Child and Adolescent Mental Health Outcomes Are Declining Despite Continued Improvements in Well-being Indicators

Recent trends in child and adolescent mental health are dramatic and worrying to researchers, policymakers, and advocates. Although the COVID-19 pandemic brought a greater sense of urgency to the issue, the roots of this problem go back more than a decade, with worrying trends in depressive and anxiety symptoms—as well as suicide—beginning around 2010.

To directly address this issue, Congress and the Biden administration have proposed a broad set of policy responses. While most of these actions focus on expanding access to, and affordability of, mental health services, others have called for complementary policies that focus on improving a set of social indicators thought to correspond with improved mental health and well-being, such as raising high school graduation rates, decreasing adolescent substance use, and reducing food insecurity.

However, our recent research published in The Milbank Quarterly argues that policies that focus on improving these social indicators, while important, may not be as effective at addressing young peoples’ mental health as has been the case historically. This brief summarizes our findings, which show an apparent contradiction between the direction of social indicators and mental health outcomes. We posit that improved population-level monitoring of mental health—especially through better data collection—is a vital first step toward explaining the divergence between social indicators and mental health outcomes.


Our analysis in The Milbank Quarterly assesses available information on population-level mental health and well-being outcomes for young people in the United States and explores potential reasons why social indicators may be moving in the opposite direction. Here are some of our findings:

Child and adolescent mental health has declined even as social indicators of well-being improved.

Over the past decade, social indicators of well-being have continued to improve, even as indicators of depression, anxiety, and suicide have worsened. This pattern is most clearly illustrated by what researchers call “composite indices” of child and adolescent well-being, which summarize complex statistics on social indicators in a single number. While improvements in these measures are an important positive trend, it is concerning that direct measures of mental health outcomes have worsened over the same time span. Figure 1 below presents an overlay of one of these composite indices, the Child and Adolescent Thriving Index 1.0, with a summary measure of depressive symptoms taken from four questions fielded by the Monitoring the Future (MTF) Study (coded such that higher values correspond to a better outcome; see figure note for more information). A similar disjuncture is found when comparing an index based on the Annie E. Casey Foundation’s KIDS COUNT measures to other measures of mental health.

Figure 1: While indicators of child and adolescent thriving have improved, mental health has declined

Overlay of mental health measures and composite index scores


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