Young people are seeking more help for symptoms of anxiety and depression, but the number of diagnosed disorders is not increasing, according to a study in Norway

The study has one clear strength: it uses a very large sample and a time span long enough to detect relevant epidemiological trends. This type of design makes it possible to observe changes in how mental health issues are referred to primary care and recorded in health care systems. However, precisely because of the breadth of the data, caution is warranted in interpreting the results. What the study shows is not necessarily a direct change in the actual prevalence of mental disorders, but rather a change in the way certain psychological problems are recorded, coded, and possibly addressed within the Norwegian healthcare system.

The first important point is that these findings are not new in this field of study. The discrepancy between the prevalence of symptoms and the prevalence of diagnoses had already been noted over the past decade. A clear example is the work by Archer et al., published in 2022, which described a very similar trend in the United Kingdom regarding anxiety symptoms. There, too, an increase in symptom-related records was observed, without this automatically translating into an equivalent increase in formal diagnoses of mental disorders.

This distinction is fundamental. In the case of the Norwegian study, what the data seem to reflect is that, between 2010 and 2024, the increase in mental health contacts in primary care is concentrated primarily in records of anxiety and depression symptoms. In contrast, the codes corresponding to disorders increase much less or remain relatively stable. That is, strictly speaking, the conclusion supported by the data. Any additional interpretation (for example, that there is more suffering but not more disorders, or that diagnoses are declining) requires much greater caution.

In fact, the study by Archer and colleagues itself helps explain why. That study included interviews with physicians, and some professionals noted that they preferred to code symptoms rather than disorders to reduce the stigma associated with psychiatric diagnosis. This raises the possibility that the increase in symptom coding does not necessarily mean there are fewer diagnosable cases, but rather that professionals are choosing to label these problems differently. In other words, part of the phenomenon could stem from coding practices.

Something similar occurs when interpreting the study from a public policy perspective. At first glance, it might seem that these results call for a fundamental rethinking of how mental health care is organized. However, they can also be interpreted as the result of health policies already in place in Norway. In 2012, the country implemented a reform that granted municipalities greater autonomy in the provision of health services, reinforcing a model more heavily reliant on primary care and community resources.

This approach aligns with the Escalation Plan for Mental Health 2023–2033, which explicitly addresses the need to lower the threshold for receiving help and to prioritize municipal services over a model that is overly focused on specialized care. The plan itself acknowledges that many people with mental health issues are already in contact with their family doctor and includes interventions such as supportive conversations, stress management courses, or brief treatments for mild forms of anxiety and depression. In other words, the Norwegian system appears to recognize a middle ground between psychological distress and a formally diagnosed mental disorder.

The Prompt Mental Health Care program, launched as a pilot in 2012, should also be viewed in this context; it is specifically designed to provide psychological treatment in primary care for mild or moderate symptoms of anxiety and depression. Viewed in this light, the increase in reported symptoms need not be interpreted solely as an epidemiological warning sign, but also as a reflection of an organizational decision: to identify distress earlier, address it in more accessible settings, and not necessarily wait for it to take the form of a fully coded disorder.

Therefore, I do not believe it can be concluded that there are fewer diagnoses in Norway despite more reported symptoms. Rather, what we see is a combination of changes in professional coding, expanded access to primary care, and the choice of specific approaches to addressing psychological distress. Whether this is positive or negative is another matter. To assess this, we would need to analyze whether these individuals receive adequate care, whether severe cases are referred appropriately, whether unnecessary medicalization is avoided, or whether, on the contrary, problems that would require more specialized intervention are trivialized.

The comparison with Spain also calls for caution. We do not have a point-by-point equivalent study, but the Ministry of Health’s report Mental Health in Data highlights two relevant points. The first is that the coding method significantly alters the recorded prevalence of disorders. The second is that the difference between recording symptoms and recording disorders produces patterns that resemble, at least partially, those observed in the Norwegian study. This suggests that administrative figures not only indicate how many people suffer from certain problems but also how decisions are made regarding their classification.

One final piece of data sheds light on the issue from another angle. Anmella and colleagues analyzed antidepressant prescriptions in primary care in Catalonia between 2010 and 2019 and found a very sharp increase in antidepressant prescriptions, far exceeding the rise in depression diagnoses. This type of finding raises an uncomfortable question: To what extent does it matter that the system codes symptoms or disorders if, in practice, the approach ends up being the same?

That is, probably, the underlying issue. The debate should not be limited to whether symptoms are increasing or diagnoses are increasing, but rather to what is done for people who come to primary care with psychological distress. If symptoms are coded to reduce stigma, facilitate access, and provide appropriate brief interventions, it may be a reasonable strategy. If, on the other hand, symptoms are coded but the response is always the same pharmacological approach or insufficient care, the change in terminology adds little.

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.”

This is a recent and innovative study conducted in Norway with a sample of approximately 3.7 million individuals that addresses an issue of global significance: the mental health of our young adult population. Globally, there is talk of a marked trend toward higher levels of anxiety and depression in this group, but is this trend real? Is the mental health of our population deteriorating due to social, family, or technological changes?

In this study, the authors follow individuals aged 10 to 46 over a 15-year period (2010–2024), include a cohort of adults (aged 31–46) as a comparative reference group, and analyze trends among men and women throughout the entire period, as well as before and after the pandemic. The main methodological strength is that the Norwegian coding system in primary care allows for distinguishing between visits recorded as symptoms (e.g., feeling anxious) and visits recorded as diagnosed disorders (e.g., anxiety disorder), which makes it possible to compare these two trajectories.

The study’s main finding is a clear divergence: consultations for anxiety symptoms increased by 286% (compared to 46% for anxiety disorder), and consultations for depressive symptoms increased by 147%, while depressive disorder remained stable and even declined slightly (4%). The sharpest increases were observed among women aged 16–20 for anxiety symptoms (+475%) and among adults aged 21–46 for depressive symptoms, particularly after 2020. It is important to note that the post-pandemic surge is not widespread: it is specifically evident in depressive symptoms among young adults, while diagnosed disorders remain stable or even decline.

What is happening? The study suggests that the increase may reflect a shift in thresholds for seeking help and in clinical coding practices rather than an actual deterioration in psychological well-being, although an increase in mental health symptoms cannot be ruled out. The implications are significant: it may be necessary to rethink diagnostic criteria and pathways in primary care and to strengthen psychoeducation programs and brief digital psychological interventions as a more appropriate response to a growing volume of symptomatic demand that does not necessarily require a traditional clinical pathway.

As limitations, the authors correctly point out that they lack measures of symptom severity and information on specialized care; therefore, it would be desirable to supplement this type of analysis with self-reported questionnaires that provide information on the severity and type of symptoms in the young adult population.