Adolescent mental health evidence brief 2: the relationship between emotional and behavioural problems in adolescence and adult outcomes

Our evidence briefing on adolescent mental health focuses on the links between emotional and behavioural problems during adolescence and adult outcomes, including mental health, education and employment, and physical health and broader social outcomes. 

Understanding long-term associations between adolescent emotional and behavioural problems during adolescence and adult outcomes is important. It provides crucial information about the impact of emotional and behavioural problems at an individual level — in terms of impairments to family life, professional life and overall quality of life — and at a societal level, in terms of the economic costs in health, education and welfare. 

Adolescents who experience persistent emotional problems, such as anxiety and depression, are at greater risk of a range of negative outcomes: 

• Persistent depression during adolescence is associated with a significant increased risk of depression during adulthood. This finding is not limited to those with clinical diagnoses: those with subclinical symptoms are also at risk.
• Young people with persistent emotional problems are at an increased risk of poorer employment and educational outcomes, including school drop-out and NEET (not in education, employment or training) status.
• Some evidence from individual studies suggests there is an association between adolescent mental health disorders and poorer general health in adulthood, social withdrawal, increased risk of intimate partner victimisation, and unplanned pregnancy. 

Adolescents who exhibit behavioural problems, such as conduct problems, are also at increased risk of poor adult outcomes, including: 

• poor mental health, such as depression and anxiety, education outcomes — school drop-out, NEET, and at work without basic education level — and a range of physical and social outcomes, including poor physical health, substance abuse, early parenthood, and drug-related and violent crime, including violence against women and children.
• Importantly, behaviour problems do not seem to occur in isolation and often coexist with mental health problems, including depression and anxiety, and neurodevelopmental problems, including autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). 

Being a perpetrator and/or victim of bullying is strongly associated with a range of mental health problems in young adulthood, including increased risk of anxiety disorders, depression and suicidal behaviour. 

These findings illustrate that issues during adolescence cast a long shadow over individuals’ life chances. The findings highlight the need to invest not just in the treatment of disorders but also in prevention and early intervention support, and the promotion of positive mental health and prosocial behaviour, to reduce vulnerabilities and enhance protective factors. Priorities include: 

• targeted support for young people with persistent emotional and behavioural problems
• addressing the needs of young people with subclinical symptoms
• further investigation of the coexistence of mental health, behavioural and neurodevelopmental problems (such as ASD and ADHD) during adolescence, and their combined impact on adult outcomes
• addressing the significant gap in the evidence concerning the long-term impact of emotional and behavioural problems for ethnic minorities and vulnerable adolescent groups, such as young people with special educational needs and disabilities, and lesbian, gay, bisexual and transgender (LGBT) young people. 

Evidence-based mental health and behavioural interventions which are tailored to the needs of young people could have important consequences at both an individual and societal level. Research examining the efficacy of these interventions in improving long-term outcomes is required.

Adolescent mental health evidence brief 1: prevalence of disorders

Our first evidence briefing on adolescent mental health focuses on prevalence: what do we know about the incidence of mental disorders in young people, and how has this picture changed over recent years?  This briefing provides data on the prevalence of mental disorders among adolescents, aged 11–19 years, in England, including data gathered during the Covid-19 national lockdown.

• More than one in seven young people (15.3%) aged 11–19 in England had at least one mental disorder in 2017.
• A follow-up survey carried out during the Covid-19 lockdown (July 2020) indicates that one in six young people (17.6%) aged 11–16 years were identified as having a probable mental disorder. This figure increases to one in five (20.0%) among young adults aged 17–22.
• Emotional disorders such as anxiety and depression are the most common mental disorders experienced by young people.
• The rate of mental disorders among 11–15-year-olds in England seems to be increasing, having risen from 11.4% in 1999 to 13.6% in 2017. The latest data from 2020 suggest that young people’s mental health has further deteriorated.
• In younger adolescents (aged 11–16), the prevalence of mental disorders is similar among boys and girls. However, among older adolescents (17–19), mental disorders are more common in girls, with almost one in four girls (23.9%) experiencing a mental disorder, compared with one in 10 boys (10.3%).
• Self-harm and attempted suicide are around six times more common among adolescents (aged 11–19) with a mental disorder (32.8%) than those without (5.1%). Similar to mental disorders, rates of self-harm and attempted suicide among the adolescent population are increasing, with reported self-harm having increased from 5.3% in 2000 to 13.7% in 2014 (11–16-year-olds).
• While these increases over the last two decades may reflect more accurate reporting – potentially due to increased awareness and help-seeking behaviours, reduced stigma and improved screening – they may also represent an increase in prevalence rates. Further research is required to understand these trends.
• The increasing concern around young people’s mental health, particularly in relation to the Covid-19 pandemic, highlight the need for immediate action to support young people most at risk. It is essential that this action is underpinned by a strong evidence base.
• Early intervention, including promotion and prevention strategies, has the potential to produce the greatest impact on young people’s mental health and wellbeing by taking action before mental health problems worsen and preventing the onset of mental disorders.