Mental Health. Conclusions

WHO estimates that 20% of children and adolescents have a disabling mental illness (WHO, 2001). However, data are incomplete in most regions due to poor tracking systems and underreporting. Untreated, mental health issues can cause a lifetime of problems. As discussed previously, anxiety and sadness are normal parts of ado­lescence, and many teenagers can be moody and reflective at times. However, these normal emotions are distinctly separate from pathologic mental illness that impairs daily functioning.

Many psychiatric illnesses present during adolescence: 14 years is the median age to develop a mental health or psychiatric disorder. Common diagnoses include mood disorders such as depression or bipolar disease, anxiety disorders, behavioral problems such as oppositional defi­ant disorder, and cognitive pathology such as learning disabilities. Adolescents with mental illness may lack judgment to recognize their symptoms and skills to deal with the stress.

As a result, they often turn to drugs or alcohol as a coping mechanism; they are more likely to engage in early sexual activity, perform poorly in school, and be a victim or perpetrator of physical and sexual abuse. Young people with mental illness represent lost employment, lost productivity, poor educational out­comes, and increased health expenditures, all of which can contribute to a cycle of poverty and mental illness.

In particular, depression and suicide are major causes of disease and death in young people. Depression is asso­ciated with having poor relationships with one’s family and community, and not having an interest in academic achievement. Depressed youth are more likely to engage in risk-taking behaviors, including ‘cutting’ or self-mutilation to relieve pressure.

Depression is also a leading cause of suicide. Ninety thousand young people per year die from suicide, which is a major cause of death across the world, especially in Eastern Europe and the Americas. Teenagers who closely identify with a religion that bans suicide are less likely to attempt suicide, such as those living in the Middle East and parts of Latin America. Although females are generally more likely to attempt suicide, males are more likely to complete suicides, often because they use more effective methods such as guns or hanging.

Eating disorders seem to be more common in the indus­trialized world, including anorexia nervosa and bulimia nervosa. Anorexia nervosa is one of the most deadly forms of mental illness, causing death by starvation, heart failure, or arrhythmias. Eating disorders are more common among females with low self-esteem, and are associated with other types of mental illness including depression, anxiety dis­orders, and borderline personality disorder.

Many societies have a stigma attached to mental ill­ness. Parents, medical providers, and peers may believe that a teenager’s illness is his or her own fault, imaginary, or a normal part of growing up. This attitude may cause adolescents to not seek care or to have a poor self-image. There is an enormous gap in services for adolescents with mental health issues.

Many teenagers do not have access to specialized providers who treat mental illness, while most primary care providers have not been adequately trained to provide care. In addition to improved mental health and social services, improvements in housing, med­ical care, and the economy are vital to improving the mental health of adolescents.

Conclusions. The largest number of adolescents in history is cur­rently making their way toward adulthood. Lacking adult problem-solving skills, judgment, and resources, they engage in risky behaviors that can have lifelong devastating consequences. Now more than ever, social and behavioral problems cause most deaths and diseases in adolescence.

Because many of these problems coexist, are interrelated, and have common origins, piecemeal and short-term interventions are ineffective in produ­cing long-lasting health benefits. Widespread social and economic reforms that improve education and augment resources to enhance medical, reproductive, and finan­cial health are needed to provide long-lasting change. Specifically, future efforts to stem the HIV epidemic and to disseminate reproductive health information and resources will be important for the health of young people.

Health care for adolescents that respects their privacy, engenders their trust, and is nonjudgmental and of high quality is essential for this group. A focus on prevention can have both immediate and lifelong effects on this population’s health. Supportive and nurturing social environments, along with educational and economic opportunities, are necessary to provide this dynamic pop­ulation with skills and resources to make good choices for themselves and for society at large.

See also: Adolescents; Alcohol, The Burden of Disease of; Alcohol-Socio-Economic Impacts (Including Externalities); Child Abuse/Treatment; Child Labor; Child Obesity and Health; Child Soldiers; Child Witness to Violence; Children and Adolescents, Measuring the Quality of Life of; Children, Media and Health; Chlamydia (Trachoma and Sexually Transmitted Infections); Cultural Context of Reproductive Health; Family Planning/ Contraception; Gender in Health and Illness; Health

Literacy; Health-Related Stigma and Discrimination; HIV/ AIDS; Internet, Health Information on the; Mental Health Policy; Mental Health Promotion; Orphans Due to AIDS; Populations at Special Health Risk: Displaced Populations; Preventing Uptake of Smoking; Puberty; School Health Promotion; Sexual Health; Sexual Violence; Sexually Transmitted Infections: Overview; Social Gradients and Child Health; Social Science Contributions to Public Health: Overview; Socio-Cultural Context of Substance Use/Abuse (Alcohol/Drugs/ Tobacco); Specific Mental Health Disorders: Child and Adolescent Mental Disorders; Suicide and Self-Directed Violence; Violence Against Women; Violence/Intentional Injuries - Epidemiology and Overview; Violence/ Intentional Injuries - Prevention and Control; Young People and Violence.