clear that relationships and schoolwork can be demanding, but it is also this that gives meaning, according to the respondents.”

A possible explanation that young people report more problems now than in the 1980s is that such questions are more openly discussed today. People talk about themselves in a completely different way, and increasing numbers are receiving diagnoses. More are seeking help from the healthcare system, but this may not mean that we are sicker than previously, rather that young people today generally want more guidance, even with everyday problems. The way in which we use words changes with time. A word such as “anxiety”, for example, has a more everyday meaning now than it had 30 years ago.

“It’s probably also a factor that we live in a society and in a time when we are continuously encouraged to examine ourselves and contemplate how we are feeling. It’s meaningless to discuss how mental health has changed over time unless we also take into account the way in which young people’s lives, school and society have changed in the same period, and the effect of social media.”
At the same time, Anette Wickström makes it clear that their study demonstrates that some young people have very serious problems. This is the second trend in the results.

“We know that some young people have mental and social problems. They must be taken extremely seriously. We hear stories about grievous situations involving maltreatment, substance abuse and death. And serious difficulties in school or difficult relationship problems. Such young people need measures targeted at them individually and professional support.”

The results presented by the two researchers are arousing increasing interest in Sweden. A Radio Sweden science programme has taken it up several times and arranged debates in which Anette and Sofia have participated, and they are in demand as lecturers at conferences that deal with education, care and social services.

“Many practitioners who meet young people recognise the phenomenon we are describing of the simplified interpretations of young people’s responses.”
Anette Wickström and Sofia Kvist Lindholm are themselves surprised by their results. This was not what they expected when they applied for a grant for the study.

“We had no idea about what we would discover. But we have understood that it is vitally important. A report concerning increased mental ill-health that fails to consider all the nuances of the topic may lead to several general measures that are not suitable for either of the two groups. In this case, there is a risk that young people who truly require more support are missed.”

Translated by George Farrants

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