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Young people’s mental health and well-being and its relationship with lifestyle

Key message
Over the past decade, the frequency of mental health problems among young people in Estonia has increased. More than a third of all girls and about a fifth of all boys between the ages of 11 and 15 feel sad or depressed more than once a week. Young people in Estonia experience sadness and depressive symptoms significantly more often than their peers in neighbouring countries. Lifestyle factors that support young people’s mental well-being include a healthy diet with adequate physical activity and sleep. Poorer mental health indicators are strongly associated with drug use (cigarettes, alcohol, cannabis). Healthier lifestyle choices can exponentially improve the mental well-being of young people.

Young people’s well-being and health behaviour are largely influenced by their parents’ beliefs and health behaviour. Many lifestyle factors support mental well-being, such as a healthy diet, sufficient sleep and physical activity. On the other hand, adolescent independence often comes with a craving for new experiences and the desire to test boundaries, which can involve experimentation with drugs. This can, in turn, affect young people’s mental well-being. Adolescence impacts people’s ability to cope with their emotions, and one solution may be to seek relief from using psychoactive substances. The first substances young people most often come into contact with are tobacco and alcohol, but also cannabis and stimulants or sedatives/hypnotics used for non-medical purposes (ESPAD report 2019).

This article provides an overview of Estonian adolescents’ mental health and well-being over the last two decades and their relationship with lifestyle and socioeconomic factors.

Young people’s mental health and well-being and its relationship with lifestyle

Current research increasingly treats mental health outside the framework of psychiatric illness, with a clear focus on psychosocial well-being (Moore et al. 2019). Many factors influence psychosocial well-being during childhood and adolescence. This is the inception period for several behavioural risk factors that can contribute to lifestyle-related disease. These factors include an unhealthy diet, physical inactivity, smoking and alcohol consumption, which can result in habits that carry over into adulthood. The 21st century has brought dramatic changes in the everyday life of young people, including their health behaviour. These have transformed, for example, the nutritional composition of food and eating habits more generally, decreased physical skills and activity, as well as increased the selection and availability of drugs.

Adolescent health and well-being are influenced by a number of individual, behavioural, social, cultural, environmental and organisational factors that operate on different levels and change over time (Inchley et al. 2020). This calls for updated risk models that involve youth behaviour and related factors and reflect the social context. The social context combines the immediate social environment that young people inhabit (e.g., family, peers and school) and broader social systems (e.g., education, healthcare, politics and the economy), while individual components include identity, attitudes, and biological aspects. The adolescent years provide an opportunity for prevention and intervention to support young people’s healthy development, promote physical as well as mental health and well-being in adulthood, and thereby improve the health of the next generation.

Mental health of Estonian adolescents over the past two decades

Our analysis is based on data from the study Health Behaviour in School-Aged Children, HBSC) andmed (Oja et al. 2019). HBSC is an international survey that has been conducted in Estonia since 1993. It has taken place every four years, for a total of eight times. The study provides a regular and comprehensive overview of the health status and well-being of adolescents aged 11, 13 and 15. It is the only population-based study on health behaviour with a representative sample of young people in Estonia. Our analysis relies on data from six waves of the study that span from 2002 to 2022 and feature the relevant characteristics associated with mental health. Each wave contains the health behaviour data of an average of 5,000 adolescents. The results are compared with neighbouring countries based on data from the 2018 survey.

In what follows, we use two variables to describe young people’s mental health: (1) sadness and depressive symptoms over the past six months and (2) periods of depressiveness lasting two weeks or longer over the past 12 months. While the absence of these symptoms does not necessarily indicate high levels of mental well-being, measurable characteristics make it possible to assess young people’s mental health. The survey has inquired about sadness and depressive symptoms in all participating countries since 2002, which enables Estonian data to be compared with data from other countries. Questions about a two-week period of depressiveness have been featured in the survey since 2006. The comparison period is therefore shorter, and since not all countries have included this question in the survey, this data cannot be used in international comparisons. However, because a period of depressiveness lasting for two weeks or longer indicates a more serious mental health problem, we took this variable as the basis for assessing the relationship between mental health and socioeconomic and lifestyle factors.

During the reference period of 2002–2022, the prevalence of sadness and depressive symptoms in Estonian adolescents was lowest in 2006 and 2010. In those years, less than a quarter of girls and a tenth of boys experienced these feelings more than once a week in the previous six months (Figure 2.2.1). The prevalence of depressive symptoms was the highest for girls in 2022 and for boys in 2002.

As many as 40% of girls and nearly 20% of boys felt sad or depressed more often than once a week during the previous six months.

Based on data from the latest survey, as many as 40% of girls and nearly 20% of boys felt sad or depressed more than once a week during the previous six months.

Figure 2.2.1. Students aged between 11 and 15 who felt sad or depressed more than once a week during the previous six months (%), by gender

Figure 2.2.1
Source: figure by the authors, based on data from six waves of the HBSC survey (2002–2022)

Figure 2.2.2 describes the experience of a period of depressiveness lasting for two weeks or longer during the previous year, for the period of 2006–2022. As with the previous figure, it shows that periods of depressiveness were more frequent in girls than in boys and that there has been an increase in the trend since 2010, regardless of gender. It is difficult to say whether this increase is related to young people perceiving their lives as more problematic or whether they are simply more aware of and attentive to their feelings.

Figure 2.2.2. Students aged between 11 and 15 who experienced a period of depressiveness lasting for two weeks or longer during the past 12 months (%), by gender


#faili sisselugemine ja andmete formaadi korrigeerimine
J222=read.csv("PT2-T2.2-J2.2.2.csv",header=TRUE, encoding ="UTF-8")

  theme(legend.position = "bottom")+
  ylab("Share of young people (%)")+
  theme(text = element_text(color="#668080"),axis.text=element_text(color="#668080"))

Source: figure by the authors, based on data from five waves of the HBSC survey (2006–2022)

Mental health indicators of Estonian adolescents compared with peers in neighbouring countries

Comparing Estonian adolescents with their peers in neighbouring countries revealed that in all the analysed age groups, there were significantly more girls and boys in Estonia who have felt sad and depressed more than once a week than there were in Latvia, Lithuania, Finland or Sweden (Figure 2.2.3). In addition, Estonian scores were significantly higher than the average of the 45 countries participating in the HBSC survey.

Compared with neighbouring countries, Estonia has significantly more adolescents who have felt sad or depressed more often than once a week.

Nevertheless, comparing data from 2018 with those from the previous survey in 2014 revealed that the prevalence of sadness and depressive symptoms among 11-to-15-year-olds has increased in all the countries presented in the figure, regardless of age group and gender (Oja et al. 2019). The figure also shows that the occurrence of sadness and depressive symptoms increased with age; among girls, it almost doubled between the ages of 11 and 15.

Figure 2.2.3. Students aged between 11 and 15 who felt sad or depressed more than once a week during the last six months (%) by gender, age, the average of the countries neighbouring Estonia and those participating in the HBSC survey