10 October -World Mental Health Day 2018: Young people and mental health in a changing world

10th October is celebrated as World Mental Health Day each year. This year, the focus is on youth, especially adolescents.

Background Information:

Around 1.2 billion people, or 1 in 6 of the world’s population, are adolescents aged 10 to 19.

Whilst most adolescents have good mental health, multiple physical, emotional and social changes, including exposure to poverty, abuse, or violence, can make adolescents vulnerable to mental health problems.

Promoting psychological well-being and protecting adolescents from adverse experiences and risk factors which may impact their potential to thrive are not only critical for their well-being during adolescence, but also for their physical and mental health in adulthood.

Several social and emotional habits are important for mental well-being. These include

adopting healthy sleep patterns;
taking regular exercise;
developing coping, problem-solving, and interpersonal skills; and
learning to manage emotions.

Factors which can contribute to stress during adolescence include

a desire for greater autonomy,
pressure to conform with peers,
exploration of sexual identity, and
increased access to and use of technology.

Media influence and gender norms can exacerbate the disparity between an adolescent’s lived reality and their perceptions or aspirations for the future.

Other important determinants for the mental health of adolescents are the quality of their home life and their relationships with their peers.

Violence (including harsh parenting and bullying) and socio-economic problems are recognized risks to mental health. Children and adolescents are especially vulnerable to sexual violence, which has a clear association with detrimental mental health.

Adolescents with mental health conditions are in turn particularly vulnerable to

social exclusion,
discrimination,
stigma (affecting readiness to seek help),
educational difficulties,
risk-taking behaviours,
physical ill-health and
human rights violations.

Children with mental disorders face major challenges with stigma, isolation and discrimination, as well as lack of access to health care and education facilities, in violation of their fundamental human rights.

Key Messages:

Worldwide 10-20% of children and adolescents experience mental disorders.

Emotional Disorders

Emotional disorders commonly emerge during adolescence. In addition to depression or anxiety, adolescents with emotional disorders can also experience excessive irritability, frustration, or anger. Symptoms can overlap across more than one emotional disorder with rapid and unexpected changes in mood and emotional outbursts. Younger adolescents may additionally develop emotion-related physical symptoms such as stomach ache, headache, or nausea.

Globally, depression is the ninth leading cause of illness and disability among all adolescents; anxiety is the eighth leading cause. Emotional disorders can be profoundly disabling to an adolescent’s functioning, affecting schoolwork and attendance. Withdrawal or avoidance of family, peers or the community can exacerbate isolation and loneliness. At its worst, depression can lead to suicide.

Behavioural Disorders

Childhood behavioural disorders are the sixth leading cause of disease burden among adolescents. They represent repeated, severe and non-age-appropriate behaviours such as

hyper-activity and inattention (such as attention deficit hyperactivity disorder) or
destructive or challenging behaviours (for example, conduct disorder).

Childhood behavioural disorders can affect adolescents’ education, and are sometimes associated with contact with judicial systems.

Eating Disorders

Eating disorders commonly emerge during adolescence and young adulthood. Most eating disorders affect females more commonly than males.

Eating disorders such as anorexia nervosa, bulimia nervosa and binge eating disorder are characterised by harmful eating behaviours such as restricting calories or binge eating.

Anorexia and bulimia nervosa also include a preoccupation with food, body shape or weight, and behaviours such as excessive exercise or vomiting to compensate for calorie intake.

People with anorexia nervosa have a low body weight and a heightened fear of weight gain.

People with binge eating disorder can experience feelings of distress, guilt or self-disgust when binge eating.

Eating disorders are detrimental to health and often co-exist with depression, anxiety and/or substance misuse.

Psychosis

Disorders which include symptoms of psychosis most commonly emerge in late adolescence or early adulthood.

Symptoms of psychosis can include

hallucinations (such as hearing or seeing things which are not there) or
delusions (including fixed, non-accurate beliefs).

Experiences of psychosis can severely impair an adolescent’s ability to participate in daily life and education. In many contexts, adolescents with psychosis are highly stigmatized and at risk of human rights violations.

Suicide and Self-harm

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). Nearly 90% of the world’s adolescents live in low- or middle-income countries but more than 90% of adolescent suicides are among adolescents living in those countries.

Suicide attempts can be impulsive or associated with a feeling of hopelessness or loneliness.

Risk factors for suicide are multifaceted, including

harmful use of alcohol,
abuse in childhood,
stigma against help-seeking,
barriers to accessing care, and
access to means.

Communication through digital media about suicidal behaviour is an emerging concern for this age group.

Risk-taking Behaviours

Risk-taking behaviours can be both an unhelpful strategy to cope with poor mental health, and can negatively contribute to and severely impact an adolescent’s mental and physical well-being.

Worldwide, the prevalence of heavy episodic drinking among adolescents aged 15-19 years was 13.6% in 2016, with males most at risk.

Harmful substance use in adolescents increases the likelihood of further risk-taking such as unsafe sex. In turn, sexual risk-taking increases adolescents’ risk of sexually-transmitted infections and early pregnancy – a leading cause of death for older adolescent girls and young women (including during childbirth and from unsafe abortion).

In 2016, based on data available from 130 countries, it was estimated that 5.6% of 15–16 year olds had used cannabis at least once in the preceding year. Many adult smokers have their first cigarette prior to the age of 18 years.

Perpetration of violence is a risk-taking behaviour which can increase the likelihood of low educational attainment, injury, involvement with crime, or death. Interpersonal violence was ranked the second leading cause of death of older adolescent boys in 2016.

Prevention and Health Promotion

Examples of promotion and prevention activities include:

one-to-one, group-delivered, or self-guided online psychological interventions;
family-focused interventions such as caregiver skills training, including interventions which address caregivers’ needs;
school-based interventions, such as:
- organizational changes for a safe, secure and positive psychological environment;
- teaching on mental health and life-skills;
- training staff in detection and basic management of suicide risk; and
- school-based prevention programmes for adolescents vulnerable to mental health conditions;
community-based interventions such as peer leadership or mentoring programmes;
prevention programmes targeted at vulnerable adolescents, such as those affected by humanitarian and fragile settings, and minority or discriminated groups;
programmes to prevent and manage the effects of sexual violence on adolescents;
multisectoral suicide prevention programmes;
multilevel interventions to prevent alcohol and substance abuse;
comprehensive sex education to help prevent risky sexual behaviours; and
violence prevention programmes.

Building life skills in children and adolescents and providing them with psychosocial support in schools and other community settings can help promote good mental health. Programmes to help strengthen the ties between adolescents and their families are also important.