Mental and Psychosocial health among adolescents
Adolescence (10-19 years) is the transitional stage of development between childhood and adulthood during which a variety of biological and emotional changes occur. It is a vulnerable phase which is often influenced by several intrinsic and extrinsic factors that affect mental and psychosocial health. The more an adolescent is exposed to risk factors, the greater is the impact on their mental health. Risks for adolescent mental health problems include poverty, violence, substance use, chronic illness, harsh parenting, bullying, sexual violence, teenage pregnancy, early and/or forced marriages etc. Although each risk factor has poor outcome on mental health but sexual violence has a clear association with detrimental mental health. Studies have shown that around two-thirds of married women in India were victims of domestic violence. Girls from nuclear families and women married at a very young age are at a higher risk for attempted suicide and self-harm.
According to WHO, mental health conditions account for 16% of the global burden of disease and injury in people aged 10–19 years. Also, half of all mental health conditions start by 14 years of age but most cases are undetected and untreated. In addition to depression or anxiety, adolescents with emotional disorders also experience excessive irritability, frustration, or anger. Globally, depression is the ninth leading cause of illness and disability among all adolescents and anxiety is the eighth leading cause. As per WHO records, it is estimated that worldwide 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 yrs.). Childhood behavioral disorders are the sixth leading cause of disease burden among adolescents. These include hyper-activity and inattention (such as attention deficit hyperactivity disorder) or destructive or challenging behaviors (for example, conduct disorder). Childhood behavioral disorders may lead to adolescent education difficulties and are sometimes may lead to contact with judicial systems also. Adolescents may also experience eating disorders such as anorexia nervosa, bulimia nervosa and binge eating disorder which may lead to many health problems.
Substance abuse such as alcohol or drugs is also a major concern in many countries. In 2016, worldwide the prevalence of heavy episodic drinking was 13.6%, among adolescents, with males most at risk. Harmful substance use in adolescents increases the likelihood of further risk-taking such as unsafe sex which increases them at risk of sexually-transmitted infections and early pregnancy. Tobacco and cannabis use are also no less. Many adult smokers have their first cigarette prior to the age of 18 years. Multiple behaviors and conditions often coexist in the same individual adding a cumulative risk for their poor health. These predispose them at risk of non communicable diseases (NCDs) in later life including mental and neurological disorders and injuries. This will further be a burden on Indian society in terms of mortality, morbidity, disability and socio-economic losses.
The main strategies suggested to improve adolescent mental and psychosocial health is primary prevention by improving the social environment for development of mental wellbeing. The school is the most strategic place for shaping the adolescent’s behavior and promoting mental health. There is a great need for vocational counselors and psychologists in schools for guiding the children. Education, training, and interventions targeting the social and physical environment are also crucial for addressing women's mental health so that their belief that domestic and social violence being “normal” part of life can be changed. Secondary prevention includes early diagnosis of mental illness and of social and emotional disturbances through screening programs in schools, universities etc. and provide them with appropriate treatment. Tertiary prevention to reduce the duration of mental illness and thus reducing the stresses for the family and the community is also needed.
The SDG target 3.4-the WHO Global Strategy for Women’s, Children’s, and Adolescents’ Health 2016-2020 and the Global Accelerated Action for the Health of Adolescents (AA-HA) implementation guidance have already come into action to increase awareness of adolescents’ mental health needs and hence will strengthen global commitments to improve adolescents’ health and wellbeing. WHO’s mhGAP (Mental Health GAP Action Program) Intervention Guide and Helping Adolescents Thrive (HAT) considers issues related to adolescents mental and behavioral disorders and on Self-harm/suicide. It is for use by doctors, nurses, other health workers as well as health planners and managers. WHO has also developed a psychological intervention manual – Early Adolescent Skills for Emotions (EASE) for 10-14 year old adolescents with high distress and impaired functioning. It is currently undergoing randomized controlled trial testing at four sites in Jordan, Lebanon, Pakistan and Tanzania. WHO is also developing a digitally delivered psychological intervention to reduce psychological distress experienced by adolescents aged 15-18 years old in urban environments. This will be the first available technology supported mental health intervention for adolescents that will be available as a public good, will be evidence-based and designed for global use and ease of adaptation.
Indian Association for Adolescent Health has taken various initiatives in school health program. One of the researches on Aggression. It is found that aggression in school adolescents is highly prevalent in India. Stress and suicidal ideation are also studied in school adolescents. Various interventions have been tried in various studies by the members of IAAH in their studies with successful results. Conflict In recent years, young people have shown increasing trend towards mental and psychosocial problems which needs to be addressed with combined efforts of International agencies, state governments NGO’s, local bodies/panchayats and communities.
Dr. Seema Sharma
Associate Professor
Dr. Pooja Sindwani PG student,1st year
Maharaja Agrasen Medical College, Agroha
References
- Garg I, Sethi S, Kishore J. The Prevalence and Patterns of Aggression in School Adolescents in a Rural Area of Moga District of Punjab, India. Ind J Youth Adol Health 2018; 5(1): 43-46.
- Goyal A, Kishore J, Anand T, Rathi A. Suicidal ideation among medical students of Delhi. Journal of Mental Health and Human Behaviour 2012; 17(1): 60-70.
- Watode BK, Kishore J, Kohli C. Prevalence of Stress among School Adolescents in Delhi. Ind. J. Youth Adol. Health 2015; 2(4): 4-9.
- Drishti, Kishore J. Sharma N, Shukla A. Pilot study for Process Evaluation of School Based Life skills Education Program for Prevention of Violence in Adolescents. Ind. J. Youth Adol. Health 2014; 1(2):12-25.
- Salodia UP, Roy N, Kumari S et al. Prevalence and Factors Associated with Depression in SchoolGoing Adolescents of India. Ind J Youth Adol Health 2016; 3(4): 48-52.
