Adolescent depression


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Adolescent depression

  1. 1. North South University Department of Public Health Adolescent Depression Sumitted to Dr. Arifu Bari Chowdhury Prepared by Dr. Rehnuma Haq Sarah ID # 121 1280 580 Adolescent Health Spring 2013
  2. 2. 1 Table of Content Introduction……………………………………………….....4 What is depression…………………………………………..…5 Types of depression……………………………………………5-6 Depression Scenario……………………………………..…6 Worldwide: DALY…………………………………………….7 Bangladesh……………………………………………………..8 Contributing factors…………………………………………….9 Key Findings………………………………………….10 Existing Policies & Programs………………………..11 GoB and NGO activities……………………………………….11-13 Discussion……………………………………………..14 Recommendation……………………………………..15-16 Conclusion…………………………………………….16
  3. 3. 2 Glossary AFLE Adolescent Family Life Education AHI Assistant Health Inspector AIDS Acquired Immune Deficiency Syndrome ASD Assistance for Slum Dwellers BCC Behaviour Change Communication BDHS Bangladesh Demographic and Health Survey BPHC Bangladesh Population Health Consortium BRAC Bangladesh Rural Advancement Committee BWHC Bangladesh Women's Health Coalition CDS Centre for Development Studies CMES Centre for Mass Education in Science CWFP Concerned Women for Family Planning DFP Directorate of Family Planning ESP Essential Services Package FDSR Family Development Services and Research FPAB Family Planning Association of Bangladesh FP Family Planning FPHP Fourth Population and Health Programme GoB Government of Bangladesh H&FWC Health and Family Welfare Centre HIV Human Immuno-deficiency Virus HPSP Health and Population Sector Programme ICPD International Conference on Population and Development ICDDR,B International Centre for Diarrhoeal Disease Research, Bangladesh IEC Information, Education and Communication ILO International Labor Organization INACG International Nutritional Anaemia Consultative Group IUD Intra-uterine Device MA Medical Assistant
  4. 4. 3 MCH-FP Maternal and Child Health and Family Planning NCTB National Curriculum and Textbook Board NFPE Non-formal Primary Education NGO Non-government Organization NIPORT National Institute of Population Research and Training
  5. 5. 4 INTRODUCTION Depression is a significant contributor to the global burden of disease and affects people in all communities across the world. Today, depression is estimated to affect 350 million people. The World Mental Health Survey conducted in 17 countries found that on average about 1 in 20 people reported having an episode of depression in the previous year. Depressive disorders often start at a young age; they reduce people’s functioning and often are recurring. For these reasons, depression is the leading cause of disability worldwide in terms of total years lost due to disability. The demand for curbing depression and other mental health conditions is on the rise globally. A recent World Health Assembly called on the World Health Organization and its member states to take action in this direction (WHO, 2012). While depression is the leading cause of disability for both males and females, the burden of depression is 50% higher for females than males (WHO, 2008). Infact,depression is the leading cause of disease burden for women in both high-income and low- and middle-income countries (WHO, 2008). Research in developing countries suggests that maternal depression may be a risk factor for poor growth in young children (Rahman et al, 2008). This risk factor could mean that maternal mental health in low- income countries may have a substantial influence on growth during childhood, with the effects of depression affecting not only this generation but also the next.
  6. 6. 5 What is depression? Depression is a common mental disorder that presents with depressed mood, loss of interest or pleasure, decreased energy, feelings of guilt or low self-worth, disturbed sleep or appetite, and poor concentration. Moreover, depression often comes with symptoms of anxiety. These problems can become chronic or recurrent and lead to substantial impairments in an individual’s ability to take care of his or her everyday responsibilities. At its worst, depression can lead to suicide. Almost 1 million lives are lost yearly due to suicide, which translates to 3000 suicide deaths every day. For every person who completes a suicide, 20 or more may attempt to end his or her life(WHO, 2012). Variety of depression There are multiple variations of depression that a person can suffer from, with the most general distinction being depression in people who have or do not have a history of manic episodes. I. Depressive episode involves symptoms such as Depressed mood Loss of interest and enjoyment Increased fatigability etc. Depending on the number and severity of symptoms, a depressive episode can be categorized as mild, moderate and severe. An individual with a mild depressive episode will have some difficulty in continuing with ordinary work and social activities, but will probably not cease to function completely. During a severe depressive episode, on the other hand, it is very unlikely that the sufferer will be able to continue with social, work, or domestic activities, except to a very limited extent
  7. 7. 6 II. Bipolar affective disorder typically consists of both manic and depressive episodes separated by periods of normal mood. Manic episodes involve elevated mood and increased energy, resulting in over-activity, pressure of speech and decreased need for sleep.2 ADOLESCENT DEPRESSION WORLDWIDE Children and adolescents constitute almost a third (2·2 billion individuals) of the world’s population and almost 90% live in low-income and middle-income countries (LMIC), where they form up to 50% of the population. 1 For young people, neuropsychiatric disorders are a leading cause of health- related burden, accounting for 15–30% of the disability-adjusted life-years (DALYs) lost during the first three decades of life.
  8. 8. 7 Disability adjusted life years (DALY): The total number of incident DALYs in those aged 10–24 years was about 236 million, representing 15.5% of total DALYs for all age groups. Africa had the highest rate of DALYs for this age group, which was 2.5 times greater than in high-income countries (208 vs. 82 DALYs per 1000 population). Across regions, DALY rates were 12% higher in girls than in boys between 15 and 19 years (153 vs. 137). Worldwide, the three main causes of YLDs for 10–24-year-olds were neuropsychiatric disorders (45%), unintentional injuries (12%), and infectious and parasitic diseases (10%).4 Risk factors The main risk factors for DALYs in 10–24-year-olds were: Alcohol (7% Of DALYS) Unsafe Sex (4%) Iron Deficiency (3%) Lack of Contraception (2%) Illicit Drug Use (2%)
  9. 9. 8 BANGLADESH SCENARIO  Adolescents –22.5%  young people — 40% of population  Early age at marriage – 48% of 15-19 years old girls are married  54% of them have had first child  MMR in adolescents double than national figure  IMR 30 percent higher for adolescents  Information, services and life skills crucial  Adolescents fertility High: 135
  10. 10. 9 Contributing factors Problems Experiences Implications for mental health leading towards suicide Teenage love -Parents disagree to establishment- Unwanted pregnancy -Depression -Emotional distress Sexual violence -Social insecurity-Unwanted pregnancy-Isolation from family members and society -Depression -Emotional distress -Addiction -Hopelessness Unexpected academic results -Isolation from family members and society-feeling of guilty -Stress, -Hopelessness - Addiction Low socioeconomic status and unemployment -Decline in social status -Persistent insecurity, -Feeling of discrimination-Social instability - Addiction to cannabis, heroin -Emotional distress - Depression-Anger and hostility -Hopelessness -Cannabis psychosis Religious -Perceived injustice -Restriction to move freely and to express their opinion -Mental instability -Emotional distress -Anger-Loss of autonomy a number of brother and sister -Persistent quarrel,-Feeling of discrimination-Family disharmony -Emotional distress -Depression -Anger and hostility-Addiction- boys Dowry -Domestic violence -Shame, helplessness, humiliation -Depression Social isolation -Restricted opportunities-Broken social and cultural ties -Hopelessness, disappointment, and demoralization -Addictions ― Bokhate chelae‖ -Feeling of discrimination-social Insecurity -financial crisis -Helplessness, humiliation- Depression-addiction
  11. 11. 10 KEY FINDINGS They reach adulthood with little knowledge about their physical and mental changes. The majority of youths (aged between 10 and 25 years) have no correct knowledge about sexually transmitted infections, including HIV/AIDS, and risky sexual behavior is common among them (National AIDS and Sexual Transmitted Disease Programme [NASP] 2006). One out of every three girls aged 15-19 experience teenage pregnancy (BDHS 2004) and face the concomitant risks of childbearing before attaining physical maturity. A large number of adolescents, especially girls, suffer from malnutrition. Many young adolescents get addicted to drugs because of lack of awareness and peer pressure. All this factor are responsible to develop depression. The National Adolescent Strategy has been finalized and adolescent-friendly health services have been introduced recently to meet the special needs of this group. The failure of formal and informal education in dealing with sensitive health issues and cultural sensitivities are key factors that prevent adolescents from making full use of the health-care system. Mental health problems affect 10–20% of children and adolescents worldwide and account for a large portion of the global burden of disease Although only 10% of trials come from low-income and middle-income countries (LMIC; where 90% of children and adolescents live), sufficient evidence exists to justify the set-up of services The development of services is hampered by lack of government policy, inadequate funding, and a dearth of trained clinicians. Support of child and adolescent mental health research is needed, particularly in LMIC, including prevalence and longitudinal studies, high-quality clinical trials, and cost-effectiveness analyses.5
  12. 12. 11 EXISTING POLICIES & PROGRAMS GoB Programs Health and Population Sector Program (HPSP) a. Behavior change communication (BCC) through effective information, education and communication. (The school health education program will be strengthened. Health and FP workers, will conduct counseling and health education sessions, in the community and in schools, and refer suspected cases of anemia, malnutrition, and RTI/STD to the nearby healthcarecenter b. Postponing the first birth or preventing unwanted pregnancy through proper IEC and by increasing the use of contraceptives by the newly-married couples. C Prevention of unsafe abortion due to unwanted pregnancy by giving training to service providers. c. Special antenatal and safe-delivery care to pregnant women aged less than 24 years. d. Creation of awareness among adolescents about RTI/STD and availability of high-quality services for management of STD/RTI. e. Involvement of private and NGO sectors in promoting adolescent health. f. Inter-sectorial coordination among the various concerned sectors, i.e. education, law, labor, social welfare, and youth welfare. The Government of Bangladesh is planning to allocate sufficient funds for improving adolescent health, and also to train service providers with regard to adolescent health [47]. In 1997, the GoB held four workshops on adolescent health in different parts of the country. The health and FP program managers of both GoB and NGOs participated in these workshops. School Health Pilot Project (SHPP) In addition to train school-aged children and adolescents to properly care for themselves and to promote a healthy lifestyle within their families, communities, and peer groups, the Ministry of Health and Family Welfare began the 'School Health Pilot Project' (SHPP) in 1996, following the design of the 1993 National School Health Plan.3
  13. 13. 12 Name of the organization s Target groups Activities Coverage ASD Boys and girls (9-19 years) AFLE, skill development credit programme, and health services 250 boys and girls BRAC Boys and girls (12-16 years) AFLE 21 secondary schools, 210 adolescent clubs and 202 NFPE schools BWHC Girls (11-18 years) AFLE, health services, leadership and skill development training, and cultural activities 40 schools, 99 class groups (6,600 adolescents) CDS Girls (9-19 years) AFLE 6,100 girls CMES Girls (11-19 years) AFLE 3,200 girls CWFP Girls (9-19 years) AFLE, health services (TT), skills training, savings, and credit activities 1,492 girls Dipshikha Girls (12-18 years) AFLE 3,000 girls FDSR Boys (15-25 years) Girls (12-18 years) Better life education, indoor games, growth monitoring, skill development and leadership training, income-generation activities 54 unions of 7 selected thanas (3,348 girls and 532 boys) FPAB Boys (15-30 years) Girls (9-20 years) AFLE 21,000 youths in 70 unions of 30 districts NM Girls (9-19 years) AFLE, adolescent health clinics, income-generating activities, skills training, and credit programme 316 girls OMI Girls (11-18 years) AFLE, adolescent health clinics, and income-generating activities 350 girls
  14. 14. 13 Name of the organization s Target groups Activities Coverage PDAP Girls (10-19 years) Skill training, credit support, basic education, and health services 350 girls PI Newlywed couples Reproductive health education 29 NGO project sites PSTC Girls (9-19 years) AFLE Five selected areas (130 girls) World Vision, Bangladesh Girls (10-19 years) AFLE 16,000 girls
  15. 15. 14 DISCUSSION Reducing the Burden 0f Depression While the global burden of depression poses a substantial public health challenge, both at the social and economic levels as well as the clinical level, there are a number of well-defined and evidence based strategies that can effectively address or combat this burden. For common mental disorders such as depression being managed in primary care settings, the key interventions are treatment with generic antidepressant drugs and brief psychotherapy. Economic analysis has indicated that treating depression in primary care is feasible, affordable and cost-effective. The prevention of depression is an area that deserves attention. Many prevention programs implemented across the lifespan have provided evidence on the reduction of elevated levels of depressive symptoms. Effective community approaches to prevent depression focus on several actions surrounding the strengthening of protective factors and the reduction of risk factors. Examples of strengthening protective factors include school-based programs targeting cognitive, problem-solving and social skills of children and adolescents as well as exercise programs for the elderly. Interventions for parents of children with conduct problems aimed at improving parental psychosocial well-being by information provision and by training in behavioral childrearing strategies may reduce parental depressive symptoms, with improvements in children’s outcomes.
  16. 16. 15 RECOMMENDATION 1. WHO technical support to policy makers and service planners WHOs three most important recommendations for the development of policy, strategic plans and for organizing services are to deinstitutionalize mental health care; to integrate mental health into general health care; and to develop community mental health services. Support to countries is provided at multiple levels and includes, but is not limited to, the following: 2. Mental health situational analysis and needs assessment Helping countries to analyze in as comprehensive way as possibletheir mental health situation and needs. What are the priority mental health problems, what are the major needs, what are the available resources to address needs? What are the service and resource gaps? 3. Facilitating stakeholder consultations within countries Facilitating discussions and consultations between the different stakeholders within the country interested in mental health reform. 4. Analysis, drafting and implementation of mental health policies, strategic plans and proposals for service organization Working closely with the MOH and committees to analyses and draft mental health policies and strategic plans and advice on their implementation. 5. Assistance to improve capacity of mental health systems and services Ongoing technical assistance to policy makers to improve overall functioning of the mental health system and services. Two core related issues that always assume importance in countries where we work are service development and human resource
  17. 17. 16 development and training. Primary health care is nearly always featured in countries requests for assistance. 6. Building knowledge and skills of policy makers, health planners and service providers Providing the opportunity to policy makers, health planners and service providers to gain more knowledge and skills through training workshops in a number of areas critical to policy making and service planning (developing policies and plans; developing law; improving access to psychotropic drugs, developing mental health information systems, implementing quality improvement strategies, budgeting and financing for mental health, mental health monitoring and evaluation). CONCLUSION Mental disorders also rise sharply during the adolescent years. Many risk processes that lead to chronic non-communicable diseases in later life, including tobacco, alcohol, and illicit substance misuse, unsafe sex, obesity, and lack of physical activity, typically emerge around this time. Depression is a mental disorder that is pervasive in the world and affects us all. Unlike many large scale international problems, a solution for depression is at hand. Efficacious and cost-effective treatments are available to improve the health and the lives of the millions of people around the world suffering from depression. On an individual, community, and national level, it is time to educate ourselves about depression and support those who are suffering from this mental disorder.