The Gen-Z Mental Health Crisis.

Essays | Konor Nichols | September 16th, 2024.

The US is undergoing what 90% of Americans are claiming to be "a mental health crisis," according to a survey by the Kaiser Family Foundation (KFF), an independent health policy research organization. Despite mental health issues sweeping the nation broadly, the effect is far more pronounced in younger generations. According to Sophie Bethune, Director of Public Relations at the American Psychological Association, 37% of Gen-Zers, 35% of Millenials, 26% of Gen-Xers, 22% of Baby Boomers, and 15% of older generations "reported they received treatment or therapy from a psychologist or other mental health professional," demonstrating a significant mental health disparity, which was only aggravated by the onset of the Covid-19 pandemic. Karel Kostev, Scientific Principal for Epidemiology Research at IQVIA, a provider of biopharmaceutical development, explains that the "prevalence of mental health problems increased from 18% before the COVID-19 pandemic to 30% during the crisis" (874). Because those suffering from mental health issues are disproportionately members of young and, consequently, vulnerable demographics, it is imperative to pose the following question: how should the US healthcare system address the growing rates of anxiety disorders in Gen-Z? When considering the causes of this problem, it is apparent that although mental health issues are primarily unavoidable given their dependency on evolution, mental development, and the social and economic climate, the mental health crisis among Gen-Z in the US should be addressed through the reformation of the current methods of diagnosis and treatment.

Mental health disorders are complex to prevent because of their origins. Although the rate of mental health and anxiety issues has noticeably grown in recent years, the prevalence of such phenomena is deeply rooted in evolution. According to Liana Zanette, Professor of Biology at Western University, and her colleagues in the Zannete Lab, psychological adaptation can be linked to Darwinism, survival of the fittest. They explain that PTSD is simply the manifestation of "retaining a powerful enduring memory of a life-threatening predator encounter," which is "clearly evolutionarily beneficial if it helps the individual avoid such events in the future" (Zannete 32). Although Zannette illustrates how mental health issues, such as PTSD, may arise for survival purposes within a zoological context, there are also many applications to human psychology. Chet Sharewood, Biological Anthropologist and Neuroscientist, distinguishes the psychology of animals, as illustrated by Zannete, from that of humans, whom she claims to have "unique brain development, structure, and function," as opposed to animals and humans' evolutionary predecessors (79). Trino Baptista and Elis Aldana, Professor and Principal Investigator, respectively, at the University of the Andes Medical School, and Serge Beaulieu, Professor of Psychiatry at McGill University, concur, adding that the human mind has not evolved past humans from the Pleistocene period and now "we, like them, are adapted to that environment," meaning that humans are still wired to operate in an ancient context (22). Therefore, Baptista and Aldana propose that this evolutionary stagnation "leads to conflict that promotes psychopathology" (22). Because of the innate and unpreventable relationship between biology and mental health, a solution that targets reducing the rate of mental health would be complicated, if not impossible, to achieve, not only for Gen-Z Americans but for all human beings. Although this relationship accounts for the origins of mental health disorders, such as anxiety, it does not account for the overwhelming increase of anxiety disorders in younger people, particularly members of Gen-Z, as established by Bethune. Therefore, the causes of Gen-Z's soaring mental health issues, specifically, should be considered to identify what makes Gen-Z's mental health distinct from other generations. 

Gen-Z's high rate of anxiety is the result of their interaction with a stressful economic and social environment at a young age. Greta Bushnell, Assistant Professor in the Department of Epidemiology and Biostatistics at Rutgers School of Public Health, explains that "anxiety disorders are prevalent, typically onset during childhood, and often precede other psychiatric conditions," meaning that there is an innate tendency for younger people to experience anxiety disproportionately due to their developmental stage (529). However, an immature mental stage is experienced by all generations at some point during their life cycle, making this trait non-unique to Gen-Z. However, Sylvia Burwell Mathews, former United States Secretary of Health and Human Services, disagrees, acknowledging the hardships uniquely plaguing today's youth by addressing the abundance of mass shootings, dismal state of the economy, overly competitive job market, and exposure to social media (152). Although these historically prevalent social and economic issues have been commonplace in some capacity for other generations, social media is uniquely characteristic of Gen-Z's childhood. Despite Burwell citing social media usage as one of the causes of high anxiety, Kyun Eun Lee, Postdoctoral Research Associate of Boston University's School of Public Health, and her colleagues disagree to an extent regarding exposure to social media as a cause of this issue. In their study, they investigate Gen-Z's unique trait of smartphone dependency and its relationship to anxiety among students in South Korea, finding that "With each one-point increase in smartphone dependency score, the odds of having abnormal anxiety in men and women increased by 10.6% and 9.2%, respectively," demonstrating that smartphone usage may serve as an environmental aggravator of anxiety rather than a cause (414). Thus, the intersection of Gen-Z's fragile developmental stage due to their young age and the increase in stressors both socially and economically are responsible for the disproportionate rise of anxiety in this demographic, rather than their age or the climate they grew up in alone. However, given that anxiety can be linked to psychological evolution, mental development, and the social and economic state of the world, none of which are realistically controllable, optimizing the diagnosis and treatment of patients should be considered.

The current ways that patients are diagnosed are flawed, leading to improper treatment later on in the patient's treatment journey. Worldwide, there are two main methods of diagnosing: the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM). Darrel Regier, Senior Scientist at the Center for the Study of Traumatic Stress, explains the DSM III's creation as a "descriptive approach that classified disorders based on observable symptoms, physical signs, and clinical course" was meant to improve on the originally used ICD criteria (268). Since then, the DSM has undergone several iterations, the most updated being the DSM-5, which has been criticized by some experts, such as Gordon Parker and Ian Hickie, Professor of Psychiatry at the University of New South Wales and Co-Director of Health and Policy at The University of Sydney's Brain and Mind Centre, respectively, as overly inclusive and risking over-diagnosing patients (328). They assert that under the current diagnostic criteria, normal human behavior, such as "normal grief, family conflict, and occupational concerns," is being medicalized and treated, even though it is unnecessary (328). Therefore, the flaws in current diagnostic manuals are of significant concern. Jerome Wakefield, professor of social work at NYU, concurs, further echoing this concern over the DSM-5,  examining the detrimental effects of basing treatment on a faulty diagnosis, stating that treatments stemming from an improper diagnosis are "likely to include unnecessarily risky and intrusive forms of medical intervention, such as medication with potentially negative side effects," thus establishing the high level of concern regarding the DSM (67). However, Alba Vilaplana-Pérez, Doctor of  Clinical Psychology and Psychotherapy, disagrees, instead citing the ICD as causing diagnostic issues. Vilaplana-Pérez illustrates this by investigating the Swedish National Patient Register, which uses the ICD. Ultimately, she found that only "81%... were deemed as 'true positive' cases," thus demonstrating that the ICD, in addition to the DSM, is flawed (7). Although the ICD and DSM may lead to overdiagnosing patients, Stacy Carter, Professor of Empirical Ethics in Health, argues that there are practical benefits to having overdiagnosis as an issue. Carter recognizes that the act of granting a diagnosis leads to "reduced stigma,...improved physical health outcomes, … and wider public understanding of the risks and benefits of coming forward for care" (329). Thus, the current flaws in diagnoses, despite their immediate adverse effects on patient outcomes, have the tangential effect of improving the social climate surrounding mental health. However, it is more probable that the ICD and the newer iterations of the DSM may be increasingly driving rates of anxiety disorders upward in the US as a whole, not only skewing data on anxiety but, more importantly, introducing patients to potentially dangerous treatment. Therefore, changing the diagnostic criteria would facilitate more accurate diagnoses and, consequently, safer treatment options.

It is unreasonable to assume that any solution will completely solve the mental health crisis, let alone the unique and multi-faceted one plaguing Gen-Z. Thus, ensuring that effective treatment options are available to Gen-Z is vital for the US healthcare system to address their growing rates of anxiety. One proposed solution is to implement support and treatment options in schools. Some proponents of this are Howard Adelman and Linda Taylor, Co-directors of the School Mental Health Project at UCLA, who advocate for the address of mental health within schools, as it can directly provide a link to many affected Gen-Zers due to the large volume of Gen-Zers enrolled in educational institutions. By instating such programs, Gen-Z would be assured access to treatment. However, Burwell limits this solution, explaining that Universities are currently struggling to produce an adequate supply of healthcare professionals for the large number of students seeking help, where "34 percent of college counseling centers had to put some students on a waitlist," thus hindering the potential success of increasing mental healthcare access points for Gen-Z (155). Therefore, creating broad access to mental health counseling on college campuses for suffering Gen-Zers would best target the Gen-Z demographic. In doing so, the US Healthcare system could ensure that healthcare professionals can treat a large volume of Gen-Zers. However, this effect would be limited by universities' current supply-demand issues. Moreover, this solution would best target Gen-Z students but does not include the problems with faulty diagnoses and their subsequent treatments. Therefore, a solution that reforms how the US healthcare system makes diagnoses should be considered.

Current methods of mental health diagnosis, such as the DSM and ICD, are flawed, yet they are the most widely used; thus, identifying other methods of diagnosis should be considered. One promising option is the National Institute of Mental Health's (NIMH) Research Domain Criteria (RDoC). According to Bruce Cuthbert, coordinator for the RDoC, the RDoC promotes considering treatment of a specific internal issue rather than being based on treating the diagnosis, which, according to Brett Thombs, Professor in the Faculty of Medicine at McGill University, "are based primarily on expert consensus rather than evidence of benefit to patients who receive diagnoses" a vital distinction between the RDoC and the current DSM and ICD guides (200). However, the RDoC is entirely research-based and not used in clinical settings, making it challenging to function individually. Therefore, Regier argues for the cooperation of the DSM, the most widely used and accepted diagnostic system in the United States, and the RDoC. Similarly, Jonathan Gornall, a freelance British journalist, agrees and advocates that the RDoC itself is not the solution. Instead, Gornall argues that it should be used to change future iterations of the DSM by incorporating the RDoC's research findings "into future DSM editions to further strengthen patient care" (20). Therefore, supporting the NIMH's pursuit of the RDoC would have a significant impact on the way that mental health professionals diagnose patients in terms of scope because the DSM is already widely used. However, the magnitude of this change is also limited because it relies on the already flawed DSM. Although the usage of the RDoC may be inhibited because of its inability to be used independently due to its clinical status, its gradual influence on the DSM can facilitate broad changes to how patients are diagnosed and subsequently treated. However, they would be unable to provide a specialized solution to Gen-Z, who are suffering the most.

Their respective limitations hinder both of the proposed solutions. However, they each have implications that would improve different aspects of the Gen-Z mental health crisis. While instating better access to treatment on college campuses will best ensure that Gen-Z has access to treatment, adopting the RDoC will improve the level of treatment that patients receive later on. Thus, both of these solutions should be adopted so that the US healthcare system can be well-equipped to fight the rising rates of anxiety disorders in Gen-Z. Despite the inevitability of anxiety disorders because of mental health's dependence on evolutionary, developmental, and environmental factors, reformations to the current ways in which the US healthcare system diagnoses and treats such issues can have a significant impact on the outcomes of these patients. Therefore, by instating the RDoC, the already widely accepted methods of diagnosis can undergo gradual reforms and further be implemented into school treatment options, providing the best treatment options directly to Gen-Zers, hence best combating the growing rates of anxiety disorders in Gen-Z.