Thriving Teens: A whole systems approach to benefit preadolescent mental wellbeing in Amsterdam

Abstract Background ‘If many children are struggling with the same issues and falling outside the ‘normal’ system, we need to examine the circumstances and structures in which they grow up-rather than focusing solely on the child.’ This quote from Amsterdam's city council Alderman Moorman and her 2024 youth vision aligns with a movement in public health to use systems thinking for complex societal challenges. The Thriving Teens project aligns with this and aims to uncover the factors and their interrelations ('system dynamics’) underlying preadolescent mental wellbeing, providing a foundation for informing action development and driving system changes in three Amsterdam neighborhoods. Methods A causal loop diagram (CLD) was developed iteratively by integrating insights from both science-through an umbrella review of 143 systematically reviewed articles and seven focus groups with scientists (N = 18)-and the community, including short questionnaires with preadolescents (N = 233) and caretakers (N = 83), as well as semi-structured interviews with professionals (N = 56). The CLD was analysed to find overarching themes and recurrent patterns of system behaviour. Results The CLD offered insights into the complex interplay of factors influencing preadolescent mental wellbeing, uncovering eleven themes, including always online, increased pressure, caretaker challenges, and safety and livelihood security. Additionally, analysing recurring patterns offered insight into deeper organizational challenges and the unintended consequences of certain interventions and policies-such as the fragmentation of school programs and the shifting of responsibility for screen use onto caretakers rather than technology companies. Conclusions These system dynamics show opportunities for systems change and highlight that an integrated action-approach will be essential, combining actions and policies to target multiple leverage points across various levels and contexts. Key messages • Combining scientific knowledge and community-based insights is essential to understand system dynamics within a specific context. • Understanding system dynamics reveals how the system operates and where targeted disruption can improve preadolescent wellbeing.