Adolescent mental health and supportive relationships: 21st century challenges

It is firmly established that personal relationships play a pivotal role in adolescent mental health and well-being. During adolescence, individuals become aware of their distinctiveness and uniqueness from others, initiating the development of a personal identity. Developing a coherent sense of identity is crucial for adolescent mental health, and relationships serve as a vital source of support that aid adolescents to navigate this task1. Supportive relationships with parents who are sensitive and responsive to their evolving needs provide a secure base from which adolescents can confidently explore various aspects of their identity. As adolescents increasingly find independent exploration of new social contexts intriguing and rewarding, peers gain centrality in their lives, offering opportunities to learn through novel experiences with friends. Furthermore, interactions with both parents and peers provide adolescents with self-relevant feedback that enables them to assess whether their self-perception aligns with how they are perceived by significant others. This feedback serves as a tool for them to strengthen or adjust their identity. Hence, these relationships are fundamental for adolescent mental health and well-being2, 3. During the latter decades of the 20th century and the first decades of the 21st century, there has been a significant increase in mental health problems among adolescents worldwide. Multiple repeated cross-sectional surveys across the world, with extensive sample sizes ranging from over 100,000 to as high as 915,054 individuals, have indicated declining trends in adolescent mental health over recent decades. Although there are considerable national variations regarding the prevalence and changes over time in adolescent mental well-being, declines have been observed in 36 countries4. These declines are particularly noticeable in higher-income countries, especially among girls. These declines coincide with an increase in perfectionism over the past three decades5. Recent generations of young people perceive higher expectations from others, and place more demands on themselves. This heightened pressure to achieve perfection partly accounts for the rise in mental health issues4. When perfectionism becomes maladaptive, it might complicate the development of a coherent identity, and result in worrying, rumination, indecisiveness, and negative emotions such as guilt and shame. This might explain the association between perfectionism and mental health problems. The rise in perfectionism probably stems from a combination of various factors, including the growing prevalence of individualistic and materialistic values in society. These trends foster highly competitive settings and set unattainable standards, contributing to unrealistic expectations for youth. These macro-level societal factors not only intensify adolescents’ inclination towards perfectionism and the perceived pressure to excel, but also affect adolescents’ pivotal relationships. Interaction dynamics with parents and peers may be characterized by an increasing preoccupation with youth's successes and setbacks. Puberty and the associated neurodevelopmental changes contribute to changing power dynamics in parent-adolescent relationships, that are often associated with a temporary increase in conflict. However, relationships with parents usually tend to be warm and supportive throughout adolescence around the world6. Research illustrates a marked decrease in authoritarian parenting practices over the last decades, transitioning towards more egalitarian practices7. However, the increase in warm and supportive parenting tends to coincide with heightened parental overinvolvement, anxious overcontrol, and an inclination toward overprotectiveness. Especially during adolescence, such intrusive parenting practices, despite their well-intentioned nature, might impede healthy development. Furthermore, there has been an increase in parental expectations and criticism5, which could contribute to the increase in perfectionism and related mental health issues. Adolescents also face increasing pressure to meet the (perceived) expectations set by their peers, resulting in burgeoning perfectionism and mental health issues. This might have been exacerbated by the widespread use of social media. However, it is important to note that, although trends in mental health problems have been related to social media use8, the use of social media is not detrimental for adolescent mental health per se. Contrary to the presumption that social media undermine genuine peer communication, they primarily function as an extension of offline interactions, predominantly fostering and facilitating social connections, and often yielding positive effects on mental well-being9. A poignant example arose during the COVID-19 pandemic, when physical interactions among adolescents significantly decreased, and many of them felt more lonely and experienced more mental health issues. Staying connected with peers online helped alleviate some of these adverse effects of physical isolation. Whereas social media use can be linked to fewer mental health issues when it fosters positive interactions, enhances social support, and facilitates social connectedness, it tends to be associated with more mental health problems when it becomes excessive, displaces time spent in face-to-face interactions, and involves negative interactions or social comparisons8. These risks primarily stem from the characteristics of adolescents or their environment, rather than directly from the use of social media itself9. There is also a genuine concern regarding addictive behaviors, where youth struggle to disengage from social media and neglect other crucial aspects of their lives, such as schoolwork, relationships or sleep. Social media provide opportunities for positive self-presentation, which might increase feelings of insecurity, perfectionism and depression among youth who grapple with insecurities and constantly compare themselves to seemingly more successful and socially thriving peers. Rather than discouraging adolescents from using social media, we need to focus on understanding the individual and environmental factors that predispose youth to the adverse effects of these media. Guiding adolescents toward a healthier engagement with social media can reinforce positive social interactions and minimize potential harm for mental health. Future research should address the repercussions of societal and technological changes on the way in which adolescents’ relationships with both parents and peers are constructed. The prevailing societal trend towards heightened individualism and materialism is fostering increasingly competitive environments and unrealistic expectations. These changes not only directly impact the development of adolescents' identities and mental well-being, but might also affect the nature of their interactions with parents and peers. Even within the context of warm and supportive parent-adolescent relationships and friendships, these societal changes are likely to influence the perceptions of these relationships, the interaction behaviors, and the interpretation of these behaviors. We need to acquire a more nuanced understanding of the interactions with parents and peers that contribute to the cultivation of perfectionism, which impedes healthy identity development and jeopardizes adolescent mental health. Perhaps even more important is addressing the macro-level factors that contribute to a societal landscape characterized by increasing competitiveness, economic disparities, and pressure to constantly excel. This socio-cultural context creates an environment in which some youth, along with parents and peers, inadvertently cultivate conditions that breed perfectionism. Therefore, comprehensive research must aim not only to scrutinize the micro-level interactions within relationships, but also to understand the broader societal forces shaping these dynamics.