The WHO's European office published the HBSC (Health Behavior in School-aged Children) report, which shows the status of adolescent mental health and well-being across a range of indicators, including gender, age and social inequality.

The report shows an alarming development – a decline in the mental health of teenage girls. In Estonia, the situation is particularly dire.

The HBSC investigation is conducted every four years. Multiple health complaints have increased from 33 percent in 2014 to 36 percent in 2018 and 44 percent in 2022 presumably as a result of the many challenges adolescents have faced over the past four years, including the pandemic, accelerating climate change and increasing costs of living.

Boys have shown a linear increase since 2014, while girls had a steeper increase between 2018 and 2022. Although prevalence for boys was lower than for girls across all survey years, the gender gap increased over time.

Cross-cutting themes:

• The survey found that girls had worse mental health and well-being than boys across all measured indicators.
• All indicators measured in the report showed gender differences, which were increasing with age.
• Life satisfaction and self-reported health declined significantly between the surveys in 2018 and 2022, with the trend being more pronounced among girls.
• Girls consistently reported higher levels of loneliness than boys, except at age 11, where the gender differences were insignificant.
• The prevalence of multiple health complaints (headaches, anxiety, dizziness) increased with age, particularly among girls. By the age of 15, two-thirds of girls reported experiencing multiple health complaints compared with just over a third of boys. This gender gap is the largest since 2014.
• Teenagers from more affluent families reported higher levels of life satisfaction and mental well-being only in seven countries.

Key findings in Estonia:

• Young people in Estonia have lower than average mental well-being and more frequent health complaints (headaches, depression/anxiety, dizziness/drowsiness).
• Depression and sadness are felt more than once a week by 29 percent of pupils surveyed, which is four percentage points higher than the survey average.
• Compared to four years ago, the situation has especially worsened among 13- and 15-year-old girls.
• While on the survey average 28 percent of all 15-year-old girls and 13 percent of 15-year-old boys "always" or "most of the time" feel lonely, the figures are significantly higher among young people in Estonia, at 36 percent and 19 percent respectively.
• Estonia is one of seven countries, along with Austria, Belgium, Canada, the Czech Republic, Hungary and the United Kingdom, where the higher prevalence of health complaints among young people is clearly evident among lower-income families.

Acute loneliness: Measuring mental health and depression risk factors

Sixteen percent of teenagers across the survey, on average, reported feeling lonely "most of the time" or "always" during the past year. The percentages nearly doubled between 11 and 15 years of age. The gender difference was consistent across all countries/regions and age groups, with girls reporting higher levels of loneliness than boys, with the largest gender differences emerging at age 15. In some countries and regions, the prevalence of loneliness among 15-year-old girls was three times that of boys.

Estonia ranks fourth after the United Kingdom, Poland and Belgium (French) in terms of the percentage of 15-year-old girls who reported being lonely "most of the time" or "always" in the past year.

Moreover, Estonia leads all other countries in the survey in terms of the sharp increase between the percentage of 11-year-olds who have reported severe loneliness (14 percent) and the percentage of 15-year-olds (36 percent), who have reported the same.

In more detail, at the age of 11, only 10.6 percent of girls who live in rural areas in Estonia reported feeling long-lasting loneliness, which is a third less than in urban centers; however, among 15-year-olds in rural areas, the percentage already matched that of urban residents. This percentage is highest, 43.6 percent, in Western Estonia and the islands compared to other regions in Estonia, where it stays around 32 percent.

While there is no difference between Estonian- and Russian-speaking boys aged 15, the percentage of Estonian-speaking girls who reported acute loneliness increases steeply and significantly from 12.5 percent at age 11 to 38 percent at age 15. The same transition for Russian-speaking girls is less sharp, from 17.8 percent to 27.7 percent.

In Western Estonia and the islands, the percentage of girls who have experienced depressive episodes in the past year increased from 21.6 percent at age 11 to 62 percent at age 15, which is the sharpest increase and highest number in Estonia. In particular, Russian-speaking youngsters, both boys and girls report a higher prevalence of depression across all ages.

In the pas year 16.1 percent of 15-year-old boys and 33.6 percent of 15-year-old girls have considered suicide. There are no distinctions in this regard between urban and rural areas, nor are there any regional differences across Estonia. However, there is a significant difference between native Estonian speakers and speakers of other languages: a higher proportion of Estonian-speaking 15-year-old girls, 35.6 percent, reported having suicidal thoughts than Russian-speaking 15-year-old girls, at 25.9 percent.

To measure depression risk factors young people were asked how often over the last two weeks they had: felt cheerful and in good spirits; calm and relaxed; active and vigorous; woken up feeling fresh and rested; and felt their life was filled with things that interested them. Response options ranged from "all the time" to "at no time." Estonia's 15-year-olds had one of the lowest scores and ranked fourth-from-last across all 44 countries, after Poland, Slovenia, Italy and the United Kingdom.

In terms of life satisfaction and self-esteem, Estonian young people are in the middle of 44 countries.

More positive trends are visible in the self-efficacy of Estonian youth – young people in Estonia, both boys and girls, are significantly more confident in solving problems and achieving goals compared to the HBSC average; however, the gender difference is also apparent in this parameter and it grows with age.

"Both international and national results in Estonia provide the opportunity not only to compare results, but also to create more tailored mental health interventions and support for our young people. In Estonia, the emphasis should be on early intervention in the school environment," Leila Oja, head of the HBSC Estonia study and researcher at the TAI, said.

The Health Behavior in School-aged Children (HBSC) study is a large school-based survey carried out every four years in collaboration with the WHO Regional Office for Europe. The results of the latest survey are based on the opinions of nearly 280,000 11-15-year-olds from 44 countries. In Estonia, the survey was carried out by the National Institute for Health Development (TAI) from November 2021 to March 2022 and involved nearly 5,000 primary school pupils from 100 schools.

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