top of page
Search

Should We Be Talking About Medication Reliance, or About the Stress-causing Conditions People Are Living In?

12 minutes ago
13 min read

What rising stress is doing to Australian mental health, and where the leverage sits.


A short answer first. Australian mental health has worsened over the past fifteen years, and the deterioration is concentrated in young adults. Over the same period, antidepressant use has grown much faster than the conditions it treats. The public debate has settled on the prescription as the problem to solve. I think the prescription is a downstream response to an upstream change in how stressful ordinary life has become. Treatment matters and works. The larger lever is the conditions that produce the stress in the first place.

Hand holding colorful pills and capsules beside open bottles on a pink background, with a calm, medical still-life feel

Key takeaways

  • Roughly one in five adults met criteria for a mental disorder in each of the 1997, 2007 and 2020 to 2022 national surveys. The total has not moved, but its composition has. Anxiety disorders rose from 14.4 to 17.2 per cent between 2007 and 2020 to 2022 and affective disorders from 6.2 to 7.5 per cent, while substance use disorders fell (Slade et al., 2009; Australian Bureau of Statistics, 2023; Slade et al., 2025).

  • Young adults aged 16 to 24 in 2020 to 2022 were nearly three times as likely to have an anxiety disorder or a depressive disorder as their counterparts in 2007. Across all other age groups the change was small (Slade et al., 2025).

  • Antidepressant use rose from 45 per 1,000 adults in 2000 to 96 per 1,000 in 2013 (OECD, 2015) and now sits at around one in seven Australians (Wallis, King and Moncrieff, 2025).

  • Loneliness among 15 to 24 year olds rose from 14.4 per cent in 2008 to 20.2 per cent in 2019 and above 26 per cent in 2020, and no other age group saw a comparable change (Melbourne Institute, 2024).

  • Mental health falls measurably once housing costs pass 30 per cent of income, and again after a missed rental payment, in a study following more than 10,000 Australian renters (summarised in Bentley et al., 2026).

  • Reviews in The Lancet Psychiatry and World Psychiatry conclude that poverty, inequality, insecure housing, unemployment, discrimination and childhood adversity are causal contributors to mental disorder, and that intervening on them is a legitimate and under-used form of prevention (Lund et al., 2018; Kirkbride et al., 2024).


Starting from the consulting room

In an earlier post I looked at whether contemporary adults are carrying more trauma exposure than previous generations did and concluded that they are. This post picks up the thread one step earlier. Most of the people I see do not describe a single traumatic event. They describe an accumulation. Rent that consumes half a wage. A contract that ends in three months with no word about renewal. A commute that has crept past ninety minutes. A phone that delivers global catastrophe alongside a message from a manager at ten at night. Parents who are ageing, children who need more than there is time to give, and a body that does not sleep properly anymore.


Individually, none of these is a clinical problem. Together they produce a nervous system that never fully returns to baseline, and in time that state has a name. It becomes generalised anxiety, or a depressive episode, or burnout, and at that point the person is sitting across from a GP, and the GP has a prescription pad and fifteen minutes.


The recent public conversation about antidepressants, including The Daily Aus Deep Dive newsletter asking whether Australia has an antidepressant problem, has focused on that last moment. Whether the prescription should have been written, how long it should run, how it should be stopped. Those are real questions and I have written about them elsewhere. The question I want to ask here is different. What would have to change for the person not to have arrived in that room at all?


The stress and disorders have grown, and the medications have grown faster

The Australian Bureau of Statistics has run a national diagnostic survey three times, in 1997, 2007 and 2020 to 2022. In each one, roughly one in five adults met criteria for a mental disorder in the previous twelve months. That headline stability hides two things.


The first is a shift in what people have. Anxiety disorders rose from 14.4 per cent in 2007 to 17.2 per cent in 2020 to 2022, affective disorders from 6.2 to 7.5 per cent, and substance use disorders fell (Slade et al., 2009; Australian Bureau of Statistics, 2023). The second is where the shift sits. People aged 16 to 24 in the most recent survey were close to three times as likely to have an anxiety or depressive disorder as the same age group in 2007. Across all adults the change was modest (Slade et al., 2025). Australia's young people are carrying almost the whole of the national increase.


Over roughly the same period, antidepressant use went from 45 per 1,000 adults in 2000 to 96 per 1,000 in 2013 (OECD, 2015) and now stands at about 140 per 1,000, or one in seven (Wallis, King and Moncrieff, 2025). Prescribing has roughly tripled while the conditions it treats have risen by something in the order of a third to a half, depending on the baseline chosen. That is my arithmetic from the published figures, and it is approximate, but the direction is not in doubt.


Two readings are available. One is that Australia is medicating distress that does not warrant it. The other is that a great deal of that distress has a cause that a medication cannot reach, and the prescription is being asked to do a job for which it was never designed. I think the second reading is closer to the truth, and it leads somewhere more useful.


What has become more stressful

The word stress is used loosely, so it is worth being concrete about what has changed in Australian life since the first survey.


Housing has moved from a settled background condition to an active source of strain for a large share of the population. The price-to-income ratio for housing rose 78 per cent between 1980 and 2015, home ownership fell, public housing shrank from around six per cent of households to around three, and private renting grew (Abbasi Shavazi et al., 2022, citing ABS data). Among lower-income households, 57 per cent of private renters and 41 per cent of mortgage holders now spend more than 30 per cent of gross income on housing. That threshold is not arbitrary. A 2025 study following more than 10,000 Australian renters found that mental health drops once housing costs pass 30 per cent of income and drops again after a missed rental payment (summarised in Bentley et al., 2026). Renters in prolonged financial hardship show the largest declines (Abbasi Shavazi et al., 2022). Younger cohorts are most exposed. Of Australians born between 1974 and 1977, 26.5 per cent owned a home by their mid-twenties. For those born between 1994 and 1997, the figure is 18 per cent (Melbourne Institute, 2024).


Financial strain more broadly follows the same pattern. The Australian Institute of Health and Welfare, drawing on HILDA data from 2001 to 2023, records that psychological distress rose sharply in 2020 among younger Australians and those who lost work or income, eased briefly while emergency payments were in place, and returned as those supports were withdrawn and interest rates rose (AIHW, 2025). Cost of living was the top concern of 64 per cent of the 17,000 young people in Mission Australia's 2025 Youth Survey, up from 31 per cent two years earlier, and one in five reported high psychological distress in the weeks before the survey (Mission Australia, 2025).


Social connection has thinned in the group that most needs it. Loneliness among 15 to 24 year olds rose from 14.4 per cent in 2008 to 20.2 per cent in 2019, jumped above 26 per cent in 2020 and stayed high, and no other age group saw a similar change. Older Australians, once the loneliest, now report the least loneliness (Melbourne Institute, 2024). Loneliness is a recognised risk factor for both depression and anxiety, and the stress-buffering role of social support that I described in the earlier post depends on that support actually being present.


Work has changed in ways that psychology now measures directly. Since 2021 Australian work health and safety law has required employers to manage psychosocial hazards, including high job demands, low control, poor support, insecure work, and exposure to traumatic material, as hazards in their own right. The regulation exists because the evidence linking those conditions to psychological injury was strong enough to legislate on. Insecure and contract-based work has grown across the same decades that the surveys cover.

And on top of all of this sits the exposure I described in the earlier post on trauma exposure and the brain. Adverse childhood experience scores have risen across birth cohorts (Anderson et al., 2023), and indirect exposure to violence and disaster through screens has expanded to a level no previous generation encountered (Holman, Garfin and Silver, 2014).


Conditions cause disorder, they do not simply accompany it

For a long time, it was possible to argue that the link between hardship and mental disorder ran the other way. People who were unwell drifted into poverty, insecure housing and unemployment, rather than being made unwell by them. Some of that is true. The weight of the longitudinal evidence now shows that causation runs strongly in both directions and that the social-to-clinical direction is large.


Lund and colleagues (2018), in a systematic review of reviews in The Lancet Psychiatry, identified poverty, inequality, low education, food insecurity and unsafe environments as consistent predictors of depression and anxiety, and found that exposure to several of them at once has a cumulative effect. Kirkbride and colleagues (2024), in a major review for World Psychiatry, went further, mapping the evidence for a causal link between social determinants and later mental health across the life course, and concluding that the chances of being exposed to those determinants are shaped by the distribution of money, power and resources, which are themselves the product of policy choices. Their central argument is that mental health prevention has arrived at a point where intervening on living conditions is a legitimate, evidence-based strategy rather than an aspiration. stress and medication


The Australian renter data I cited above is a small local example of the same thing. Following the same people over time, mental health falls when housing costs cross a threshold and falls further when a payment is missed. The housing cost came first.

In practice, this means that a proportion of the distress arriving in GP consulting rooms has a cause that sits outside the person, and treating the person, whether with a medication or with therapy, addresses the symptom while leaving the cause in place. The person improves, returns to the same conditions, and in time returns to the consulting room. Both the pharmaceutical and the psychological literatures record this as relapse. From where I sit it often looks more like a predictable response to an unchanged environment.


What treatment can and cannot do

None of this is an argument against treatment. I treat people for a living and the evidence that psychological therapy works for anxiety and depression is among the most secure in the field. Antidepressants have a place, particularly for moderate to severe depression and where relapse risk is high. A person in acute distress needs help now, and neither housing policy nor workplace regulation will arrive in time for them. Treatment is the right response to the individual who is already unwell.


Treatment does have limits that are worth naming. It operates one person at a time, after the fact. Its effect sizes in mild to moderate depression are modest for medication and moderate for therapy. It cannot reduce a person's rent, shorten their commute, renew their contract, or make their neighbourhood safer, and where those things are driving the presentation, the treatment is working against a headwind. Under half of Australians with a twelve-month disorder seek any treatment at all (Slade et al., 2025), so even a perfectly delivered treatment system reaches a minority of the people who need it.


Prevention through conditions has the opposite profile. It is slow, political and difficult to evaluate, and it does nothing for the person in front of me today. It also operates on everyone at once, before the fact, and it reaches the majority who never present. A society that keeps housing costs below the threshold at which mental health falls does not need to identify which renters would have become depressed. It simply has fewer of them.


So which should we focus on?

The honest answer is that this is a false choice at the level of the individual and a real choice at the level of policy and public conversation. An individual who is unwell should be treated, and the argument about whether their prescription was warranted or how it should be tapered is a legitimate argument about treatment quality. It is not an argument about why they became unwell.


At the population level, the public conversation has spent the past year on the prescription. That is the easier conversation to have. It has identifiable actors, GPs and psychiatrists and pharmaceutical companies, and a clear technical fix in the form of better review and slower tapering. The conversation about conditions has no single actor and no single fix. It runs through housing supply, income support, rental regulation, workplace law, urban design and the structure of the working week. It is harder, and it is where most of the leverage sits.


My clinical view, offered as a view rather than a finding, is that the tripling of antidepressant use is best understood as a measurement of how much unresolved stress the population is carrying, taken at the one point in the system where the stress becomes visible. Reducing prescribing without reducing the stress moves the distress somewhere less visible. It does not remove it. If Australia wants the next national survey to show something other than a further rise in young adult anxiety and depression, the work is upstream.


What this means in practice

For individuals, the practical implication is to notice how much of what they are experiencing has an address outside themselves. A formulation that includes housing, money, work security and connection is a more accurate formulation than one that stops at thoughts and neurochemistry, and it points to a wider set of things that might help, some of which are practical rather than psychological. Where those things cannot be changed, treatment helps a person carry them, and that is a legitimate use of treatment. Where they can be changed, changing them is often the intervention that lasts.


For clinicians, it means holding the social determinants in the formulation and in the treatment plan, referring to financial counselling, tenancy services, and employment support alongside therapy where those are the load-bearing issues, and being honest with people about what a therapy room can and cannot reach.

For those with any influence over conditions, whether as employers, landlords, policy makers or voters, it means recognising that mental health outcomes are being decided in rental markets, workplaces and budgets long before they reach a clinician, and that the case for acting there is now an evidence-based case rather than a moral one alone.


A final word

The earlier post ended by saying that the path through trauma is real and well evidenced. The same is true here, with an addition. The path through for the individual runs through treatment and buffering, and both work. The path through for the population runs through the conditions people live in, and that path is one we are still choosing whether to take. A country can keep improving how it treats distress. It can also produce less of it. The second is harder and, on the evidence, more effective.


If this resonates

Behavioural Edge Psychology provides assessment and treatment for adults experiencing stress, burnout, anxiety, depression and trauma-related presentations, with attention to the workplace and life circumstances that contribute to them. Consulting rooms in Caulfield South and St Kilda, Victoria, and telehealth across Victoria.

To book, visit behavioural-edge-psychology.au4.cliniko.com/bookings or contact the practice directly.


Frequently asked questions


Is mental health in Australia actually getting worse?

The overall twelve-month prevalence of mental disorder has been stable at around one in five adults across the 1997, 2007 and 2020 to 2022 national surveys. Within that, anxiety and affective disorders have risen and substance use disorders have fallen, and the rise is concentrated almost entirely in people aged 16 to 24, who are now nearly three times as likely to have an anxiety or depressive disorder as the same age group in 2007 (Slade et al., 2025).


Does stress cause mental illness or just make it worse?

Both. Longitudinal research now supports a causal contribution from social and economic conditions, including poverty, inequality, insecure housing, unemployment, loneliness and childhood adversity, to the onset of depression and anxiety, alongside the older finding that mental illness also increases the risk of hardship (Lund et al., 2018; Kirkbride et al., 2024).


Are antidepressants overprescribed in Australia?

Antidepressant use has roughly tripled since 2000 while the conditions they treat have risen by a much smaller amount, so use has grown well ahead of measured need. Whether any given prescription is appropriate is a clinical judgement, and a share of antidepressant prescribing is for pain, sleep and other conditions that the mental health surveys do not capture. Decisions about starting, continuing or stopping medication should be made with the prescribing doctor.


Can therapy help with stress caused by money, housing or work?

Yes. Psychological therapy helps people regulate their response to stressors, recover capacity, and make decisions under pressure, and it is effective even where the stressor itself cannot be removed. It works best when the formulation includes the external circumstances and when practical supports such as financial counselling, tenancy services or employment advice are engaged alongside it where relevant.


What would actually reduce rates of anxiety and depression at a population level?

The strongest evidence points to housing affordability and security, adequate income support, secure work and effective management of psychosocial hazards at work, reduced loneliness through community infrastructure, and early-life interventions that reduce childhood adversity. These operate on whole populations before illness develops, which individual treatment cannot do (Kirkbride et al., 2024).


References

 
 
 

Comments

©2026 by Behavioural Edge Psychology. I acknowledge the Traditional Custodians of the land on which we work, the Wurundjeri Woi Wurrung and Bunurong Boon Warrung people of the Eastern Kulin Nation. I pay my deepest respect to elders past, present and emerging. I am a proudly inclusive organisation and an ally of the LGBTIQ+ community and the movement toward equality. Click here to read our accessibility statement.

bottom of page