Troubled youth: an island of misery in an ocean of happiness, or the tip of an iceberg of suffering?

Aim: To critically examine the orthodox view that young people's health and wellbeing are continuing to improve in line with historic trends. Methods: Transdisciplinary synthesis is used to analyse and integrate a wide range of evidence on young people's health and wellbeing. Synthesis seeks coherence in the overall conceptual picture rather than precision in the empirical detail. Results: The orthodox view rests mainly on declining mortality among teenagers and young adults, and findings that most say they are healthy, happy and satisfied with life. With health improving for most, the focus of attention is on social inequalities in health. However, mortality rates understate the growing importance of non-fatal, chronic health problems, especially mental illness; self-reported health and happiness are flawed indicators of overall well being. Evidence suggests that rates of mental illness in young people have increased over time, and are higher than in older age groups. Explanatory factors include quite fundamental features of modern societies, which go beyond inequality and disadvantage; trends in these factors predict a deterioration in health and wellbeing. Conclusion: Contrary to the dominant view that young people have never been healthier, their health and wellbeing may have declined over several generations. Which perspective is right has important implications for understanding and addressing youth mental health problems, implications that go well beyond medical interventions.