Singaporean youths grapple with depression, anxiety

A significant portion of Singapore’s youth are experiencing ‘severe’ to ‘extremely severe’ levels of depression and anxiety, according to the National Youth Mental Health Study.

The recorded prevalence of severe and extremely severe depressive symptoms was 14.9 percent. The prevalence was higher among those in the 20–24-year age group (20.9 percent), those of Malay ethnicity (23.3 percent), those with technical diploma (25.9 percent), unemployed (29.7 percent), and those with a monthly income below SGD 5,000 (19.4 percent). [Asian J Psychiatr 2025:105:104405]

Meanwhile, severe and extremely severe levels of anxiety symptoms were documented in 27.0 percent of youths, being more common in females (28.9 percent) than males (25.0 percent). As was the case for depressive symptoms, the prevalence of severe and extremely severe symptoms of anxiety was higher among those in the 20–24-year age group (34.1 percent), of Malay ethnicity (40.9 percent), with technical diploma (42.8 percent), unemployed (38.3 percent), and with a monthly income below SGD 5,000 (35.3 percent).

Looking at groups of interest, youths who were classified as Not in Education, Employment, or Training (NEET) had the highest prevalence of severe and extremely severe symptoms of depression (29.8 percent) and anxiety (38.4 percent). This was in stark contrast to the group of working youths, among whom the prevalence was lowest (11.8 percent and 24.1 percent, respectively).

The analysis included 2,600 young Singaporeans (50.2 percent female, 71.5 percent Chinese) between 15 and 35 years of age. These individuals completed programmed questionnaires on a tablet. The questionnaires included the Depression Anxiety and Stress Scales Short Form, Adverse Childhood Events – International Questionnaire, Alcohol Use Disorders Identification Test, Body Shape Questionnaire, Connor - Davidson Resilience Scale, Cyberbullying questionnaire, Multidimensional Scale of Perceived Social Support, Rosenberg Self-Esteem Scale, and the smoking questionnaire adapted from the Youth Tobacco Survey.

Unravelling the causes

“The findings of the [study] are largely consistent with population surveys of youths conducted elsewhere that have documented a high prevalence of depressive and anxiety symptoms in the post-COVID-19 era,” the investigators said.

The symptoms were tied to several factors. One was body shape concerns, which were associated with more than twofold greater odds of severe and extremely severe depression symptoms (moderate concern: odds ratio [OR], 2.7; p<0.001; marked concern: OR, 2.5; p<0.001) and up to threefold increased odds of severe and extremely severe anxiety symptoms (mild concern: OR, 1.6; p=0.003; moderate concern: OR, 2.2; p<0.001; marked concern: OR, 3.2; p<0.001). [Front Public Health 2022:10:857147; Child Adolesc Psychiatry Ment Health 2021;15:80]

“Body image concern is a multidimensional construct, described as a preoccupation and dissatisfaction with the body’s appearance, including its shape, weight, and other characteristics,” the investigators said. They explained that unhappiness with one’s appearance peaks during adolescence when young people perceive a gap between their ideal and actual physique—a discrepancy reinforced by peer comparisons and social media influence. [J Adolesc Health 2017;60:38-43; Clin Child Fam Psychol Rev 2022;25:681-701]

Another factor was cyberbullying, which was associated with 40-percent greater odds of having severe and extremely severe symptoms of anxiety (OR, 1.4; p=0.021).

“Cyberbullying … can occur anytime, anywhere, unlike traditional bullying, which typically occurs within the school or home environment. It is characterized by the anonymity of the bully and invasiveness beyond the physical space,” the investigators explained. “Victims of cyberbullying are thus constantly exposed to negative online interactions, which can contribute to heightened levels of general anxiety and stress.”

Smoking was also implicated. Notably, young people with extreme and severely extreme symptoms of depression and/or anxiety were more likely to be smokers. This association may be explained by self-medication model, which suggests that individuals with mental illnesses initiate and maintain their tobacco use as a way to alleviate their symptoms, with nicotine potentially exerting a positive effect on stressful stimuli and in affect regulation, according to the investigators. [J Behav Med 2012;35:139-148]

Overall, the National Youth Mental Health Study underscores the need for comprehensive and accessible mental health services tailored to the unique challenges faced by youths, they said.