Mental ill health is the largest burden of disability in the community and this new paper suggests and acceleration of this effect especially among millennials. This is a major public health issue and will be a drain on Australia’s brain capital or mental wealth. This change suggests there are plastic factors driving this deterioration, however the precise factors are unknown. Plausible candidates include the transition amongst millennials for social interactions to be via social media rather than face-to-face, deteriorating diet quality, low levels of physical activity, poorer sleep and economic pressures. It is critical for these to be identified for preventive interventions to be put in place.

The recently published study is a critical examination of mental health trends in Australia, spanning two decades and involving 27,572 participants. Notably, the research attributes the recent downturn in mental health to individuals born in the 1990s and, to a lesser extent, those born in the 1980s. This nuanced analysis reveals a concerning trend of ongoing mental health decline across all ages among younger generations compared to their older counterparts.

The study challenges the assumption of transient period effects, suggesting that population-wide mental health trends may not naturally recover over time. This finding has significant implications for public health strategies and underscores the need for targeted interventions to address the mental health challenges faced by young Australians. As experts, we must emphasise the importance of understanding the scope of these trends, acknowledging the potential long-term impact on the well-being of our youth, and advocating for comprehensive mental health support systems.

In providing commentary, it is crucial to convey the urgency of addressing these trends, not only in terms of individual well-being but also for the broader societal implications. This study serves as a wake-up call for policymakers, healthcare professionals, and the public to collaboratively address the mental health needs of younger generations and work towards a healthier and more resilient society.

This recently published paper reports on a large number of Australians and uses a strong study design which increases the likelihood of the paper’s findings being true.

Similar to the information shown in this recently published paper, data from multiple studies and sources demonstrate that Australians' mental health has been worsening over the past decade, even prior to the pandemic. The pandemic has worsened mental well-being. This is important as the problem is common, and for young people poor mental health affects education, employment and quality of life long-term. There is great economic value in supporting mental health during childhood/youth. Yet only half of Australian children who have a mental health condition receive care from a professional.

What does this mean for Australia? We need to address the societal reasons for declining mental well-being, and increase support for families, in schools and access to health professionals. We need to focus on those at particularly high risk for poor mental well-being (those who are Indigenous, refugees, those in out-of-home care (aka foster care/adoption), children who have been abused or who have a parent with a mental illness.

The isolation due to the pandemic, and youth worries about climate change and housing, are known pressures on the well-being of young people in Australia. The impact of social media is less clear. We need to better understand why Australia, and globally, is experiencing declining mental health and where our ‘biggest bang for buck’ will be in terms of turning this around.

The kids are not alright.
 
This is a really interesting and rigorous research article. The authors have been extremely robust with their data analysis and their interpretation of the data. It reports on a representative sample of the Australian population, over a long period of time, which makes it very impactful in what it can elucidate. The paper indicates that for Australians, mental health statistics are being driven by a portion of the population, particularly by those born in the 1990s and to some extent those in the 80s. While mental health has typically been worse in the younger years of adulthood, it usually stabilises as we get older, however, this trend too is declining with time.

It’s evident that mental health is getting significantly worse for each cohort, and that the rate at which mental health is worsening between cohorts, is also worsening. The data paints a very grim picture, but a significant and important message that will hopefully shape and drive efforts to understand and better manage the mental health of our younger generations. This paper allows us to rule out periodic events as the drivers of poor mental health or particular age-stages of life (i.e., your 20s), and indicates where efforts may be best channeled. 
 
Personal opinion: our mental health care system is busting at the seams. We need to employ the end-users (consumers) in the design, creation and implementation of new treatment approaches and models of care for prevention as well as management of sub-clinical and mild presentations of poor mental health.

There are two key messages for me arising from this study:
1.    Overall, the percentage of health spending in Australia allocated to mental health has not shifted since 1992-1993, when the first national plan commenced. It was 7.25% then and the same in the latest year reported, 2020-21. Mental health’s contribution to the overall burden of disease is 12%. This gap does not explain everything, but underfunding in mental health in Australia remains a very significant problem.

2.    Overall, our health system is not geared to respond to the needs of teenagers and young adults. It focuses on the needs of mothers and babies, people with chronic illnesses and acute physical problems (accidents, cancer etc). Yet 75% of all mental illness manifests before the age of 25. 

This generational study found the mental health of young people is worsening now, not improving. We cannot rely on ‘spontaneous resolution’ of this problem.

So while more funding is urgently needed, It must also be properly calibrated towards services that effectively identify and meet the emerging mental health care needs of Australia’s young people. Failure to do so embeds greater distress on young people and their families. It also imposes greater costs on the community and taxpayers in terms of the need to provide disability, unemployment or other support over the long course of these young people’s lives.

The research from the team of Botha and colleagues from various Australian academic centres describes that Australian millennials (born in the 1990s) are significantly unhappier than Australians born earlier, at any given age.

The findings are based on a large and repeated survey of households across Australia. The reasons for this increased misery in this birth cohort are not explained by the research, but many potential factors could contribute, such as the growing dominance of social media, climate change, lack of job security, financial strains and unaffordable housing costs.

Whatever the causes, our healthcare system needs to brace for an escalation in the need of mental health services. We are faced with an oncoming tsunami of millennials in greater need of mental health support than their predecessors.

The newly released report presents pivotal and rigorous statistical evidence highlighting the alarming decline in the mental health of millennials. This comprehensive study, tracking over 27,500 Australians across two decades, underlines the urgency of the situation.

Crucially, the age bracket of 25-34 years old, which represents the most productive and fertile segment of society, is of immense policy significance. 

The prevalent mental health issues within this group pose a substantial threat to Australia's economic future. In the immediate term, labour shortages are a concern, and in the long term, the implications extend to diminished family formation and fertility rates. The latter is based on the previously established correlation between lower mental health and reduced likelihood of marriage, alongside poorer parenting practices. While it is evident that mental health tends to follow a U-shaped trajectory, reaching its nadir around the age of 40, the specific causes for millennials' mental health decline remain less clear.

The report mentions a list of factors such as job insecurity, worry about climate change and unfulfilled aspirations, like homeownership, which could play a significant role. These elements, though not explicitly reflected in socio-economic status indicators, greatly impact happiness by casting a shade over the future life outlook. Encouragingly, the established evidence is that early intervention in mild to moderate mental health issues can lead to full recovery with a minimal chance of recurrence. Hence, prioritising mental health support for millennials is imperative in national health strategies.

The research by Botha and colleagues adds to the picture we are seeing of a younger generation that is struggling with mental health more than previous generations. 

This is a well-developed paper using a long-standing panel survey (i.e. they survey the same people regularly over time and include core sets of consistent questions with occasional other questions such as those about mental health). The methods used have allowed them to clearly show that there is a generational difference in mental health, and particularly that younger people are doing worse and failing to make the same improvements in mental health as earlier generations did as they aged. 

So why? Researchers and policymakers have pointed to a whole range of factors. One possibility is alluded to in the article – the economy has broadly improved across the lifespan of young people, but the benefits of that improvement have not been equally distributed with young people receiving little direct benefit through, for example, greater access to education or housing.

Instead, education has become more expensive and more competitive to access. Following education or training, employment has become more casualised and less stable for current young people, and increasingly involves periods of unpaid internship work to get a foothold in industry. Added to these factors are the more general ones of climate change, increasing war and global uncertainty and the paradox of higher connection via social media and higher loneliness. It all adds up to a situation where it is harder now than it ever has been for young people to feel a sense of hope or certainty for their future, and that is a situation ripe for mental ill health and poor wellbeing.

Overall - this was a strong evaluation of data covering 20 years with a large sample. The analyses were sophisticated and appropriate, revealing solid evidence of generational (or age-cohort) trends in mental health - revealing that our youngest generations are reporting greater mental distress than their predecessors when of the same age.

The study conveniently grouped age cohorts by decade (e.g.,1960s, 1990s). In addition, they use terms such as 'millennials', however, these are convenient groupings. The true age-cohort effects might occur through different years and ranges. For example, those born from 1958 to 1974 might be a genuine 'mental health generation' cohort. While, those born between 1998-2001 to 2010-11, might form a unique cohort. That is, there is no good reason to believe that a single birth year (1959 or 1960) can really distinguish between cohorts. There are always overlaps.

However, the data does show age-cohort trends. Follow-up research might explore more unique age cohorts, rather than conventional decade ranges.

In addition, these studies require much better measures of mental health. Both the MI-5 and K-10 are rough instruments that attempt to assess several types of mental problems. The items do not really sum up well. Improved assessment of mental health factors, and better use of that data, would greatly improve research going forward.

Implications - this data, with solid analyses, shows strong evidence that our youngest generations are experiencing greater mental health difficulties, and require greater care, than what we have seen in previous human societies. The world is changing, not always for the best, and mental health care can no longer be considered as optional. This year, the WHO had the theme 'mental health is a universal human right'. It appears we are not doing enough to protect those rights of our youngest and most vulnerable members of society.

These findings are consistent with other Australian data showing worsening of mental health in young people. This worsening has occurred despite substantial investment in youth mental health services. It shows the need for urgent investigation of the causes of the worsening and greater attention to preventive approaches, which have been largely neglected.

This research indicates that the post war generation were tough because they had to be (1940’s-1970’s), so what happened?  As the decades passed, generations adapted to more luxurious lifestyles, starting in the booming 80’s.  Anxiety is most prevalent in young people today aged between 15 and 35 years old with 17% of the Australian population having an anxiety disorder (ABS 2023).

Abraham Maslow identified a hierarchy of needs that are required for positive mental health, basic needs like food, shelter, employment, and friendship.  Home ownership and a steady job used to be the mainstay, essential life anchors.  Employment has become more tenuous and contractual and housing for some is now only a dream.

The evolution of social media and phone technology in the last few decades has led to constant exposure to the news of the world including wars, climate disasters, and other atrocities.  We don’t just worry about what’s happening in our local community anymore, but instead we are alerted to everything that is going wrong on the planet.

Climate change anxiety is a new cultural trend.  The birth of Facebook, Twitter, and Instagram led to the scrutiny of peers and whilst it provided dopamine hits for our pleasure centres, young people were exposed to online bullying and negative self-thoughts. 

On a positive note, young people are more caring and compassionate, less aggressive, and are more choosey about their careers but they care for the planet and think deeply. 

However, we need those life anchors for stability, something to work towards, a sense of belongingness, a secure job for our self-esteem and a sense of purpose like owning a home.

The findings of a deterioration of Australian mental health will be of little surprise to those of us in touch with Australian young people, including those in their early 30s, as they witness an apparent lack of care and responsibility among those in power regarding their future.

Global studies have observed a rising intensity of climate anxiety and, in fossil fuel states like Australia, arguably even deeper distress from moral injury and sense of betrayal as governments progress expansion, rather than elimination, of coal, oil and gas developments and petrochemical operations. Fear of pollution, grief at the loss of diversity and natural spaces and experience of the horrors of unprecedented weather extremes are in our faces daily.

I increasingly hear from students in their late 20’s and early 30’s torn between a deep desire to, and simultaneously fear of, starting a family as greenhouse gases rise unabated, knowledge about what this means has grown and greenwash spreads like wildfire.

Those with growing children will be increasingly distressed by climate impacts on the economy and cost of living. The solutions are clear – the government must adopt, like Aboriginal and Torres Strait Islander people have held since time immemorial, a multigenerational duty of care. Whoever decided that having governments that make decisions which rob the future of humanity is okay?  

A common observation is that population mental health in high income developed economies appears to be worsening among younger adults. Plausible explanations of for this trend often appeal to climate change, the Global Financial Crisis, the malign effects of social media and drug use.

Botha et al illustrate the value of attempting the difficult task of separating the contributions made to these recent trends in population mental health by age, period and cohort differences.

As far as I can judge, they present a plausible case that cohort differences are a major factor, with members of the birth cohorts born since the 1980s reporting poorer mental health at the same age than the members of older birth cohorts. Their findings are consistent with similar findings in recent studies in the UK and USA, although apparently not in Canada.

The authors are careful not to claim that they can explain these trends, although they do argue that they are unlikely to be due to the effects of unemployment because pre-COVID, employment in these cohorts was high, and alcohol, tobacco, and cannabis use have declined among young adults, for reasons that are not well understood. The study should prompt more detailed inquiries into the potential factors explaining these trends if we are to effectively ameliorate them.

This paper provides clear insight into the generational patterns of mental ill-health in Australia. The study shows that young Australian adults (up to 35 years) are experiencing poorer levels of mental health now than prior generations and that this ill-health is likely to continue for them into the future.

These results strongly advocate for an intergenerational perspective in mental health service delivery, emphasising the importance of tailoring services and treatments to meet the specific needs and demands of each new generation. These findings also support the call for more research to better understand how the increased prevalence rate of mental health symptoms in younger generations relates to their actual day-to-day functioning and overall quality of life.

This is critical to ensuring that services focus on the aspects of mental health that have the greatest impact on the wellbeing of the young person, rather than symptoms alone.

This is very large study of over 25,000 Australians which examines and describes the birth cohort patterns of mental ill-health over the last 20 years. The  National Health Survey showed a worrying doubling of rates of reported mental and behavioural disorders between 2001 and 2017/18. This study highlights that it is millennials who are showing more severe mental health compared to previous generations at similar ages.

Whilst this study does not elucidate causes for this worrying trend, it brings into stark relief the fact that Australia has a worsening deterioration of the mental health of young people. This should prompt even more focus on these cohorts (Australians born 1990’s and 1980’s) with mental health support, funding and effective care.

This should prompt urgent research into causes of this cohort effect in order to both care for these cohorts and arrest this pattern in emerging Australians.