Children’s Mental Health: Understanding Vulnerability Factors to Improve Intervention

The initial findings of Enabee, a national epidemiological survey on the mental health of children in preschool and elementary school in mainland France, were published in 2023. By combining the perspectives of parents, teachers, and children, these groundbreaking findings revealed that 13% of elementary school children (ages 6 to 11) exhibit at least one probable mental health disorder (emotional disorder, oppositional defiant disorder, or attention-deficit/hyperactivity disorder). 

Santé publique France is releasing new analyses today that describe the individual and contextual characteristics (family, relational, environmental) associated with these probable mental health disorders in children aged 6 to 11. These new findings may help identify situations of vulnerability in which children are more likely to suffer from mental health disorders, although it is not possible to establish causal links.

The study shows that, in this age group: boys, children whose mothers reported pregnancy complications, and children with chronic illnesses are more frequently affected by probable mental health disorders. In addition, children experiencing academic difficulties (according to parents and/or teachers) or who have experienced difficult events (bereavement, assault, placement in child welfare) are also more likely to have a probable mental health disorder.

Furthermore, the study reaffirms the impact of the COVID-19 health crisis on children’s mental health. Indeed, significant distress during lockdown or significant anxiety within the household during the pandemic are associated with a higher prevalence of at least one probable mental health disorder in the child.

The family environment (separated parents, conflicts between separated parents, a household’s financial situation perceived as difficult, or the presence of an anxiety disorder in the responding parent) creates a context of vulnerability for the child, which is more strongly associated with the presence of mental health disorders. Being likely to be bullied by other children or spending a significant amount of time at the recreation center on days when school is not in session are also factors associated with at least one mental health disorder in the child. However, it is important to note that these associations should not be interpreted as causal or deterministic relationships.

Mental Health and Well-being of Adolescents: Signs of Improvement, but Persistent Suffering

Adolescence is a period during which young people face numerous changes, pressures, and challenges that can make them more vulnerable in terms of mental health. It is a period more conducive to the emergence of symptoms of anxiety, depression, or suicidal behavior.

Santé publique France is releasing new findings today on adolescent mental health from the national survey of middle and high school students on health and substances (EnCLASS), conducted in partnership with the École des Hautes Études en Santé Publique (EHESP) and the French Observatory on Drugs and Addictive Trends (OFDT).

The data, collected in 2024 from 11,400 secondary school students, reveal a mixed picture of the well-being and mental health of middle and high school students. Following a marked decline in all indicators of well-being and mental health between 2018 and 2022, some indicators show improvement, while others indicate a downward trend. It is also noted that adolescent girls consistently have less favorable mental health indicators than boys, with these gaps widening during secondary school.

• In 2024, the majority of middle school students (82%) and high school students (78%) perceive themselves to be in good or excellent health and are satisfied with their current lives (80% and 72%, respectively), despite a downward trend in these indicators since 2018.
• In addition, 70% of middle school students and 63% of high school students report a good level of mental well-being, with respective increases of 11 and 12 percentage points compared to 2022, observed among both boys and girls. There has also been a decrease in the proportion of young people who say they feel lonely most of the time during the year (this applies to 15% of middle school students and 20% of high school students in 2024).

However, these indicators coexist with persistent signs of psychological distress among young people:

• 45% of middle school students (in grades 6, 7, and 8) report psychological complaints more than once a week for at least the past 6 months (a 4-point decrease compared to 2022). Nervousness is the most frequently reported symptom (32%), followed by irritability (29%) and feelings of depression (21%). These symptoms become more pronounced as students advance through grade levels and are more common among girls.
• Furthermore, 19% of high school students are at high risk for depression, a risk that is more pronounced among girls (+3.5 percentage points compared to 2022). The most frequently reported symptoms are: lack of energy (58%), difficulty concentrating (44%), and feelings of discouragement (42%).
• Finally, 20% of high school students report having had suicidal thoughts in the past 12 months; this figure is down compared to 2022 (-4 percentage points). While this decrease is an encouraging sign, the increase in reported lifetime suicide attempts (15% of high school students, a 2-point increase compared to 2022) serves as a reminder that the most severe forms of psychological distress persist among some adolescents.

These results confirm the importance of promoting behaviors and environments conducive to mental health, and of developing psychosocial skills programs, particularly in schools. These results also call for strengthening efforts to raise awareness among parents, teachers, and educational staff regarding the early identification of signs of distress in adolescents and their referral to support services, particularly in cases of suicidal thoughts. Prevention strategies that take gender inequalities into account must also be developed. 

Caring for young people’s mental health: what tools and levers for action?  

In light of these findings, we must continue and strengthen efforts to prevent mental health issues and promote mental health among children and adolescents.

Santé publique France is committed to promoting psychosocial skills (PSS) in schools, a lever to be leveraged for the benefit of mental health from an early age. Strengthening PSS can indeed help create a protective and inclusive educational environment, while preventing dynamics of domination and peer violence. Thus, in 2022, the Agency published an initial review of the current state of knowledge on PSAs and a theoretical framework, supplemented by an operational framework and resources published in 2025 for Volume 1 and in 2026 for Volume 2. As part of the interministerial strategy on the development of children’s social and emotional skills (SES), Santé publique France develops and co-creates these tools to support stakeholders in local communities. This is how it contributed SES expertise to the development of the Ministry of National Education’s empathy kit, which will be rolled out in all preschool and elementary schools by the start of the 2024 school year.

Effective or promising prevention programs on the topic of mental health are listed in ReperPrev, the national registry of health prevention and promotion interventions established by Santé publique France, such as the Good Behavior Game (GBG) and the Family and Parenting Support Program (PSFP).
In addition, numerous information tools supported by Santé publique France, such as CléPsy and Psycom, help raise awareness and guide education professionals and families on mental health-related topics. Furthermore, the Mon soutien psy program provides access to a psychologist for children as young as 3 years old. 

Supported by Santé publique France and aimed at young people aged 12 to 25, Fil Santé Jeunes offers a helpline (0 800 235 236) available 7 days a week from 9 a.m. to 11 p.m. (anonymous and free service). Young people can also visit the website, which provides information, a forum, a chat feature, and referrals to support services (counseling centers, teen centers, community organizations, professionals, and healthcare providers). These services are provided by professionals (psychologists, educators, family counselors, and doctors).

Finally, 3114, the national suicide prevention hotline, is available 24 hours a day, 7 days a week. This line is intended for people in distress, as well as their loved ones, professionals, and those grieving a suicide. Calls are free and confidential and are handled by healthcare professionals—psychologists or nurses—trained in suicide prevention. This service also includes a website that provides resources to better understand suicidal crises and advice on how to overcome them.

To view the previously published results of the Enabee study: 

• Bullying and Aggressive Behavior Among Children Aged 6 to 11: Santé publique France Releases New Findings from the Enabee Survey
• Seeking care for mental health issues, including learning difficulties, among schoolchildren in grades 1 through 5 in mainland France - Results of the national study on children’s well-being
• Screen time among children aged 3 to 11: early, daily use marked by social inequalities
• Mental health of children aged 3 to 6: Santé publique France publishes new results from the Enabee study
• Mental health: initial findings from the Enabee study among children aged 6 to 11 enrolled in grades 1 through 5