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A large global report has found ongoing poor mental well-being worldwide, with no sign of improvement since prior to the COVID-19 pandemic.

Published online on March 4, the Global Mind Project of Sapien Labs included 71 countries and included over 500,000 internet-enabled respondents. It showed the steepest decline in mental health was in young adults. The poorest mental well-being was in wealthier countries and better mental well-being in several less-developed African and Latin American countries.

"Our report paints a worrying picture of our post-pandemic prospects," Tara Thiagarajan, PhD, Sapien Labs founder and chief scientist, told Medscape Medical News.

'Unexpected' Findings

The objective of the Global Mind Project is to provide an "evolving global map of mental well-being and enable deep insights into its drivers that can be used for more effective management of population mental well-being through evidence-based social policy and interventions," the authors wrote.

The report was based on responses to the Mental Health Quotient (MHQ), an anonymous online survey that captures 47 aspects of mental capability and functioning on a Life Impact Scale. The MHQ "aligns with the World Health Organization's definition of mental well-being," said Thiagarajan. This refers to a person's ability to handle life's normal stressors and adversities and contribute productively to society.

The first report, which was published in 2021 and reported by Medscape Medical News at that time, included eight countries and ~49,000 adults. Each report since then has included more countries, languages, and participants.

In 2023, the average MHQ score across all 71 countries was 65 on the 300-point MHQ scale, with 27% of respondents categorized as "distressed or struggling" and only 38% as "succeeding or thriving."

Of the eight English-speaking countries that have been tracked since 2019, the MHQ Declined by 8% between 2019 and 2020 (coinciding with the onset and global spread of the pandemic).

In 2021, those countries showed a further decline of 3%. Disturbingly, the average MHQ as well as the percentage of "distressed or struggling" respondents showed little change. Similarly, the 32 countries tracked since 2021 and the 64 countries tracked since 2022 also remained relatively unchanged.

What's encouraging is that "declines in mental well-being that took place during the pandemic have been halted, but unfortunately, there has been no uptick, and not even the beginning of an uptick, to pre-pandemic levels," said Thiagarajan.

She said the research findings were unexpected. "We thought we'd see a 'U-shaped curve', in which mental well-being plummeted and slowly came up again, but that's not what we saw."

Which Countries Fared Best and Worst?

The Dominican Republic, Sri Lanka, and Tanzania had the highest rankings on the MHQ, with scores of ≥ 88, while Brazil, South Africa, the United Kingdom, and Russian-speaking Uzbekistan were at the lowest, with scores ranging from 48 to 53. On the MHQ scale, this represents a 14.3% difference between top- and bottom-ranked countries. At an average score of 72, the United States was between the top- and bottom-ranked countries.

The smallest percentage of those who reported being "Distressed and Struggling" were in Sri Lanka (14%) and Italy, Georgia, and Nigeria (17% each), while the highest were in the United Kingdom and South Africa (35% each), Brazil, and Australia (34% and 33%, respectively). One quarter of those in the United States reported being "Distressed and Struggling."

"One of the most surprising findings was that the countries coming out on top weren't the most economically successful. We've been working to understand why countries such as Tanzania and the Dominican Republic are doing so much better, in terms of mental well-being, than countries in the 'core Anglosphere', such as the US, the UK, and Australia, which are wealthier," Thiagarajan said.

One possible reason may be age-related. For the eight English-speaking countries, the mental well-being of those in the younger age groups (< 34 years) declined 42-50 MHQ points from prior to the pandemic, while individuals aged ≥ 65 saw almost no decline.

They "seemed to emerge more unscathed, perhaps because many lived through major crises, such as World War II, and bring a different attitude to crisis," said Thiagarajan.

Another reason older individuals fared better might be connected with internet use — particularly the role of smartphones.

"In 2023, we published a brief report showing that the younger a person was when receiving the first smartphone, the worse the person's mental well-being was as a young adult, especially in females," Thiagarajan recounted.

Social Self (an aggregate measure of how we view ourselves and relate to others) showed dramatic improvement and suicidal thoughts declined significantly with older age of first smartphone ownership.

"Countries with the best mental well-being, such as the sub-Saharan countries, got internet later than other countries did, and the average age of receiving a smartphone was older," Thiagarajan said. By contrast, the age of receiving a smartphone is getting "lower and lower" in the United Kingdom, for example.

This may account not only for the difference in mental well-being between countries but also for the difference in age groups, with the youngest groups showing the poorest mental well-being.

Processed Foods, Weaker Family Units

Other factors include the consumption of ultra-processed food (UPF), much more common in wealthier vs more disadvantaged countries — a phenomenon described in a 2023 report of close to 300,000 adult respondents in 26 countries.

"The more UPF consumed, the worse the outcomes in every dimension of mental health," Thiagarajan said. "It was a widespread effect in all age groups, all genders, and all symptoms of mental well-being — particularly depression, but also emotional and cognitive control and resilience."

Countries in the top quartiles of mental health reported much less consumption of UPF, and those with the highest UPF consumption had the poorest mental well-being. In wealthier countries, "the majority of calories consumed today come from UPF," she said.

A third factor emphasized in Sapien Lab's annual 2022 report showed that countries with stronger family bonds — typically less economically advantaged countries — showed superior mental well-being than Western countries where "family bonds are more degraded," she said. "We didn't include this narrative in this year's report, but we believe it plays an important role.

A related potential cause for the perpetuation of poorer mental well-being includes the continuation of remote work, leading to less in-person social interactions, Thiagarajan added. "In-person interactions build social connections and social skills."

'Long Tail'

Commenting for Medscape Medical News, Ken Duckworth, MD, assistant professor, Harvard Medical School, Boston, Massachusetts, and chief medical officer of the National Alliance of Mental Illness (NAMI), said the survey's findings were "compelling, creative, and important, suggesting that returning to pre-pandemic mental well-being is more like a sock that you keep stretching out than a rubber band that snaps back."

Put differently, the impact of the pandemic "has a long tail. It's been years, and people still haven't snapped back, according to this report — especially younger people."

Duckworth, author of You Are Not Alone: The NAMI Guide to Navigating Mental Health, added a caveat. When he conducted interviews for the book, individuals from the United States were more comfortable talking about their mental health vulnerabilities vs those from Latin American or Asian cultures. "So, we can't assume that all respondents to this survey worldwide have the same cultural approach to self-reporting mental health difficulties, and the report didn't account for these cultural differences."

Thiagarajan is the founder and chief scientist of Sapien Labs. Duckworth disclosed no relevant financial relationships.

Batya Swift Yasgur, MA, LSW, is a freelance writer with a counseling practice in Teaneck, NJ. She is a regular contributor to numerous medical publications, including Medscape and WebMD, and is the author of several consumer-oriented health books as well as Behind the Burqa: Our Lives in Afghanistan and How We Escaped to Freedom (the memoir of two brave Afghan sisters who told her their story).