New study reveals gaps in how mental health is measured in European Region

A new WHO/Europe study found wide variation in how research measures mental health in the WHO European Region, underlining the urgent need for standard monitoring.

The review covered 75 studies and identified 450 distinct mental health indicators in use, highlighting significant fragmentation in how mental health is tracked, compared and translated into policy. The findings will support the development of a regional mental health monitoring framework and offer a structured overview of the types of indicators currently used in peer-reviewed research.

A region under pressure

Mental health is an urgent and growing public health challenge in the European Region. More than 143 million people in the Region were living with some form of mental health condition in 2021, representing 16% of the population.

The COVID-19 pandemic made the situation considerably worse, with the prevalence of mental health conditions estimated to have risen by 25% compared to pre-pandemic levels in 2019. The pandemic also exposed weaknesses in how mental health data is collected and used. Gaps in information made it harder for decision-makers to respond quickly, plan services effectively and use mental health data during the height of the crisis.

Measuring mental health at the population level is complex. Experiences are subjective, symptoms are expressed differently in various cultures and the understanding of mental well-being continues to evolve. The absence of universally accepted definitions or measurement tools for some conditions has contributed to the large number of distinct indicators found in the review. This is why the study calls for approaches to mental health surveillance that are flexible enough to reflect population diversity, while still enabling consistency and cross-country comparability.

A need for consistency

Out of the 450 mental health indicators identified in the WHO review, the majority related to mental health status and to risk factors or determinants of mental health. The wide range of indicators in use reflects the breadth of research activity, but it also creates challenges for comparing findings between countries, assessing progress over time or evaluating whether broad interventions are working.

Geographic coverage in the reviewed literature was uneven, with northern and western European countries most represented. This imbalance risks creating evidence gaps that leave some populations and health systems overlooked in regional planning. The review also found a notable scarcity of system-level and quality-oriented indicators.

Dr Ledia Lazeri, Regional Adviser for Mental Health at WHO/Europe, said: "Most indicators in the literature focus on mental health status and risk factors. In other words, how sick people are and why. What's missing is the data about the capacity of mental health systems to provide high-quality services. That is a serious gap. Governments are investing in mental health, and they deserve to know how those investments are making a difference."

Looking ahead

The study calls for future research to prioritize alignment between research-generated indicators and national monitoring frameworks. Greater standardization would strengthen policy translation and help the Region respond more effectively to mental health challenges, including potential future crises of the scale seen during the COVID-19 pandemic.

Dr David Novillo Ortiz, Regional Adviser for Data, Artificial Intelligence and Digital Health at WHO/Europe, added: "If a researcher in Finland and a researcher in Bulgaria are both studying depression in adolescents but using different thresholds and definitions, it would be hard to meaningfully compare their findings. Apply that to 450 different indicators across the Region and you see the problem clearly. Behind every gap in data is a gap in our response, and behind every gap in our response are people who did not get the support they needed".

This review was conducted under WHO/Europe's contribution agreement with the European Commission, "Addressing mental health challenges in the European Union, Iceland and Norway". The initiative aims to support countries in strengthening mental health policies, improving service delivery and promoting well-being across the Region through coordinated, evidence-based action.