Emotional problems in young people were rising rapidly even before the pandemic

It wasn’t just the virus that spread during the pandemic – anxiety, depression and other mental health concerns saw a worrying rise as well. But new research from my colleagues and I confirms there had already been a substantial increase in emotional problems among young people even before COVID-19.

Adolescence is an age when people are particularly vulnerable to mental health problems, which may then continue into adulthood. Studies have highlighted concerning trends showing a steep rise in mental health issues in recent decades.

However, the reasons most frequently given for this rise, such as changes in family life, school factors and social media, do not fully explain all the issues.

We wanted to know if rates of emotional problems had increased in young people in Wales between 2013 and 2019 – and if any trends varied between groups of young people, such as boys and girls or richer or poorer families. We also wanted to determine whether changes in friendship quality and the prevalence of bullying over time mirrored any increase in adolescent emotional problems, and whether these factors could explain a part of this rise.

Good quality friendships are associated with better self-esteem and mental health, whereas bullying is linked with poorer mental health.

We used data from secondary school children which is collected every two years via the School Health Research Network. This is used to increase our understanding of risk factors for health, and to help schools and other organisations improve the lives of young people in Wales.

Students answered questions about emotional problems, including how often they felt low, irritable, nervous and had sleep difficulties. They also answered questions about friendship quality and bullying, both in person and online. In total, we looked at data from more than 200,000 students aged between 11 and 16 from three surveys of Welsh secondary schools in 2013, 2017 and 2019.

Rise in emotional problems

We found a substantial increase in emotional problems among young people in Wales between 2013 and 2019. The proportion of young people with high numbers of emotional problems rose from 23% to 38%. Our findings are in line with increasing rates of emotional disorders, referrals to child and adolescent mental health services, and youth self-harm and suicide during this period.

Our study highlights that existing mental health inequalities were getting worse even before 2020. This is a particularly concerning trend as it predates COVID, which is known to have exacerbated mental health problems. Girls and those from poorer families experienced steeper increases in emotional problems.

The reasons for this finding are complex. While our study doesn’t examine potential reasons, other research suggests that being richer allows families to access better housing, adequate food, better healthcare and less stressors more generally.

There are several possible reasons for worse mental health among girls, including sex hormones, lower self-esteem, more interpersonal stressors, gender-based violence and – on a societal level – a lack of gender equality and discrimination. But not enough research has been conducted in this field.

The proportion of students experiencing bullying increased slightly between 2013 and 2019, and friendship quality decreased slightly. However, while we found a strong association between the quality of adolescent social relationships and emotional problems, social relationships such as friendship quality and bullying did not appear to explain these population-level increases in mental health problems.

Mental health support

Our findings highlight a growing need for mental health support for young people to address the steep increase in their emotional problems over the past decade, particularly among poorer families. Currently, one in three Welsh children live below the poverty line. We need to pay particular attention to supporting these young people, and others across the UK, who are at greater risk of emotional problems.

While social relationship measures didn’t follow the same steep trend as emotional symptoms, improving the quality of young people’s social relationships and reducing bullying are still important priorities. There is currently a move towards a whole school approach in Wales, which involves providing a supportive context for healthy relationships in schools more generally.

The growing needs of young people with mental health issues are adding to our already significantly strained child and adolescent mental health services. Much more investment needs to be made to support our young and most vulnerable people.

Policy-makers, schools and practitioners should pay particular attention to this steep rise in emotional problems, particularly among girls and young people from less-affluent families.