Are mental health awareness efforts contributing to the rise in reported mental health problems? A call to test the prevalence inflation hypothesis

Foulkes, Lucy; Andrews, Jack L

doi:10.1016/j.newideapsych.2023.101010

Cited by 67 publications

(47 citation statements)

References 63 publications

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“…Second, increasing awareness of students’ mental health problems can paradoxically contribute to higher and higher rates of mental illness being reported; this phenomenon has been called the “prevalence inflation hypothesis” [ 45 ]. Increasing students’ awareness of very high rates of mental illness through crisis narrative awareness campaigns could lead some students to interpret and report relatively mild forms of distress as mental health problems, rather than interpreting these as the everyday vicissitudes of life [ 45 ]. This, in turn, could also promote the idea that students need formal psychological/psychiatric treatments for any emotional distress.…”

Section: Could There Be Unintended Harmful Consequences Of a Crisis N...mentioning

confidence: 99%

Anxious, Depressed, and Suicidal: Crisis Narratives in University Student Mental Health and the Need for a Balanced Approach to Student Wellness

Bantjes

Hunt

Stein

2023

IJERPH

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There is growing global awareness of the poor mental health of university students, as well as the need to improve students’ access to services and expand the range of available evidence-based interventions. However, a crisis narrative is emerging, particularly in the wake of the COVID-19 pandemic, that runs the risk of positioning all students as potential patients in need of formal psychiatric interventions. Our aim in this commentary is to critically present the evidence that supports increased attention to student mental health, while also raising a concern that the crisis narrative may itself have unintended harmful consequences. We highlight some of the potential dangers of overtly medicalizing and thus pathologizing students’ experiences of everyday distress, inadequacies of formal diagnostic categories, limitations of focusing narrowly on psychotherapeutic and psychiatric interventions, and the short-sightedness of downplaying key social determinants of students’ distress. We argue for an integrative and balanced public health approach that draws on the rigor of psychiatric epidemiology and the advances that have been made to identify evidence-based interventions for students, while simultaneously being mindful of the shortcomings and potential dangers of working narrowly within the paradigm of diagnostic labels and psychotherapeutic interventions.

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Section: Could There Be Unintended Harmful Consequences Of a Crisis N...mentioning

confidence: 99%

Anxious, Depressed, and Suicidal: Crisis Narratives in University Student Mental Health and the Need for a Balanced Approach to Student Wellness

Bantjes

Hunt

Stein

2023

IJERPH

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“…This nding suggests that the large sex differences observed in adolescent emotional symptoms between males and females (Patalay & Fitzsimons, 2018) could be partly overestimated using self-report measures. A recent concept in mental health research, known as the prevalence in ation hypothesis, suggests that youth are reporting more mental health symptoms than ever before, partly due to increased awareness and discussion of these topics in the media and wider society, resulting in improved recognition, but also overinterpretation of symptoms (Foulkes & Andrews, 2023). It is possible that prevalence in ation could have a greater effect on females, as they are more likely to be exposed to discussions around mental health through affected female friends and greater social media use (Svensson et al, 2022).…”

Section: Conditional Effectsmentioning

confidence: 99%

Parent-adolescent informant discrepancies on the Strengths and Difficulties Questionnaire in the UK Millennium Cohort Study

Booth

Moreno-Agostino

Fitzsimons

2023

Preprint

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Background: Developmental researchers often use a multi-informant approach to measure adolescent behaviour and adjustment, but informant discrepancies are common. In general population samples, it is often found that parents report more positive and less negative outcomes compared to adolescents. The aim of this study was to investigate factors associated with informant discrepancies, including adolescent’s sex, and parent’s level of psychological distress and highest level of education. Methods: Informant discrepancies on the Strengths and Difficulties Questionnaire were investigated using a Latent Difference Score (LDS) approach, which estimates the true difference between parent and adolescent reports in a structural equation model. The sample were parent-adolescent dyads from the seventh wave of the UK Millennium Cohort Study (N = 6,631, 49.1% female, aged 17 years). Results: Compared to adolescents, parents reported lower levels of difficulties (emotional symptoms, peer problems, conduct problems) and higher levels of pro-social behaviour in their children. Conditional effects were found, as discrepancy was greater amongst parent-daughter dyads for emotion and peer problems, and greater amongst parent-son dyads for pro-social behaviour. Parent-adolescent discrepancy was also greater if parents had a lower level of psychological distress or a higher level of education. Conclusions: In a large general population sample from the UK, it was found that adolescents tended to report more negative and less positive outcomes than parents reported about them. Discrepancy was conditional on various factors, including adolescent’s sex, and parent’s level of psychological distress and education, showing that specific informant biases are likely to impact the measurement of adolescent behaviour and adjustment.

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“…Clinicians should be concerned that unreflective framing of distress as disordered might lead to changes in an individual's self-conception and behaviors that in turn exacerbate or perpetuate symptoms. 7 Psychosocial and environmental stressors in combination with individual vulnerability and resilience factors help explain the diverse trajectories of response and transcend biological vs psychosocial etiological dichotomies. Substantial increases in normal distress at the population level would also likely accompany increases in states of psychopathology.…”

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confidence: 99%

“…Judgments of psychopathology are not innocuous. Clinicians should be concerned that unreflective framing of distress as disordered might lead to changes in an individual’s self-conception and behaviors that in turn exacerbate or perpetuate symptoms …”

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confidence: 99%

Addressing the Mental Health Crisis in Youth—Sick Individuals or Sick Societies?

Aftab

Druss

2023

JAMA Psychiatry

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Are mental health awareness efforts contributing to the rise in reported mental health problems? A call to test the prevalence inflation hypothesis

Cited by 67 publications

References 63 publications

Anxious, Depressed, and Suicidal: Crisis Narratives in University Student Mental Health and the Need for a Balanced Approach to Student Wellness

Anxious, Depressed, and Suicidal: Crisis Narratives in University Student Mental Health and the Need for a Balanced Approach to Student Wellness

Parent-adolescent informant discrepancies on the Strengths and Difficulties Questionnaire in the UK Millennium Cohort Study

Addressing the Mental Health Crisis in Youth—Sick Individuals or Sick Societies?

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