Is uncertainty driving the youth mental health crisis?

Susanne Schweizer, incoming associate professor at the University of New South Wales, has been studying the trends in adolescent mental health over the past decade and believes one of the drivers of the downturn is increases in uncertainty. This might account for, as she argues, why we see the problem getting worse during the Covid pandemic - an extremely uncertain time for so many, as she related to James Tytko…

Susanne - Young people coming of age today, they've faced very volatile financial markets, they were all born during or post the global financial crisis, and they have experienced a steadily increased worsening of the global climate. They now don't know about the future liveability of their planet, let alone the liveability of the planet for any offspring that they may have.

James - Haven't we always lived in uncertain times? Could you argue there's been war, there's been economic downturn, there's been political upheaval for time immemorial?

Susanne - Absolutely. And I think that's a really good point. Surely, you'd say, world wars, droughts, famines, these are times of extreme uncertainty. So what's different now? Well, I don't think that they are different. The thing is that we don't know what was happening to youth mental health at the time because we've only been systematically assessing it and tracking it over the last couple of decades. So from the time since we've been tracking youth mental health, it's the first time that we see this statistically significant increase in mental health problems. Definitely in the last decade, but there's some indicators that put it even a bit earlier, sort of 2008/2006 as a starting point at which this really started to significantly increase in this age group.

James - I wonder if we could backtrack slightly and talk about uncertainty from the psychological perspective because, as much as we might say it might be a driving factor towards poor mental health, it's also in us for a reason, right? It's got its uses.

Susanne - Absolutely. As a species we're incredibly averse to uncertainty. We really don't like it. There was this early experiment in the 60's by an economist called Ellsberg. It showed that people will be willing to incur financial cost in order to avoid uncertainties. The avoidance, or trying to eracidate uncertainty, is incredibly important because that gets us to try and predict the weather, gets us to try and predict stock markets, etc. Developmentally, adolescence has always been a time of great uncertainty. It's a time point where you go from your known environment, your family environment to, with increasing independence, your world really drastically changes; your relationships, the amount of relationships you have, the focus away from the immediate family towards peers and dynamically changing relationships. All of these scenarios are inherently novel and therefore also uncertain. We've seen time and again in behavioural research, in neuroscience research, adolescents are much more willing to go and explore their environment. That's, again, arguably developmentally important because to be successfully navigating a new adult environment, you have to go out and explore it!

James - We talk about how resilient children are and that chimes with what you're saying: that uncertainty is a fact of life when you are young and something that can't be avoided and so you have to be able to deal with it.

Susanne - Yes. Beyond that, even within normative levels of uncertainty, why do some young people go on to develop mental health problems but others not? We've looked at the behavioural willingness to approach uncertainty: uncertainty makes you feel more negative than someone else. If you're less able to cope with uncertainty emotionally, then you are more vulnerable towards developing mental health problems. But what we've not done is we haven't actually looked at intolerance of uncertainty across the lifespan. In a recent study where we've actually done this, we see again that young people are those who report the highest levels of intolerance of uncertainty when we directly compare it to adults. So while they may be behaviourally ready and, especially in social contexts, willing to go out and explore, go out and take risks, this may actually come at an effective cost in that they may actually not feel good doing this. This may actually be distressing to them.

James - And I guess that would make sense as to why you become more risk averse as you age because you begin to associate uncertainty with these not nice feelings.

Susanne - That's exactly right. We see an increase in sensation seeking and risk taking over the course of adolescence and it peaks in late adolescence around 18 to 19 years old where it then decreases to stable adult levels. At the same time, we see that behavioural avoidance of uncertainty increases throughout adolescence. So they sort of co-occur. I think the important part is also what type of uncertainty are you talking about. So, in the context of the pandemic of course, we were able to look at different types of uncertainty.

James - Well that was going to be my next question. Perhaps an obvious point to clarify, but what about the pandemic could you analyse from the psychological perspective as enhancing this malaise of uncertainty?

Susanne - You would think surely health uncertainty would be maladaptive to mental health or detrimental to your mental health. We do see that increased health anxiety was associated with more depression and anxiety symptoms more broadly as well. While we did see that, we didn't see this pattern as clearly in the data compared to other types of uncertainty. Indeed, young people, when they were asked explicitly about what caused them the most distress about the pandemic, uncertainty worries about the health of their loved ones, their next of kin, their friends was really high. But the concerns that were highest above everything else were social; the worry about not being able to see their friends. Now, in some ways, this could simply be interpreted as, 'Well, there's a loss of social interaction and that's what's causing the distress. That's what's causing the increase in mental health problems.' But we've argued, from a neuroscience perspective, we know that isolation is interpreted as exclusion and at no other time points in our lives are we more sensitive to social exclusions than during adolescence. And so there really seems to be something about this sensitivity to social exclusion that was driving the distress in these young people.