There is an unprecedented epidemic of depression and anxiety among young people.

Introduction

From 1990 to 2017, the number of cases of depression and anxiety increased by 49.86% (Liu et al., 2020). Yet contemporary treatments for youth depression and anxiety, like antidepressants and CBT (cognitive behavior therapy), show only short-term efficacy and a high relapse rate, suggesting that alternative treatments will need to be found. This renders the problem unsolvable in the short term. What we can do is mitigate this through changes to the environment, in particular by focusing on key relationships with parents and at school. This begins with maternal health during pregnancy, and extends into the academic sphere, socio-economic considerations, and lifestyle habits. While interventions targeting parents and schools are crucial, they represent just the most important target for a range of solutions. A significant challenge lies in the influence of modernity and technological advancements on mental health disorders. Although changing these factors is difficult, there are ways to mitigate their impact through regulation.

Existing solutions

Although current treatments for depression and anxiety have shown some success in alleviating symptoms in the short term, their long-term effectiveness and sustainability are limited. Antidepressant medications have not resulted in a significant reduction in depression rates among the general population since the 1980s, despite increased spending on mental health care and treatment (Ormel et al., 2020). Further targeted studies have found that, in contrast with adults, young people with depression exhibit only modest improvements in their symptoms when treated with new-generation antidepressants (Hetrick et al. 2012). The use of these medications may even be associated with increased depression severity and consequently poorer neurocognitive functioning.

Cognitive Behavioral Therapy (CBT), which typically involves extended one on one talk therapy with a psychiatrist, aimed at modifying dysfunctional thinking and behavior, has demonstrated considerable success in alleviating major depressive disorder and anxiety. It has even been associated with lower relapse rates than other treatments. However, CBT cannot yet be rigorously characterized as a definitively curative treatment. Research conducted by Kennard et al. (2008) found that relapse rates ranged from 30% to 40% within 1 to 2 years after acute treatment for depression, demonstrating that while CBT is effective in the short term, its long-term efficacy in preventing relapse is uncertain. In addition, the study acknowledged that residual symptoms are common in adolescents successfully treated for depression. Thus, CBT, as one of the current treatments, necessitates ongoing support and possibly supplementary interventions to sustain long-term remission.

Key Targets for Interventions

If the current mainstream treatment solutions have limited efficacy in combating anxiety and depression, then we have to shift our effort elsewhere - to the environment. The impact of children’s environment on their mental health begins with the perinatal mental and physical health of their mother during pregnancy, as this can significantly impact children’s well-being.

Brannigan et al (2022) conducted a longitudinal birth cohort study using ordered logistic regressions to analyze the association between prenatal smoking and later offspring psychiatric disorders. The study concluded that smoking more than five cigarettes daily during pregnancy impacted not just physical development but also increased the risk of offspring developing personality disorders as well as various Axis I psychiatric disorders, including mood, anxiety, and psychotic disorders.

Infants and young children of perinatally depressed mothers are also more likely to have a difficult temperament, as well as cognitive and emotional delays (Muzik et al, 2021). In fact, researchers have been exploring treatments to address maternal health issues and their impact on children. A study demonstrated a significant 11% reduction rate in children’s depression after three months of medication for mothers (Weissman et al., 2006) Therefore, it is evident that proper maternal health care can effectively decrease newborn depression rates.

The influence of a parent on their child is significant both prior to and post-birth. Children are shaped by various parental influences, including their parents' values, nurturing styles, and dedication to care. As children enter the education system, for instance, in the face of increasing competition in modern society, parents inevitably impose high expectations and standards on their children to excel academically and in extracurricular activities. This combination of external expectations and academic pressures is strongly associated with socially prescribed perfectionism, defined as the pressure to be perfect imposed by others (Hewitt and Flett, 1991). This study demonstrates that socially prescribed perfectionism has a positive correlation to concurrent suicidal potential in student and psychiatric samples. Hence, it is urgent for parents to consider their potential impact on their children and for governments to increase provision of parental education to build and maintain a healthy parent-child relationship, thereby mitigating the risk of depression and anxiety.

Most young individuals' lives are divided between home and school environments, making it imperative that they receive positive influences from both parents and schools individually, as well as through an amalgam of parental and academic efforts. Some studies indicated that school-based interventions combined with parental support and involvement could significantly impact children's mental well-being. One notable study investigated the impact of the Family Check-Up (FCU) and linked intervention services on reducing health-risk behaviors and promoting social adaptation among middle school youth. The FCU, a brief three-session program, addressed problematic parenting practices through an initial interview, a brief assessment, and a feedback session. The experiment found that families who engaged in the intervention had youth who reported lower rates of antisocial behavior and substance use over time (Stormshak et al., 2011). These results demonstrate that proactive efforts by families committed to supporting their children can yield successful outcomes. This reduction in harmful behavior is a clear indicator of the positive impact of combined efforts from both the school and parents on reducing mental distress, as physical behaviors are often indicative of internal thoughts and feelings. The challenge for parents is often to find the time to participate in their children’s school, which requires governments to offer supportive childcare policies.

While Stormshak et al. 's (2011) study demonstrated the efficacy of short term interventions, Vitaro et al. (in Shucksmith et al. 2010) found similar results from a long-term study. They followed the academic and social trajectory of kindergarten boys from disadvantaged urban areas, with disruptive behavior through their teenage years. Their initial findings showed no teacher-reported differences, but long-term follow-ups revealed that treated boys were more likely to stay in regular classrooms and exhibit fewer delinquent behaviors from ages 10 to 15.

It should be noted that these interventions are not only contingent upon parental involvement and school-based intervention but also deeply intertwined with the complex economic conditions prevailing in a given country. School-based humanistic counseling in the UK costs are estimated at £300 to £400 per pupil (Cooper et al., 2021), rendering such interventions impractical and ineffective for many countries due to financial constraints. Moreover, a carefully crafted school-based intervention in Santiago, Chile, failed to decrease depressive symptoms among socioeconomically disadvantaged adolescents (Araya et al.). Their study suggests that other environmental factors, such as poverty, might play a more significant role in the mental health of adolescents.

Perhaps our contemporary values are themselves the issue, as young people nowadays shift their goals from intrinsic to extrinsic pursuits, such as the pursuit of money, status, and appearance. This shift makes wealth an even more urgent and insatiable drive among young people (Twenge et al., 2010). Consequently, this leaves young people suffering from isolation and a sense of unfulfillment, as their self-worth becomes increasingly tied to external validation rather than genuine connections and personal achievements. All of these factors suggest that while these interventions are largely successful, there is still a bottleneck in terms of accessibility of resources and finances to make this possible. Therefore, the long-term success of these programs is contingent on a larger socio-economic structural modification.

The reality of these programs is that they do not exist in a vacuum; addressing deficiencies in social and economic issues cannot be achieved immediately. Therefore, while paying attention to both, it is crucial to place more emphasis on developing strategies for mitigation and prevention within the current socioeconomic context.

Mitigation and Prevention- Health and Lifestyle Changes

Young people spend almost a third of their lives in front of screens. Technology has redirected young individuals' understanding of society and themselves, enabling communication without physical presence, access to shared information through social media, and entertainment via online mediums. Technology has transformed our modern lifestyle into one of extended periods of sedentary behavior in education, profession, and leisure, which exacerbates physical inactivity (Hidaka, 2012). Most of our lives are now spent sitting down.

Research indicates that physical exercise correlates with a reduced risk of depression, while sedentary behavior is associated with a higher risk among the general population (Teychenne et al., 2010). Additionally, exercise exhibits a dose-dependent effect, where increased physical activity correlates with greater benefits (Dunn et al., 2005).

Modern diets often include ultra-processed foods (UPF), which are energy-dense, low in fiber, and high in saturated fat, salt, and sugar. These nutritionally unbalanced products are proven to contribute to the incidence of obesity and cardiometabolic diseases (Mambrini et al., 2023). Obese individuals have a 55% higher likelihood of developing depression compared to those with normal weight during follow-up, while those experiencing depression were 58% more prone to obesity than those without depression (Luppino et al., 2010). Hence, mitigating the risk of depression necessitates prioritizing the construction of a healthy and nutritious diet for young people, especially since they are still in critical stages of both physical and mental development.

A comprehensive longitudinal investigation highlighted the protective effect of adherence to the Mediterranean diet against the incidence of self-reported depression (Sánchez-Villegas et al., 2009). Additionally, suboptimal levels of specific micronutrients commonly deficient in the

Western dietary pattern may impact depression among the broader populace. Evidence supports the role of folate in both the prevention and management of depression (Alpert and Fava, 1997; Bodnar and Wisner, 2005). Therefore, enhancing the intake of micronutrients is essential in formulating a balanced diet aimed at curbing the incidence of obesity and, consequently, depression and anxiety.

Solutions for fostering a healthier lifestyle could begin with providing healthier school meals, including making breakfast available and subsidizing fresh fruits and vegetables, ensuring that children receive the necessary nutrients for physical and mental development (Guzek et al., 2020). Implementing mandatory afternoon sports activities would enhance physical activity, help alleviate stress for students, and reduce the negative effects of prolonged sitting and studying. Additionally, governments might follow the incentive structures of insurers, who provide discounts for families that are physically active together.

Thus, by promoting a healthier lifestyle through increased physical activity in schools and encouraging family-based activities, along with improved dietary habits regulated by parents and schools, children can naturally develop a robust mental health foundation. This, in turn, equips them to critically navigate challenges in the modern era of technology.

Conclusion

Contemporary treatments for depression and anxiety in young people, such as medication and cognitive-behavioral therapy, have limited long-term efficacy. There are targeted interventions we can make to better support parents, ultimately mitigating their children's risk of depression and anxiety, as well as through regulation using school-based programs. However, these interventions face broader challenges which are the product of economic societal and cultural issues inherent in the modern society we live in.

To effectively combat depression and anxiety, it is imperative to go beyond these approaches and focus on prevention within our current societal framework. By tackling the root causes exacerbated by technology under proper regulation and guidance by parents and schools, we can effectively mitigate the prevalence of depression and anxiety among young individuals.