The Mental State of
the World in 2022
A publication of the Mental Health Million Project
March 1, 2023

Dear Reader,
We are happy to present the 3rd year of the Mental State of the World report, providing a view of themental wellbeing of the Internet-enabled world. This report aggregates data acquired in nine languages
from almost 500,000 people across 64 countries in 2022, a substantial expansion over 2021 making it
now the largest database of comprehensive mental wellbeing profiles in the world.
Here are the highlights: In 2022 mental wellbeing remained the same as in 2021 showing no recovery
following the substantial 2-year decline associated with the COVID-19 pandemic. As at the peak of
the pandemic, almost a third of this population still struggled with their mental health, and young
adults age 18-24 were five times more likely to have mental health challenges compared to their
grandparents' generation. This pattern, apparent even prior to the pandemic, represents a sharp
reversal of patterns documented prior to 2010, indicating a dramatic decline in mental wellbeing witheach younger generation rather than an increase in wellbeing as we age.
The most dramatic decline from older to younger generations has been along the dimension of theSocial Self, a metric of the way we see ourselves and our ability to form and maintain relationships
with others. In 2022 we probed the state of family relationships and friendships and highlight here theirprogressive degradation over generations as one driving factor. Younger adults report increasingly
higher rates of family instability and conflict and lack of love and emotional warmth during childhood,despite growing rates of material support by their parents and investment in their accomplishments.
They are also three times more likely to have poor adult family relationships compared to their parents’generation and twice as likely to lack friends who will help them in times of need. Poignantly, thosewith poor family relationships and no close friends are ten times more likely to suffer from significant
mental health challenges than those with many close family bonds and friendships.
These data suggest that we have not fully appreciated the profoundly relational nature of the human
psyche. Importantly, it invites each of us to reflect on our role in the growing social disintegration. What
have we valued and why? Where have we focused our attention? And with finite time, just how much
have we cast aside an active commitment to love or social nurturing for material success or evenjust mindless scrolling of the Internet? We can’t change the past, but with some collective reflection
perhaps we can change how it plays out for future generations.

2

Tara Thiagarajan, Ph.D.		

Jennifer Newson, Ph.D.

Founder and Chief Scientist

Lead Scientist, Cognitive and Mental HealthA report of the Mental Health Million projectsapienlabs.org/mental-health-million-project

Advisory Committee
Dr. Jennifer Newson, Lead Scientist, Cognitive and Mental Health,
Sapien Labs, USA (Project Lead)
Dr. Helen Christenson, Director and Chief Scientist, Black Dog Institute, Sydney, Australia
Dr. Pim Cuijpers, Full Professor, Faculty of Behavioural and Movement Sciences,
Clinical Psychology, VU University Amsterdam, Netherlands
Dr. Eiko Fried, Associate Professor of Clinical Psychology, Leiden University, Netherlands
Dr. Brandon Kohrt, Associate Professor of Psychiatry and Behavioral Sciences,
George Washington University, USA
Dr. Vikram Patel, Professor, Department of Global Health and Population, Harvard University,
USA and Adjunct Professor and Joint Director, Centre for Chronic Conditions and Injuries,
Public Health Foundation of India, India
Dr. Joshua Seidman, Chief Research and Knowledge Officer, Fountain House, New York City,
USA
Take part at sapienlabs.org/mhq© Sapien Labs 2022
sapienlabs.org

3

4

EXECUTIVE SUMMARY5INTRODUCTION

7

1. THE MENTAL STATE OF THE INTERNET-ENABLED WORLD

10

The mental state of the world in 2022 relative to previous years
Mental wellbeing by regions and language groups
The ranking of countries

11
12
15

2. THE GLOBAL DECLINE IN YOUNGER GENERATIONS

17

Globally young adults struggle with mental health far more than older generations

18

Dimensional scores across generations

20

The decline in the Social Self: a geographic view22

3. FAMILY RELATIONSHIPS AND MENTAL WELLBEING

23

Trends in family closeness23

Family relationships and mental wellbeing

24

The generational shift in childhood family experience25

The childhood home and mental wellbeing in adulthood

27

A geographic view of family trends

28

4. FRIENDSHIPS AND MENTAL WELLBEING30

The demographics of friendships

30

The quality of friendships

31

Friendships and mental wellbeing

32

A geographic view of friendship trends

33

The impact of family relationships on friendships

34

An additive impact of family relationships and friendships on mental wellbeing

35

INSIGHTS AND INTERPRETATIONS

36

The global trends of 2022

36

The persistent decline of younger generations

36

Deteriorating Social Self, family bonds and friendships

36

Culture and our deteriorating social bonds

37

The Internet and our deteriorating social bonds

38

In conclusion

39

Appendix 1: THE MHQ ASSESSMENT AND SCORES

40

Appendix 2: DATA ACQUISITION AND ANALYSIS

44

REFERENCES

47

Executive Summary
This Mental State of the World report provides insight into the mental wellbeing of Internet-enabled
populations around the globe in 2022 across 64 countries in the Core Anglosphere, continental
Europe, Latin America, the Arab world, South and South East Asia and Africa based on responses
to the Mental Health Quotient (MHQ) assessment in English, Spanish, French, Arabic, Portuguese(European and Brazilian), German, Swahili and Hindi. The assessment provides an aggregate metricof mental wellbeing (the MHQ) as well as multiple dimensional views.
Key findings this year are as follows:• The global MHQ average was 64 in the category “Managing” in the lower half of the positive
scale.

• In the aggregate, the highest mental wellbeing was largely in Spanish-speaking Latin America
although Tanzania topped the list at 94. At the bottom were the United Kingdom, South Africa
and Brazil with MHQ scores between 46 and 53.

• Mental wellbeing stays largely the same compared to 2021 across the majority of countries

tracked in previous years showing little to no recovery from the Covid-19 pandemic years during
which average MHQ scores declined 32 MHQ points (11% of the scale).

• The dimension of Social Self is the most challenged across the world followed by Mood &Outlook, and has the largest drop from older to younger generations. The regions of Latin

America, South and South East Asia see the greatest deterioration in the Social Self from older toyounger generations with Peru and India topping the list.

• Family relationships are increasingly disintegrating across the globe. The youngest generationof adults are half as likely to be close to their adult families and three times more likely to not getalong with them at all relative to their grandparents' generation.

• The fraying of adult family relationships may have its origins in changing childhood

experience. The percentage who report growing up in stable, loving homes declined three-foldfrom older to younger generations, although having material comfort and parents invested intheir accomplishments grew.

5• Friendships too, are deteriorating. While younger generations do not consistently report fewer
close friends, they are less likely to be able to confide in their friends or rely on them for help
when they need it.

• The risk of mental health challenges is ten times higher among those who lack close family

relationships and friendships compared to those with many close family and friends. For eachindividually, the difference was about 5-fold suggesting an additive impact of family and friends.
Altogether this year’s report describes a global population still mentally scarred by the pandemic
years, highlights the global deterioration of the Social Self in younger generations, and quantifies
the globally diminished bonds of family and friendship that may lie at its core. While many factors
such as the Internet are likely to contribute to the diminishing Social Self and bonds of family andfriendship, one significant factor may also be cultural trends in parenting that trade off warmth, loveand stability for greater focus on material comfort and accomplishments.
As always the data is freely available to academic researchers and we invite deeper analysis of therelationships between factors.

6

Introduction
Our collective mental wellbeing in 2022
The Mental State of the World report is the annual report of the Mental Health Million Project andprovides a comprehensive view of the evolving mental wellbeing of the Internet-enabled world andinsights into significant underlying trends. As of January 2022, there were 4.95 billion active Internet
users worldwide, representing 62% of the global population. 2022 was the third year of the project andconsolidates responses from 407,959 people during the year across 64 countries spanning a wide
range of demographic groups in the Core Anglosphere, Continental Europe, Latin America, South andSouth East Asia, West and North Africa with translations in English, Spanish, French, Arabic, Portuguese(European and Brazilian), German, Swahili and Hindi.
It is important to keep in mind that trends reported here are not likely to be reflective of offline
populations who typically live in a different context. This is particularly relevant for developing countries
such as those in Africa where the Internet-enabled population are a minority and generally represent
higher socioeconomic groups or those who have achieved greater levels of education.

The Mental Health Million Project
The objective of the Mental Health Million Project is to provide an evolving global map of mental
wellbeing, and enable deep insights into its drivers that can be used for more effective management of
population mental wellbeing through evidence-based social policy and interventions. This project utilizes
the Mental Health Quotient, or MHQ (Newson, Pastukh, & Thiagarajan, 2022; Newson & Thiagarajan,
2020), delivered as an open online anonymous survey that takes approximately 15 minutes to complete
and returns overall wellbeing scores as well as a comprehensive report with tailored self-care andhelp-seeking recommendations via email. The MHQ has been demonstrated to relate systematically to
productivity in work and life as well as clinical burden (Newson et al., 2022, see also Appendix 1) and is afunctional reflection of how well-equipped we are to handle both life’s adversities and opportunities. Moreinformation on the MHQ can be found here. Feel free to take it yourself.

7

Mental wellbeing on a spectrum from Distressed to Thriving
The MHQ assessment captures a comprehensive spectrum of emotional, social and cognitive attributes
encompassing both problems (or symptoms) across 10 different mental health disorders (as defined by
the DSM-5), as well as positive mental attributes. An aggregate mental wellbeing score based on these
aspects (the MHQ) positions individuals on a spectrum from Distressed to Thriving (Newson et al., 2022;
Newson & Thiagarajan, 2020). The scale is divided into positive and negative components. The positive
range of the scale represents the spectrum of normal functioning, and is a 200-point scale calibrated toa mean of 100 based on pre-pandemic responses in 2019, similar to the IQ scale. The negative range ofthe scale represents mental wellbeing scores associated with a negative impact on the ability to function
and is associated with clinical level risks and challenges. Six functional dimensions of Mood & Outlook,
Social Self, Drive & Motivation, Adaptability & Resilience, Cognition, and Mind-Body Connection are also
computed. In addition, the assessment captures information on demographics, lifestyle factors, friend
and family dynamics, and traumas and adversities, providing a rich context for understanding key driversof risks. You can learn more about the MHQ and its scale in Appendix 1.

Interpreting the MHQ
Mental wellbeing, a reflection of how we ‘feel’, is by its very nature subjective. The MHQ captures theperceptions of each mental aspect on a life impact scale. Thus, individual judgement of how much amental aspect impacts our ability to function must necessarily be within our individual context. For one
person this may mean being able to carry out a particular type of knowledge work, while for anotherit may mean managing a household or performing physical labor. Furthermore, each person will havein their own mind what appropriate functioning looks like. Thus, mental wellbeing, as we measure it,
inherently reflects an individual’s sense of how their inner state impacts their ability to function within
their life context rather than an absolute of human mental function.

What’s in this report
In this report we show mental wellbeing comparisons of 64 countries and regions, highlighting thedramatically lower mental wellbeing of younger (18-24) generations across the globe, one that largely
reflects a decline of the Social Self with each younger generation.
Additionally, we focus on family relationships and friendships across the globe. The importance offriendship and family to mental health and wellbeing has been highlighted across multiple studies overthe past few decades (Berkman, Glass, Brissette, & Seeman, 2000; Sroufe, Egeland, Carlson, & Collins,
2005; Thomas, Liu, & Umberson, 2017; Umberson & Montez, 2010). For example, longitudinal studies,
tracking individuals from childhood through adulthood have shown how the warmth of family upbringing

8

can impact relationships people have during adulthood (Waldinger & Schulz, 2016), while others haveshown how parental relationships and practices during adolescence have long-term consequences forpeople’s wellbeing as young adults (Aquilino & Supple, 2001; Chen & Harris, 2019). In addition, having
positive and supportive family relationships as a child creates a foundation for positive family relationshipin adulthood (Ramos et al., 2022). Beyond family, studies have also shown that having a network of closefriends is important for increasing happiness and wellbeing (Dunbar, 2018) and preventing loneliness(Nicolaisen & Thorsen, 2017) by providing the context for meaningful social connections and interactions(Cacioppo & Patrick, 2008).
However, evidence also suggests that feelings of loneliness are on the rise around the world (Buecker,
Mund, Chwastek, Sostmann, & Luhmann, 2021), something exacerbated by the Covid-19 pandemic (Ernst
et al., 2022) and other studies have documented the fraying of social relationships and communities innations such as the United States (McPherson, Smith-Lovin, & Brashears, 2006; Putnam, 2000). Withsocial relationships through kin and friendship being critical not only for mental health, but also physicalhealth (Holt-Lunstad, Smith, Baker, Harris, & Stephenson, 2015), it’s imperative that we better understandthe characteristics that are most important to mental wellbeing, and how these are changing overtime and across generations around the globe. Here we document trends in family relationships andfriendships across the Internet-enabled world to determine the extent to which these factors contribute to
the deterioration of the Social Self.
The descriptive analysis in this report represents the tip of the iceberg. The data from the Mental HealthMillion Project is freely available for academic research and we hope that it will interest researchersinterested in changing sociocultural trends and the human experience to look more deeply at the trends
and relationships between factors.

9

1.

The Mental State of theInternet-Enabled WorldIn 2022, the Mental Health Million Project collected data on the mental wellbeing status of 491,196
Internet-enabled individuals across the globe. In this report, following data cleaning we report findings
from 407,959 respondents from 64 countries with adequate data samples (Figure 1.1). This represents
an expansion to 30 additional countries over 2021 arising from the addition of 5 new languages to now
include English, Spanish, French, Arabic, Portuguese (European and Brazilian), German, Swahili and Hindi.
Throughout this report we show two aggregated views, one that reflects geographic regions, and theother that reflects linguistic culture and heritage. These groupings are shown below.

Figure 1.1: Countries and regions that form part of the 2022 report

10North America

EuropeMiddle East and North Africa

Oceania

Canada, United States

Austria*, Belgium, France,
Germany, Ireland, Portugal,
Spain, Switzerland*, United
Kingdom

Algeria, Egypt, Iraq, Jordan,
Morocco, Saudi Arabia, Tunisia,
United Arab Emirates, Syria*,
Yemen

Australia, New
ZealandLatin America and Caribbean

Sub-Saharan Africa

South Asia

South-East Asia

Argentina, Bolivia, Brazil, Chile,
Colombia, Costa Rica, Dominican
Republic, Ecuador, El Salvador,
Guatemala, Honduras, Jamaica*,
Mexico, Nicaragua, Panama,Paraguay, Peru, Puerto Rico, Trinidad
and Tobago, Uruguay, Venezuela

Angola, Cameroon, Coted'Ivoire, Democratic
Republic of Congo,
Ghana*, Kenya,
Mozambique, Nigeria,
South Africa, Sudan*,Tanzania, Zimbabwe

Bangladesh, India, Nepal*,Pakistan, Sri Lanka

Malaysia,
Philippines,
Singapore

Language Groupings
Anglosphere (core)

Germanosphere

Lusosphone

SwahiliEnglish-speaking in United States,
Canada, United Kingdom, Ireland,
Australia, New Zealand, Jamaica,
Trinidad and Tobago

German speaking in Germany,
Austria*, Switzerland*

Portuguese speaking in
Portugal, Brazil, Angola,
Mozambique

Kenya, Tanzania

Anglosphere (other)

HispanosphereArabsphere

Francosphere

English-speaking in India,
Pakistan, Bangladesh, Sri Lanka,
Cameroon, Ghana*, Malaysia,
Nepal*, Philippines, Singapore,
South Africa, Tanzania,
Zimbabwe, Kenya, Nigeria

Spanish speaking in Argentina, Bolivia,
Chile, Uruguay, Venezuela, Colombia,
Costa Rica, Dominican Republic, Ecuador,
El Salvador, Guatemala, Honduras,
Mexico, Nicaragua, Panama, Paraguay,
Peru, Puerto Rico, Spain, United States

Arabic speaking in
Algeria, Egypt, Iraq,
Jordan, Morocco, Sudan*,Syria*, Tunisia, Saudi
Arabia, United ArabEmirates, Yemen

French speaking
in France, Belgium,
Switzerland*, Canada,
Algeria, Morocco, Tunisia,
Cote d'Ivoire, Democratic
Republic of Congo* Countries with under 1000 respondents

The mental state of the world in 2022 relative to previous years
Global mean (64 countries)

64

27%
Distressed Struggling

-100

-50

Enduring

038%Managing Succeeding

50

100

150

Thriving

200

MHQ Score

The average MHQ score across the 64 countries measured in 2022 was 64 on the 300-point MHQ scale
as shown above. Across the spectrum of mental wellbeing 27% of respondents were Distressed or
Struggling (MHQ scores of below 0, typically indicating 5 or more clinical symptoms according to theDSM-5), while 38% were Succeeding or Thriving (MHQ scores above 100).

The average MHQ score across the 64 countries measured in 2022 was 64
on the 300-point MHQ scale with 27% Distressed or Struggling and 38%
Succeeding or Thriving (MHQ scores above 100).
11

Of these 64 countries, eight core English-speaking countries have been tracked since 2019 (Figure 1.2),
with an additional 26 countries tracked since 2021. Across the eight English-speaking countries during
the Covid-19 pandemic, the MHQ slid 24 points or 8% down the scale in 2020 and a further 8 points or
3% down the scale in 2021. In 2022, we see no further overall decline in these countries with an overall
MHQ score of 61 and 29% Distressed or Struggling. However, there is also no recovery towards prepandemic levels and mental wellbeing in the aggregate remains at the same level as 2021. Similarly, forall 34 countries tracked in 2021, average MHQ remained constant at 64 and the percentage Distressed or
Struggling shifted insignificantly from 26% to 27%.

Figure 1.2: Mental wellbeing trends 2019-2022
The mental wellbeing of 8 English-speaking countries tracked since 2019 showed little recovery after the dramatic fallof the Covid-19 pandemic years with only an insignificant upward movement of 1% of the MHQ scale with only 1% fewer
people Distressed or Struggling. In the aggregate 34 countries tracked since 2021 showed no change in 2022.

90

80

40%

8%

66

60

3%

64

64

58

1% 61

40
8 English-speaking Countries

20

34 countries% Distressed/Struggling

Average MHQ Score

100

26%

30%

20%

30%

29%

26%

27%

14%
8 English-speaking Countries

10%

34 countries

0%

0

2019

2020

2021

2022

2019

2020

2021

2022

In 2022, we see no further decline. However, there is also no recovery
towards pre-pandemic levels and mental wellbeing in the aggregate
remains at the same level as 2021.

Mental wellbeing by regions and language groups
Regional views of the data are provided by geography and language groups (Figures 1.3 and 1.4; fordetails on construction of these regional views see Appendix 2). Regional analysis by geography showed
average MHQ scores were highest in South East Asia and Sub Saharan Africa, while Oceania and South
Asia showed the lowest overall mental wellbeing (Figure 1.3). Among language groupings Swahili(average MHQ of 94) and Spanish speaking (Hispanosphere; 77) populations had the highest MHQ

12scores while Portuguese speaking populations (Lusophone, 55) and the Core Anglosphere (60) had thelowest. Conversely, the percentage of respondents who were Distressed or Struggling were highest in thegeographical regions of Oceania and South Asia (31% and 29%, respectively) and in the Core Anglosphereand Portuguese speaking populations (29% and 32%, respectively) (Figure 1.4). Sub-Saharan Africa,
South East Asia, Swahili and French-speaking populations showed the lowest portions of respondents
who were Distressed or Struggling (all below 23%). Altogether, mental wellbeing was highest in Swahilispeaking Sub Saharan Africa, French-speaking North Africa, and English-speaking South East Asia, andlowest in the Core Anglosphere, English-speaking South Asia and Portuguese Latin America.

Figure 1.3: Mental wellbeing across regions and language groups
Average MHQ scores were highest in Swahili-speaking Sub-Saharan Africa and English-speaking SouthEast Asia and lowest in the Core Anglosphere, English-speaking South Asia and Portuguese Latin America.
100

100
Swahili

90

80South-East Asia

70

Sub-Saharan Africa
North America
Latin America and Caribbean
Middle East and North Africa

60South Asia

Average MHQ Score

Average MHQ Score

9080
Hispanosphere
Francosphere70
Germanosphere60

Oceania

Arabsphere
Anglosphere (other)
Anglosphere (core)
Lusosphone (Portuguese)

50

50

Geographic
Regions

LanguageGroupsMental wellbeing was highest in Swahili-speaking Sub Saharan Africa,
French-speaking North Africa, and English-speaking South East Asia,
and lowest in the Core Anglosphere, English-speaking South Asia andPortuguese Latin America.

13

Figure 1.4: Percentage Distressed or Struggling across regions
The percentage of the Internet-enabled population that were Distressed or Struggling with their mental wellbeing (i.e. had negative MHQ scoresindicating typically 5 or more clinical symptoms) varied across regions and language groups from 17% to 32%. Portuguese Latin America had
the greatest percentage while Francophone North Africa, Swahili Sub Saharan Africa and English South East Asia had the lowest percentage.

Oceania

Lusosphone(Portuguese)South Asia

Anglosphere (core)

Latin America
and Caribbean

Anglosphere(other)North America

Arabsphere

EuropeGermanosphere

Middle East andNorth Africa

Hispanosphere

Sub-Saharan Africa

SwahiliSouth-East Asia

Francosphere

0%

10%

20%

30%

Distressed Struggling

-100

-50

40%

Enduring

00%Managing Succeeding

50

100

150

10%

20%

30%

Thriving

200

MHQ Score

We note once again that these are views limited to the Internet-enabled populations. Developing regions
have low Internet penetration typically less than 50%, and in some countries in Sub Saharan Africa it isstill as low as 22%. Thus, in these regions the Internet-enabled populations are not reflective of the overall
population of the country but instead represent individuals who typically have greater levels of educationand come from higher socioeconomic groups. In addition, cultural and language differences acrosscountries are also likely to influence how people interpret and respond to survey questions and may also
play a role in the differences between countries. Comparisons of whole country populations will therefore
provide a very different view.

14

40%

How countries rank
Figure 1.5 shows the ranking of 64 countries measured in 2022 based on MHQ scores that are aweighted average of each age and gender group in the proportion that they are represented in the
country’s population (see Appendix 2 for more information). Thus, differences in these demographics canplay a role in the ranking position.
Within these parameters, Tanzania, Panama, Puerto Rico, Dominican Republic and Venezuela top the
rankings with MHQ scores ranging from 86 to 94 (Figure 1.5 left). Ireland, Australia, Brazil, South Africa
and the United Kingdom are at the bottom with MHQ scores ranging from 56 to 46. Overall, there is a 16%
difference in the position of MHQ scores on the scale between the top and bottom ranked countries.

Tanzania, Panama, Puerto Rico, Dominican Republic and Venezuela top
the rankings while Ireland, Australia, Brazil, South Africa and the United
Kingdom are at the bottom
On the right are the percentages of respondents who were Distressed or Struggling in each country. While
the pattern is similar to the pattern for average MHQ scores, there are some differences. While Puerto
Rico, Tanzania and Sri Lanka have the lowest percentages of Distressed/Struggling, the Democratic
Republic of Congo and Cote d’Ivoire also rank highly for this metric (Distressed/Struggling proportion
ranging from 16 to 19%). At the other end, Ireland, Australia, Brazil, South Africa and the United Kingdom
all show the greatest proportion of respondents who are Distressed or Struggling ranging from 30 to36%. Compared to 2021, the majority of the 34 repeat countries remained the same or changed by amarginal 2% or less in both directions. The only notable change in average MHQ scores was for Spain(5% decline in MHQ scores compare to 2021), while Spain, Peru, United Arab Emirates, Tunisia all showedsmall increases in the proportion of Distressed/Struggling in the range of 4-5%.

15

Figure 1.5: Mental wellbeing across countries
Countries positioned in terms of average MHQ scores on the left and the percentage of the population Distressed or Struggling with their mental
health on the right. Countries with the highest MHQ scores were Tanzania followed mainly by Spanish speaking countries. At the bottom end ofthese mental wellbeing rankings were mainly English-speaking countries and Brazil.
Average MHQ

Percentage of Distressed/Struggling
93.6

Sri Lanka

16.1
17.4

87.2

Puerto Rico
Congo Democratic
Republic
Tanzania

Venezuela

85.8

Cote d'Ivoire

18.7

Sri Lanka

85.6

Venezuela

18.8

Tanzania
Panama88.2

Puerto Rico

88

Dominican Republic

2%

3%

17.4
17.5

Uruguay

80.5

Dominican Republic

18.9

Trinidad and Tobago

80.4

Belgium

18.9

2%

Nigeria
Congo Democratic
Republic
Philippines

78.6

France19

77.7

Panama19.3

77.3

Uruguay

19.5

El Salvador

77.3

Trinidad and Tobago

19.5

Nicaragua

76.3

Nigeria

19.7

Malaysia

76.1

Zimbabwe

19.9

Zimbabwe

75.8

Cameroon

20.1

Paraguay

74.9

Philippines

20.7

Kenya

74.7

Kenya

21.1

Costa Rica

74.6

Mozambique

21.3

Ecuador

74.5

Malaysia

21.6

Singapore

74.2

Morocco

21.9

Portugal

74.2

Portugal

22.2

France

74.1

Spain

22.6

Mozambique

72.7

Nicaragua

22.6

Chile

72.5

Singapore

22.7

Argentina

72.3

Algeria

22.9

Belgium

72.1

Saudi Arabia

22.9

Cote d'Ivoire

72

Paraguay

23

Honduras

71.7

Argentina

23.1

2%

4%

7%

Peru

71.6
70.5

Tunisia4%
UnitedArab
Emirates4%

23.3

Cameroon
Spain

70.2

Jordan23.6

Saudi Arabia

70.2

Angola24.1

United Arab Emirates

70

Yemen

24.2

Mexico

69.5

Chile

24.2

Angola69.2

Ecuador

24.3

Guatemala69.1

Germany

24.4

Colombia

68.9

El Salvador

24.7

Morocco68.8

Costa Rica

25.1

Jordan68

New Zealand25.4

United States

67.9

Peru

25.7

Algeria66.3

United States

25.8

Germany

65.9

Honduras

26.1

Tunisia64.4

Canada26.1

Canada64.4

Bangladesh

26.2

New Zealand

63.7

Guatemala

26.3

Yemen

63.1

Pakistan

26.9

Bolivia

61.9

Iraq

27

Pakistan

61

Mexico

27.5

5%

2%
3%

4%
5%
3%

23.3

India

58.8

Colombia

27.7

Egypt

58.4

Egypt

27.9

Iraq

58.2

Bolivia

28

Bangladesh

57.9

India

30.1

Ireland56

Ireland

30.4

Australia

54.4

Australia

Brazil

52.9

BrazilSouth Africa

47.5

United Kingdom

46.2

15.8%

40

60

0
Change in MHQ
Score compared
to 20212080

new countries added in 2022

33.5

United Kingdom

35.7South Africa

35.8

100

Average MHQ Score

32.1

0%
Change in %Distressed/Struggling
compared to 2021

10%

20%

30%

40%

% Distressed / Struggling
new countries added in 2022

2.

The global decline inyounger generations

One of the most prominent trends in the Mental Health Million data over the years is the declining mental
wellbeing with each successively younger generation. This is reflected in decreasing MHQ scores and acorresponding increase in percentage Distressed or Struggling with significant mental health challenges
in each younger age group.
This trend is apparent in the Internet-enabled populations of every country measured from Africa to Asia,
Europe to the Americas. The trend was already clear in data from 2019 prior to the Covid-19 pandemic.
Given the Mental Health Million data alone, one interpretation could be that mental wellbeing simply
increases with age. However, studies on psychological wellbeing prior to 2010 showed universally thatyoung adults fared best in all countries and regions of the world measured (Stone, Schwartz, Broderick,& Deaton, 2010). This reversal points to a progressive global decline of younger generations since then,
one that is corroborated by the growing suicide rates among young adults over the last decade or more
(Twenge, Cooper, Joiner, Duffy, & Binau, 2019).

One of the most prominent trends in the Mental Health Million dataover the years is the declining mental wellbeing with each successively
younger generation, a decline that is most severe along the dimension of
the Social Self, a measure of how we see ourselves with respect to others
and our ability to form and maintain positive relationships with others.
Here we show in more detail the dimensional and geographic contours of this decline. We show that the
decline is most severe along the dimension of the Social Self, a measure of how we see ourselves withrespect to others and our ability to form and maintain positive relationships with others. A close second
is the dimension of Mood & Outlook. We also show that English-speaking South and South East Asia as
well as Latin America have the greatest collapse in Social Self scores across generations despite highscores overall, while Sub Saharan African countries are still relatively more stable across generations.

17Globally young adults struggle with mental health far more thanolder generations
There is not a single region or language group or country where the decline in mental wellbeing acrosssuccessively younger generations is not apparent. This translates into a dramatic increase in thepercentage of each younger generation that are mentally distressed or struggling at a level that would
qualify as clinical in nature or requiring of professional help.
Below we show the percentage that are Distressed or Struggling across regions and language groups
for two age groups, 55-64 and 18-24. The percentage Distressed or Struggling in the 18-24 age group
was three to five times higher than in the 55-64 age group across all regions and language groups.
Latin America (both Spanish and Portuguese) as well as English-speaking South Asia had the steepest
increase from older to younger generations. For example, while only 10-12% of the 55-64 age group in
Spanish-speaking Latin America and English-speaking South Asia were Distressed or Struggling in 2022,
45-50% were Distressed or Struggling among the 18-24 age group.

The percentage of the 18-24 age group Distressed or Struggling wasthree to five times higher than in the 55-64 age group across all regions
and language groups.

The smallest increases in the percent Distressed or Struggling were in the Core Anglosphere and Swahili
speaking Sub Saharan Africa, both growing 20%. However, while the Core Anglosphere had the highest
percentage Distressed or Struggling in the 55-64 age group at 25% growing to 45% among those 18-24,
Swahili speaking Sub Saharan Africa had the lowest percentage Distressed or Struggling in the 55-64 age
group at 6%, growing to 24% among those 18-24.

18

Figure 2.1: Globally young adults are three to four times as likely to
struggle with their mental health as their parents’ generation

60%

60%

50%

50%

40%

40%

South Asia

30%

South-East Asia
EuropeLatin America andCaribbean

20%% Distressed/Struggling% Distressed/Struggling

The percentage of those Distressed or Struggling with their mental health is dramatically higher among 18-24 year
olds relative to 55-64 year olds across all regions and language groups. This differential in mental health is greatest
among the Portuguese and Spanish speakers of Latin America and English speakers of South Asia.

Anglosphere (core)30%

Anglosphere (other)
Francosphere

20%

Germanosphere
HispanosphereNorth America
Oceania10%

Middle East andNorth Africa

Lusosphone(Portuguese)

10%

Arabsphere
Swahili

Sub-Saharan Africa

0%

Older
(55-64)Younger(18-24)0%Older(55-64)Younger(18-24)

Among countries, nine of the ten with the greatest increase in the percentage Distressed or Strugglingfrom older to younger generations were in Latin America. Peru held the top position with 46% more 18-24
year olds Distressed or Struggling compared to the 55-64 age group. The only country outside of Latin
America in the top 10 was India which came in second on the list at 43%.

Latin America (both Spanish and Portuguese) as well as Englishspeaking South Asia had the steepest increase in the percentage
Distressed or Struggling from older to younger generations.
In the bottom ten were a mix of countries largely from Sub Saharan Africa and the Core Anglosphere.
Tanzania was the lowest at 16% followed by Puerto Rico, the Democratic Republic of Congo andCameroon.

19

Figure 2.2: Difference in mental health distressbetween older and younger generations by country
Peru, India, Bolivia top the list with over 42% more young adults 18-24 Distressedor Struggling with their mental health compared to those aged 55-64. Tanzania,
Puerto Rico and the Democratic Republic of Congo are the lowest with only
~16% more young people struggling relative to their parents’ generation.
46.2

Tanzania
Peru

43.1

PanamaIndia
PuertoBoliviaRico

42.8

Dominican
El Salvador
Republic

41.9

Venezuela
Colombia

41.6

Guatemala
Sri Lanka

40.7

Uruguay
Mexico40.6

Trinidad andEcuador
Tobago40.2

Nigeria
BrazilCongo Democratic
Honduras
Republic
Philippines
Chile

39

metrics relating to specific aspectsof mental function. We computescores for six dimensions of mental
function. These include Social

38

Self, Mood & Outlook, Adaptability

35.6

Nicaragua
France35.6

Malaysia
Argentina

34.9

Zimbabwe
Pakistan

34.5

Paraguay
Saudi
Arabia34.2

Kenya
Singapore

34

Costa
Rica
Panama33.5

Ecuador
Spain

33.2

SingaporeSouth
Africa33.1

Portugal
Venezuela

33

FranceParaguay

33

Mozambique
Nicaragua

32.7

Chile
Ireland32.2

United ArabArgentina
Emirates

32.2

Belgium
Egypt

32.1

CoteZealandd'IvoireNew

31.7

Honduras
Uruguay

31.3

Peru
Bangladesh

30.9

Cameroon
Trinidad andTobago

29.8

Spain
Iraq

29.7

Saudi
ArabiaPortugal

29.3

UnitedArab Emirates
Dominican
Republic

29

MexicoPhilippines

28.9

AngolaNigeria28.4

20

Dimensional scores represent

37.6

El
Salvador
Costa
Rica

Guatemala
Malaysia

28

Colombia
Jordan26.8

MoroccoCanada26.7

JordanAngola26.2

UnitedStatesGermany

26

Dimensional scores
across generations& Resilience, Drive & Motivation,
Cognition and Mind-Body Connection.
Each dimensional score aggregatesacross a subset of the elementsin the MHQ. Furthermore, someelements in the MHQ may contributeto more than one dimension.

Mood and Outlook
Your ability to manage andregulate your emotions
effectively and to have aconstructive or optimistic
outlook for the future.

Social Self

Algeria25.6

How you interact with, relate toGermany
Tunisia24.6

Tunisia
Mozambique

24.5

and see yourself with respect to

CanadaBelgium

24.2

New
Zealand
Zimbabwe

23.4

Yemen
Cote d'Ivoire

22.3

SriBolivia
Lanka

22.1

Pakistan
Yemen

21.3

India
United States

21.2

Egypt
Morocco

20.9

Iraq
Australia

20

Bangladesh
Kenya

19.7

IrelandUnited Kingdom

19.2

Australia
Cameroon
Congo Democratic
BrazilRepublicSouth
PuertoAfrica
Rico
United Tanzania
Kingdom

18.8

others.

Drive and Motivation
Your ability to work towards
achieving your desired goals
and to initiate, persevere andcomplete activities in your daily
life.

16.9
16.4
16.1

0
0%

10%
20

20%
40

30%
60

40%
80

100
50%

Difference in % Distressed/Struggling between
18-24 and 55-64 year olds

Cognition
Your ability to perform basic cognitive
functions, make sense of complex

Across the global Internet-enabled population, average

sets of events and situations andscores were highest for Adaptability & Resilience at 85

display a longer-term perspective infollowed by Drive & Motivation at 81 and lowest for Social

your thoughts and behavior.

Self at 66 and Mood & Outlook at 63 (Figure 2.3).

Adaptability & Resilience

Furthermore, the drop in MHQ points was highest forYour ability to shift your behaviour

Social Self at 66. Correspondingly the increase in theand outlook in response to changing

percentage of young adults 18-24 struggling relative tocircumstances and cope with thethose age 55-64 was also highest for this dimension atchallenges and setbacks that you

33%. This was followed by Mood & Outlook as a close

encounter.

second.

Mind-Body Connection

Of all dimensions the drop in MHQ
points was highest for Social Self at
66 MHQ points.

The regulation of the balance between
your mind and body.

Figure 2.3: Mental wellbeing across dimensions
Globally the dimension of Adaptability & Resilience scored high while Mood & Outlook and Social
Self scored the poorest. Among the dimensional scores Social Self has the biggest drop from older
to younger generations. All differences shown are between the age groups of 55-64 and 18-24.
70

35%

60

30%

80

70

Drop in Dimensional Scores(from age 55-64 to 18-24)

Average Dimension Score

90
50

40

30

20

60
10

Difference in % Distressed/Struggling(from age 55-64 to 18-24)

100

25%

20%

15%
Cognition

10%

Adaptability & Resilience
Drive & Motivation

5%

Mood & Outlook
Social Self

50

21

0

0%

Mind-body Connection

The decline in the Social Self: a geographic view
The geographic trends in the decline in Social Self across age groups are similar to those for overallmental wellbeing. Latin America and English-speaking South and South-East Asia form a distinct groupwith high decline of 77 to 84 Social Self points relative to other regions which ranged from 43 to 57. Hereagain Swahili-speaking Sub Saharan Africa shows the smallest decline. Thus, the overall decline in mental
wellbeing is driven substantially by a deterioration of the Social Self.
Interestingly while the Social Self is highest in Asian and African countries that have been traditionallycollectivist cultures, it is the English-speaking of these that are seeing the greatest deterioration.

Figure 2.4: The generational decline of Social Self by Regions and Language Groups
The Social Self has declined most substantially from older to younger generations in English-speaking South andSouth East Asia, Spanish and Portuguese Latin America and least among Swahili speakers of Sub-Saharan Africa.
90

Decrease in Social Self Scores(from age 55-64 to 18-24)

80

Latin America and Caribbean
South Asia
South-East Asia

60
50

Hispanosphere80

Anglosphere (other)
Lusophone (Portuguese)

70

70
Middle East and North Africa
EuropeSub-Saharan Africa
North America
Oceania40

60
50

Arabsphere
Francosphere
Germanosphere
Anglosphere (core)
Swahili

40

30

30

20

20

10

10

0

0

Geographic
Regions

50

50

LanguageGroupsDifference in % Distressed/Struggling(from age 55-64 to 18-24)

90

40South Asia
Latin America and Caribbean

40

Hispanosphere
Anglosphere (other)
Lusosphone (Portuguese)

30

EuropeSouth-East Asia
North America
Middle East and North Africa
Oceania

30

Germanosphere
FrancosphereArabsphere
Anglosphere (core)

20

Sub-Saharan Africa

20
Swahili

10

10

0

0

Geographic
Regions

LanguageGroupsIn the next sections we explore trends relating to family relationships and friendships to understand thenuances of the Social Self and its deterioration.

22

3.

Family Relationships
and Mental Wellbeing

The breakdown of the Social Self in younger generations reflects a breakdown of relationships, the senseof self and the sense of secure embeddedness within a social fabric. Our first relationships are with
our family and many studies have shown a link between strong family relationships and happiness aswell as other outcomes of life success (Martin-Joy et al., 2017; Ramos et al., 2022; Sroufe et al., 2005;
Thomas et al., 2017; Waldinger & Schulz, 2016). Here we explore the nature of family relationships
across generations and geographies to reveal a progressive deterioration in younger generations acrossthe global Internet-enabled world. We also show the profound relationship between family bonds andmental wellbeing that suggests the breakdown of family relationships as a substantial contributor to theprogressive decline of mental wellbeing in younger generations.

Trends in family closeness
Figure 3.1: Relationship with adult family across age groups

Percentage of Population

Older adults are twice as likely to be close to many of their adultfamily members as the youngest adults. Conversely the youngest
adults are twice as likely to not get along with their family.

We asked in the MHQ how close people
were to their adult families. Were theyclose to many of their family members
or just a few? Did they get along with
their families but were not close, or50%

did not get along at all, preferring not45%

to see them. Perhaps not surprisingly,

40%

across the globe, the percentage whoreported being close to many members

35%of their family decreased with each

30%
25%

younger generation. On average only

Close to many family members

22% of young adults 18-24 were close

Don't get along and prefer limited contact

20%

to their families compared to 44% of the15%

oldest generation aged 75+, a two-folddifference. Conversely, 10% in the 18-24

10%

age group did not get along with any

5%of their family and preferred not to seethem compared to only 3% of the oldest

0%

75+

65-74

55-64

45-54

Older

25-34

18-24
YoungerAge group

23

35-44

generation.

10% in the 18-24 age group did not get along with any of their family andpreferred not to see them compared to only 3% of the oldest generation.

Family relationships and mental wellbeing
We looked at mental wellbeing across all adults for each answer group. MHQ scores were highest for
those who were close to many of their family members with an average of 102, placed in the range wecall ‘Succeeding’, and declining steadily to 33 for those who did not get along with any of their family,in the range we call “Enduring”. Among those close to their families, 12% still struggled with theirmental health. However, this was almost four times lower than the 44% of those who did not get alongwith their families. Thus, in the aggregate, the risk of mental health challenges are four times lower if
you have close family relationships. This 70 MHQ point difference and four-fold differential in mental
health struggles was consistent across all age groups. This is a profound difference in risk, twice thatof the mental health risks associated with other factors such as lack of exercise, lack of education or
unemployment.

In the aggregate, the risk of mental health challenges in adulthood are
four times lower if you have close family relationships.

Figure 3.2: Relationship with adult family and mental wellbeing outcomes
Globally, those who have a close relationship with many of their adult family have an average MHQ
score of 102 with only 12% struggling with their mental health. In contrast, those who do not getalong with their family have an average MHQ score of 33 with 44% Distressed or Struggling.

Close to a many
Close to a few
Get along but not close
Don’t get along

50%

40%

30%

20%

10%

% Distressed/Struggling

24

0% 0

20

40

60

80

Average MHQ Score

100

120

Why is this so?
Is it that young people have increasingly abandoned the idea of family or have younger generationsof parents precipitated a crisis of family? To gain insight into this we probed their childhood family
experience. Did their parents provide for all their material needs? Were they invested in their academic
and other accomplishments? How did they rate their childhood home from unstable with conflictto stable and supportive? From emotionally distant to warm and loving? And how did these factors
influence how close they were to their families in adulthood and their adult mental wellbeing? Wesummarize the results in the next section.

The generational shift in childhood family experience
Starting with those who were born in the 1980s (age 45 and younger), there was a steady and substantial
increase in the percentage who reported that their parents provided everything they needed materially,soaring to 68% of those 18-24 from only 50-54% in generations older than 45. Similarly, there was also adramatic increase in the percentage who reported that their parents were invested in their academic andother accomplishments which grew from about 33-35% to 58%. There was also a small increase in thepercentage of younger generations who reported that their parents always supported their choices from
36% for those over 65 to 39% of the 18-24 age group.

Figure 3.3: Nature of childhood home across generations

80%

80%

70%

70%

60%

60%

50%
40%
30%
Invested in academic/accomplishments

20%

Provided everything I needed materially10%

Supported my choices

0%

50%
40%
30%
Stable & Supportive

20%

Warm & Loving

10%

Always made time for me growing up

0%

75+

65-74

55-64

45-54

35-44

Older
Age group

25

Percentage of population

Percentage of population

Adults younger than 35 increasingly report that their parents provided everything they needed materially and were very
invested in their academic and other accomplishments. On the other hand the percentage reporting a stable and loving
childhood home decreases dramatically with younger generations.

25-34

18-24

75+

Younger

Older

65-74

55-64

45-54

35-44

25-34

18-24
YoungerAge groupOn the other hand, while 70-72% of those over 65 reported growing up in homes that were both stable
and loving, only 46-48% of the 18-24 age group reported the same. So also the percentage reporting that
their parents always made time for them declined but only slightly from about 35% for those 65+ to 29%
for those 18-24.
Figure 3.4: Prevalence of parent driven traumas in childhood across age groups
The reported incidence of trauma in childhood increases with each younger generation of
adults. This includes incidence of emotional abuse or neglect by a parent or caregiver tophysical violence in the home and divorce or family breakup.

of instabilities, conflict and lackof emotional warmth showed adramatic and steady increase
with each younger generationin the percentage reporting

25%

parental divorce or family

Emotional/ psychological abuse/neglect from parent/ caregiver

20%

Percentage of Population

Further probing of the nature

breakups, violence between

Physical violence in the homebetween family members

family members and emotional

Divorce/ Family breakup

abuse or neglect by their

15%

parents (Figure 3.4).
Among the age groups

10%

between 18 and 34, those
who were provided everything

5%

they needed materiallyand whose parents were
invested in their academics or

0%

75+

65-74

55-64

45-54

Older

35-44

25-34

18-24
YoungerAge group

accomplishments, only 48%
reported a stable and loving
home. This was in contrast
to 70% for the age groups

between 45 and 64. And unsurprisingly, 49% of those from stable and loving homes reported being
close to many family members in adulthood compared to only 14% of those who reported unstableand emotionally distant childhood homes. Altogether this paints a picture of changing parenting
priorities from providing a stable and loving childhood home to a greater focus on material comfort andaccomplishment. Alongside this shift is a home life with greater conflict and abuse.

This paints a picture of changing parenting priorities in younger
generations from providing a stable and loving childhood home to one
focused on material comfort and accomplishment, that fosters greater
conflict and abuse.

26

The childhood home and mental wellbeing in adulthood
Mental wellbeing increased with ratings of warmth and stability of the childhood home. Those who camefrom both stable and loving homes had MHQ scores that were 58 points higher on average than those
who came from homes that were both unstable with conflict and emotionally distant. Correspondingly,
35-40% of those who reported either homes that were unstable with conflict or emotionally distant
struggled with their mental health in adulthood while only 13-17% of those who reported homes thatwere stable or loving had mental health challenges. When combined, 41% of those who reported bothinstability and emotional distance had mental health challenges compared to just 13% of those fromstable and loving homes.

41% of those who reported both instability and emotional distance had
mental health challenges compared to just 13% of those from stable andloving homes.

Figure 3.5: Difference in mental wellbeing based on childhood home and adult family relationships
Having a stable and loving childhood home means much higher MHQ scores on average in adulthood and far lesslikelihood of mental health struggles. For those with parents who provided all material comfort and were invested intheir accomplishments MHQ scores were slightly lower and distress slightly higher.

Stable &LovingMaterial comfort,
Invested inaccomplishments
Stable & Loving

50%

70

40%

50
Unstable &Distant

30-10

Don’t getalong
Unstable & DistantMaterial comfort,
Invested inaccomplishments

Material comfort,
Invested inaccomplishments
Unstable & Distant

60%

90

10

27

Close toadult family% Distressed/Struggling

Average MHQ Scores

110

Don’t getalong
Unstable &Distant

30%

20%

10%

0%

Close toadult family

Stable &LovingStable & loving
Material comfort,
Invested inaccomplishments

Interestingly, those from stable and loving homes whose parents provided all material comfort and were
invested in their accomplishments had MHQ scores that were not much different on average (Figure 3.5).
On the other hand, those who came from unstable and emotionally distant homes where their parents
provided everything they needed materially and invested in their accomplishments had worse mental
wellbeing than those whose parents did not.

A geographic view of family trends
Where are family bonds the strongest? And in which regions of the world is this deterioration of familybonds most apparent?
First, in the aggregate, the Middle East & North Africa had the highest percentage of reported closenessto many adult family members (42%) as well as stable and loving childhood homes (60%). This wasfollowed by English-speaking South Asia and South East Asia as well as Sub Saharan Africa, (in particular
Swahili-speaking) that were all similar. At the bottom was Portuguese Latin America (Brazil) and the Core
Anglosphere (North America and Oceania as well as UK and Ireland) where closeness to many adultfamily members ranged from 23 to 29% while growing up in a stable and loving home ranged from 39 to
41% (shown as dots on the left of each panel in Figure 3.6 and 3.7)
Figure 3.6: The demographics of close adult family relationships

60%

60%

50%

50%

40%
South Asia
South-East Asia

30%

EuropeLatin America andCaribbean

20%

North America

Percentage of Population

Percentage of Population

English-speaking South and South East Asia, the Middle East & North Africa and Swahili-speaking Sub Saharan Africa havethe closest families overall. However the decline in family closeness from older to younger generations is also steepest.
Conversely, North America, Europe and Oceania as well as Portuguese Brazil are least likely to have close families.

40%
Anglosphere (core)
Anglosphere (other)

30%

Francosphere
Germanosphere20%

Hispanosphere
Lusosphone(Portuguese)

Oceania
Middle East andNorth Africa

10%Arabsphere10%

Swahili

Sub-Saharan Africa

0%28

All agegroupsOlder(55-64)Younger(18-24)0%

All age Oldergroups (55-64)

Younger(18-24)

Figure 3.7: The demographics of adults from stable and loving childhood homes

80%

90%

70%

80%

60%
South Asia
South-East Asia

50%

EuropeLatin America andCaribbean

40%

North America

Percentage of Population

Percentage of Population

Adults in the Middle East and North Africa, Swahili speaking Sub Saharan Africa and South and South East Asia grew up in themost stable and loving homes. However the decline in stable and loving childhood homes from older to younger generations is
also steepest. Overall adults in North America and Portuguese Brazil had the least stable and loving childhood homes.

70%
Anglosphere (core)
Anglosphere (other)

60%

Francosphere
Germanosphere50%

Hispanosphere
Lusosphone(Portuguese)

Oceania
Middle East andNorth Africa

30%

Arabsphere40%

Swahili

Sub-Saharan Africa

20%

All agegroupsOlder(55-64)Younger(18-24)30%

All age Oldergroups (55-64)

Younger(18-24)

However, when comparing older and younger generations separately, a different picture emerges. Whilethe deterioration encompasses the entire Internet-enabled world, the fall was steepest from older toyounger generations among English-speaking South & South East Asia, followed by the Middle East &North Africa and Sub Saharan Africa where older generations had considerably higher family closenessand stable, loving childhood homes. In contrast, the fall was not as significant in Europe and the Core
Anglosphere where closeness and stable, loving childhood homes are already lower among older
generations. Thus, for the youngest generation of adults, the gap between regions was narrowed.

The Middle East & North Africa had the highest percentage of reported
closeness to many adult family members (42%) as well as stable andloving childhood homes (60%) while Portuguese Latin America (Brazil)
and the Core Anglosphere had the lowest closeness to many adult family
members (23-29%) and stable and loving childhood home (39-41%).

29

4.

Friendships andMental Wellbeing

What about the bonds of friendship? Like family relationships, friendships form an essential bedrockto our adult lives as well as providing a supportive social buffer during times of adversity, and studies
have shown a link between friendship and mental health outcomes. Are friendships too deteriorating?
Here we explore the nature of friendship across generations and geographies and reveal a decline in thepercentage of people with friends to confide in and rely on with increasingly younger generations acrossthe global Internet-enabled world. We also show that the nature of people’s home life growing up, and therelationship they have with their family as an adult, influence the number and quality of their friendships.
Finally, we show that close family relationships and friendships have an additive impact on mental
wellbeing.

The demographics of friendships
Across the global population in 2022 most people indicated having between 1 and 5 close friends witha global average of 3.5. 12% reported having no friends while an equivalent percentage have 7 or moreclose friends (Figure 4.1 left). Across age groups the average number of friends decreased with younger
generations, flattening out after age 45 (Figure 4.1 right). The generation aged 75+ reported 4.7 closefriends on average while those under 45 reported an average of 3 to 3.2 friends. Twice as many 18-24
year olds (12%) reported having no close friends compared 75+ year olds (6%) (Figure 4.2 right)

On average people have between 3 and 4 close friends while 12% have no
close friends at all.

30

Figure 4.1: The Demographics of Friendships
The majority of the population has between 1 and 5 close friends while 12% have no close friends (left) while adults older
than 45 have increasingly more close friends (right). The average number of close friends across the population is 3.5.

Average number of close friends

Percentage of group

25%
20%
15%
10%
5%
0%

0

1

2

3

4

5

6

7

8

9

5
4
3
2
1
0

10 +

75+

Number of close friends

65-74

55-64

45-54

35-44

25-34

Older

18-24
YoungerAge group

The quality of friendships
Close friends can mean different things. To understand the support offered by close friendships, we
also asked people whether they had friends who they could confide in, or who would help them out inpractical ways during times of need. The more close friends you have, the more likely you are that someof them are ones you can confide in or will help you out (Figure 4.2 left). Furthermore, 75% of 75+ year
olds said they had friends they could confide in and help them out. This declined with each younger
generation such that only 64% of 18-24 year olds had friends that they could confide in, and only 51% had
friends who would help them out, an even sharper decline (Figure 4.2 right). This despite 18-24 year olds
reporting slightly more close friends on average than the next two older generations.
Figure 4.2: The changing quality of friendships
The probability of having a friend you could confide in or one who would help you out practically in a time of need increased steeply as thenumber of reported close friends increased from 0 to 5 (left). The percentage having friends to confide in and help them out decreased witheach younger age group. This was despite all adult age groups younger than 45 having an equivalent average number of close friends.
80%

80%
60%
40%
Friends to confide in

20%

60%
Friends to confide in
Friends to help you out

40%

0 Close friends

20%

Friends to help you out

0%

0%

31

Percentage of group

Percentage of group

100%

0

1

2

3

4

5

6

Number of friends

7

8

9

10

75+

65-74

55-64

45-54

Older

35-44

25-34

18-24
YoungerAge groupAcross the generations there is a decline in the proportion of people
reporting that they had friends who they could confide in or who would
help them out.

Friendships and mental wellbeing
How does the number of close friends impact mental wellbeing? MHQ scores increased as number ofclose friends increased, plateauing slightly at higher numbers (Figure 4.3 right bars). MHQ scores were
lowest for those who reported no close friends, with an average of 28, a score in the “Enduring” range,
increasing to an average of 110, in the “Succeeding” range for those with 10+ close friends. Conversely,
among those who reported having no close friends, 45% reported struggling with their mental health, fourtimes greater than people with 10+ friends (9.5%; Figure 4.3 left bars). Even having 4-6 close friends was
associated with a 60-point increase in MHQ score and a 3-fold reduction in people with mental healthstruggles compared to having no close friends. This substantial difference in MHQ score, and multi-folddifference in the proportion of people struggling was consistent across all age groups, highlighting theimportance of close friendship on mental health.

Figure 4.3: Relationship between friendship and mental wellbeing
The average MHQ score of those having 10+ close friends was 110 with ~9% Distressed or Struggling. In
contrast the average MHQ score of those with no close friends was 28 with 44% Distressed or Struggling,a 4.5-fold increase. MHQ scores went up and % Distressed or Struggling decreased when those friendships
included someone to confide in and rely on to help you out (shown by vertical bars).

Number of
Close Friends
10+
7-9
4-6
1-3
0

50%

40%

30%

20%

10%

% Distressed/Struggling

0% 0

20

40

60

80

100

120

Average MHQ Score

For each number of friends, when specifically considering those who also reported friends they could
confide in and rely on to help them out in times of need, MHQ scores were higher and the percentage32Distressed or Struggling lower than when considering only number of friends alone. This difference isshown by the arrows in Figure 4.3.

The percentage of people Distressed or Struggling with their mental
wellbeing is over 3.5 times higher in those who report having no friends
compared to those with many close friends they can confide in and rely on.

A geographic view of friendship trends
Where do people have the greatest number of friends? And in which regions around the globe are people
more likely to have friends who will help them out or who they can confide in?
Most regions of the world had between 3 and 3.5 friends per person on average. However, South East
Asia and the Spanish-speaking world stood out with 4.7 and 4.3 friends on average, respectively. South
East Asia also had the highest percentage of people who reported having friends that they can confide in(74%). Sub-Saharan Africa has the lowest average number of close friends, but has the second highest
percentage of people who report having friends that they can confide in (72%), and the second highest
percentage of people who report having friends who will help them out during times of need (65%).
Conversely, it’s Portuguese speakers who report the lowest number of close friends (2.8), and the lowest
likelihood of having friends who would help them out (54%) and who they can confide in (66%). The Core
Anglosphere also reports a similarly low proportion of people who have friends that they can confide in(66%).
While these numbers are not shown here graphically they are available in the associated tables.

South East Asia and the Spanish-speaking world have the highest
number of close friends on average while Sub Saharan Africa has thehighest proportion of friends to confide in and rely on for help.

33

The impact of family relationships on friendships
Family relationships are typically the first relationships we experience. How does the nature of yourchildhood home or the relationship you have with your adult family impact the number of close friends
you have or the quality of those friendships?
First, those who reported being close to many family members have 4.6 close friends on averagecompared to an average of 2.6 among those who reported that they don’t get along with their family.
In addition, those who grew up in loving stable homes have more close friends as adults (average 4.3)
compared to those who grew up in emotionally distant and unstable home (average 2.9).

Figure 4.4: Strong family relationships mean better friendships
Of those who were close to many of their family members and/or grew up in
stable and loving homes 78-81% had one or more close friends to confide inand 75-78% had one or more close friends who they could rely on to help themout when they needed it. Only 6-7% had no close friends.

Moreover, among those who wereclose to their families only 6% reported
having no close friends, while 81%
reported friends they could confide in,and 77% reported friends they could
rely on to help them in times of need

90%

(Figure 4.4). In contrast, more than 3times as many people who reported

Percentage of respondents

80%
70%

Close to manyfamily members

60%

Stable and loving
childhood home

not getting on with their family at allreported having no close friends (19%,not shown in Figure).

50%
40%
30%
20%
10%
0%

0 Closefriends

Friends toconfide in

Friends tohelp you out

Only 6% of those who
were close to theirfamilies had no closefriends compared to
19% of those who did
not get along with
their family.

This pattern was similar for those who grew up in stable and loving homes where 78% and 73% had
friends they could confide in and rely on respectively, a 17-20% difference compared to those who grew
up in unstable and emotionally distant homes. Thus, having a stable, loving childhood home and strong
relationships with one’s adult family are strongly associated with more friendships and higher quality
friendships in adulthood.

34

An additive impact of family relationships and friendships on
mental wellbeing
Among those with close family relationships and a large number of friends, 74% were Succeedingor Thriving compared to only 14% of those who did not get along with their family and had no closefriends. Conversely, only 6% of people with close family relationships and a large number of friends wereDistressed or Struggling with their mental wellbeing, in contrast to 61% of people who didn’t get along with
their family and who did not have any close friends (Figure 4.5). Thus, the risk of mental health challenges
is ten times lower for those with a large number of both close family relationships and friendships.
Figure 4.5: The combined impact of family
relationships and friendship on mental wellbeing
Having having no close friends and not getting along with family were both associatedwith four times higher risk of mental health struggles or distress compared tohaving many close friends and family. When combined the risk was ten times higher
suggesting that close friendships and family relationships are additive to our wellbeing.

70%

0 Close Friends
and Poor family
relationships

60%

0 Close Friends
and Distant/
Unstable
Upbringing

This was a muchlarger difference inrisk compared to that
conferred by either nothaving close friends orgetting along with family
where the percentage
Distressed or Struggling
decreased from 44% to% Distressed /Struggling

about 10% when going
50%

No
friends

from either no friends

Don’t getalong

to 10+ friends or poor

40%

family relationships tomany close relationships.

30%

Thus, the benefitsof close family and20%

friendships appear to be
additive in nature.

10%
10+ closefriends0%

Close
Family10+ close friends
and Close Family
relationships

10+ Close Friends
and Loving/Supportive
Upbringing

Indeed, having friends
can also lift mental
wellbeing when people
experienced a difficult

childhood or when they don’t get along with family as an adult. For example, 58% of those who grew up in
homes that were emotionally distant and unstable and also had no close friends were struggling with theirmental wellbeing but this reduced to 19% for those with a similarly difficult upbringing but who had morethan 10 close friends. Similarly, 61% of people who didn’t get along with their family and who had 0 closefriends were struggling with their mental wellbeing but this reduced to 27% for those with similarly poorfamily relationships but who had more than 10 close friends.

35

Insights and Interpretations
The global trends of 2022
The data presented here provides a barometer for how our global society is faring as we emerge fromthe Covid-19 pandemic. We find that in 2022, the needle on this barometer stayed steady, with no further
decline in mental wellbeing, but also no signs of a recovery to pre-pandemic levels. At an individual
country level, the trend was similar, with only small or insignificant increases or decreases across a
handful of countries. Heading into 2023, we will continue to track how the 64 countries included in thisreport are faring while expanding outreach to new countries in new languages.

The persistent decline of younger generations
Across these 64 countries, another worrying trend persists; the decrease in MHQ scores andcorresponding increase in the proportion of those distressed or struggling with significant mental healthchallenges in each successively younger age group. This trend is apparent in the Internet-enabled
populations of every country measured from Africa to Asia, Europe to the Americas. Identified first in
our data in 2019 and exacerbated by the pandemic, this trend is also reported by others (Krokstad etal., 2022; Twenge et al., 2019) and is at odds with studies of psychological wellbeing prior to 2010 thatshowed universally that young adults fared best in all countries and regions of the world measured(Stone et al., 2010). Furthermore, in the United States for instance, where the CDC has consistently
measured mental distress in teens over three decades, rates of reported sadness and hopelessness
have steadily increased from 2011 to 2021 and particularly in girls where it has increased from 36% to57% (Centers for Disease Control and Prevention, 2023). This points to a progressive global decline ofyounger generations since that time rather than a natural increase in wellbeing as we age.

Deteriorating Social Self, family bonds and friendships
We find that it’s the Social Self – a dimensional score encapsulating the way we see ourselves andour ability to relate to others - that is most diminished in young adults aged 18-24 compared to older
generations. The global deterioration of family relationships and friendships across generations that we
document here is thus both a reflection of, and a dominant contributor to our deteriorating Social Self in aself-reinforcing feedback loop.

36

A poor Social Self does not just represent an absence of positive relationships. Poor Social Self at acountry level correlates with national rates of suicide, physical assault and sexual abuse (Sapien Labs,
2022). Conversely, the experience of assault and abuse in turn impact the Social Self and our overallmental wellbeing. For instance, the negative impact of parental emotional abuse and neglect or divorce/family separation on mental wellbeing is well established (Auersperg, Vlasak, Ponocny, & Barth, 2019;
Carr, Martins, Stingel, Lemgruber, & Juruena, 2013). The growing rates of parent driven trauma acrossgenerations we show here may thus reflect a downward spiral as childhood experiences translate into
one’s own parental behavior (Condon, Dettmer, Baker, McFaul, & Stover, 2022; Dixon, Browne, & HamiltonGiachritsis, 2005). So too the growing rates of sexual abuse, assault and cyberbullying with younger
generations that we described in a previous report, where the perpetrators are likely peers, both reflect
and perpetuate the deteriorating peer relationships and Social Self.

We have perhaps not appreciated the degree to which we are evolved associal beings. As much as we may believe that we are each independent,
our wellbeing is profoundly relational in nature.

Altogether, the mental wellbeing differential between those with strong family bonds and friendships
and those without at ten-fold, is greater than the differential between the extremes of any other driver ofmental health that we have documented such as education, employment or exercise. While deteriorating
family bonds in childhood may be a dominant precipitating factor, it is also possible that mental healthproblems arising for other reasons, in turn cause challenges to family dynamics and social bonds.
This suggests that we have not appreciated the degree to which we are evolved as social beings. That asmuch as we may believe that we are each independent, our mental wellbeing is profoundly relational innature. This also explains in large part why countries such as Tanzania and Venezuela top the countries’
rankings despite relatively lower wealth and political challenges. Tanzania, for instance, has among thestrongest relationships of both friends and family.

Culture and our deteriorating social bonds
What drives our deteriorating social bonds? There are many possible factors. Prominently among themis our changing culture. We have shown in last year’s report a positive correlation between average MHQ
scores of countries and the cultural index of Family Collectivism (Hofstede, 2013) and conversely anegative correlation between the cultural indices of Individualism and Performance Orientation (House,
Hanges, Javidan, Dorfman, & Gupta, 2004). Thus, countries with greater Individualism and Performance
Orientation had worse mental wellbeing despite greater economic success.

37

Decades of analysis show a growing spread of western cultural values of Individualism across theworld (Santos, Varnum, & Grossmann, 2017). This comes alongside greater economic productivity andchanging employment trends where it is now more common for both parents to work as the number ofwomen participating in the labor market has increased (Our World in Data, 2017). In reflection of thesetrends, this data shows a growing proportion of adults in younger generations who report that theirparents provided everything they needed materially and were invested in their accomplishments. While
there is no evidence that these factors of material comfort and performance orientation alone have a
directly negative impact on mental wellbeing, what the data reveals is that they increasingly come not as
an addition to, but as a trade-off to nurturing stable and loving family bonds. It is this loss of stable, loving
family bonds that fundamentally challenges our psyche.

The data suggests that material comfort and performance orientation
increasingly come not in addition to, but as a trade-off to stable andloving family bonds. It is this loss of stable, loving family bonds that
fundamentally challenges our psyche.
In developing countries these cultural shifts towards individualism, materialism and performanceorientation are most prominent for younger generations where many are also first generation English
speakers. The consequent experience of a profoundly different environment of culture and values relative
to their parents can also lead to inter-generational conflict. Together this may be one explanation as towhy the core English-speaking countries or Core Anglosphere show poorer mental health across evenolder generations, but that the English-speaking of South and South East Asia see a greater fall between
older and younger generations.

The Internet and our deteriorating social bonds
Beyond facilitating the rapid global spread of western culture, the Internet also exerts an impact on
culture that may play an outsized role in driving the deterioration of our Social Self. With its command of
our individual attention for an average of 7 to 10 hours a day, it leaves little time for the effort required tonurture social bonds. For the younger generation who are born as digital natives, it diminishes from theoutset the time available to both develop their social capabilities and form strong social bonds.

With its command of our individual attention for an average of 7 to 10
hours a day, it leaves little time for the effort required to nurture social
bonds. Like team sports, getting good at navigating social situations andbuilding relationships requires putting in the time on the field.
38

While we are all born with an inherent social capability, it must nonetheless be learned, practiced, anddeveloped (Soto-Icaza, Aboitiz, & Billeke, 2015). Like team sports, getting good at navigating social
situations and building relationships requires putting in the time on the field. Developing and navigating
relationships is complex. It requires us to learn how to read facial expression, body language and tone
to judge intent, how to navigate complex group dynamics, resolve conflict, regulate emotions to thesituation and more. If we spend just a quarter of the time or less, as younger generations now do, theoutcomes of social bonding and the capability for positive social behavior will be commensurate. And ofcourse, even if you developed it well, like all human capabilities, when you don’t use it you lose it.
Besides the diminished time for in-person social interaction, there is also the increasingly documented
challenges to sense of self arising from social media (Saiphoo, Dahoah Halevi, & Vahedi, 2020; Strimbu &O'Connell, 2019). This altered mode of interaction drives less moderated social exchange and permanent
record of comments and opinions that distort our social perceptions with lasting consequences. The
mental health challenges resulting from this mode of social engagement may therefore precipitate
challenges in relating to others. In an earlier report, for example, we have described the rapid increase in
the rate of young adults reporting the experience of cyberbullying in childhood. This experience appears
to have an equal impact on their adult mental wellbeing as childhood sexual abuse; a further testament to
the profoundly relational nature of our psyches.

In conclusion
Our success in the creation and garnering of resources depends on our ability to cooperate, which isin large part motivated by relationally derived purpose, trust and affection. In the quest for material
success as a path to enhancing our wellbeing, by turning away so profoundly from social nurturing, weare paradoxically dismantling the very wellbeing and economic success for which we have cast it aside.
If there is one clear message in this data, it is that we must more explicitly acknowledge our inherently
relational nature and its crucial role in our collective wellbeing.

39

Appendix 1:
The MHQ Assessment
and Scores
Understanding the MHQ
Data for the Mental Health Million project is collected using an online assessment tool called the Mental
Health Quotient (MHQ) that was developed at Sapien Labs. The MHQ is a unique comprehensive
assessment of mental wellbeing comprised of 47 elements of mental function including both problems
that include symptoms of ten major disorders and positive assets of mental function (Newson &Thiagarajan, 2020). It uses these elements to provide an aggregate score to position individuals on aspectrum from Distressed to Thriving, as well as sub-scores across 6 broad functional dimensions. The
MHQ is freely available online, is anonymous, and takes ~15 minutes to complete. It is currently available
in English, Spanish, French, Arabic, Hindi, German, Portuguese (European & Brazilian) and Swahili withadditional translations planned for 2023 and beyond. In addition to the 47 scored questions, respondents
answer questions relating to their demographics, life experience and lifestyle. To encourage thoughtful
and honest responses, respondents receive an MHQ score along with tailored feedback on completion of
the MHQ and can opt to receive a more detailed report with recommendations for action via email.
More information on the development and validation of the assessment can be found in peer reviewed
publications here and here.

The MHQ scale
The MHQ positions individuals on the spectrum from Distressed to Thriving, spanning a possible range ofscores from −100 to +200 where negative scores indicate a mental wellbeing status that has significant
negative impact on the ability to function. Importantly the MHQ score is not based on a simple averaging
of question ratings but rather each individual rating is thresholded along the functional scale between
positive and negative impact to function and nonlinearly transformed based on a ranked severity of40

implications. The positive range of the scale is modeled on the IQ scale. Positive scores, which are largely
normally distributed, are calibrated to a mean of 100 based on our original 2019 sample and can range
from 1 to 200. Negative scores, on the other hand, have a long-tailed distribution. In order to ensure that
overall average scores are not inordinately determined by the small number of individuals in the longtail, the negative scale was compressed to a smaller scale of 0 to -100 in order to mitigate the impact ofnegative scores on the population average. More details of this methodology are provided in (Newson &Thiagarajan, 2020).

Functional implications of the MHQ
Figure A1: Relationship of MHQ score to productivity

less productive and assuming a range of
20% to 50% loss of productivity on less

200

175

150

days of work missed and days that were

0125

of MHQ score (taking into account both100

total loss of life productivity as a function

5752022). Cumulatively, when considering the

1050

as MHQ scores increase (Newson et al.,15

25

the past month decreases systematically

Employed0

average number of days of work missed in

All respondents

20

-25

For example, we have shown that the

25

-100

(Sapien Labs, 2021; Newson et al., 2022).

Weighted productivity lost (days)

function of an individual in work and life

-50

to relate systematically to the productive-75

The MHQ score has been demonstrated

MHQ ScoreLines show top and bottom of the range

productive days) those with the lowest
MHQ scores (between -75 and -100) had
an overall reduction in life productivity of anywhere from 18-23 days per month on average (Figure A1).
While those with the highest MHQ scores did not often miss a day of work, even this group reported
a few unproductive days a month. Thus, the MHQ score is a good representation of behavioral loss offunction and supports the use of the MHQ as an assessment of the productive capacity of a population,
independent of any disorder classification. It also positions the MHQ as an important tool for companies
and universities to be more strategic in their management of mental health and wellbeing.

41

Relationship of the MHQ scale to clinical disorders
The MHQ elements map to diagnostic criteria for each of 10 major DSM-5 disorders (Newson &Thiagarajan, 2020, 2021). Mapping individual profiles to these criteria has shown that MHQ scores
relate systematically to clinical burden (Newson et al., 2022). The percentage of people with clinicalsymptom profiles that aligned with any of 10 DSM-5 defined disorder criteria increased as the MHQ
score decreased, such that 89% of those with scores in the Distressed range had symptom profiles thataligned with at least one of the 10 DSM-5 defined disorders compared to 0% for those with scores in
the Succeeding or Thriving range (Newson et al., 2022). Similarly, the number of disorders per individual
decreased systematically as MHQ scores increased with the average number of disorders per person at
3.8 for those in the Distressed group and 0.0 for those in the Succeeding and Thriving groups. Thus, theMHQ score is also reflective of the overall clinical burden of mental health.

Friendship and Family Questions
In addition to the standard MHQ questions, various other questions were asked on family relationships
and friendships as well as childhood traumas and adversities that are compiled here. These included
ratings of the nature of their childhood home on a 5-point scale as shown below as well as selections ofwhether or not the following statements were true.

Friendship Questions:
How many close friends do you have?

(Number answer)
Do you have friends who would help you out when you are sick or have a problem(e.g. bring food, watch kids)?

Yes/No/Not sure
Do you have friends you can confide in and with whom you can express your true feelings and opinions?

Yes/No/Not sure42

Family Questions:
What was the nature of your household growing up?

1 = Unstable with Conflict…5 = Stable and Supportive
How would you describe your household growing up?

1 = Emotionally distant…5 = Warm and Loving
How did your parents or caregivers support you? Please select any of the following that apply:

They provided everything I needed materially; They were supportive of my choices; They were very
invested in my academic and other accomplishments; They always made time for me
How would you describe your relationships with your adult family?

I don’t have any family; I don’t get along with most of them and prefer not to see them often; I getalong OK with them but we are not close; I am very close to some of them but not all; I am very
close to many of my family members

43Appendix 2:
Data Acquisition and Analysis
Data Acquisition
491,196 respondents from around the world completed the MHQ assessment between 1st January
and December 31st 2022. Participants were recruited through advertising on Google and Facebook bytargeting a broad audience within each age-gender demographic across a wide geography within eachof 64 countries (See Section 1 of this report for a map and list of countries). Recruitment in 2022 initially
focused on English, Spanish, French and Arabic speaking countries, and was then expanded to German,
Portuguese (European and Brazilian), Swahili and Hindi speaking countries with the launch of thesetranslations in May, August, September and October, respectively. The Google Ads outreach specificallytargeted those individuals who were searching for terms relevant to mental health (e.g. psychological test,
cognitive assessment test, mental health assessment) and were applied consistently across all countries.
Those recruited through this stream may therefore have had a specific interest or concern relating to theirmental health. In contrast, Facebook outreach was much broader, spanning individuals who had showna previous interest in mental health and wellness
topics, as well as all adults in that country withthe simple tagline “What is your mental wellbeing

Figure A2: Distribution of sample by age groups

score?”. Those recruited through this stream were
therefore not specifically searching for information
relating to a mental health interest or concern.

75+
4%

65-74
12%

The number of respondents for each targetedcountry is shown in the associated data tables.

18-24
13%

25-34
15%

55-64
20%

Respondents spanned all age groups roughly
equally (Figure A2) while the gender split was 54%
female, 46% male. Those who answered that they
were “Under 18” were unable to continue with theassessment and so were automatically excluded.

44

35-44
17%

45-54
19%

Data exclusion criteria
Only those respondents who stated that they found the MHQ easy to understand were included in theanalysis. This exclusion criterion was applied by only selecting respondents who answered “Yes” tothe final question in the MHQ which asks them “Did you find this assessment easy to understand?”. In
addition, those who completed the assessment in under 7 minutes were excluded (the minimum timeneeded to read and respond to the MHQ) and responses with a standard deviation of less than 0.2(representing people who answered with the same value across all 47 rating items) were excluded. This
resulted in 407,959 data responses being available for the final analysis.

Computing average MHQ Scores for countries
The spread of respondents across age and gender groups was not an accurate representation of their
proportion of the population in each country. Furthermore, the proportion of respondents in each agegender group were not identical across countries. Thus, to enable a more representative view of acountry’s population, and more accurate comparisons between countries, scores were first computedfor each age-gender group and then a weighted average score was computed based on the relative
proportions of each group within individual countries. Analyses comparing age brackets were only
weighted by gender, while conversely, analyses comparing genders were only weighted by age. All
population estimates and age-gender distributions that are utilized for these weightings were taken fromthe United Nations population estimates (United Nations, 2022). Note that in some countries (e.g. some
Sub-Saharan nations such as Tanzania), the general population profile is generally younger, somethingthat is also observed in the spread of respondents across age groups for these countries in this data. In
some cases, there were no respondents over the age of 75 for these countries and therefore they are notrepresented in these older age groups.
We note that respondents across countries varied in terms of their education level and employment
status. Education and employment levels are shown in the associated data tables.

Computing average MHQ Scores for regions
Computation of the regional MHQ and dimension scores were not a simple average across countries but
were additionally weighted based on the proportion of Internet users within the country (Data Reportal,
2022). Thus, more populous countries or countries with larger Internet populations would have a greater
contribution to these regional estimates. Where the Internet population may be larger than the particularlanguage groups in the country in which the MHQ was offered (e.g. Belgium), the proportion of thoselanguage groups was used as the weighting factor rather than the proportion of Internet users.

45

Score Reporting in MHQ points and percentage differences
We typically report differences in terms of MHQ points and the corresponding percentage shift along
a 300-point scale i.e. ((Value 1 – Value 2)/300) * 100. For instance, 75 points represents 25% of the 37
possible length of the scale. Thus a 75-point shift or difference between groups would be a 25% shift
along this scale.

Statistical analysis
Statistics were computed by comparing groups using a standard t-test. P-values obtained were thencorrected for multiple comparisons using a Bonferroni correction. All statistical tables showing these
corrected p-values are provided in a supplementary download along with the report.

Limitations of sampling and data interpretation
Although respondents were similarly recruited across all countries, three key caveats must be highlighted.
First, these samples may not reflect a true sample of any country’s population and will be biased bythose with language proficiency, Internet access and the willingness to spend 15 minutes completing an
online assessment. Thus, results must be interpreted strictly in this context. Second, cultural differencesin language usage and culture itself can significantly influence how people interpret and respond toeach individual question. Any individual country’s results will therefore reflect these differential effects ofculture. Third, data is cross-selectional and not longitudinal and therefore trends over time do not reflect
the same individuals. However, we note that the MHQ has been validated for sample-to-sample reliability
within the same time frame.

46

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