Mental ill-health in contemporary young adults

Sammanfattning: Young adulthood is the peak age for the onset of most mental disorders and is a period of crucial importance for the establishment of emotional well-being in adult life. Mental health problems, including psychological distress and depressive symptoms, as well as suicide attempts, are reported to be increasing among young people, especially females, in many Western countries. Thus, the overall purpose of this thesis is to examine trends and causes of mental ill-health in contemporary young adults, with a focus on gender differences. In Study I, we investigated recent time trends in several indicators of mental ill-health, and the patterning of these indicators between genders and younger vs. older individuals in Stockholm County, Sweden during 1997-2006. Self-reported anxiety and psychiatric service use increased among young individuals of both genders, while attempted suicides increased only among young women. By contrast, these indicators decreased or remained stable in the older age group from year 2001 and onwards. In Study II, we studied the association between social position and the risk for different severity levels of psychological distress, as well as depression in the Stockholm Public Health cohort. We found that the socioeconomic gradient for clinical depression is more pronounced than that for distress. Low income is associated with the risk of distress and the association is stronger for severe distress. Depression is markedly linked with occupational class in men and with family income in women, and this is especially true among younger individuals. In Study III, we explored the relationships between a number of possible causes and subsequent psychological distress as well as suicide attempts, immigrant status, age at transition into adult life (as reflected by employment status, age at becoming a parent and housing tenure), social adversity (including unemployment and financial strain), in a large population-based sample of young adults, with a focus on possible gender differences. We found that immigration from outside Europe and social adversity are associated with mental health problems in young adults, especially females. Postponed transition into adulthood furthermore appears to be associated with poor mental health in young women. In Study IV, we examined the relationship between poor school performance and selfreported suicide attempts in a large sample of young adults, and the extent to which this is explained by adult health behaviours or social conditions. We also examined the potential modifying role of previous suicidal thoughts. We found that poor school performance is a strong predictor of future suicide attempts in young adults, and that this relationship appears to be strongest in individuals without a history of suicidal thoughts. Furthermore, adult socioeconomic factors and health behaviours do not seem to explain the association. Instead, other factors linked with poor school performance, such as poor coping, may explain the relationship. In conclusion, our findings indicate a rising, and highly prevalent, mental ill-health among the young in Stockholm and underscore the importance of social factors, such as social position, social adversity, immigration, age at transition to adulthood, and school performance in the causation of mental ill-health in contemporary young adults.