According to WHO, one in six people is aged 10–19 years and mental health conditions account for 16 per cent of the global burden of disease and injury in people aged 10–19 years. Half of all mental health conditions start by 14 years of age but most cases are undetected and untreated. Globally, depression is one of the leading causes of illness and disability among adolescents. The consequences of not addressing adolescent mental health conditions extend to adulthood, impairing both physical and mental health and limiting opportunities to lead fulfilling lives as adults.
Adolescence has been considered to be the foundation of a person’s life where they get to formulate and maintain many social and emotional habits which are important for their physical and mental wellbeing.
There are multiple factors which can affect or determine the mental health of an adolescent at any particular time. The more the risk factors and the more their severity is, the greater will be their impact on their mental health if proper precautions are not taken in time.Stress has an immense impact on an adolescent’s life. An adolescent who can cope adaptively with the stressors can move on happily in life.
Sometimes many adolescents are not able to cope well, buckle under the pressures and turn to maladaptive coping strategies like indulging in drugs or risky behaviour.
There are many factors which contribute to stress the adolescents face which may include a desire for a greater autonomy and identity, pressure from peers to try to fit in, understanding and exploration of sexual identity, increased access to and use of technology, parental and academic pressures.Media has a tremendous influence on our youth. But is is like a double edged sword, which also paints a ‘larger than thou picture’ for adolescents who get confused between the reel and the real life. This can also affect their perceptions or aspirations for their future.Violence (including harsh or negligent parenting and bullying), physical abuse or a history of adolescent sexual abuse and other socio-economic problems are detrimental for their mental health.
Parenting workshops are a must today where parents can be taught good parenting skills which will enable them to understand and bond better with their children.We should also give special attention to those adolescents who face greater mental health hazards due to their struggle of trying to live in poverty, those who face stigma, discrimination or lack of access to quality medical support and services. Special attention and education should also be given to the adolescents with chronic illness, autism spectrum disorder, intellectual disability or other neurological conditions.
Adolescence is an age when Emotional distress is common. Depression,anxiety, excessive irritability, frustration, or anger are some symptoms which are commonly encountered in them. There may be rapid and unexpected changes in mood and emotional outbursts and many may complain of stress related physical disorders. Emotional disorders can be debilitating and disabling for adolescents and these can profoundly and adversely affect their normal daily functioning. It can lead to withdrawal from or avoidance of family, peers or the community, and can lead them to isolation and loneliness.
Globally, depression is spreading like an epidemic and is considered to be the ninth leading cause of illness and disability among all adolescents whereas anxiety is the eighth leading cause.It has been found that childhood behavioural disorders are the sixth leading cause of disease burden among the adolescents. Adolescence is a time where rules, limit- setting and boundaries are tested.
However, childhood behavioural disorders such as hyper-activity and inattention or destructive/challenging behaviours represent repeated, severe and non-age-appropriate behaviours. Such childhood behavioural disorders in a person can affect the adolescents’ education later on, and sometimes land them on the wrong side of law.
Eating disorders such as anorexia nervosa, bulimia and binge eating disorder are common among adolescents and young adults, being more common in females than males. Further, disorders which include symptoms of psychosis most commonly emerge in late adolescence or early adulthood. Symptoms of psychosis can include hallucinations or delusions.
Experiences of psychosis can stigmatise the person and stop him from interacting with others or participate in school or daily activities. Stress, genetic predisposition and substance abuse maybe some predisposing factors for the psychosis.
According to WHO, it is estimated that 62 000 adolescents died in 2016 as a result of self-harm. Suicide is the third leading cause of death in older adolescents (15–19 years). Suicide attempts can be impulsive or associated with a feeling of hopelessness or loneliness which means they may be having chronic depression. Today the trend of communicating ones suicidal intent through digital media is an ominous sign that we need to wake up to and empower our adolescents and prevent them to do so.
Risk-taking behaviours are poor and maladaptive coping to the daily life stressors by the youth. These can harm the youth mentally and physically.
WHO has quoted that harmful use of substances are major concerns in most countries. Worldwide, the prevalence of heavy episodic drinking among adolescents aged 15-19 years was 13.6 per cent in 2016, with males most at risk. Indulging in acts of violence is also a risk-taking behaviour and can lead the youth to low educational attainment, injury, involvement with crime or death.There must be appropriate and continuous interventions to promote adolescents’ mental health and aim to strengthen many protective factors which will empower the youth to find alternatives to risk-taking behaviours. They should be taught many soft skills like improving their emotional intelligence, assertive skills, self esteem and resilience building which will protect their mental well-being so that they can cope well in difficult situations or adversities. Promotion programmes for all adolescents and prevention programmes for adolescents at risk of mental health conditions should be undertaken at various levels.
There should be a one to one or group/family counselings.Parental awareness programmes should be held and school based interventions should be done. The teachers should be guided how to recognise the high risk adolescents.
Community based programmes should be enhanced where we can freely talk about stress, depression, substance abuse, sex education, suicides and empower the youth to be resilient and cope adaptively. The need of the hour is early detection and treatment. It is crucial to address the needs of adolescents with defined mental health conditions. As far as possible we should focus on the age old adage of prevention being better than cure.We should try to catch them as early as possible, educate them, empower them and help them adopt healthy coping skills.
We should avoid over-medicalisation and try to adopt measures prioritising non-pharmacological approaches. Interventions for adolescents should consider that not all mental health treatments require medicines as psychoeducation, counseling and psychotherapy are also very useful tools.WHO’s mental health Gap Action Programme (mhGAP) provides evidence-based guidelines for non-specialists to enable them to better identify and support priority mental health conditions in lower-resourced settings. Psychotropic medication should be used with great caution and should only be offered to adolescents with moderate-severe mental health conditions when psychosocial interventions prove ineffective and when clinically indicated and with informed consent. The treatments should be provided under the supervision of a specialist and with close clinical monitoring for potential adverse effects. Face-to-face methods, electronic mental health interventions serve a great purpose for mental health today.
The take home message is that parenting is a skill which needs to be constantly learned and updated. Parents should learn the art of understanding and bonding with their adolescent children. Adolescents should be psycho-educated and taught healthy coping skills and their day to day problems should be treated empathetically by their parents teachers and school. Peers are an integral part of their life at this stage.
(The author is a neuro psychologist and CBSE designated counsellor)