Rather than increase in worsening psychological ill health, Norwegian study suggests
Strongest rise seen for symptoms of anxiety and depression, not actual disorders
Lower thresholds for seeking medical help and/or changes in diagnostic practice, rather than a true increase in worsening psychological ill health, may help to explain the rise in young people's primary care service use for mental health issues, suggest the findings of a large, long term Norwegian study published online in the Journal of Epidemiology & Community Health.
The strongest increase in consultations for anxiety and depression was observed for symptoms, such as feeling depressed or anxious, rather than anxiety or depressive disorders, the findings indicate.
Mental health problems have reportedly increased in many high-income countries, particularly among teens and young adults, raising concerns about deteriorating population mental health, note the researchers.
But it's not clear if rising service use might reflect greater underlying mental ill health or changes in help seeking behaviour and diagnostic practice, they add.
In a bid to find out, the researchers studied all 10-46 year olds in Norway between 2010 and 2024-a total of 3,728,002 people.
They analysed administrative registers of general practitioner (GP) data to estimate the annual sex- and age-specific prevalence of any mental health consultation.
In the Norwegian primary care reimbursement system doctors code the reasons for contact as either symptoms or disorders.
Analysis of the data showed that the proportion of 10-46 year olds with any mental health consultation recorded by a GP rose from just under 10% in 2010 to 16% in 2024.
Among girls and women, it rose from nearly 12% to just over 19.5%, and from just over 8% to just over 12.5% among boys and men.
The steepest increases occurred among 21-30 year olds, with relative increases of 69% for women-from 13% to 22%—and 52% for men-from just under 9% to nearly 14%.
Among the youngest age group (10-15 year olds), the proportion of those with any mental health consultation rose from 3.5% of girls and just over 5% of boys in 2010 to around 9% for both sexes in 2024.
When consultations for anxiety and depression-two of the most common reasons for mental health consultations-were disaggregated, symptom codes showed notably steeper increases than disorder codes across all age groups.
The proportion of primary care consultations for anxiety or depressive symptoms increased substantially over the study period: 286% relative rise in those coded as anxiety symptoms (from 0.44% to 1.7%); 147% relative rise in those coded as depressive symptoms (from 0.73% to 1.8%).
By comparison, the proportion of consultations coded as anxiety or depressive disorders rose only slightly or remained stable: 46% relative increase for those coded as anxiety disorder (from 0.95% to 1.4%); 4% decrease for those coded as depressive disorder (from 2.8% to 2.7%).
The steepest increase in recorded anxiety symptoms was among 16-20 year old women, rising from 0.4% to 2.3%-a 475% relative increase-while the proportion recorded as anxiety disorder rose by a relative increase of 64%–from just under 1.5% to just over 2%.
The steepest increases in depressive symptom consultations were among 21-46 year old women, particularly after 2020, and particularly among 21-30 year olds.
By comparison, there was no comparable increase in the proportion of depressive disorder consultations in either sex at any age.
The researchers caution that their study relied only on primary care data, which didn't include symptom severity, so can't be used to provide conclusive evidence on the mechanisms underlying the changes in primary healthcare service use for mental health problems.
"The observed increases could reflect changes in underlying distress, but also changes in recognition, willingness to disclose symptoms, help-seeking and clinical recording practices," they note.
"While the observed over-proportional increase in symptoms is consistent with changes in norms for help-seeking, it cannot exclude alternative explanations, such as an actual increase in lighter mental health problems among young people, for example, due to increased social media use, the pandemic experience, or other factors," they add.
Nevertheless they conclude: "The findings suggest that changes in help-seeking behaviour and/or diagnostic recording, rather than worsening underlying morbidity, are key drivers of rising primary care mental health contacts."
The findings also have implications for primary care, they point out.
"The growing volume of symptom-level presentations poses an organisational challenge for GPs, who face increasing demand that may be more appropriately managed through psychoeducation or brief digital interventions rather than traditional clinical pathways," they suggest.
