In recent years, mental health has become a central topic in childhood and adolescence. Teens talk about psychiatric diagnosis and treatment on TikTok and Instagram. Alarmed by rising levels of distress and self-harm, school systems are introducing prevention courses in emotional self-regulation and mindfulness.
Now some researchers are warning that we risk taking it too far. They argue that mental health awareness campaigns can help some young people identify illnesses that desperately need treatment, but have a negative impact on others, overinterpreting their symptoms and treating themselves poorly. begin to think that they have more problems than they actually do.
Researchers point to unexpected results from trials of school-based mental health interventions in the UK and Australia. Students who received training in the basics of mindfulness, cognitive behavioral therapy, and dialectical behavior therapy did not become healthier than those who did not participate, and some were even worse off, at least for a while.
And new research from the US shows that among young people, 'self-labeling' as having depression or anxiety is associated with poorer coping skills such as avoidance and rumination. .
In a paper published last year, two research psychologists at the University of Oxford, Lucy Foulkes and Jack Andrews, found that the “prevalence'' caused by reporting mild or episodic symptoms as a mental health disorder He coined the term 'inflation' and suggested that awareness campaigns were: contributing to that.
Dr Foulkes, a Prudence Trust Research Fellow in the Department of Experimental Psychology at the University of Oxford, said: “Teenagers are vulnerable and are likely to have problems, and this creates a message that the solution is to outsource them to professionals.'' “There is,” and wrote: Two books on mental health and youth.
They argue that school systems should proceed cautiously with large-scale mental health interventions until high-quality research reveals these unintended negative effects.
“That doesn’t mean we need to go back to square one, but it does mean we may need to press pause and reroute,” Dr. Foulkes said. “It's possible that something that was very intended went a little too far and needs to be undone.”
Among adolescent mental health experts, most agree that this remains a minority view, and that the far more pressing problem is lack of access to treatment.
According to the nonprofit research group Mental Health America, about 60% of young people in the United States with severe depression do not receive treatment. Desperate families in crisis turn to emergency rooms, where teens often remain there for days until a psychiatric bed becomes available. Experts say there's good reason to take a proactive approach to teaching schoolchildren basic skills that could forestall future crises.
Dr. Foulkes said he understood that his argument contradicted that consensus and was prepared for a backlash when he began presenting it. To her surprise, she said, many educators reached out to her to express their silent approval.
“It's definitely scary for me to say that,” she says.
Atrophying results
In the summer of 2022, groundbreaking research into mindfulness training in UK classrooms arrived like a lead balloon.
The trial, 'My Resilience in Adolescent' (MYRIAD), was ambitious, meticulous and far-reaching, following approximately 28,000 teenagers over eight years. The initiative was launched with optimism that the practice would work and improve students' mental health later in life.
In 10 30-50 minute lessons, half of the teens were trained by teachers to focus on the present moment, including their breathing, physical sensations and activities of daily living.
The results were disappointing. The authors reported that “our hypothesis is not supported” that mindfulness training improves students' mental health. In fact, the authors concluded that students most at risk for mental health problems performed slightly worse after receiving the training.
But by the end of the eight-year project, “mindfulness was already embedded in many schools, and there were already organizations selling the program to schools for a profit,” researchers said. said Dr. Fawkes, who supported the research. Postdoctoral researcher. “And it's very difficult to get the scientific message out there.”
Some may wonder why mental health programs are harmful.
Researchers involved in the study said the training program “brings awareness to disturbing ideas” and encourages students to sit with dark emotions, especially those such as racism and poverty. I suspect that it does not provide solutions to social problems. It was also found that students did not enjoy the sessions and did not practice at home.
Another explanation is that mindfulness training may encourage “co-rumination,” a type of long, unresolved group discussion that stirs up problems without finding a solution.
While the MYRIAD results were analyzed, Dr Andrews led an evaluation of Climate School, an Australian intervention based on principles of cognitive behavioral therapy. There, students observed cartoon characters solving mental health problems and answered questions about practices to improve mental health. .
Here, too, he found negative effects. Students who took this course reported higher levels of depression and anxiety symptoms after 6 and 12 months.
According to the professor, female students are more likely to engage in co-rumination, are more likely to attend programs with more worries, and are more likely to conform to their friends. “Maybe they're getting together and making things a little bit worse for each other,” he said.
Dr Andrews, a Wellcome Trust Research Fellow, has since joined efforts to improve climate schools by addressing their negative impacts. He concluded that schools should slow down until “we know a little more about the evidence base.” Sometimes he said, “Doing nothing is better than doing something.”
paradox of consciousness
One of the problems with mental health awareness is that labeling your symptoms may not be helpful, some research suggests.
Isaac Ahuvia, a doctoral candidate at Stony Brook University, recently tested this in a study of 1,423 college students. Twenty-two percent “self-reported” having depression, telling researchers “I have depression” or “I have depression,” while 39% met diagnostic criteria for depression.
He found that students who self-labeled themselves as having less control over their depression, were more likely to have a breakup, and were more likely to blame their difficulties than other students with similar symptoms of depression. They found that people felt less likely to objectively cope with their pain.
Jessica L. Schrider, co-author of the self-labeling study, said this is not surprising. People who self-label “seem to think depression is biologically inevitable,” she says. She says, “People who don't see emotions as malleable and who think they're stuck, stuck, and uncontrollable tend to have trouble coping because they don't think there's any point in trying.'' .”
But Dr. Schrider, an associate professor of medical social sciences at Northwestern University and director of the school's Scalable Mental Health Laboratory, rejected the prevalence inflation hypothesis. She disputed claims that students were overdiagnosing themselves, noting that Ahuvia's findings suggested otherwise.
Awareness campaigns always have multiple effects, helping some students and not others. And ultimately, she argued, the public health priority is to reach young people who are suffering the most.
“The urgency of the mental health crisis is very clear,” she says. “In the partnerships that I do, we're more focused on the kids who are really struggling and don't have anything right now, rather than the risks that could be to some kids who aren't really struggling. We need to help them.”
Perhaps we need to look beyond a “universal all-school assembly-style approach” to targeted, light-touch interventions, she said. Studies have shown that it is effective in reducing anxiety and conduct disorders, especially in younger children.
“You risk throwing out the baby with the bathwater,” Dr. Schrider says. “The answer can't be, 'Forget everything.' It should be, 'What didn't work about this intervention?' ”
Other researchers echoed her concerns, pointing to studies showing that students, on average, benefit from social and emotional learning courses.
One of the largest meta-analyses, a 2023 study of 252 classroom programs in 53 countries, found that participating students had better academic performance, improved social skills, and lower levels of psychological distress. Low levels of behavioral problems were found. In that context, the adverse effects in a small number of trials appear to be modest, the researchers said.
“Obviously we haven't found a way to do it yet, but I can't think of any population-based intervention that the field has gotten right the first time,” said Dr. Andrew J. Gerber, president and medical director of Silver Hill. He works in a hospital and as a child and adolescent psychiatrist.
“The truth is, if you think about almost everything we do in schools, there's not a lot of evidence that it's working,” he added. “That doesn't mean we don't do it. It means we're always thinking of ways to improve it.”
“I want everyone to have it too.”
These discussions are taking place far from classrooms, where mental health curricula are increasingly common.
Alison Kanguisser, a counselor at Woodsdale Elementary School in Wheeling, West Virginia, said her school focuses on basic coping skills. In the lower grades, students are asked, “What can you do to take care of yourself when you're feeling big?”
From third grade onwards, students start working on more complex content, such as looking at cartoon characters and differentiating between temporary stress and chronic illnesses such as depression. “We're not trying to force them to diagnose themselves,” Kangisser says. “We're saying, what do you feel? How do you feel about this? Or this?”
At the school's sixth annual mental health fair last month, Woodsdale students walked through a giant inflatable brain with neatly labeled leaves. They did yoga stretches and talked about controlling their emotions. Kangisser said the event is valuable because it is universal and children with problems are not specifically excluded.
“Everyone is doing mental health fairs,” she said. “It's not 'I need it, but you don't need it.' Everyone wants to have it.
By the time students reach university, they have absorbed a tremendous amount of information about mental health, not only from school but also from social media and from each other.
Dr. Jessica Gold, chief health officer for the University of Tennessee System, says the college students she sees are clearly unusual, more comfortable talking about their feelings and willing to be vulnerable. said. They also overuse diagnostic terminology and have the confidence to question the judgment of psychiatrists.
“It's like a double-edged sword,” she said. “We want people to talk more about this, but we don't want it to lead to overdiagnosis or misdiagnosis or overtreatment. It normalizes having feelings. I hope it will lead to.”
Lucy Kim, a senior at Yale University who has campaigned for more mental health support on campus, called the inflation rate hypothesis “disheartening, negative, and potentially dangerous,” calling it He said it offers another way to downplay the experience.
“As a college student, I witnessed a generation of young people around me suffering deep and pervasive loneliness, fatigue, and disillusionment that suggested a deeper malaise than the general ups and downs of life.''23 Kim, who is 20 years old, said:
Overdiagnosis is real, and so is the glorification of mental health disorders, she said. However, stigma and barriers to treatment remain major issues. She said: “I can confidently say that I have never heard anyone respond to a confession of depression by saying, “That's amazing, I want to be like that too.'''' .