Are mental health awareness efforts contributing to the rise in reported mental health problems?: Interesting article

On May 6, 2024 I was interested to read in a New York Times email newsletter, a discussion about an article in The New York Times about a possible (partial) explanation for the mental health crisis among young people.

An excerpt from the newsletter reads:

Too much talk?

By Ellen Barry – She covers mental illness.

For years now, policymakers have sought an explanation for the mental health crisis among young people. Suicide attempts and psychiatric hospitalizations were rising even before the pandemic. Then the rates of anxiety and depression doubled worldwide.

Why is this happening? The social psychologist Jonathan Haidt points to smartphones, and the algorithms that draw kids away from healthy play and into dangerous, addictive thought loops. No, his critics say. The real problem is a grim social landscape of school shootings, poverty and global warming. Or academic pressure. Or insufficient health care.

A group of researchers in Britain now propose another, at least partial, explanation: We talk about mental disorders so much. I cover this notion in a story The Times published today.

This hypothesis is called “prevalence inflation.” It holds that our society has become so saturated with discussion of mental health that young people may interpret mild, transient suffering as symptoms of a medical disorder.

This is a problem, they say, because identifying with a psychiatric diagnosis may not be helpful. Students who self-label as anxious or depressed are more likely than similar students who don’t self-label to view themselves as powerless over the disorder, recent studies have shown. They may respond by avoiding stressful situations like parties or public speaking, which could make their problems worse.

One of the psychologists behind the prevalence inflation theory, Lucy Foulkes of the University of Oxford, traces her skepticism back to 2018, when she began teaching undergraduates. They were “bombarded” with messages warning that they might be in crisis, she said. “It seemed like the more we were trying to raise awareness about it, it wasn’t getting better, and in fact, it only seemed to be getting worse.”

The article features links to a number of studies including one entitled:

Are mental health awareness efforts contributing to the rise in reported mental health problems? A call to test the prevalence inflation hypothesis

An excerpt reads:

Over the same time period, reported rates of mental health problems, including anxiety, depression, eating disorders and self-harm, have increased (Collishaw, 2015; McManus et al., 2019; Richter et al., 2019; Santomauro et al., 2021; Vizard et al., 2020). There is some evidence that this follows an existing trend observed over the preceding decades (Collishaw et al., 2004). There are many proposed explanations for the increase in mental health problems, including increased use of social media (Orben, 2020), the impact of austerity (Knapp, 2012), increased income inequality (Patel et al., 2018), increased academic pressure in young people (Högberg, 2021) and the multitude of hardships brought about by the Covid-19 pandemic (Saunders et al., 2021).

Here we present the hypothesis that, paradoxically, awareness efforts are an additional factor contributing to the recent rise in mental health problems. Moreover, we argue that the relationship between these two constructs is bidirectional. Increased rates of mental health problems understandably drive more awareness efforts, but the awareness efforts themselves might lead to increased reporting and experiencing of symptoms, as we describe below. We therefore propose that mental health problems and awareness efforts are affecting each other in a cyclical, intensifying manner (see Fig. 1). We term this the prevalence inflation hypothesis.

Comment

This is an interesting hypothesis. Whether it’s going to gain support from additional research remains to be seen. One possible reason for skepticism is the prevalence of news reports documenting worsening student behaviour in schools such as in Canada, the United States, and Germany.

For example a March 26, 2024 CBC article is entitled: “Violence in N.L. schools worse than it’s ever been, teachers’ union says: 29 violent incidents occur across province daily: NLTA.”

An excerpt reads:

Langdon also pointed to last year’s brutal attack on a student at Prince of Wales Collegiate in St. John’s, saying that near-murders were unheard of when he began working in the education system two decades ago.

“It’s a different world,” he said.

“You look at the evening news — that represents itself in our buildings. We have the children of all of those families that are being represented in our school system.

“The stressors of inflation, the stressors of poverty, stressors of homelessness, the stressors of of having a parent who’s involved in the legal system, mental health issues, backlogs in our mental health system — all of that finds its way into school.”

It occurs to me there may be more to such behavioural issues than the hypothesized phenomenon of prevalence inflation.

Similarly, a May 4, 2024 DW article is entitled: “German schools see rise in violence: Frustrated students and teachers are forced to put up with dilapidated buildings and increasing violence in schools, putting a strain on Germany’s education system.”

An excerpt reads:

And a survey conducted in April, known as the Schulbarometer (school barometer), had one in two teachers reporting that they had witnessed psychological or physical violence from pupils.

“We’re seeing a snapshot of a sick system,” said Dagmar Wolf, a former teacher and head of education research at the Robert Bosch Foundation, which contacted more than 1,600 teachers for the survey. “We’re talking about bullying, we’re talking about vandalism, but also about physical altercations, some of which of course go beyond the schoolyard,” she told DW.

“We have even received reports of parents getting involved. It’s more of an exception, but it’s not as if it doesn’t happen.”

At least with regard to what is happening is schools, more may be at play than the hypothesized harmful effects of mental health awareness efforts. That said, I look forward to learning more as additional research is conducted.

Mindfulness

I had the good fortune to get first-rate instruction twenty years ago in the practice of mindfulness. I learned to practise mindfulness meditation and I learned to practise a measure (a small measure) of mindfulness in my day to day life. At that time I was working as a public school teacher and was finding life very stressful. Having taken a course in mindfulness-based stress reduction, as I’ve outlined elsewhere at this website, my life became decidedly easier, more relaxed than it otherwise would have been. In my anecdotal experience, there’s a lot to be said for such courses, for people who are in a position to benefit from them.

That said, mindfulness meditation is not for everyone. For the course that I took, prospective students first had to attend an intake interview. In some cases, a person would be advised that such a course would not be in their best interests. There is plenty of research available as noted elsewhere at this website, which underlines that mindfulness meditation can in some cases, for some people, lead to less than optimal results. A situation where students in a high school would all be taught to do mindfulness meditation would not be a good situation. The New York Times article referred to above underlines this fact.

A one-size-fits all approach to such matters entails a situation where the people offering instruction may not be fully qualified to attend to the matters at hand. Such an approach may possibly offer a clue that the focus may be primarily on the profit motive as contrasted to an approach that is primarily focused on taking the needs of potential and actual clients closely into account. Regarding such matters, it may be useful to keep in mind the expression, ‘Consumer Beware.’