Adolescence is a transforming phase from the identity of a kid to an adult, which depends on several personal, familial, and social conflicts and challenges. As adolescence is the age of curiosity and is the phase where various physical, emotional, and social developments can pave the path to behaviour formation happen. Developing and maintaining positive emotional and social habits is a must for mental wellbeing. The peak age of onset of which mental illness occurs in adolescence and early adulthood. The peak age of onset of physical illness occurs much later in the fifth to sixth decade of life. Clinically it means that younger patients with the physical illness are relatively more likely to have co-existing psychological difficulties in comparison to older patients. Unfortunately, the available data suggests that the mental health of teenagers is something that is poorly addressed in the present day. Mental health conditions account for 16% of the global burden of disease and injury in people aged 10-19 years. Half of all mental health conditions start at 14 years of age, but most cases are undetected and untreated. Suicide is the fourth leading cause of death in 15-19-year-olds. Several studies conducted at the community level in India reported the prevalence of child and adolescent mental disorders varying from 1.06% to 5.84% in rural areas, 0.8% to 29.4% in urban areas. National Mental Health Survey 2016 reported that the prevalence of mental disorders is 7.3% among children aged 13–17 years and it is similar in both genders. The prevalence among urban children is nearly double (13.5%) compared to rural children (6.9%).
Mental Health Determinants
Adolescence is the crucial age in the development of essential life skills such as problem-solving, decision making, maintaining interpersonal relations, communication skills, coping mechanisms, and managing emotions.
The major factors which can determine mental health outcomes are:
Personal factors: Lack of education and awareness about the adolescent phase of life can cause conflict in understanding the physical and psychological changes during puberty. The desire for greater autonomy and stigma can also contribute to adolescent stress.
Familial factors: Non-cordial familial environment including harsh parenting, parental conflicts, family problems due to substance use among parents, lack of family support and sibling rivalry can affect the mental health of an adolescent.
Social Factors: Children and adolescents are vulnerable to sexual violence and exploitation. Witnessing suicide or other traumatic events, peer pressure, bullying and body shaming, increased access and use of technology, forced marriages, lack of access to quality support and services, and lack of social connectedness are the major social factors that can determine the mental health of the teens.
Common Mental health problems among teens
Emotional Disorders
Emotional disorders commonly emerge during adolescence. In addition to depression or anxiety, adolescents with emotional disorders can also experience excessive irritability, frustration, or anger. Rapid unexpected changes in mood and anger outbursts are also common. Globally, depression is the fourth leading cause of illness and disability among adolescents aged 15-19 years and fifteenth for those aged 10-14 years. Anxiety is the ninth leading cause for adolescents aged 15-19 years and sixth for those aged 10-14 years.
Suicide and Self-harm
An estimated 62 000 adolescents died in 2016 as a result of self-harm. Suicide is the third leading cause of death in older adolescents (15-19 years). Risk factors for suicide are multifaceted, including harmful use of alcohol, abuse in childhood, stigma against help-seeking, barriers to accessing care, and access to means. Communication through digital media about suicidal behaviour is an emerging concern for this age group.
Substance abuse
Risk-taking behaviour is relatively high during adolescence. It results as a coping strategy to come out of low self-esteem or by peer group influence. Such attempts end up in developing dependence on various psychoactive substances. Worldwide, the prevalence of heavy episodic drinking among adolescents aged 15-19 years was 13.6% in 2016, with males most at risk. The use of tobacco and cannabis are additional concerns. Cannabis is the most widely used drug among young people with about 4.7% in an age group of 15-16 years using it at least once in 2018.
Apart from the above major problems, there is a number of warning signs that must be closely monitored in order to identity/understand the mental health problems of the children.
- Children who have lost interest in things that they used to enjoy
- Children who have frequent tantrums or are intensely irritable much of the time
- Often talk about fears or worries
- Have low energy
- Sleep too much or too little, or seem sleepy throughout the day
- Struggle academically or have experienced a recent decline in grades
- Are spending more and more time alone, and avoiding social activities with friends or family
- Diet or exercise excessively, or fear gaining weight
- Engage in self-harm behaviors (such as cutting or burning their skin)
- Engage in risky or destructive behavior alone or with friends
- Have thoughts of suicide
- Have periods of highly elevated energy and activity, and require much less sleep than usual
- Children who say that they think someone is trying to control their mind or that they hear things that other people cannot hear.
Ayurveda and Adolescent mental health issues
According to Ayurveda the end part of balyavastha and the early half of youvana/ madhyama avastha constitute the adolescent phase. As all the bodily tissues are constantly under transformation and process of development during this period, this phase is called aparipakwa dhatu avastha. Proper nourishment, growth, and development of the body (sarira poshana) can be ensured only with healthy dietary and lifestyle patterns. Such healthy practices help in developing optimum satwa bala (resilience). A person with avara satwa (poor resilience) is more prone to develop psychological disturbances and psychiatric disorders.
Ayurveda primarily aims to prevent various physical and psychological illnesses. Specific regimes of the day and according to various seasons have been explained to maintain physical health. In order to address the mental health sadvritta and achara rasayana; i.e., codes of conduct pertaining to the physical, psychological, social, moral, and personal domain of a person is advised to follow. Following those principles helps in developing an optimal status of satwa bala (mental strength) thereby playing a key role in achieving the basic life skills during the adolescent phase.
Prevention and Management
Preventive strategies include early identification of vulnerable populations (with the help of parents and teachers) and strengthening their capacity to regulate emotions, enhance alternatives to risk-taking behaviours, build resilience for difficult situations and adversities, and promote supportive social environments and social networks. Healthy dietary and lifestyle practices along with following the principles codes of conduct from childhood help in the development of good physical and mental health. Daily practice of Yoga helps to build a positive mental state thereby helping in controlling the emotional disturbances.
Skill development strategies, various therapies (like CBT, etc) to address the specific mental health problems, pharmacological interventions are required according to the severity of the conditions.
