The Lancet Psychiatry Commission on youth mental health

——《柳叶刀-精神病学》2024年第11卷第9期——

<Lancet-Psychiatry> Volume 11, Issue 9, 2024

【摘要】几十年来，精神疾病一直是影响年轻人生活和未来的主要健康和社会问题，如今已进入危险阶段。越来越多的研究证据表明，在许多国家，新成年人的心理健康在过去二十年中一直在稳步下降，而精神疾病的激增主要是由于新冠疫情、为控制疫情而采取的措施及其后果。这一令人担忧的趋势发出了一个警告，即过去二十年全球大趋势（重大、持久的社会变化，如环境、社会、经济、政治或技术变化）和世界各地许多社会的变化损害了年轻人的心理健康，并增加了其中的精神疾病。

精神疾病的发病高峰年龄为15岁，63-75%的发病年龄在25岁之前，这与身体疾病的流行病学相反。除非得到有效治疗，否则精神疾病是导致身体疾病和自杀导致过早死亡的主要原因。即使这些疾病不会造成死亡，它们也是导致残疾和人类潜能及生产力丧失的最大且增长最快的原因。2011年，世界经济论坛报告称，在非传染性疾病中，精神疾病是全球国内生产总值（GDP）损失的最大来源。这些对人类的影响和经济损失很大程度上源于它们在生命中发病的时间，再加上由于医疗保健和医学研究中的污名和歧视，全世界都忽视了精神疾病。精神疾病被描述为一种丑闻，是一种社会对自己造成的自我伤害。

令人鼓舞的迹象表明，人们已经意识到了危险，并正在采取一些应对措施。美国卫生局局长将日益恶化的情况称为青少年心理健康危机，并正在制定美国应对危机的战略。然而，这场危机是全球性的，需要对影响它的大趋势和可塑风险和保护因素进行法医分析，并制定一项能够催化国家和地方行动计划来应对危机的全球战略。世界各地社会的凝聚力和繁荣都面临危险，而且不仅限于健康结果。精神财富的概念已经形成，旨在捕捉更好地促进心理健康和福祉，以及对新出现的精神疾病年轻人进行早期干预和高质量治疗（并根据需要延长治疗时间）可能带来的巨大潜在利益。认识到现代医疗保健的成本正在变得难以承受，我们需要用逻辑而不是情感来决定有限资源的分配方式。医疗保健已经以一种隐蔽的方式进行配给，在世界范围内，精神疾病受这种配给的影响最大。应该重新考虑各种低价值医疗保健的广泛提供，以考虑拯救年轻人生命和富有成效的未来的价值主张。年轻人精神疾病发病率的上升使得继续忽视他们的需求变得不可容忍。

[Summary] Mental ill health, which has been the leading health and social issue impacting the lives and futures of young people for decades, has entered a dangerous phase. Accumulating research evidence indicates that in many countries, the mental health of emerging adults has been declining steadily over the past two decades, with a major surge of mental ill health driven by the COVID-19 pandemic, the measures taken to contain it, and its aftermath. This alarming trend signals a warning that global megatrends (major, long-lasting societal changes such as environmental, social, economic, political, or technological changes) and changes in many societies around the world in the past two decades have harmed the mental health of young people and increased mental ill health among them.

Mental illnesses have a peak age of onset of 15 years, with 63–75% of onsets occurring by age 25 years, which represents the epidemiological inverse of physical illnesses. Unless treated effectively, mental illnesses are a major cause of premature death from physical illness and suicide. Even when these illnesses do not cause death, they are the largest and most rapidly growing cause of disability and lost human potential and productivity across the lifespan. In 2011, the World Economic Forum reported that among the non-communicable diseases, mental illness was the largest source of loss of gross domestic product (GDP) globally. These human impacts and economic losses largely stem from the timing of their onset in life, combined with worldwide neglect of mental illness due to stigma and discrimination within health care and medical research. Mental illness has been described as a scandal and a form of self-harm inflicted by society upon itself.

Encouraging signs suggest that the danger is being sensed and some responses are emerging. The US Surgeon General has labelled the deteriorating situation a youth mental health crisis and is formulating strategies to combat it in the USA. However, the crisis is global and demands forensic analysis of the megatrends and the malleable risk and protective factors that are influencing it, and a global strategy that can catalyse national and local action plans to counter it. The cohesion and prosperity of societies around the world are at risk and not limited to health outcomes alone. The concept of mental wealth has been formulated to capture the enormous potential benefits that could flow from better promotion of mental health and wellbeing, combined with early intervention and high-quality treatment of young people with emerging mental illness that is extended for as long as necessary. With the recognition that the cost of modern health care is becoming unsustainable, logic, rather than emotion, will need to determine how finite resources are allocated. Health care is already rationed in a covert fashion and, worldwide, mental illness is affected most by this rationing. The widespread delivery of low-value health care of many kinds should be reconsidered in relation to the value proposition of saving the lives and productive futures of young people. The rising incidence of mental ill health in young people makes continuing neglect of their needs intolerable.

论文原文：Patrick D McGorry, Cristina Mei, Naeem Dalal, Mario Alvarez-Jimenez, Sarah-Jayne Blakemore, Vivienne Browne, et al. (2024). The Lancet Psychiatry Commission on youth mental health. Lancet - Psychiatry, Volume 11, Issue 9, p731-774. September 2024.

https://doi.org/10.1016/S2215-0366(24)00163-9

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