1 in 3 adolescents report depression, anxiety but only 10% of parents can spot mental health issues: NUS-led study

SINGAPORE — About one-third of Singapore adolescents reported mental health symptoms such as depression, anxiety and loneliness, but just one in 10 parents were able to identify "clinical-level mental health symptoms" in their children, a survey has found.

The researchers behind the survey said that the results, released on Wednesday (April 26), suggest that there is room for parents to be “involved more deeply in identifying and supporting” their children’s mental health conditions.

This could be achieved by raising awareness of mental health literacy among parents, the researchers from the National University of Singapore (NUS) said of their Youth Epidemiology and Resilience study.

In response to TODAY's queries, NUS said on Wednesday that the one in 10 parents in the study who could identify symptoms had spotted internalised symptoms such as their child feeling anxious.

Anxiety tended to be more obvious than depression and loneliness, which were harder to pick up at first instance, NUS added.

The findings distinguished between internalised mental health symptoms such as depression and anxiety, and externalised symptoms such as aggressive and disruptive behaviour towards others.

The study sought responses from 3,336 adolescents aged between 10 and 18 over the Covid-19 pandemic period from 2020 to 2022, and was led by Associate Professor John Wong from the NUS Yong Loo Lin School of Medicine.

Other researchers included a consortium of investigators from the department of psychological medicine at NUS Medicine, NUS Mind Science Centre, the Institute of Mental Health, and the Netherlands' Erasmus University Medical Centre.

NUS said that the research, done in collaboration with the Ministry of Education, is the first nationwide epidemiological study that seeks to “understand and establish” the mental health and resilience of Singapore’s adolescents.

The university defined resilience as the “ability and capacity” of an individual to prepare for, withstand, adapt and progress in the face of adversities.

The study looked at four key areas: Mental health, resilience, identity development and media activity use.

The finding that the one in three adolescents reported mental health symptoms was also included in a preliminary version of the study released last year.

WHY IT MATTERS

Assoc Prof Wong, who is also the Lin Jo Yan and Yeo Boon Khim Professor in Mental Health and Neuroscience, said that adolescents today face a series of “distinctive challenges which are unique to this era they are living in”.

This includes experiencing not just evolving sociocultural systems and parenting styles, but the importance of peer relationships.

He added that adolescents also need to deal with changes in the academic learning environment, adjust to the “psycho-social effects of the Covid-19 pandemic”, while also cultivating their own identity.

“Understanding the state of mental well-being among the youth in Singapore and the challenges that they face will help to inform and guide the planning of prevention and treatment services in Singapore, especially to those at risk,” Assoc Prof Wong said.

The findings of the NUS study are broadly in line with the TODAY Youth Survey 2022, which found that 35 per cent of respondents were mentally unwell or only slightly well. However, the TODAY survey covered a somewhat older cohort, aged between 18 and 35.

Young people surveyed by TODAY mentioned a variety of stressors, including work, new parenthood and identity issues.

Separately, TODAY has also reported that parents are worried about the stigma associated with mental health conditions and that this can also present an obstacle to youth seeking help for these challenges.

ADOLESCENTS AND MENTAL HEALTH

In order to assess the respondents' mental health, NUS said that the adolescents had to self-report how they were feeling.

These are the results:

• About one in three adolescents reported internalised mental health symptoms such as depression, anxiety and loneliness

• This was more serious among those aged 14 to 16

• Roughly one in six young people said that they experienced externalised mental health symptoms such as hyperactivity, rule-breaking and aggression

NUS said that those who reported clinical-level mental health symptoms were then either interviewed or assessed online, with the aim of establishing the prevalence of mental health disorders among adolescent respondents.

Adolescent respondents and their parents also responded to survey questions on parent-child dynamics and quality of life.

The study found that:

• About one in 10 (12 per cent) adolescents met the full diagnostic criteria for having at least one current mental health disorder

• 6 per cent of adolescents had previously met criteria for at least one disorder more than a year ago, but no longer met the criteria for the same disorder. This suggests that their condition may have improved

Taken together, NUS said that the findings suggest the importance of distinguishing between adolescents experiencing mental health symptoms influenced by the Covid-19 pandemic, stressors in life and developmental challenges, and those with diagnosed mental health disorders.

Such disorders are influenced by a confluence of biological, psychological and social factors, it added.

However, targeted support would need to be offered to both groups of adolescents.

ADOLESCENTS AND RESILIENCE

The study scored adolescents along a “resilience scale”, which measured 10 “domains” such as perseverance and commitment; positive self-image and optimism; and relationship and social support.

Resilience scores, the study found, differed significantly across the age groups for most of the domains.

The survey shows that resilience can be improved over time as the adolescents, especially those in the vulnerable “tween years”, mature and accumulate life experiences, NUS said.

The data gathered also showed that the “resilience factor” is highly correlated to the score for internalised symptoms, where participants with lower resilience run a higher risk of facing internal psychological distress that is difficult to spot on the surface.

Assoc Prof Wong said that to better deal with and manage challenges and adversities in life, it is important that adolescents “build a fortified sense of resilience”.

The ages between 10 and 18 have been identified as a window of opportunity, where adolescents are entering puberty and have the time and space to work on themselves to grow into the young adults they want to be.

“Parents and educators alike can be informed on how to use these resilience domains as a guide to nurture their child, and facilitate their youth’s growth,” he added.

OTHER FINDINGS

The study touched on findings related to identity development and media use as well.

On identity development:

• Adolescents with higher resilience tend to possess fewer impairments in identity development

• Identity development is a critical phase of emotional and psychological growth that starts at puberty

• NUS said that the focus on building resilience would aid in the prevention and remedy of identity disturbances and mental health difficulties in youth

On media use:

• Young people usually turn to socialising activities and listening to music online to address their “inner psychological void”

• This helps them better internalise and process their emotions in a productive way

• Therefore, parents need to recognise their critical role in establishing strong foundations of media literacy and habits early in their child’s life

HELPING YOUNG PEOPLE

Commenting on the findings at a symposium where the survey results were released, Ms Sun Xueling, Minister of State for Social and Family Development,  said that Covid-19 has made growing up even more challenging for young Singaporeans.

Aside from stressors in their life related to work, studies and family, they also did not have the opportunity to interact and socialise with their peers as much as they would have liked to, she added.

On the subject of personal confidence, Ms Sun said that for many young people in Singapore, their self-confidence is tied to how they think they are doing in school.

She suggested that it would be helpful to develop their confidence in other areas instead such as art, music, culture, sports and so on.

To that end, the Government is looking at ways to “build resilience in our children and youths”, which includes better managing the use of digital media so that it becomes a positive contributor to their mental health, she added.

“When we help (young people) develop themselves as confident individuals, it means so much to them when it comes to building that inner sense of resilience so they can better manage other challenges and adversities that come their way.”