José César Perales
Professor in the department of Experimental Psychology at the University of Granada
Is it of good quality? Are the conclusions backed up by solid data?
“This study examines consultations for mental health reasons in a cohort of 3.7 million users of the primary care system in Norway over several years (2010–2024). It considers different age groups, from pre-adolescents and adolescents to young adults, and includes a comparison group of adults aged between 31 and 46. The analysis distinguishes between consultations coded as diagnoses of depressive or anxiety disorders and those recorded as the presence of symptoms of depression or anxiety that do not meet the threshold for a clinical diagnosis.
The descriptive data show that the increase in symptom codings over the period analysed clearly outstrips that observed in diagnostic codings; in other words, there is a clear decoupling between the two trends, with a marked shift towards symptom codings.
The size and representativeness of the sample (virtually the entire population of Norway in the age groups under consideration), together with the stability of the trends, make it unlikely that this divergence is due to chance. Everything points to this being a consistent pattern in the population studied.
One plausible interpretation is that the recent increase in mental health-related consultations – and consequently their greater visibility both amongst professionals and in the public sphere – is largely due to changes in people’s help-seeking behaviour and to changes in clinical coding practices. From this perspective, the recorded increase would reflect not so much a change in the underlying incidence of disorders as a shift in how they are detected, named and recorded.
However, this interpretation should be qualified. Whilst it is consistent with the data, it does not rule out other possible explanations. It is important not to confuse the quality and robustness of the data with the strength of a particular interpretation of them”.
How does this work fit in with the existing evidence?
“The study is based on a well-known and indisputable fact: the rise in diagnoses of depression and anxiety disorders, as well as in consultations for associated symptoms—particularly amongst adolescents and young adults—can be partly explained by a greater propensity to seek help or by improved detection. The available evidence supports this possibility.”
What are its limitations?
“The existence of this phenomenon of diagnostic inflation does not entirely rule out the possibility that there has also been an increase in underlying mental health problems. It would, however, explain why these underlying trends appear to be less clear-cut and universal than is claimed by certain viewpoints, which are not always strictly scientific.
Assessing these underlying trends presents an inescapable difficulty. We do not have objective indicators that allow us to measure them directly. As this study shows, diagnoses alone do not provide information on undetected cases, whilst studies based on self-reports have their own inherent limitations.
Among these limitations, a possible shift in the meaning and use of expressions such as ‘being depressed’ or ‘suffering from anxiety’ stands out; this may lead different cohorts to interpret and respond to the same questions in non-equivalent ways.
In this context, any attempt to infer the true trend in mental health problems involves a high degree of interpretation. It is therefore advisable to adopt a cumulative perspective and consider the body of evidence as a whole, drawn from diverse methodologies and employing different analytical strategies. Focusing the discussion on a single study narrows the scope of the conclusions and increases the risk of overreacting to results which, on their own, cannot settle the debate.”
What are the implications for public policy?
“As regards the measures to be adopted, it is advisable to maintain a cautious stance without succumbing to alarmism. The available evidence does not support the idea of a disproportionate increase in mental health problems among adolescents in recent years. An excessive reaction to a perceived threat can be just as harmful as inaction.
Beyond the possible over-interpretation of trends, the priority is to identify the factors that have a significant impact on adolescent mental health and to design coordinated interventions targeting them. This requires tailoring the intensity of interventions according to the weight each factor carries within the general population or specific groups. It also involves avoiding single-cause explanations and resisting the temptation to focus attention on the most visible determinants at the expense of others that are less apparent but potentially more influential.”