Youth mental health problems are widespread and often go unaddressed, particularly because many barriers such as long waitlists hinder access to support. Burden of disease studies, which quantify health problems in terms of years lived with reduced quality of life, and years of life lost, have shown that youth mental health problems are a major contributor to the worldwide burden of disease. This burden has increased significantly over recent decades, and especially after 2019 [1]. As such, accessible and effective mental health support must be a top priority, where obstacles are removed, encouraging those who need support to receive it earlier. @ease is one such initiative, offering low-threshold walk-in mental health support to youth. We asked: what does the burden of disease look like among youth who visit @ease? And how can we use this knowledge to improve walk-in support and gain insight into the specific risk factors associated with a higher burden?
Our new publication in PLoS One [2] reported on the burden of disease of new visitors accessing the @ease mental health walk-in centres (the YEAH in the Netherlands) across six years (2018 to mid-2024). This study looked at how much young people’s wellbeing was affected at the moment of first accessing peer support, what experienced problems costed, and which factors were strongly linked to this.
This study is an expansion to an earlier study published in 2020 that focused on the first 80 eligible @ease visitors [3] and was planned in detail in 2023 [4]. Almost 1,000 young people answered a short anonymous questionnaire at the end of their first or only @ease visit, across eleven cities in the Netherlands. Most were in their late teens or early twenties, over 60% were female, most were in school, and one-third had one or more parents who (had) experienced mental health problems.
The “burden of disease” is the gap between a completely healthy life and a life cut short or changed by health problems. Measuring this burden helps to observe which problems are most influential in society, and how this impact changes over the years. In the so-called “Global Burden of Disease Study”, researchers have earlier shown differences between the years 1990 and 2019. In 2019, the six problems with the highest burden among young people aged 10-24 were road injuries, headache disorders, self-harm, depressive disorders, interpersonal violence, and anxiety disorders. (This also shows that mental health problems should be taken as seriously as physical illnesses in their impact and need for prevention and intervention investments.) The fact that depressive and anxiety disorders used to be on spot 8 and 12 in the 1990s [5], indicates that the impact has only grown. However, it should be noted that the ranking also changed because other problems decreased as measures were taken. Important actions are also taken in the field of mental health, but more is needed.
The first measure was called ‘health-related quality of life’, which assesses how well someone is doing on aspects like self-care, daily activities, pain/discomfort, and anxiety/mood. That boils down to a single number under or between 0 and 1 (1=perfect health). The second measure was the cost, measured by how many times young people had already sought support from a general practitioner or psychologist for mental health problems or addiction in the months before walking into @ease, and how many days of school young people had missed. These sessions and school days were translated into euros using national cost data, resulting in a cost estimate. These measurements and calculations of health-related quality of life and cost-of-illness are standard, widely used, approaches.
Among young people who visited @ease, the average health-related quality of life score was 0.64, which is well below the 0.91–0.96 typical for Dutch youth, and close to scores seen in people with depression. About 90% of @ease visitors reported some anxiety or low mood. The societal financial cost was also considerable. About a third of visitors had missed school in the past three months before their first @ease visit, and only about a third had already accessed mental healthcare. Together, this added up to roughly €2,318 per young person for a year’s cost, and about €1.5 million annually across the group studied before finding @ease.
The study also provides insight into who carries the heaviest burden. Health-related quality of life was significantly lower for those who lived alone or who had one or more parents with mental health problems, and higher for those who were functioning well socially and at school or work. Healthcare costs were higher for young people without school or a job. During the COVID-19 pandemic, school absence was higher and healthcare costs lower than other years, perhaps because online classes were easier to log into (not directly indicating actual presence) and in-person therapy was not always possible or chosen. Young people born outside the Netherlands had higher school-related costs but lower healthcare costs, possibly reflecting language or access barriers.
It matters to invest in easy-access services early on, since they reach young people with an evidently higher burden than the general population earlier on. Most new walk-in visitors had not visited a mental health professional yet, even though many were already experiencing a reduced quality of life and high levels of distress. Then, a listening ear can help before problems grow into something bigger, and costlier, for both the person and societal impact.
It also informs new cost-effectiveness research currently conducted by the YOUTHreach consortium [6], where health-related quality of life and financial costs are also the main measures. The aim of that is to measure if an intervention’s extra health benefits are worth its extra overall financial price. In other words: compared to doing nothing, are the walk-in centres improving young people’s wellbeing enough to be worth the money it takes (or the money it saves, ideally)?
References:
[1] Tian, J., Yan, N., Hu, X., Tian, S., Wang, Y., Mackay, L. E., … & Wang, W. (2025). Global burden of mental disorders among adolescents and young adults, 1990–2021: a systematic analysis of the Global Burden of Diseases Study 2021. General Psychiatry, 38(6), e102278. https://doi.org/10.1136/gpsych-2025-102278
[2] Boonstra, A., van Mastrigt, G. A., Evers, S. M., Osstyn, S., de Winter, R. F., Boonstra, N., … & Leijdesdorff, S. M. (2026). Health-related quality of life and cost-of-illness in young people seeking peer support at @ease: A Dutch burden of disease study. PLoS One, 21(7), e0352652. https://doi.org/10.1371/journal.pone.0352652
[3] Leijdesdorff, S. M. J., Huijs, C. E. M., Klaassen, R. M. C., Popma, A., van Amelsvoort, T. A. M. J., & Evers, S. M. A. A. (2023). Burden of mental health problems: quality of life and cost-of-illness in youth consulting Dutch walk-in youth health centres. Journal of Mental Health, 32(1), 150–157. https://doi.org/10.1080/09638237.2020.1836555
[4] Boonstra, A., van Mastrigt, G. A. P. G., Evers, S. M. A. A., van Amelsvoort, T. A. M. J., Leijdesdorff, S. M. J., & @ease consortium (2023). @ease peer-to-peer youth walk-in centres in The Netherlands: A protocol for evaluating longitudinal outcomes, follow-up results and cost-of-illness. Early Intervention in Psychiatry, 17(9), 929–938. https://doi.org/10.1111/eip.13443
[5] GBD 2019 Diseases and Injuries Collaborators. (2020). Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet (London, England), 396(10258), 1204–1222. https://doi.org/10.1016/S0140-6736(20)30925-9
[6] van Amelsvoort, T., Boonstra, A., Lekadir, K., Pujadas, E. R., Broome, M. R., Griffiths, S. L., … & Leijdesdorff, S. (2026). Bridging gaps in youth mental health care: YOUTHreach—a comprehensive European strategy. European Child & Adolescent Psychiatry, 1-9. https://doi.org/10.1007/s00787-026-03033-3
This post was written by:
and reviewed by Isabel Erven, Research assistant and
Youth Advisory Group member in the Netherlands
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