Table of Contents
Mental illness in adolescents remains a major milestone to be mitigated by social workers. This is because social work entails efforts geared towards improving the economic, physical, and mental wellbeing of all members of the society, particularly the most vulnerable. It is the necessity of social workers to improve the living conditions and wellbeing of those suffering from different problems in the society, with mental illness being one of them.
Mental illness refers to a wide range of mental disorders or health complications which negatively impact the behavior, moods, thinking, and emotions of an individual. In the current world, adolescents aged between 10 and 19 years are increasingly susceptible to mental illness. During adolescence, various emotional, physical, and social changes occur, including the exposure to physical abuse, poverty, and violence, which makes adolescents highly vulnerable to violence.
In addition, the adolescence is a vital period during which individuals acquire and maintain various emotional and social habits essential for their mental wellbeing. Some of the key characteristics of adolescent behaviors include taking part in regular exercises, adopting healthy sleeping patterns, acquiring unique problem solving, critical thinking, interpersonal skills, and emotional management. These traits are developed to help them cope with the emotional, social, and psychological challenges which they might face during adolescence.
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However, numerous adolescents continue to suffer from mental illness worldwide, primarily due to the risk factors they are exposed to. Some of the most common risk factors include the craving for autonomy, pursuance of sexual identity, parenting style, physical abuse by adults or peers, sexual violence, peer pressure, impacts of technology such as cyberbullying on social media, and fear of failure. Furthermore, the influence of mass media, negative aspects of gender stereotyping, negative relationship with peers, and quality of home living standards as well as their perceptions of future success prospects dictate their mental health.
In addition, some adolescents are at increased risk of developing mental illness as a result of exclusion, discrimination, living conditions and stigma. Pre-existing health conditions such as autism spectrum disorder, chronic illnesses, and intellectual disability, early or unwanted pregnancy leading to forced marriages also impacts the mental health of adolescents.
Without the necessary social support, adolescents are at elevated risks of developing mental illness. Some of the most common mental illnesses encountered by adolescents include depression, post-traumatic stress disorder (PSTD), eating disorders among others. The net effect of mental illness on adolescents include poor educational performance, increased risk of suicide, poor physical health, stigma, and reduced productivity.
Objective
The study aims at establishing the burden of suicidal behavior, suicidal ideation, and depression in adolescents aged between 10 and 19 years at 8 different locations in six sub-Saharan nations, then evaluate related risk and potential mitigation measures to be taken.
Significance of the Study
The research is relevant since it evaluates the negative impacts of mental illness on the educational, socio-economic and health welfare of adolescents, hence informing the policy frameworks which need to be adopted by social workers to mitigate the challenges. Considering that social work majorly entail improving the living conditions and wellbeing of individuals in the society including the vulnerable, delving into the negative effects of mental health on adolescents can help in developing counter-measures of combating them.
Literature Review
The ecological model is a public health strategy in which the various intrapersonal, interpersonal, institutional and organizational, community, and public policy aspects influencing the behaviors of individuals and their health are assessed. The ecological model is essential in the identification of factors which propagate unhealthy behaviors detrimental to public health, in order to develop mitigation strategies against them (Kilanowski, 2017). Furthermore, the health belief model is essential in evaluating the patient’s beliefs on particular illnesses to help in predicting their health-related behaviors and developing mitigation strategies (Mo, Wong, & Lam, 2019).
From the ecological model, age, gender, individual lifestyle, preexisting individual health aspects, interpersonal, and social factors influence the development of mental illness. At least one in every five individuals of between 9 and 17 years of age suffers from a mental health disorders which may be diagnosed, and which causes intensive extents of impairment to those affected (Committee on Adolescent Health Care, 2017). In addition, one in every ten adolescents are affected by mental disorders and can suffer severe and fatal impairments (Committee on Adolescent Health Care, 2017).
Furthermore, half of all serious mental health disorders onset from 14 years of age (Committee on Adolescent Health Care, 2017). As pertains gender, depression, mood and anxiety disorders are three times more prevalent in females than male adolescents, although the case is opposite for attention deficit disorder (Committee on Adolescent Health Care, 2017). Furthermore, obstetrician gynecologists who examine young females and adolescents have a great probability of coming across one or more mental illness cases in every ten patients (Committee on Adolescent Health Care, 2017). A section of mental health disorders interferes with the capability of an adolescent patient to assess their health concerns and effectively abide to the treatment offered to them, thereby leading to negative health outcomes.
In addition, some mental disorders, as well as their treatment methods can negatively impact the hypothalamic-pituitary –gonadal axis, resulting to mental disturbances for instance uterine bleeding (World Health Organization, 2019). Mental illness facilitates negative and detrimental social behaviors in adolescents. Adolescents suffering from mental illness mostly participate in increase substance abuse and acting out practices which upsurges their likelihood of engaging in risky sexual behaviors which may result in the contracting of dangerous STIs and unwanted pregnancies. Furthermore, pregnant adolescents can increasingly intake psychopharmacologic agents which pose hazardous impacts on their health and that of their fetus.
The ecological model evaluates the risk factors and impacts of depression and mood disorders to help in establishing formidable policies of countering them, while the health belief model evaluates patients’ beliefs to help in predicting their detrimental behaviors and mitigate them.
Depression and mood disorders is one of the main prevalent mental health disorders in adolescents. Some of the risk factors for mood disorders include stressful family environments, significant or early losses such as parental divorce or death, chronic illnesses, parental anxiety disorder history, history of depression, bullying, alcohol abuse, and antisocial behavior history (Committee on Adolescent Health Care, 2017). At any particular moment, one in every twenty adolescents display mood disorder from clinical diagnosis (World Health Organization, 2019). In addition, approximately one in every four children are likely to develop and experience mood disorders in the later stages of their adolescence (World Health Organization, 2019).
Some of the most common mood disorders include major depressive disorder, adjustment depressed mood disorder, bipolar disorder, and premenstrual dysphoric disorder. The instances of depression are much higher in female than male adolescents. Adolescents suffering from mood disorders exhibit fewer vegetative signs such as low energy and fatigue, including higher irritability levels compared to adults suffering from the same mood disorders. In addition, adolescents having mood disorders are more likely to self-medicate through substance abuse such as hard drugs and alcohol are in turn more inclined towards suicidal practices.
Furthermore, an estimated two thirds of adolescents suffering from mood disorders also exhibit comorbidity with other related mental disorders such as ADHD, conduct disorders, and anxiety disorders (World Health Organization, 2019). Depressed moods in adolescents significantly subsides their motivation levels in embracing measures of preventing STIs and pregnancy cases. Furthermore, individuals with highly depressive thoughts can develop panic, prompting them to engage in detrimental sexual practices. Depression also reduces the motivation of adolescents to take their medications as instructed by their clinical physicians, for instance seizure control drugs, inhalers, oral contraceptives as well as schedule appointments with their physicians (World Health Organization, 2019). In addition, adolescents who suffer from depressed moods exhibit reduced performance at school and in work. Furthermore, depressed adolescents are less likely to forge any meaningful social relationships.
Through the ecological model, factors which propagate the suicidal ideations and behaviors can be ascertained. Suicide is the second most prevalent cause of death among young individuals aged between 15-24 years, with approximately 13.9 deaths per day emanating from suicide cases (Committee on Adolescent Health Care, 2017). Suicide attempts are 100-200 times higher than their completion rates (Committee on Adolescent Health Care, 2017). Approximately 62,000 adolescents succumbed as a result of self-harm and suicide (World Health Organization, 2019).
In addition, an estimated 90% of the global adolescent population live in developing countries, and above 90 % of the global suicide cases in adolescents emanate from these regions (World Health Organization, 2019). A critical area of concern is suicidal ideation among pregnant females, adolescents with anxiety disorders, and parenting adolescents suffering from mood disorders and depression. Adolescents who exhibit high risk of suicidal ideation include those experiencing meager academic performance which negatively affects their emotions. In addition, adolescents with a family history of suicide have a high likelihood of engaging in suicide behavior. Social problems such as drug and alcohol abuse, sexual or physical abuse, sexual orientation problems, and family dysfunction increase the incidences of suicide ideation. In addition, psychological conditions such as chronic sadness also propagate suicide ideation. Furthermore, due to technological advancement, the cases of depression have been on the rise due to the harassment, threats and cyberbullying on social media sites.
The ecological model also helps in establishing the causative factors of self-harm. Self-harm ideation and behaviors can also escalate to suicidal ideation and actions. Self-harm entails the intentional action of individuals in inflicting damage to their body surfaces as a means of getting relieved from negative cognitive states and conditions.
Approximately 12-13 % of adolescents take part in self-injury in their lifetime (Committee on Adolescent Health Care, 2017). Like suicidal ideations, self-injury has a higher prevalence in female than male adolescents (Committee on Adolescent Health Care, 2017). In addition, anxiety, mood, eating, personality disorders, as well as sexual and physical abuse propagate the acquisition of self-harm ideations.
Through the health belief model, obstetrician gynecologists are charged with establishing the patient’s beliefs on their likelihood of engaging in suicide to help them in predicting their behaviors. To establish the likelihood of engaging in suicide, obstetrician gynecologists can inquire from the adolescents on their perceptions of self-harm and suicide, their thoughts of engaging in suicide, as well as any impending plans to do so (Committee on Adolescent Health Care, 2017). The enquiries can help the medical personnel to predict the potential hazardous behaviors in the adolescents, and in turn enforce preventive measures with the help of community members, parents, teachers, friends of the adolescents and law enforcement personnel (Committee on Adolescent Health Care, 2017).
The risk of committing suicide is highest when adolescents elaborate their plan for location, time, and means of suicide they prefer. In addition, if adolescents confess that they have easy access to the facilitators of suicide such as firearms or medication, the suicide risks increases. Clinical personnel can assess the instances of self-harm by inquiring from adolescent patients on unexplained wounds and scars, when physically examining them when undressed. In essence, the screening for suicide, depression, and self-harm need to be carried out jointly.
Methodology and Justification
The researchers utilized a household-based cross-sectional design in conducting the research. The African Research, Implementation Science, and Education (ARISE) carried out a health study research on adolescents in nine study locations in 7 sub-Saharan nations. The study was conducted in six nations namely Ethiopia, Tanzania, Uganda, Ghana, Burkina Faso, and Nigeria. The cities of concern include Harar, Kersa, Dodoma, Daresalaam, Mayuge, Iganga, Ibadan, Ningo Prampram, Nouna. The primary research outcomes were suicidal behaviors and ideation, and depressive symptoms. The sample size entailed 7,662 participants collected from eight locations in 6 nations (Nyundo et al., 2020). Nouna had 1628 participants, Harar, 1059, and Dodoma, 1226. Furthemore, Ibadan had 750 participants, Mayuge and Ingaga, 598, Ningo, 625, and Daares allam 825(Nyundo et al., 2020).
To screen and evaluate the adolescent depression severity, the researchers utilized the 6-Item Kutcher Adolescent Depression Scale (KADS-6) (Nyundo et al., 2020). Aspects of depression assessed include feelings of hopelessness, worthlessness, and negativity; emotions of low energy, tiredness, fatigue and demotivation; feelings of being moody, sadness, depressed, and excluded; perceptions of life as boring; and feelings of nervousness, worries, tension, panic, and anxiety. To evaluate the depressive symptoms, the respondents were interviewed through the questionnaires, and their responses were summarized and classified into tertiles (Nyundo et al., 2020). The questions were rated on a scale of one to five with the extreme answers as never and always. In this study, the respondents having the highest tertiles were regarded as possessing escalated levels of depression in the past one week before the research.
Furthermore, to assess for suicidal ideation and behavior of the respondents in the past 12 months before the research activity, the research team adopted three queries from the Global school student health centered survey. The survey questions were optimized and included as: having developed a plan on attempting suicide, having seriously thought of committing suicide, and having attempted suicide in the past twelve months (Nyundo et al., 2020).The answers to the suicide responses were coded as 0 for No and 1 for Yes, and the possible scores were outlined from 1 to 3 (Nyundo et al., 2020). In this regard, individuals who scored between 1 and 3 were categorized as possessing positive suicide behavior (Nyundo et al., 2020).
The independent variables were included in the research, and they included the wealth quartiles, food insecurity, supportive home environment, supportive school environment, exposure to bullying, exposure to physical violence, poor access to healthcare, satisfaction with health, satisfaction with life, having close friends, feeling of loneliness in the past one year, and feeling of worries in the past one year. The wealth quartiles were developed based on the whether the households of the respondents had material aspects such as viable energy source, electronic gadgets, furniture, and automotive (Nyundo et al., 2020).
Furthermore, the food insecurity variable was directly measured with the aid of a 5-point Likert scale to establish the frequency by which the respondents went hungry within the past 30 days, with the responses of never, rarely, sometimes, most of the time, and always being coded as 1,2,3,4, and 5 respectively (Nyundo et al., 2020).
In addition, possession of close friends was considered a continuous variable, hence encoded once a respondent had one friend or more. A supportive home environment was assessed as a composited variable. The questions for this variable were initially assessed on a five point Likert Scale, with the questions ranging from never, rarely, sometimes, most of the time, and always, coded as 1,2,3,4, and 5 respectively (Nyundo et al., 2020). The composited variable was then redefined to assess whether the guardians or parents of the respondents took their time to check their homework, understand their worries, and spare time for them in the past 30 days.
Furthermore, a supportive school environment was also assessed on a similar Likert scale, and was noted as classmates being helpful and kind sometimes, most of the times, and sometimes in the past 30 days (Nyundo et al., 2020). Exposure to physical violence was a composite variable assessed on grounds of whether the respondents had been physically attacked, engaged in a fight, or undergone injury in the past one year.
The exposure to bullying was evaluated with the aid of a simplistic yes and no question, while poor healthcare access was evaluated as a composite variable composed of three yes and no questions regarding the experiences of the adolescents on healthcare access. Satisfaction with health, satisfaction with life, feeling of loneliness in the past one year, and feeling of worries in the past one year were evaluated though the above criteria
