Adolescent Mental Health: Common Mental Health Issues in Youth

Adolescent Mental Health:
Common Mental Health Issues in Youth
Irasangappa Mudakavi
MSc N, Ph.D. Scholar (INC, 2018)
Faculty of Nursing
College of Nursing
All India Institute of Medical Sciences (AIIMS)
Jodhpur, Rajasthan-342005

Content of the Topic
• What is health and mental health?
• What do we know about youth?
• Youth and mental health
• Personality Development: Implications to Adolescence/Youth
• Prevalence of mental health issues: Global & Indian Scenario
• Are Some Adolescence/Youth Vulnerable to Mental Health Issues?
• Common Mental Health Issues in Youth
• Consequences of adolescent/youth mental health issues
• Presentation and Assessment
• Early detection and treatment

What is Health?
• “Health is a state of complete
• physical,
• mental, and
• social well-being
and not merely the absence of
disease or infirmity.”
Mental health is an integral part
of health; indeed, there is no
health without mental health.
-WHO

What is Mental Health?
• The World Health Organization (WHO)
defines mental health as a state of well-
being that involves:
• Being able to recognize a person’s
own abilities
• Coping with normal stressors
• Working productively
• Contributing to society

What do we know about youth?
• YOUTH is best understood as a period of
transition from the dependence of childhood
to adulthood’s independence.
• The United Nations, for statistical purposes,
defines those persons between the ages of
15 and 24 as youth.

• In India, 24 percent of people aged 15 to 24 years (Knoema, 2020).
• Youth have the creativity, the potential, and the capacity to make change
happen – for themselves, for their communities, and for the rest of the
world.
• Mental difficulties or problems can be part of normal adolescent
development; may be responses to events in the adolescent’s life or
stressors.
• International Youth Day: 12th August
• National Youth Day: 12th January (birth anniversary of Swami Vivekananda)

Youth and Mental Health:
• Mental health is fundamental to good health and well-being, and it
influences social and economic outcomes throughout life.
• Childhood and adolescence are crucial for laying a foundation for healthy
development and good mental health.
• Children’s emotional wellbeing is just as important as their physical health.
• Good mental health helps them develop the resilience to cope with
whatever life throws at them and grow into well-rounded, healthy adults.

What Changes in Adolescence?

Personality Development: Implications to Adolescence/Youth
To be in optimal mental health is essential for optimal functioning as
well as for productivity for any person.
Adolescence is a critical developmental period.
Many self-concepts are redefined and constructed and undergo various
changes. (Ernst et al. 2011)
Developmental theories identify behaviours appropriate to each stage
through which every individual pass.
Appropriate or inappropriate behaviours at each developmental level
define the personality of an individual.

• Theories of Personality Development: Implications to Adolescence/Youth
Sigmund Freud
(Psychoanalytical Theory)
• Latency: Quite stage in sexual
development; learn to
socialize.
• Genital: Sexual maturity and
satisfactory relationships with
the opposite sex.
Erik Erikson (Theory of
Psychosocial
Development)
• Identity vs Role Confusion
• Highly critical transition period
because adolescents become
more independent and begin
to consider the future in terms
of relationships, families and
careers.
Jean Piaget (Theory of
Cognitive Development)
• Formal Operations
• Learns to think and reason in
abstract terms.
• Further develops logical
thinking and reasoning and
achieves cognitive maturity.
Failing to achieve successful
completion of milestones at
each specific age may lead to
mental or behavioral issues in
adolescents/youths

Prevalence of mental health issues in youth:
• One in six people are aged 10-19 years. Adolescence is a unique and
formative time.
• Physical, emotional and social changes, including exposure to poverty,
abuse, or violence, can make adolescents vulnerable to mental health
problems.
• Protecting adolescents from adversity, promoting socio-emotional
learning and psychological well-being, and
• Ensuring access to mental health care is critical for their health and
well-being during adolescence and adulthood.

Prevalence of mental health issues in youth: Global Scenario
Globally, one in seven 10-19-year-olds experiences a mental disorder.
Accounting for 13% of the global burden of disease in this age group.
This amounts to an estimated 166 million adolescents (89 million boys and 77
million girls) boys and girls globally.
Depression, anxiety, and behavioral disorders are among the leading causes of illness
and disability among adolescents.
Suicide is the fourth leading cause of death among 15-19 year-olds.
Nearly 50% of adult psychiatric disorders begin before the age of 14 years. (Sagar R,
2011)

Prevalence of mental health issues in youth: Global Scenario
Source: UNICEF analysis based on estimates from the Institute for Health Metrics and Evaluation (IHME), Global Burden of Disease Study, 2019 as presented in the State of the World’s Children
Report 2021.

Prevalence of mental health issues in youth: Indian Scenario
• Age-specific prevalence of mental disorders in India, by sex (The
Lancet Psychiatry, 2020)
Mental Disorders
Prevalence per 100 (15 to 24 years)
Male Female
Depressive Disorder 6.42 8.86
Anxiety Disorders 7.87 11.49
Conduct Disorders 8.66 5.22
Attention Deficit Hyperactivity
Disorder 3.10 1.9
Autism Spectrum Disorder 1.67 0.9
Eating Disorder 0.8 1.9

• Prevalence: Indian Scenario
Nearly 50% of adult psychiatric
disorders begin before the age of 14
years.
(Sagar R, 2011)

What Can Affect the Mental Health of Adolescence/Youth?
• Absent or imbalance personality structures: id, ego, and superego.
• Traumatic life events.
• Changes often act as triggers: moving home, changing school, the
birth of a new sibling, conflict among siblings, addiction to video
games, etc.
• Teenagers often experience emotional turmoil as their minds and
bodies develop.
• Coping with stress/transitions: Adaptive vs Maladaptive

• Are Some Adolescence/Youth Vulnerable to Mental Health Issues?
• having a long-term physical illness
• a parent who has had mental health problems, problems with alcohol or
has been in trouble with the law
• parents who separate or divorce
• the death of someone close to them
• experiencing severe bullying or physical or sexual abuse
• poverty or homelessness
• experiencing discrimination
• caring for a relative, taking on adult responsibilities
• having long-lasting difficulties at school
• pregnant adolescents, adolescent parents, or those in early or forced
marriages

• Mental Health of Youth: Impact of COVID 19

Mental Health of Youth: Impact of COVID 19
• UNICEF 2020: Rapid Survey Report
• The rapid assessment amplified the voices of 8,444
adolescents and young people between the ages of 13 and
29 in nine countries and territories in the region.
• The report gives an account of the feelings they faced in
the first months of the response to the pandemic and the
situation in September 2020.

Anxiety Disorders
• Anxiety disorders (which may involve panic or excessive worry) are
the most prevalent in this age group and are more common among
older than among younger adolescents.
• It is estimated that 3.6% of 10-14 year-olds and 4.6% of 15-19 year-
olds experience an anxiety disorder. (NIMH)
• Anxiety can severely impact adolescents’ life as well.
• It often interferes with a teen’s ability to socialize with friends,
interferes with education, difficult for them to speak up in class or
attend social events.

Depressive Disorder
• Depression is estimated to occur among 1.1% of adolescents aged 10-14
years, and 2.8% of 15-19-year-olds.
• Girls are more likely to experience depression than boys.
• Symptoms severely impact their social or academic life.
• Social withdrawal can exacerbate isolation and loneliness.
• Depression can lead to suicide.

Attention deficit hyperactivity disorder (ADHD)
• Behavioural disorders are more common among younger adolescents than
older adolescents.
• Attention deficit hyperactivity disorder (ADHD), characterized by difficulty
paying attention, excessive activity, talkative, easily distractable, and acting
without regard to consequences.
• Occurs among 3.1% of 10-14 year-olds and 2.4% of 15-19 year-olds. (WHO)
• Three subtypes of ADHD–hyperactive type, inattentive type, or impulsive
type. It’s also possible to have a combination of types. (NIMH)

Oppositional Defiant Disorder (ODD)
• Oppositional defiant disorder is characterized by extreme defiance (refusal to obey),
verbal and physical aggression, and spitefulness (hurting another person).
• According to the American Academy of Child and Adolescent Psychiatry, anywhere from
1 to 16 percent of adolescents have the oppositional defiant disorder.
• Teens with ODD tend to struggle to maintain healthy relationships and often their
behavior interferes with their education.
• Left untreated, it can lead to a conduct disorder, which is a much more serious behavioral
disorder.

Conduct disorder
• Conduct disorder is a serious behavioral and emotional disorder that can
occur in children and teens.
• A child with this disorder may display a pattern of disruptive and violent
behavior and have problems following rules.
• Conduct disorder (involving symptoms of destructive or challenging
behavior) occurs among 3.6% of 10-14 year-olds and 2.4% of 15-19 year-
olds.
• Behavioural disorders can affect adolescents’ education and conduct
disorder may result in criminal behavior.

Eating disorders
• Eating disorders include anorexia nervosa, bulimia nervosa, and binge eating
disorder.
• Anorexia nervosa is characterized by extreme food restriction and weight loss.
• Bulimia nervosa involves binge eating and purging, either by vomiting or through
the use of laxatives.
• Binge eating disorder involves eating massive quantities of food at one time
without purging.
• Among teens between 13 and 18, approximately 2.7 percent suffer from an
eating disorder.
• Prevalence is higher in females than males.

Suicide and Self-harm
• Intention to kill oneself or deliberate self-ham.
• Suicide is the fourth leading cause of death in older adolescents (15-19
years).
• Risk factors for suicide are multifaceted and include harmful use of alcohol,
abuse in childhood, stigma against help-seeking, barriers to accessing care,
and access to means of suicide.
• Digital media, like any other media, can play a significant role in either
enhancing or weakening suicide prevention efforts.

Risk-taking behaviours
• Many risk-taking behaviours for health, such as substance use or sexual
risk-taking, start during adolescence.
• Risk-taking behaviours can be an unhelpful strategy to cope with emotional
difficulties and can 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.

Risk-taking behaviours
• The use of tobacco and cannabis are additional concerns. Many adult
smokers had their first cigarette prior to the age of 18 years.
• Cannabis is the most widely used drug among young people with about
4.7% of 15-16 years-olds using it at least once in a year.
• Interpersonal violence was ranked among the leading causes of death of
older adolescent boys in 2019.

Consequences of adolescent/youth mental health issues include:
Suffering (e.g. personal distress, family distress);
Functional impairment (e.g. inability to study, work, raise a family or
be independent);
Exposure to stigma and discrimination (e.g. isolation, missed
opportunities, abuse from others);
Increased risk-taking behaviour (e.g. unprotected sex, excessive
alcohol use);
Premature death (e.g. violence, suicide, overdose of drugs).

Presentation and Assessment of Adolescent Mental Health Issues
How do we get information to assess an adolescent’s mental health when
they come to the clinic?!!
• What the adolescent says about his or her thoughts and feelings;
• What the adolescent says he or she does (self-reported behaviour);
• Observing how the adolescent looks (self-care) and speech (tone of
voice);
• What other people (e.g. parents, teachers, other adults, siblings, peers)
say the adolescent does or says about his or her thoughts and feelings;
• Observing the adolescent’s interactions with other people – behaviour;
• General physical examination;
• Medical records.

Physical (Bodily or Somatic) Symptoms:
• Sleep problems or unexplained tiredness;
• Anxiety and palpitations;
• Dizziness, trembling and sweating;
• Generalized aches and pains (including of the head, chest and
abdomen);
• Poor appetite or loss of weight.

Other presentations:
• Social withdrawal or reduced participation (in school, work or social
activities);
• Declining academic performance;
• Signs of excessive and frequent alcohol or psychoactive substance use;
• Self-report or report by others of frequently engaging in high-risk
behaviour (e.g. reckless driving, playing with firearms).

Early detection and treatment
• Alarmingly, however, 75% of children and young people who experience
a mental health problem aren’t getting the help they need.
• It is crucial to address the needs of adolescents with mental health
conditions.
• Avoiding institutionalization and over-medicalization.
• Prioritizing non-pharmacological approaches, and respecting the rights
of children in line with the United Nations Convention on the Rights of
the Child and other human rights instruments are key for adolescents’
mental health.

Thank You

Adolescent Mental Health: Common Mental Health Issues in Youth

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