We have all experienced occasional blues, sudden tantrum, a megalomaniac spell or a panic attack even. Adolescents aged 10-19 go through a cacophony of physical, mental, emotional and psychosocial transformation and it’s not surprising that they are likely to experience more of such ‘spells’. However, the vast majority of young people go through adolescence without significant problems and relate well to their families for most of the time.
Adolescence means –‘to emerge’. This phase is defined by rapid growth and development – physical, physiological and behavioural changes, complicated psychological and psychosexual change, a change from concrete thinking to abstract thinking, development of self-concept and self-esteem. Associate Director and Senior Consultant Obstetrician and Gynaecologist, Fortis La Femme Hospital, Richmond Road, Dr Aruna Muralidhar, highlight the cause and effect of mental health issue among young Indians.
Adolescents form a large demographic dividend in our country accounting for 21 per cent of the population. Every third person is a young person (10-24 years) and every fifth person is an adolescent (9-19 years). The focus on adolescents is vital and timely, as they form the powerhouse of our future. This also is the most important and impressionable stage in their life for health interventions.
WHO defines mental health as a state of well-being whereby individuals recognise their abilities and are able to cope with normal stresses of life, work productively ad fruitfully and make a contribution to their communities. Emotional well-being in adolescents is further defined as a state of mind wherein they develop and progress physically and psychologically with confidence and enjoyment, learn from experience, including how to overcome difficulty and adversity, develop a sense of right and wrong and recognise their full potential in terms of their ability, and enjoy all aspects of their life.
The current challenges that adolescents face are like never before. There is a culture of quick and easy gratification, flooding and intrusion of technology into lives, mobile and VDU addiction, a barrage of information and misinformation, various nuances of peer pressure, and to top it all, loneliness, hopelessness and a general feeling of lack of purpose and direction. Body image concerns, depression and anxiety, violence, unintentional injuries, suicide and substance abuse are becoming more common amongst these individuals. On one hand, sexual assaults are increasing and on the other hand, there are risk-taking behaviours amongst adolescents with one-night stands and promiscuity. Consequently, teenage pregnancies, sexually transmitted infections and illegal abortions are on the rise too. To make it worse, statistics tell us that self harm/suicide is the second common cause which contributes to deaths in adolescents after road traffic injury, both of which are avoidable.
All is not gloomy though, as mental health concerns may be mild and transient and amenable to intervention if detected early and there are proven factors for reducing these mental health issues. A positive relationship with parents, a positive school environment, spiritual orientation and beliefs are proven to reduce the risk. Provision of accurate information in a friendly, approachable and accessible manner; opening communication channels with peers, mentor and parents; providing life skills are all ways of combating this potentially huge burden.
The first challenge is to identify whether there is a problem in the individual. Low mood and tearfulness, physical symptoms such as, recurrent headaches or abdominal pain, school refusal or self-harm, sleep disturbance or fatigue, irritability and moodiness and academic decline are some common presenting symptoms in this age group.
Some pointers towards severity can be: (Ref: Hagan JF et al, AAP 2008)
- Boredom, sadness, irritability most of the time with difficulty to cope with
- Difficulty in sleeping or appetite
- Continually thinking of unpleasant experiences
- Feeling very upset and wishing that life is not worth living
It is probably worth spending some time on the problem itself and determining its background and duration. Questioning regarding risk factors, any undisclosed concerns and determining the impact of the problem would help establish the type of problem. Many times, there may be a physical cause contributing to it. Being persistent, pervasive, disabling and/or unexplained and disproportionate would indicate a mental health problem rather than normal adolescent development.
It would be prudent for parents to reach out to counsellors, mentors, gynaecologists or paediatricians with special interest in adolescent health. It is likely that adolescent girls and young women are seen by gynaecologists at the outset due to various other concerns at this phase of development such as period problems, weight gain, acne etc.
It is also possible that they are seen for an unwanted pregnancy or sexually transmitted infections. It would be the combined responsibility of parents, teachers, mentors and specialist doctors to have an eye out for these symptoms and take the necessary steps towards early identification and referral to specialist services. Care coordination amongst all the sectors is also of utmost importance as long term follow-up would be required in many cases.
Adolescence is the last chance to correct the growth lag and malnutrition and build confidence, self-worth and body image. I have been proactively involved in setting adolescent-friendly clinics both in the hospital and in a college where confidentiality, privacy, empathy, non-judgemental and non-discriminatory attitudes and anticipatory counselling and guidance are provided....