REVIEW ARTICLE
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Addressing the Increasing Mental Health Distress and Mental Illness Among Young Adults in the United States Mary F. Brunette, MD,* Matthew D. Erlich, MD,† Matthew L. Edwards, MD,‡ David A. Adler, MD,§ Jeffrey Berlant, MD, PhD,|| Lisa Dixon, MD,¶ Michael B. First, MD,# David W. Oslin, MD,** Samuel G. Siris, MD,†† and Rachel M. Talley, MD‡‡
Abstract: Recent surveys show rising numbers of young people who report anxiety and depression. Although much attention has focused on mental health of adolescent youth, less attention has been paid to young people as they transition into adulthood. Multiple factors may have contributed to this steady increase: greater exposure to social media, information, and distressing news via personal electronic devices; increased concerns regarding social determinants of health and climate change; and changing social norms due to increased mental health literacy and reduced stigma. The COVID-19 pandemic may have temporarily exacerbated symptoms and impacted treatment availability. Strategies to mitigate causal factors for depression and anxiety in young adults may include education and skills training for cognitive, behavioral, and social coping strategies, as well as healthier use of technology and social media. Policies must support the availability of health insurance and treatment, and clinicians can adapt interventions to encompass the specific concerns and needs of young adults. Key Words: Young adult, depression, anxiety, social media, climate, stigma (J Nerv Ment Dis 2023;211: 961–967)
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wo US population-based surveys and two national surveys of college students have shown increases in distress and mental illness among young adults (ages 18 to 24 or 30 years, with definitions varying among studies) over the past 10 years (Substance Abuse and Mental Health Administration, 2021; Duffy et al., 2019; Villas-Boas et al., 2023). Although extensive research and publicity have focused on adolescent youth (ages 12–17 years) (American Academy of Pediatrics, 2021; Askari et al., 2023; Department of Health and Human Services Office of the Surgeon General, 2021; Madigan et al., 2023; Weinberger et al., 2018), little attention has been paid to young people's mental health as they transition into adulthood. Normal young adulthood is a critical period involving ongoing brain maturation and psychosocial change, with rapidly increasing independence, expanding roles in work and romantic relationships, and waxing and waning need for support from parents, family, and other caregivers. This article examines recent trends in mental health among US young adults, potential contributors to worsening mental health in this age group, and strategies to address mental health among young adults in the current *Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; †Department of Psychiatry, New York State Psychiatric Institute/Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian, New York, New York; ‡Department of Psychiatry, Stanford University, Palo Alto, California; §Department of Psychiatry, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts; ||Canyon Manor Mental Health Rehabilitation, Novato, California; ¶Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian, New York, New York; #Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian, New York, New York; **Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, Pennsylvania; ††Department of Psychiatry, Donna and Barbara Zucker School of Medicine at Hofstra/ Northwell, New York, New York; and ‡‡Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Send reprint requests to Mary F. Brunette, MD, Geisel School of Medicine, Dartmouth College, Hanover, NH. E‐mail: Mary.f.brunette@hitchcock.org. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0022-3018/23/21112–0961 DOI: 10.1097/NMD.0000000000001734
era. We emphasize longitudinal research and meta-analyses including young adults aged 18–30 years where possible.
TEN-YEAR TRENDS IN YOUNG ADULT BEHAVIORAL HEALTH DISTRESS, DIAGNOSES, AND SERVICE UTILIZATION The prevalence of mental distress and/or depression has been increasing in the United States over many years (e.g., Compton et al., 2006). Recently this rise has taken place mostly among adolescent youth and young adults. The National Survey on Drug Use and Health (NSDUH) and the US Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System (BRFSS) survey (Substance Abuse and Mental Health Administration, 2021; Ivey-Stephenson et al., 2022; Villas-Boas et al., 2023) are nationally representative surveys providing annual estimates of mental illness prevalence and treatment use in the US civilian, noninstitutionalized population. These surveys demonstrated a disproportionate steady rise in mental illness, depression, and suicidality among 18- to 24-year-olds compared with other adults over 2011 to 2021. For example, as shown in Figure 1, the rates of reporting past year major depressive episode (MDE) with impairment rose from 5.2% to 13.3%, among this group, over a 100% increase in this group compared with a 10% to 27% increase in other adult age groups across the 10-year period. Among randomly selected college students from two large national surveys, rates of depression, anxiety, suicidal thoughts, and suicidal behaviors similarly doubled (Duffy et al., 2019). Researchers have examined and discussed whether the increase in major depression among adolescents is a cohort effect specific to the shared experiences among people born in a specific time period, or time period effect, reflective of a change in environment that could be influencing the risk of depression for all adolescents in the United States regardless of age (Askari et al., 2023). Either birth cohort effect or time period effect on mental illness in adolescent youth could translate to an increasing rate of mental illness in young adults as those adolescent individuals transition into young adulthood. Data from the NSDUH indicate that 47% of people with any mental illness received mental health treatment in 2021 (Substance Abuse and Mental Health Administration, 2021), up from 41% reported in the 2001–2002 National Comorbidity Survey Replication report (Wang et al., 2005). Among adults with MDE and impairment, young adults were less likely to report having received treatment than the older age groups (56.7% for ages 18–25 years vs. 66.6% for ages 26–49 years and 71.8% for ages 50+ years). Of note, this survey also indicated that individuals identifying as Black, Hispanic, and Asian were less likely to report receiving mental health services compared with those identifying as White. Using these NSDUH data, the Office of the Assistant Secretary for Planning and Evaluation reported an increase in unmet need among young adults and indicated that the US mental health treatment system “may not have sufficient capacity to address current rates of treatment need” (Bouchery, 2021). Factors contributing to this include a number of social determinants, the COVID-19 pandemic, the pervasiveness of social media, and destigmatization of emotional symptoms.
The Journal of Nervous and Mental Disease • Volume 211, Number 12, December 2023 Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
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