Three key things I learned about mental health
My two cents for Mental Health Awareness Week
Dear readers,
It’s Mental Health Awareness Week in the United Kingdom and Mental Health Month in the USA. This is a great opportunity for spreading new knowledge about mental health, a highly important yet (still) wildly misunderstood topic.
To mark the occasion, I want to share three surprising insights I learned as a researcher at the Netherlands Institute of Mental Health (Trimbos Institute). These are things I’ve written about before on this platform, and they are all points that I believe to be underestimated in our public debates on mental health, illness, and wellbeing.
I will illustrate each point by linking to a relevant post. Aside from contributing to mental health science communication, I hope this will provide a helpful starting point for recent subscribers to An educated guess. There are over 300 of you now, which is an honor and a privilege. Welcome all!
~ Jeroen
Insight 1. Mental health is not an individual issue—it hinges on the external circumstances of one’s life. We often think of mental illness as a personal problem, to be solved with individual therapy. But overwhelming empirical research—from cross-sectional to quasi-experimental—points to an outsized role for the context in which we live in determining our mental health and wellbeing.
This became clear to me when working as a researcher at the Trimbos Institute. For example, my colleagues running the longitudinal population study “NEMESIS” demonstrated a tight relationship between problematic debts and common mental disorders such as depression and anxiety. My own literature review (in Dutch) showed that there is now considerable international evidence for the causal effects of economic precarity and housing insecurity on common mental illnesses.
This is not all bad news though. It means that much of the burden of mental illness can be resolved by effectively intervening on the structure of the society in which we live. I explored the point in my first post on this platform, uploaded last September:
In a historical moment when earthquakes and floods are more and more frequent, we can be forgiven for applying the same [natural disaster] lens to the mental health crisis. But it is the wrong way to look at the problem. Just as with cardiovascular disease or cancer, much of mental illness is man-made. By emphasizing the treatment of psychological suffering, we risk ignoring what causes it—and how much of it is preventable.
Read on:
Insight 2. A single scapegoat is always misguided. Given the multifaceted relationships between life circumstances and mental health outcomes, it would be misplaced to blame any single factor for trends in the prevalence of mental illness. Much has been written recently about how social media use, in particular among teenagers, may have driven the mental health crisis, fueled by Jonathan Haidt’s recent book The anxious generation. But curbing this single factor is likely to fail as a public health intervention.
In March, I reflected on the problem by analyzing it through four paradigms that span the history of epidemiology. It appears that scapegoating single factors is a rudiment of the ‘chronic disease’ era of epidemiology, where single substances such as carcinogens could account for large numbers of disease cases. This approach doesn’t fit the more complex, interdependent causes of mental illness:
Perhaps because of the dominance of the chronic disease paradigm in the past few decades, researchers like Haidt appear to view social media through this lens. For them, social media use is a risk factor, an exposure, akin to a toxin in the environment or overeating. Under this model, it would make sense that you look for ‘dose-response relationships’ by which an extra hour of social media use each day should cause a proportionally greater risk of mental health problems, and by which such effects ought to be roughly consistent across people. […] But this way of thinking about the problem is fundamentally flawed. Social media aren’t a singular ‘exposure’ akin to smoking or eating fatty foods. Instead, they form a highly complex context that facilitates and shapes a host of other exposures and behaviors. More than a risk factor, social media are an environment—in some ways, even a more important one than the town or city in which we live.
Read on:
Insight 3. Uncertainty may hold a key to understanding how life circumstances shape mental health. As said above, no one factor can account for big trends in population mental health. But perhaps there are unifying principles to how the many contextual drivers such as housing and income affect mental illness.
The unifying principle in which I’m most interested is uncertainty. In my reading, it seems that contextual risk factors for mental illness (e.g. low education, debts, or a lack of social support) all shape the degree to which day-to-day life is unpredictable and volatile. This uncertainty causes adverse life events but also worries and feelings of helplessness, which are hallmarks of the most common mental disorders (anxiety, depression). On the flip side, people who live in better circumstances of life tend to enjoy a great sense of control, with which they reduce uncertainty. It is no surprise, for instance, that wealthier Americans experienced a smaller mental health impact of the COVID-19 pandemic than Americans without many financial assets. Wealth is a protective factor because it allows you to smooth out the volatile payoff structure of daily life and stop bad luck from spiraling out of control.
It turns out that a wealth of research on workplace mental health has already identified uncertainty (as opposed to control) as a main driver of cardiovascular and mental health issues. This holds important clues for understanding mental health at large. Here’s from my recent post on the topic:
Job strain is determined not just by how much you work, but also by how you work, and specifically by how much you’re allowed to choose how you work. If you’re in charge, it’s much easier to handle stressors than if you’re just trying to survive at the whim of your superiors.
Read on:
This week you might hear a lot about how important exercise and diet are for mental wellbeing—and that’s all true, but it’s certainly not the main story. Context matters more, in my view. So I will keep exploring the link between uncertainty and mental health more in my academic work and in future posts on An Educated Guess.
Will you join me? Simply subscribe, share this work with others, or leave a comment to tell me which contextual factors are most important for your mental health and that of your loved ones. Thanks!