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| EDITORIAL |
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| Year : 2019 | Volume
: 24
| Issue : 2 | Page : 63-65 |
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Focus on youth mental health: The need of the hour
Swapnajeet Sahoo, Sandeep Grover
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| Date of Web Publication | 22-Jul-2020 |
Correspondence Address:
Sandeep Grover
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jmhhb.jmhhb_65_20
How to cite this article:
Sahoo S, Grover S. Focus on youth mental health: The need of the hour. J Mental Health Hum Behav 2019;24:63-5 |
“Adolescence” is the period in human growth and development between childhood and adulthood. Adolescence is considered to be the most critical and vulnerable period in the lifetime of any individual, as several biological and psychosocial changes occur in the internal and external milieu during this period. About 16% of the world population (an absolute number of 1.2 billion)[1] and 20.9% of the Indian population (i.e., about 253 million)[2] comprise adolescents.
However, there are certain terms which are used interchangeably with adolescents, such as youth and young people. The three commonly used terms in this regard with overlapping age range as evident from the definitions by the World Health Organization (WHO) include, “adolescents” as individuals in the age group of 10–19 years, “youth” as those in the age group of 15–24 years, and “young people” covers age range from 10 to 24 years.[3]
The adolescence period and youthhood are known for a desire for getting independence, experimentation, attention seeking, and exploration, which makes them vulnerable for unhealthy lifestyle, risk of substance abuse, and high-risk sexual behaviors.[4],[5],[6]
It is also known that many mental illnesses seen in adults start during childhood and adolescence. Experts from all over the world have stressed to focus on the social determinants of adolescent health (such as ensuring safe and supportive family and school environment, the role of positive and supportive peer relationships, and assess to educational opportunities).[7] Studies have explored the role of several antecedents of mental illness in adolescents, some of which are biological/genetic factors (mostly unmodifiable) and many modifiable factors (substance abuse, academic stress, social media networking, peer relationships, family, and school environment).[8] It is also suggested that intervention delivered during this window period can be helpful in preventing the onset of mental illnesses, delaying in the onset of mental illness, and possibly improving the long-term outcome of mental illnesses.[4]
In this issue of the journal, some of the articles[9],[10],[11],[12] have focused on the mental health issues in adolescents and youth, which is the need of the hour. Gujar and Ali found about one-fifth of their adolescents' study sample (n = 387) had emotional and behavioral problems, most common being hyperactivity and peer problems (based on the Strengths and Difficulties questionnaire). Further, they reported those with emotional and behavioral problems had poor self-esteem.[9] Self-esteem is a critical aspect of an adolescent/youth life. Self-esteem has been found to have a significant association with coping skills (i.e., those with low self-esteem predominantly utilize avoidance maladaptive coping).[13] Further, poor self-esteem has been found to predict depression, anxiety, and fear.[14] It has also been reported that chronic low self-esteem has a long-lasting effect in shaping the personality of an individual and also has been found to be linked with obesity, increased television/screen time, and poor school performance.[15],[16] Moreover, it has been found that alcohol and substance use during young adulthood/youth meditates the effect of self-esteem on depression among males.[17] Therefore, efforts need to be made to identify low self-esteem in vulnerable adolescents, and due steps need to be taken to improve self-esteem.
The exploratory study of medical student mental health from Texas, United States,[10] in this issue of the journal highlights the very fact of a significant prevalence of mental health problems (depression, anxiety, posttraumatic stress disorder, and suicidal ideations) among medical students. Further, the study reported several common barriers in seeking help from mental health services, common being lack of time and stigma. A systematic review of depression, anxiety, and stress among medical students from India reported quite higher rates of depression and anxiety as compared to the above-mentioned study, i.e., the pooled prevalence rate of depression to be around 39% (16 studies), the pooled prevalence rate of anxiety around 34.5% (4 studies), and pooled prevalence rate of stress being 51.2% (28 studies).[18] Undergraduate medical students in India usually join the medical curriculum in their adolescence/youth period, and studies depicting such grave scenarios of mental health issues should set an alarming signal to look after the welfare, course curriculum, unmet needs, and social support of the medical students during their formative foundation years. If these symptoms are not taken care of in time (i.e., in undergraduate period/MBBS), then these can pile up and lead to burnout in later higher studies and professional life, as evident from the studies on burnout in the medical professionals.[19] It had been conceptualized that usually in the initial years, mostly during the undergraduate period, i.e., during late adolescence/youth exhaustion develops in response to high demands and work overload, which in turn precipitates detachment and negative reactions to people and to the job. If both of these are continued, it leads to a sense of inadequacy and personal failure.[20]
Another study on adolescents (mean age – 18.4 years) published in this issue is on recently enrolled university students at a medical school in Hidalgo, Mexico.[12] Although only 17 students completed the online survey, the study results demonstrated that sleep quality gradually decreased in the 1st week after starting of the undergraduate course, which further became poorer by the end of 1 month, and poor sleep quality was linked with depressive symptoms at 1 month assessment. This study further suggests that enrolling in a new curriculum usually occurs during the adolescent period, that can be very stressful and can lead to destabilization and lead to mental health issues in adolescents. Due steps need to be taken in the form of student counseling, a friendlier school/college environment, regular stress management sessions at school/colleges, and assessing the students' mental health need periodically. In this regard, many schools and colleges had now started mentor–mentee programs and have appointed student counselors.[21],[22] All these are needed to be a part of every college/school/university, as evident from the prevalence of suicide, self-harm, and rising rates of depression in the adolescent and youth population of the country.[23],[24],[25]
Another important pertinent problem that had been gradually cropping up among the teenagers and youth is behavioral addiction to gadgets/online gaming/problematic internet use, as reported in a case report on this issue.[11] Online gaming is now quite evident in both genders, and it had been found to be associated with low self-esteem, depression, loneliness, and a troubled family environment. Further, cyberbullying, cybersex, cyber-linked self-harm attempts, and cyber suicides are rising nowadays, and these are more prevalent among adolescents and youth. Various online games and online challenges such as “The Blue Whale Challenge,” “The Mo-Mo challenge,” “eyeball challenge,” etc., have been in the news recently, and the victims were mostly teens/adolescents. In this context, the review by Balhara and Singh in this issue discusses in detail various internet-related psychiatric issues and highlights how Internet usage can affect psychopathology in today's world.[26] This could be very relevant for adolescents/youth, as they form a major proportion of people using Internet.[27],[28],[29] Therefore, mental health professionals should be alert and take a good history about Internet and other gadget usages while dealing with adolescents and teenagers.
In India, conventionally, children are seen by pediatricians and adults are seen by medicine specialists. The age cutoff used to make this arbitrary distinction varied from 12 to 15 years across different health-care systems (pediatrics vs. adult medical/surgical branches). Psychiatry as a specialty in India has also followed the same footsteps, with traditionally, children up to 14–16 years seen by the child psychiatrists and people aged more than these age cutoffs being cared by psychiatrist catering to the adult population. This was not an issue till recent time, as adolescence was not given due importance. However, now with the expansion of the child psychiatry as a subspecialty in the country with starting of DM courses, there is a tussle between the child and adult psychiatrists for catering to the needs of adolescents. Usually, child psychiatrists take a developmental perspective in understanding the psychopathology and can be considered to be more equipped to handle adolescents. However, it is also argued that child psychiatrists operate with a family-based approach model which may not be suitable while dealing with an adolescent, as despite being legally minor, adolescents prefer to discuss their issues with confidentiality and privacy.[30] In contrast, psychiatrists who practice psychiatry, without considering the developmental perspective, may not be able to connect with the issues of adolescents and empathize with them. This can result in poor therapeutic relationship and providing overall poor care to the adolescents. Therefore, the mental health professionals need to be geared up to deal with adolescents with different skills to interview and manage accordingly.
The mental health of the 21st century adolescents and youth should be focus of national and international health authorities and sufficient steps need to be taken to safeguard the vulnerable budding minds to see a better future. In this regard, the WHO had started a global strategy named “Global Strategy for Women's, Children's, and Adolescent's Health” and had stressed upon the fact that the updated global strategy needs to include adolescents because they are central to everything we want to achieve, and to the overall success of the 2030 agenda.[31] Therefore, adolescent mental health is currently the need of the hour as by identifying at-risk adolescents earlier, and by helping the adolescents to realize their full potential, their future can be safeguarded.
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