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Richard Eckersley
Resolving psychosocial problems among young Australians will not be quick or easy and requires greater commitment from all sectors of the community
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Psychosocial problems have featured prominently in the news and on political agendas in Australia in the past year. In the wake of the Port Arthur (Tasmania) massacre, governments tightened gun laws1 and acted on portrayals of violence in the electronic media.2 The Federal Government more than doubled funding for its National Youth Suicide Strategy, to $32 million over four years.3 The Victorian Government seemed poised on the brink of major drug law reform, then retreated; recently, it established a Youth Suicide Prevention Task Force and launched a new drug strategy.4-6
However, if we, as a society, really want to get to the heart of these problems, we will have to change fundamental aspects of our society and culture. Despite many years of political action, it is arguable that none of these issues has been adequately addressed, as the developments of the past year make clear. We are still losing the war against drugs. Crime remains a serious social problem. The epidemic of youth suicide continues. In 1950, the (age-adjusted) suicide rate for males aged 15-24 was 6.9 per 100 000 and, in 1995, 24.8 per 100 000; among females in this age group, the suicide rate in 1950 was 2.2 and, in 1995, 6.2 (Jerry Moller, Assistant Director, National Injury Surveillance Unit, Australian Institute of Health and Welfare, Adelaide, SA, 1996, personal communication) (Figure). These trends occurred, even though fewer suicide attempts today are fatal, par ticularly those involving poisoning.7 This is the method favoured by females,8 who attempt suicide at least as often as males.9-11
Although suicide is an uncommon event, new research is revealing the extent to which it is the tip of the iceberg of psychological distress and disturbance among young people. The research shows that this distress is not an aberrant personal response to life; nor is it confined to marginalised or dis advantaged young people (see Box).
A similar situation exists in other Western nations. An international review of time trends in psychosocial disorders in young people concludes that there has been a "surprising and troubling" rise in these disorders since World War II in nearly all developed countries. The disorders include crime, drug abuse, depression, suicidal behaviour and suicide (only with eating disorders do the authors say the evidence for a rise in prevalence is inconclusive).13
This review says that, to a large extent, finding causal explanations of the increases "remains a project for the future"; it acknowledges causes could differ for different disorders, and even for the same disorder at different periods. However, it rejects several popular explanations for the trends, such as social disadvantage and inequality and unemployment (although these can be associated with disorder at an individual level). More likely explanations are: family conflict and breakup; increased expectations; and changes in adolescent transitions (in particular, the emergence of a youth culture that isolates young people from adults and increases peergroup influence; more tension between dependence and autonomy; and breakdowns in cohabiting relationships among young people).13
In assessing threats to the well-being of young people, the final report of a 10-year study in the United States says that: "Altogether, nearly half of American adolescents are at high or moderate risk of seriously damaging their life chances. The damage may be near-term and vivid, or it may be delayed, like a time bomb set in youth."14 The report notes that social and technological changes this century -- including more divorces and single-parent families, the erosion of neighbourhood networks, greater media and peer influence, and a lack of jobs -- mean that adolescents could lack "two crucial prerequisites" for healthy growth and development: "a close relationship with a dependable adult and the perception of meaningful opportunities in mainstream society."14
The situation may also reflect a growing failure of mod ern Western culture to provide an adequate framework of hope, moral values, and a sense of belonging and meaning in our lives, so weakening social cohesion and personal re silience.15-17 In investing so much meaning in the individual "self", we have left it dangerously exposed and isolated, because we have weakened the enduring personal, social and spiritual relationships that give deeper meaning and purpose to our lives.
These broader sociocultural perspectives suggest that, while tragedies such as suicide arise from intensely personal circumstances, they also represent the extreme end of a spectrum of responses by many young people to modern life, ranging through degrees of depression, drug abuse, delinquency and suicidal ideation to a pervasive sense of alienation, disillusionment and demoralisation.
Surveys of youth attitudes suggest that many young people are mistrustful, cynical and fatalistic; wary of commitment; outwardly confident but inwardly insecure; and alienated and disconnected from society.17,18 Young people believe that life should be fast-moving and fun; that they have to fend for themselves; that lifestyle options should be kept open; that governments are incapable of solving society's problems; and that they themselves are powerless to change social conditions.
Linked to these attitudes is a widespread pessimism about the future of the nation and the world. A recent study found that more than half of a representative sample of 800 Australians aged 15 to 24 thought the twenty-first century was more likely to be a time of crisis and trouble than one of peace and prosperity.18,19 Only a third thought Australia's quality of life would be better in 2010 than it is now, while a third thought it would be worse. Pessimism increased with age.
When it comes to their own lives, most young people are optimistic, but recent research suggests that even this personal optimism crumbles under the pressures young people face as they grow up and make their own way in the world.9,20 One study found that that at 15 youth were optimistic and positive, but by 25 many had become disillusioned and rudderless: "Youth seem unusually apathetic about the future. They are not negligent or ignorant of the challenges; they just feel powerless to do anything about it. It is a sense of being disenfranchised and disengaged, awaiting the outcome of events rather than anticipating a role in them."20
A recent international survey conducted by a consortium of advertising agencies identified a teen generation characterised by four moods -- alienated, cynical, experimental and savvy (Joanne Turner, MojoPartners, Sydney, personal communication). The survey found that Australian teens were not excited about much in life; that they expressed a lack of direction; and that they were uncertain and apprehensive about the future.
Suicidal ideation and behaviour in young people is associated with factors such as hopelessness and feelings that they have little influence over their environment (i.e., that there is an external locus of control).10,21 More broadly, hope has recently been described as "a pervasive and significant correlate of health and disorder".22 Psychological well-being is also associated with feelings that life has meaning, with positive meaning being related to strong religious beliefs, values that transcend the self, membership in groups, dedication to a cause and clear life goals.23
We need to pay close attention to the way in which the broad sociocultural features of our society could be contributing to a lack of meaning and a lack of hopefulness, and hence to psychosocial problems, among young people.
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© 1997 Medical Journal of Australia.
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