Studies give greater voice to young people to improve mental healthcare

A study found that 85% of female university students experienced depression during the pandemic and suggests digital tools could help expand access to care

Samuel Fernandes

Young Black woman with short curly hair smiling broadly while leaning against a stone wall beside an aged wooden door. She is wearing a black jacket over a dark T-shirt and a necklace with a cross pendant. Natural light illuminates her face, conveying a sense of well-being and positivity.

In 2000, Luciane Kantorski, a professor at the Federal University of Pelotas (UFPEL) and coordinator of the psychosocial care network in Pelotas, Rio Grande do Sul, helped register the Nursing, Mental Health, and Public Health Research Group with Brazil’s National Council for Scientific and Technological Development (CNPq).

In its early years, the group focused on evaluating the quality of services dedicated to psychological distress. Over time, other issues gained prominence, including studies examining the profile of people seeking help through mental health services—young people included.

Kantorski notes that psychological distress in this age group has increased in recent years, particularly during the COVID-19 pandemic. This observation prompted the expansion of research examining the intersection between mental health and youth.

A study published in 2024 analyzed the mental health of 329 female university students during remote learning. Using questionnaires and standardized models to measure levels of distress, Kantorski and her coauthors concluded that 85% of the sample showed some level of depression, 24% had high levels of anxiety, and 25% reported suicidal ideation.

Pandemic worsened psychological distress among young people

The harmful effects of the COVID-19 pandemic on the mental health of young Brazilians are also addressed in a report on mental health produced by Agenda Jovem FIOCRUZ, an initiative of the Oswaldo Cruz Foundation (FIOCRUZ) that runs projects focused on the challenges facing Brazilian youth.

In the report, the authors state that the pandemic increased levels of psychological distress in the Brazilian population as a whole, but that the effects were felt particularly strongly by young people “because this stage of life is marked by intense sociability and circulation.”

The study examined mental health data available through Brazil’s Unified Health System (SUS), focusing on information related to hospitalizations, mortality, and healthcare services provided to people between 15 and 29 years of age across Brazil.

André Sobrinho, coordinator of the initiative, argues that surveys such as this provide insight into the worsening mental health of young Brazilians.

Approximately 10% of consultations involving young people in primary care are related to mental health. The percentage could be even higher, since among young people, the rate at which mental health services are sought through primary care is less than half that observed in the general population.

A central focus of the survey was analyzing young people’s mental health in relation to factors such as gender, race, and region of residence. Considering these aspects led researchers to conclude that mental health problems and the search for specialized support vary depending on young people’s sociodemographic profile.

One example is the difference between men and women: men have a hospitalization rate 57% higher than women, a figure described in the Agenda Jovem FIOCRUZ report as “substantially higher.”

This combination of socioeconomic factors also helps explain the deterioration of mental health among young Brazilians. One of these is the labor market, marked by a high degree of job insecurity and exhausting working hours, says Sobrinho.

Family responsibilities and difficulties continuing one’s education are other factors that may affect the mental health of young people.

Therapeutic groups show positive results

This is why it is important to listen to young people to understand their circumstances and provide services tailored to their needs, says Kantorski. One example is a paper coauthored by the researcher aimed at discussing the therapeutic outcomes of groups for adolescents at Brazil’s Psychosocial Care Centers (CAPS).

Based on observations conducted in these settings, the authors documented positive outcomes in the psychosocial rehabilitation of adolescents attending CAPS facilities, particularly regarding issues such as sexuality, family conflicts, and drug use.

According to the UFPEL professor, however, research that places young people at the center of discussions surrounding mental health still needs to become more widespread.

“These health services need to be better prepared for young people. We need to understand their experiences to address their needs,” she says, pointing to the emergence of social media as an important difference between today’s youth and previous generations.

Australia inspires Brazilian care model

The difficulty of providing adequate mental health services is also being felt in other countries. Ian Hickie, a professor of psychiatry at the University of Sydney in Australia, has been studying the issue for years.

As early as the 1990s, it was already evident to the researcher that there was a gap between centers dedicated to youth mental health in Australia and the delivery of effective, high-quality services for this population.

In 2006, the National Youth Mental Health Foundation, known as Headspace, was established. The Australian service was set up to build centers where primary mental health services—or gateways into the healthcare system—could be offered to young people.

According to the program’s latest official report, released in October last year, one million young people have already accessed some kind of service offered by Headspace.

But Hickie believes the model has shortcomings. “These centers are focused on physical infrastructure. The objective is to establish new clinics that create gateways to increase access to healthcare,” the specialist says.

The effectiveness of Headspace has already been examined in scientific studies. A paper published in 2023 in PLOS One analyzed data from 58,000 young people who accessed the service between 2019 and 2020.

To evaluate patient outcomes, the authors focused on self-reported psychological distress among young people, quality-of-life measures also reported by patients, and assessments made by healthcare professionals after young people accessed Headspace centers.

The results were positive: approximately one-third of patients showed improvement in psychological distress, while half reported improvements in quality of life.

However, there are also counterarguments regarding the lack of robust evidence supporting the service. In a paper published in 2023 prior to the study featured in PLOS One, other researchers argued that published studies on Headspace lack standardization in measuring service outcomes and that, even when positive outcomes are observed, they are generally not clinically significant.

Hickie also questions the long-term relevance of programs such as Headspace. He argues that models centered on physical clinics are not scalable and are unable to address the full complexity surrounding the deterioration of young people’s mental health.

Continuous, highly personalized care, combined with ongoing monitoring and evaluation of both patients and healthcare services, is among the factors involved in this type of service.

Digital tools expand access to care

One possible solution is the adoption of digital tools. “In the digital age, young people can become active participants in monitoring their own mental health so they can access additional support,” Hickie summarizes.

The University of Sydney professor is involved in various projects using digital resources in an attempt to build high-quality mental health services dedicated to young people. One such initiative took place in Brazil through a collaboration with Pedro Pan, a psychiatrist and advisor to the graduate program in psychiatry and medical psychology at the Federal University of São Paulo (UNIFESP).

Pan had previously collaborated with a group of researchers from the University of Melbourne in Australia on a project aimed at identifying early signs of schizophrenia in young people. Years later, the physician again collaborated with Australian scientists—this time with Hickie himself.

The partnership was essential to the development of a Brazilian digital tool designed to assess young people’s mental health based on general patient data. Called Mindcheck and cofounded by Pan, the technology incorporates different aspects such as thoughts, emotions, screen time, and socio-emotional skills to conduct a digital mental health checkup.

According to the psychiatrist, tools such as these may be useful because they generate greater engagement among this age group, since “young people are already using digital media and these kinds of tools.”

Approximately 100 assessments have already been conducted. Half took place during the platform’s development phase, while the remainder occurred during the pilot stage. “Initial data show that Mindcheck helps identify mental health risk profiles that had often not previously been recognized by young people or their families, while also helping raise awareness of important day-to-day factors such as sleep, screen use, routine, stress, and emotional well-being,” Pan summarizes.

A paper on the development of the platform and qualitative evaluations of its use is currently under review for publication in a scientific journal. In the meantime, individual examples of young people assessed using the technology illustrate Pan’s observations.

One case involved a young woman who was experiencing attention difficulties at school. The initial suspicion was a cognitive disorder, but the Mindcheck assessment suggested that the problem could be related to excessive nighttime screen use. “After reorganizing her sleep routine and reducing nocturnal screen time, there was a substantial improvement in attention and academic performance, without the need for more complex interventions,” says Pan.

International cooperation faces adaptation challenges

The dialogue between Pan and Hickie that resulted in Mindcheck illustrates how international collaborations can play an important role in improving mental healthcare for young people. But these partnerships also have limitations, mainly because of local differences in each region.

Economic differences between developed and developing countries can represent a challenge—for example, between Australia and Brazil. “Not everything can really be replicated in exactly the same way,” explains Pan.

One way to improve these adaptations is to establish research standards across different countries, says André Sobrinho of Agenda Jovem FIOCRUZ. Thus, even if studies take local situations of psychological distress among young people into account, international collaboration and exchanges would become easier.

“It requires a greater effort not only to build exchange networks, but also to establish global scientific and methodological parameters that can serve as a common foundation,” the researcher concludes.

How can research on young people’s mental health be improved?

Topic 1: Expand youth-focused research: Develop more studies that place young people at the center of mental health discussions, taking into account their specific needs and differences from previous generations, including the impact of social media.
Topic 2: Consider socioeconomic factors: Analyze mental health in relation to gender, race, region of residence, and working conditions, recognizing that mental health problems and the search for help vary according to sociodemographic profile.
Topic 3: Invest in digital tools: Create online assessment and monitoring platforms that allow young people to become active participants in caring for their mental health, expanding access and engagement.
Topic 4: Strengthen primary care: Increase the use of mental health services within primary care, which young people currently access at less than half the rate observed in the general population.
Topic 5: Promote therapeutic groups at CAPS facilities: Expand collective care spaces for adolescents that have shown positive results in areas such as sexuality, family conflicts, and drug use.
Topic 6: Establish global research standards: Define shared scientific and methodological parameters across countries to facilitate international collaborations and local adaptations of best practices.

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