Mixed Signals in Child and Adolescent Mental Health and Well-Being Indicators in the United States: A Call for Improvements to Population Health Monitoring

Child Health Mental health

Policy Points:

  • Social indicators of young peoples’ conditions and circumstances, such as high school graduation, food insecurity, and smoking, are improving even as subjective indicators of mental health and well-being have been worsening. This divergence suggests policies targeting the social indicators may not have improved overall mental health and well-being.
  • There are several plausible reasons for this seeming contradiction. Available data suggest the culpability of one or several common exposures poorly captured by existing social indicators.
  • Resolving this disconnect requires significant investments in population-level data systems to support a more holistic, child-centric, and up-to-date understanding of young people’s lives.

Monitoring population health is one of the 10 essential services of public health.1 Accurate information on current and emerging threats to the public’s health forms the basis for high-quality research, practice, and policy. For this reason, critical appraisal of the measures and data systems tracking the nation’s health is a persistent necessity.

A growing body of research highlights the importance of childhood mental health and well-being over the rest of the lifecourse.2-4 Currently, we use two data streams to examine the extent to which children and adolescents are thriving. The first data stream includes indicators of the specific conditions and circumstances of young people, such as rates of low birthweight, obesity, food insecurity, reading and math proficiency, high school graduation, substance use, and similar factors. In what follows, we will refer to such measures as social indicators, because they are the metrics by which the population benefits of social policy are commonly assessed. The second data stream includes direct measures of mental health and well-being, such as symptoms of depression and anxiety as well as measures of positive mental and emotional health such as life satisfaction and self-esteem. In what follows, we will refer to such measures as subjective indicators of mental health, because they are based on self-reported perceptions, feelings, and experiences.

This essay assesses the available information on population-level mental health and well-being for young people in the United States and explores candidate reasons why the social indicators are moving in the opposite direction from the subjective indicators. Because of the limitations of existing data, we cannot determine for certain what is causing this divergence. Instead, we provide recommendations for how health monitoring can be strengthened to better understand what matters to young people, and design appropriate supports for their thriving.

Open Access


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  4. de Groot S, Veldman K, Amick III BC, Oldehinkel TAJ, Arends I, Bültmann U. Does the timing and duration of mental health problems during childhood and adolescence matter for labour market participation of young adults? J Epidemiol Community Health. 2021; 75(9): 896- 902.

Anderson N, Halfon N, Eisenberg D, Markowitz A, Anderson Moore K, Zimmerman F. Mixed Signals in Child and Adolescent Mental Health and Well-Being Indicators in the United States: A Call for Improvements to Population Health Monitoring. Milbank Q. 2023;101(2):0413.