That figure is nearly twice as high as in 1990, but adjusted for population growth, it represents an increase of 24% since then. Mental disorders are now the leading cause of disability, accounting for more than 17% of all time people spend living with a disability worldwide, according to the study.
Looking at these numbers, researchers and journals such as The Lancet Public Health speak of a public health crisis. And Europe seems to be doing worse than much of the rest of the world: the so-called “disease burden” – the burden that mental disorders have on society – is well above average in Western European countries. In a 2023 Eurobarometer survey, almost half of EU citizens reported emotional or psychosocial problems such as feeling depressed or anxious.
Besides worse health overall, the disease burden also means higher healthcare costs and lost productivity. Anxiety and depression alone cost the world about one trillion USD each year, according to WHO estimates.
The new GBD study confirms this. The researchers looked at the number of years people “lose” because a mental disorder impairs or shortens their lives. Some of the highest rates of these lost years were found in Western European countries. The Netherlands, for example, topped the list in 2023 with about 3,555 lost years per 100,000 people – more than 2.5 times the amount of the country with the lowest burden, Vietnam, where about 1,300 years per 100,000 people were lost.
And those numbers only consider people with diagnosable disorders, which many people struggling with mental health problems don't have.
The mental health paradox
So what's going on? Is Europe really more depressed and anxious than the rest of the world? And why?
Damian Santomauro, lead author of the GBD study, speaks of a kind of paradox. “In high-income countries, there is often a higher prevalence of mental disorders than in low- or middle-income countries,” he told us.
At first glance, that may seem counterintuitive. Europeans are relatively rich, have good healthcare, and low crime numbers. These and many other factors are generally expected to contribute to high general wellbeing.
Yet explaining mental health trends is complicated. There are many moving parts and influencing factors, and hard evidence can be difficult to collect, Santomauro explained.
“Several factors can reinforce each other,” Erik Giltay, psychiatrist and professor of psychiatric epidemiology at Leiden University, told us. “Together, they can have a stronger effect on mental health than one factor by itself.”
But looking at the cocktail of trends that could potentially cause global health problems to rise, it seems like most are not specific to Europe.
Lifestyle, for example, is an important one, according to Giltay. Poor diets, insufficient sleep, and a lack of physical exercise are linked to depression. Indeed, obesity rates in Europe are rising due to unhealthy diets and less physical exercise and many Europeans report sleep problems. This could go some way in explaining the higher rate of mental health problems, but, globally most other regions also see an increase in obesity. So it's not what sets Europe apart.
Socioeconomic trends in recent decades have influenced our health as well, Kadri Soova, director of Mental Health Europe, told us. “There's more economic insecurity, we have housing pressures, and there's been several rounds of austerity in Europe. All of this contributes to more anxiety, depression, and psychological distress.” But again, that is hardly just a European story: economic insecurity is rising globally.
Many phones, not much hope
One group that might offer clues to what's happening is adolescents, the group that experiences the highest mental health burden globally, mainly in the form of anxiety and depression.
Social media could play a role in this, as problematic use is associated with lower mental and social well-being. Santomauro thinks social media could contribute to more loneliness and fewer social interactions in real life, which can increase the risk of mental problems.
“We see that different risk factors for disorders increased for the generation that grew up with social media,” Giltay said. For example, children can't experiment socially in the real world as much anymore, and increasingly do so online instead. On the other hand, (moderate) social media use can at times do the opposite, creating connection to peers and offering the opportunity to support each other.
Worrying about the future is another reason why distress is growing among young people. The climate crisis causes anxiety and distress, especially among youth. We also live in a time of many armed conflicts – the highest amount since World War II. Conflict causes trauma and stress, but exposure to news about war can be linked to greater anxiety or intrusive thoughts, even among those not directly affected.
“If I were 16 now, I'd wonder if I'd have to go to war in four years, whether the job I want will still exist after I finish my degree, or if I can ever buy a house,” Santomauro said. “How can the young generation have any hope? Not having hope is a precursor to depression and anxiety.”
But again, this isn't unique to Europe. So why do studies show that the number of healthy years lost to depression is growing especially fast among young people in countries like Norway, Switzerland, Germany, and other countries that score highly on well-being and quality of life? The researchers argue in BMC Psychiatry that this may partially be related to detection: these countries may have greater awareness, better access to mental health care, and therefore more diagnoses.
Does Europe only look worse?
Perhaps part of the explanation for Europe's higher rate of mental health problems can be found in the fact that cases are simply detected more often. This could be related to the way surveys capture data, Santomauro theorises.
Surveys are often developed for Western audiences, and not always translated well to other cultures, which can lead to detection problems. Similarly, symptoms are not always expressed the same way across cultures. “In some countries people say ‘I have chest pain’ instead of ‘I'm having a panic attack’, using different words to describe the same symptom. Mental disorders can display differently across populations,” Santomauro said.
Even beyond surveys, the language for emotions seems to be changing. “I often find that young people have started to use the word ‘anxious’ instead of ‘nervous’ or ‘worried’, and ‘depressed’ instead of ‘sad’ or ‘down’,” Santomauro said. If someone is asked whether they've felt depressed in the last year, they may be more likely to say yes, because the word itself has become part of their everyday language.
Stigma may play a role, too. To limit its influence, the researchers avoided using only records of people who sought professional help, as stigma likely makes people less willing to do so. Instead, they used data from surveys in which people could respond privately, though “different cultures are definitely still more or less willing to disclose information.”
“Another simple explanation could be that people simply cannot afford to seek treatment or admit their problems,” Giltay said. “In some countries in Eastern Europe, where GDP is lower on average, we see less sick leave, for example. There is no time to be sick if you can't otherwise afford your bills. In countries like the Netherlands, where we have relatively good policies for this, it might be easier to admit problems and seek help.”
The answer is...
So, is mental health in Europe really the worst? The answer remains complex: our problems are growing because of many trends that aren't necessarily unique to our continent, but we also have a culture and healthcare system that may result in better detection and higher reported rates.
Whether the growing numbers are a crisis or a sign of progress depends on who's answering. Mental Health Europe director Soova doesn't necessarily see it as something negative. “I don't think there's a need for big crisis language. There's definitely some increase in psychological distress, but the numbers also reflect better recognition and reduced stigma. People are willing to seek more help.”
Rather, Soova argues, it exposes limitations of healthcare systems built around medical diagnosis: without one, people often have to pay for support themselves, as insurers typically only reimburse treatment tied to a diagnosis.
“There should be more options in between that are publicly funded. Community-based psychological support, for example. And mental health promotion and prevention should be part of all policies,” she said. “Mental health is about much more than treatment.”