More than 10,000 people took part in the survey in south west Scotland, carried out as part of the Year of Young People in 2018.
It found that 55 per cent of those questioned said they intended to leave the region in the future.
The 10,000 Voices consultation of young people in Dumfries and Galloway has been branded a “warning shot” to both the region’s council and employers.
Dumfries and Galloway is the third largest council in Scotland by area and is nearly 14 times the size of North Lanarkshire.
But it has less than half the population size with 149,000 people, which could tumble further in the coming years.
Councillor Adam Wilson said the outcome of the 10,000 Voices consultation was a real concern.
Mr Wilson believes they need to do more to make the region attractive for young people and highlighted recruitment problems in the public and private sectors - with both struggling to hire people.
He said: “I think there is a warning shot because if a number of young people leave and do not come back we will see a number of crises across our region.
“We are going to have a huge demand on social care over the next decade and beyond.
“We have that warning shot today and we can start to take meaningful action to address that.”
Mr Wilson also said it was important officials acted on the findings of the report and suggested a whole range of bodies - including the planned new enterprise agency - need to be involved.
He said: “If we do not keep our young people here, or attract young people to stay here and to grow their families and to work, we are going to face these difficulties.
“There are a lot of ways in which we can try to grow our economy but make sure that we deliver for our young people.”