Youth mental health : social inequalities and the role of schools in Europe

Youth mental health is now a concern for governments across Europe. In our episode, we ask whether anxiety is an illness or a consequence of our times. This article asks two other questions that the episode leaves open : does anxiety affect every background in the same way ? And what can, and what can't, schools do ?

The HBSC survey, carried out with WHO/Europe in 2021-2022 among about 280,000 young people aged 11, 13 and 15 in 44 countries in Europe and Central Asia, gives an order of magnitude. One third of adolescents felt nervous or iiritbale more than once a week over the previous six months, and one in four felt low. Fifteen-year-old girls show the worst outcomes.

These figures describe self-reported symptoms, not diagnoses. And an average always hides gaps. Those gaps are what interest us.

Question 1: does anxiety affect every background in the same way ?

Not according to the available data. But the answer is subtler than "low-income backgrounds fare worse". To understand it, we need to look at what the numbers show, then at what epidemiologists, sociologists and essayists have proposed to explain it.

What the numbers show

Researchers analysed five waves of the HBSC survey (2002 to 2018), covering more than 41,000 fifteen-year-olds in Sweden, Norway, Finland, Denmark and Iceland. In all five countries, the wealthier the family, the fewer subjective health complaints young people report (headaches, nervousness, sleep problems), and the higher their life satisfaction.

Higher poverty rates at country level go together with more complaints and lower satisfaction.

One important detail : the authors note that the perceived wealth of one's family (feeling more or less well-off than others) is more strongly linked to mental health than objectively measured affluence. The gap is present everywhere but varies in size : according to the study's abstract, it is largest in Iceland and smallest in Denmark.

Two cautions:

• the study covers the Nordic countries, often presented as egalitarian, so it cannot be transposed as is to the whole of Europe ;

• these are associations, not proof of causation.

The OECD report on youth mental health likewise links the deterioration it observes to socioeconomic pressures, inequality and poverty, alongside digital technology, climate worries, conflict, bullying and academic stress.

Five ways of reading the gap

The numbers say that a gap exists. They do not say why. Here are five explanations put forward by researchers and thinkers. They do not exclude one another.

1. Control over one's life : Michael Marmot. The British epidemiologist showed, through the Whitehall studies that began in the 1970s, a social gradient in health even among office-based civil servants in stable jobs : the lower the rank, the higher the risk of illness. In Status Syndrome (2004), he argues that autonomy, a sense of control over one's life and social participation matter as much as financial resources or medical care. His work mostly concerns physical health: applying his idea to anxiety is a hypothesis, not an established result. Still, it sheds light on the situation of a teenager whose future (orientation, housing, parents' money) seems to depend on decisions they do not control.

2. Comparison with others: Richard Wilkinson and Kate Pickett. In The Inner Level (2018), the two epidemiologists argue that income inequality fuels "status anxiety" (the fear of being judged inferior), linked to depression and other disorders, and that relative position matters more than absolute income. This echoes the Nordic study's finding on perceived wealth. The thesis is contested, however: The Economist says the authors are not circumspect enough with their evidence, recalls that their earlier book, The Spirit Level, was criticised for confusing correlation with causation, and points out that the link could run both ways.

3. Scarcity that occupies the mind : Sendhil Mullainathan and Eldar Shafir. In Scarcity (2013), the economist and the psychologist show that lacking money, time or food captures attention and "taxes" cognitive capacity, at the expense of work, parenting or self-care. One can infer, and this is our inference, that a young person whose parents are consumed by making ends meet has fewer available adults to help them through a stressful period.

4. The fear of falling : Camille Peugny and Louis Chauvel. Anxiety is not only about lack; it is also about falling. In Le Déclassement (2009), the sociologist Camille Peugny defines downward social mobility as holding a lower social position than one's parents. According to a review in La Vie des idées, about 14% of sons of senior managers born in 1944-1948 held a clerical or manual job, against nearly 25% of those born in the early 1960s (22% then 34% for daughters). More recently, Insee, cited by the Observatoire des inégalités, reports that the share of men aged 35 to 59 holding a lower position than their father rose from 7.2% in 1977 to 15% in 2015. Peugny's interviews show that some people from well-off backgrounds experience this downward move as a personal failure, which can lead to withdrawal. This work does not measure anxiety: it describes the ground on which anxiety can grow, including in the middle classes.

5. The demand to cope alone : Alain Ehrenberg, Robert Castel, Mark Fisher. For the sociologist Alain Ehrenberg, in La Société du malaise (roughly, "The society of unease"), contemporary psychological suffering has changed in nature: it is less about guilt for having broken a rule than about the fear of not measuring up, which he calls "la peur de la panne" (the fear of breakdown). In his review of the book, Robert Castel replies that autonomy cannot be decreed: "commanded autonomy is not autonomy, but a new mode of domination" (our translation). People in precarious situations first need resources and protections, and demanding autonomy of them without those supports worsens their suffering.

In the same vein, the theorist Mark Fisher argues, in "The Privatisation of Stress" (2011), that stress caused by precarity is treated as a personal problem, sought in brain chemistry or individual history, instead of being seen as a political one. For other readings of our era, such as Byung-Chul Han and Hartmut Rosa, you can listen to the episode.

What these readings have in common

None of them says that anxiety is reserved for low-income backgrounds. They describe a gradient : the fewer resources and the less hold on one's life, the heavier the pressure, and the more it is lived as a personal fault. There are at least two anxieties: the anxiety of lack, and the anxiety of falling.

A hypothesis, which is ours and not an established result: the problem may not be anxiety alone, but the distance between what we demand of young people (to succeed, to choose, to manage alone) and what we give them to get there. That distance is not the same for everyone, and nobody decided it: it is the sum of uncoordinated choices on housing, employment, education and access to care. This is what we call an inequity, in the sense used in our article "What is Inequity ? Let's start from the starting point"

Question 2 : what can schools do?

School is one of the few places where almost every young person spends time every day, whatever their background. That is why the OECD sees it as a lever for prevention. But the picture is not that simple: school is at once a place of pressure, a place where problems can be spotted, and a place where help could reach everyone, provided there are professionals to give it.

School as both a source of pressure and a shelter

School is not a neutral setting. Reporting on the OECD's PISA 2015 survey, which covered about 540,000 students, SecEd found that 59% of students often worried that a test would be difficult, 55% felt anxious about tests even after preparing well, and 66% felt stressed about poor grades. Girls reported more school-related anxiety than boys, and the students with the highest anxiety also reported lower life satisfaction. The same article says that support from schools and teachers is key to tackling this anxiety : students who report better relationships with their teachers also report higher life satisfaction.

What does the evidence say about school programmes ?

A systematic review and meta-analysis of universal school-based interventions (programmes offered to all pupils, not only to those already struggling) pooled 71 studies and 63,041 young people aged 8 to 18. It found a small but significant reduction in anxiety (d = −0.09) and in depression (d = −0.11), and no significant effect on internalising symptoms overall. For anxiety, programmes based on cognitive behavioural therapy did significantly better than those based on mindfulness or on other or mixed approaches. The authors call the effects small, but suggest that, applied to a whole population, they could still help prevent anxiety and depression.

Two lessons follow. A school programme is not a magic fix: small average effects mean that pupils who are already suffering still need individual care. And the design of the programme matters, so "doing something" is not enough.

The European framework: a whole-school approach

At EU level, the Commission's expert group on wellbeing and mental health at school recommends a "whole-system, whole-school approach". It combines universal support for all pupils with targeted help for those at risk, in cooperation with health professionals and community agencies. Its framework rests on five pillars: curriculum, school environment, family involvement, student voices and staff wellbeing. The guidelines add that wellbeing should not come at the expense of educational quality, and the reverse.

The Commission's 2023 Communication on a comprehensive approach to mental health goes in the same direction: it stresses prevention and early intervention by teachers, and calls for "adequately trained staff". The European Trade Union Committee for Education (ETUCE) welcomed the direction but criticised the gaps: an existing teacher shortage across Europe, the risk of adding pressure to already stretched staff, a call for more specialised support personnel, and the absence of ambitious measures such as legislation. The article we consulted does not mention any EU funding amount for schools.

Four national situations

In France. In a written question to the government published in the Journal officiel in December 2025, a member of parliament cites about 3,330 national education psychologists assigned to secondary schools in 2024, against nearly 4,700 in the early 1980s. He says that in some school districts one psychologist can follow up to 1,500 pupils across three to four schools, whereas the European recommendation he cites is a maximum of one psychologist per 800 pupils.

In Italy. The 2025 budget law created, for the first time, a fund dedicated to psychological support in schools: €10 million in 2025, then €18.5 million a year from 2026. The money funds regional teams of psychologists, with priority given to pupils in socially and culturally disadvantaged situations. The scheme was at an experimental stage, and the minister himself said resources would need to increase.

In England (outside the EU, but a useful comparison). The government has been rolling out Mental Health Support Teams in schools. According to an official data release, coverage reaches 60% of pupils (about 5.8 million) in 2025-26, including 79% of pupils in state secondary schools. Measured by institution, coverage is 48%. The government plans to reach all schools by December 2029. In a survey of schools, 92% of respondents said their team provided beneficial support, but only 26% of schools answered, so this figure should be read with caution.

In Finland. The Student Welfare Act (1287/2013) gives pupils the right to receive free of charge the welfare services needed for attending school, including a school psychologist and a school social worker, alongside school health services. We cite here the description given by a Helsinki teacher-training school, which does not state waiting times, so we cannot say how well the right works in practice.

What this shows

In each country, measures exist, but their scale varies and is often small compared with the number of pupils. The English and Finnish examples show two different logics: a gradual rollout of dedicated teams, or a legal right to services. Neither is a proven model for the rest of Europe. And where help in school is missing, families who can afford a private psychologist fill the gap: social inequality comes back through the back door.

Recognising anxiety and knowing who to talk to

Ordinary anxiety, before an exam for example, is normal. It deserves a professional's attention when it is intense, lasts, and interferes with daily life: sleep, studies, relationships, avoidance of everyday situations, repeated physical symptoms. Only a health professional can make a diagnosis.

Possible first contacts : a trusted adult, a family doctor, the school psychologist or nurse, or the university health service.

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