'Alarming' Worldwide Decline in Mental Health

Batya Swift Yasgur, MA, LSW

March 15, 2022

A large global report shows a decline in mental health worldwide, with the poorest outcomes reported in young adults.

The Mental Health Million Project of Sapien Labs issued its second report, published online March 15, encompassing 34 countries and over 220,000 internet-enabled adults. It found a continued decline in mental health in all age groups and genders, with English-speaking countries having the lowest mental well-being.

The decline was significantly correlated with the stringency of COVID-19 lockdown measures in each country and was directionally correlated to the cases and deaths per million.

The youngest age group (18–24 years) reported the poorest mental well-being, with better mental health scores rising in every successively older age group.

"Some of our findings, especially regarding mental health in young adults, are alarming," Tara Thiagarajan, PhD, Sapien Labs founder and chief scientist, told Medscape Medical News.

"Our data, which are continually updated in real time, are freely available for nonprofit, noncommercial use and research, and we hope that researchers will get involved in an interdisciplinary way that spans sociology, economics, psychiatry, and other fields," she said.

Pioneering Research

Thiagarajan and her team pioneered the Mental Health Million project, an ongoing research initiative utilizing a "free and anonymous assessment tool," the Mental Health Quotient (MHQ), which "encompasses a comprehensive view of our emotional, social, and cognitive function and capability."

The MHQ consists of 47 "elements of mental well-being," with scores ranging from -100 to +200. (Negative scores indicate poorer mental well-being.) The MHQ categorizes respondents as "clinical, at-risk, enduring, managing, succeeding, and thriving" and computes scores on the basis of six broad dimensions of mental health: core cognition, complex cognition, mood and outlook, drive and motivation, social self, and mind-body connection.

As reported by Medscape Medical News, Sapien Lab's first Mental Health State of the World report (n = 49,000 adults) was conducted in eight English-speaking countries in 2020. Participants were compared to a smaller sample of people from the same countries polled in 2019.

In this year's report, "we expanded quite substantially," Thiagarajan said. The project added Spanish, French, and Arabic and recruited participants from 34 countries on six continents (n = 223,087) via advertising on Google and Facebook.

Region/language (n) Country
Core anglosphere (70,025) United States
United Kingdom
New Zealand
Latin America (60,989) Argentina
Puerto Rico
Middle East (7434) Saudi Arabia
United Arab Emirates
French and Spanish-speaking mainland Europe (13,527) Spain
West Africa (11,942) Cameroon
Cote d'Ivoire
Democratic Republic of the Congo
North Africa (19,750) Algeria
Countries not aggregated into any region (39,423) South Africa


Respondents spanned all age groups equally, while the gender split was 58% female, 41% male, and 1% nonbinary/third gender.

Economic Prosperity Not Protective

Across the eight English-speaking countries, there was a decline in mental well-being of 3% from 2020 to 2021, which was smaller than the 8% decline from 2019 to 2020. The percentage of people who were "distressed or struggling" increased from 26% to 30% in 2021.

"Now that a lot of pandemic issue seems to be easing up, I hope we'll see mental well-being coming back up, but at least it's a smaller decline than we saw between 2019 and 2020," said Thiagarajan.

The decline across countries from 2019–2021 was significantly correlated with the stringency of governmental COVID-19-related measures (based on the Oxford COVID-19 Government Response Tracker, 2022; r = .54) and directionally correlated to the cases and deaths per million.

In total, 30% of respondents in English-speaking countries had mental well-being scores in the "distressed" or "struggling" range — higher than the Middle Eastern countries, North Africa, Latin America, and Europe (23%, 23%, 24%, and 18%, respectively).

Only 36% of participants in the English-speaking countries, the Middle East, and North Africa reported "thriving or succeeding," vs 45% and 46% in Latin America and Europe, respectively. Venezuela topped the list with an average MHQ of 91, while the UK and South Africa had the lowest scores, at 46 each.

Mental well-being was slightly higher in males than in females but was dramatically lower in nonbinary/third gender respondents. In fact, those identifying as non-binary/third gender had the lowest mental well-being of any group.

Across all countries and languages, higher education was associated with better mental well-being. Employment was also associated with superior mental well-being, compared with being unemployed — particularly in core English-speaking countries.

However, "country indicators of economic prosperity were negatively correlated with mental well-being, particularly for young adults and males, belying the commonly held belief that national economic prosperity translates into greater mental well-being," said Thiagarajan.

"Stark" Contrast

The most dramatic finding was the difference in mental well-being between younger and older adults, which was two- to threefold larger than differences in other dimensions (eg, age, gender, employment). Even the maximum difference between countries overall (15%) was still smaller than the generational gap within any region.

While only 7% (6% to 9%) of participants aged ≥65 years were "distressed and struggling" with their mental well-being to a "clinical" extent, 44% (38% to 50%) of those aged 18–24 years reported mental well-being scores in the "distressed or struggling" range — representing a "growing gap between generations that, while present prior to the COVID-19 pandemic, has since been exacerbated," the authors state.

With every successive decrement in age group, mental well-being "plummeted," Thiagarajan said. She noted that research conducted prior to 2010 in several regions of the world showed that young adults typically had the highest well-being. "Our findings stand in stark contrast to these previous patterns."

The relationship between lockdown stringency and poorer mental health could be play a role. "The impact of social isolation may be most strongly felt in younger people," she said.

Internet a Culprit?

"Within almost every region, scores for cognition and Drive & Motivation were highest while Mood and Outlook and Social Self were the lowest," the authors report.

The aggregate percentage of respondents who reported being "distressed or struggling" in the various MHQ dimensions is shown in the following table.

Social self 30%
Mood and outlook 27%
Drive and motivation 17%
Cognition 18%


In particular, English-speaking countries scored lowest on the social self scale.

The sense of social self is "how you see yourself with respect to others, how relate to others and the ability to form strong, stable relationships and maintain them with other people," said Thiagarajan.

Internet use might account for the "massive" difference between the youngest and the oldest generations, she suggested. "Following 2010, mobile phone penetration picked up and rose rapidly...mobile phones took over the world."

Time spent on the internet — an estimated 7–10 hours per day — "eats into the time people in older generations used in building the social self. Kids who grow up on the internet are losing thousands of hours in social interactions, which is challenging their ability to form relationships, how they see themselves, and how they fit into the social fabric," Thiagarajan added

Sedentary Time

Commenting for Medscape Medical News, Bernardo Ng, MD, a member of the American Psychiatric Association's Council on International Psychiatry and Global Health and medical director of Sun Valley Research Center, Inc, Imperial, California, called the report "interesting, with an impressive sample size" and an "impressive geographic distribution."

Ng, who was not involved in the report, said, "I did not think the impact of internet use on mental health was as dramatic before looking at this report.

"On the other hand, I have personally been interested in the impact of sedentarism in mental health — not only emotionally but also biologically. Sedentarism, which is directly related to screen use time, produces inflammation that worsens brain function."

Also commenting for Medscape Medical News, Ken Duckworth, MD, chief medical officer of the National Alliance of Mental Illness, called the survey "extremely well timed and creative, although it only looked at internet-enabled populations, so one cannot make too many overall pronouncements, because a lot of people don't have access to the internet."

The data regarding young people are particularly powerful. "The idea that young people are having a decrease in their experience of mental health across the world is something I haven't seen before."

Duckworth suggested the reason might "have to do with the impact of the COVID lockdown on normal development that young people go through, while older people don't struggle with these developmental challenges in the same way."

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