It is estimated that around 20% of the world’s adolescents have a mental health or behavioral problem. Depressive disorders, anxiety, behavioral problems, and self-harm are among the greatest contributors to young people’s burden of disease, and suicide consistently ranks among the leading causes of death for older adolescent girls and boys (ages 15-19) globally. Yet, mental health resources are very scarce and investment in mental health is < 1% of the health budget in many low and middle income countries (LMIC).
Poverty, low education, social exclusion, gender, conflict, and disasters are the major social determinants of mental disorders. Poor mental health is strongly associated with other negative health and development outcomes including higher rates of substance use, early pregnancy, school dropout, delinquent behaviors, and suicide, and can contribute to mental disorders and poor health later in life, with an estimated three-quarters of adult mental health disorders starting before the age of 24. Poor mental health also impacts economic development through lost production and consumption opportunities at both the individual and societal levels. It is estimated that the lost economic output caused by untreated mental disorders as a result of diminished productivity at work, reduced rates of labor participation, and increased welfare payments amounts to more than 10 billion days of lost work annually – the equivalent of US$1 trillion per year. Meta-analyses of gender differences in mental health indicate that gender difference in depression emerges as early as age 12, and that diagnosing and noticing symptoms of depression at that age have important implications for the timing of preventive interventions. Gender determines the differential power and control men and women have, their social position, status and treatment in society, and their susceptibility and exposure to specific mental health risks. Strengthening gender-responsive care and services for adolescents with mental disorders should be a priority but this will need additional investment in research and programming. Further research is required to better understand the local needs of adolescents and identify effective interventions to improve their mental health.
The inclusion of mental health and substance abuse in the Sustainable Development Goals is an opportunity to invest in the prevention and treatment of mental health through the strengthening of health systems, prioritizing mental health on the global healthcare agenda, improving organization of and integrating mental health services into programming, addressing the gendered drivers of mental health, and developing policies to inform the design and implementation of gender-responsive interventions in LMICs. Increased efforts to meet the health needs of adolescents are critical to achieving the Sustainable Development Goals and represent a worthwhile opportunity for investment.
Social, psychological, cultural and other factors can interact to lead a person to suicidal behavior, but the stigma attached to mental disorders and suicide means that many people feel unable to seek help. Despite the evidence that many deaths are preventable, suicide is too often a low priority for governments and policy-makers. The objective of this report is to prioritize suicide prevention on the global public health and public policy agendas and to raise awareness of suicide as a public health issue. The report was developed through a global consultative process and is based on systematic reviews of data and evidence together with inputs from partners and stakeholders.
The objectives of the present report are to: 1) Disseminate information on the needs of youth with mental-health conditions; 2) Raise awareness of the cultural and contextual dimensions related to the mental-health conditions of youth; 3) Identify the critical skills to be developed among youth with mental health conditions to overcome challenges to their self-development and social integration; 4) Increase understanding of support systems and raise awareness of access issues relating to youth with mental-health conditions; and 5) Summarize research and provide case studies of effective programs and approaches for preventing and addressing youth mental-health conditions.
This paper attempts to provide a starting point for discussion about what is currently known about the connections among gender, adolescence and mental health, and to provide some initial considerations to help guide a research and program agenda moving forward. It begins with a broad discussion of gender and health during adolescence, then turns more specifically to what is known about gender and mental health in this important life phase. It then highlights some existing interventions, poses imperatives for future work, and draws conclusions for further consideration. Building off of this paper, YouthPower Learning developed a conceptual framework and conducted additional analyses on the topic of gender and mental health.
I’m Here is an operational approach for humanitarian actors to reach the most vulnerable adolescent girls, and to be accountable to their safety, health, and well-being from the start of a response to crisis. From the start of an emergency, I’m Here enables humanitarians to engaging girls in their own solutions, ensuring effective programs and protected rights. It has been field tested by several organizations in more than 25 communities across six crisis-affected countries. Displaced adolescent girls face unique and daunting risks. With limited assets, agency, and mobility, girls cannot access life-saving resources, information, and social networks. Their vulnerability is compounded by a default, one-size-fits-all humanitarian approach. I’m Here provides humanitarians with the steps and field tools to: 1) Proactively identify girls; 2) Assess their needs; 3) Build effective programs. I’m Here is adaptable to varying on-the-ground situations. It has been field tested by several organizations in more than 25 communities across six crisis-affected countries."
Many mental health disorders emerge in late childhood and early adolescence and contribute to the burden of these disorders among young people and later in life. We systematically reviewed literature published up to December 2015 to identify systematic reviews on mental health interventions in adolescent population. A total of 38 systematic reviews were included. We classified the included reviews into the following categories for reporting the findings: school-based interventions; community-based interventions; digital platforms; and individual-/family-based interventions. Evidence from school-based interventions suggests that targeted group-based interventions and cognitive behavioral therapy are effective in reducing depressive symptoms and anxiety. School-based suicide prevention programs suggest that classroom-based didactic and experiential programs increase short-term knowledge of suicide and knowledge of suicide prevention with no evidence of an effect on suicide-related attitudes or behaviors. Community-based creative activities have some positive effect on behavioral changes, self-confidence, self-esteem, levels of knowledge, and physical activity. Evidence from digital platforms supports Internet-based prevention and treatment programs for anxiety and depression; however, more extensive and rigorous research is warranted to further establish the conditions. Among individual- and family based interventions, interventions focusing on eating attitudes and behaviors show no impact on body mass index and bulimia. Exercise is found to be effective in improving self-esteem and reducing depression score with no impact on anxiety scores. Cognitive behavioral therapy compared to waitlist is effective in reducing remission. Psychological therapy when compared to antidepressants have comparable effect on remission, dropouts, and depression symptoms. The studies evaluating mental health interventions among adolescents were reported to be very heterogeneous, statistically, in their populations, interventions, and outcomes; hence, meta-analysis could not be conducted in most of the included reviews. Future trials should also focus on standardized interventions and outcomes for synthesizing the exiting body of knowledge. There is a need to report differential effects for gender, age groups, socioeconomic status, and geographic settings since the impact of mental health interventions might vary according to various contextual factors.
What works where? A systematic review of child and adolescent mental health interventions for low and middle income countries
Child and adolescent mental health (CAMH) problems are common and serious all over the world and are linked to pre-mature deaths and serious dysfunction in adult life. Effective interventions have been developed in high income countries (HIC), but evidence from low income settings is scarce and scattered. The aim of this paper is to identify the most promising interventions in the area of global CAMH. A systematic review of all randomized controlled trials in CAMH in low and middle income countries (LAMIC) was carried out and supplemented by 1a level evidence from HIC as well as suitable information from child program evaluations and adult studies in LAMIC. In behavioral disorders parent training is a highly promising intervention, which can successfully improve children's compliance and bring down rates of conduct problems significantly. In young children cognitive, emotional and behavioral development can be enhanced through nutritional supplements and by stimulation through play, praise and reading. Trauma treatments can bring positive results even in severely traumatized children, who remain in unstable living conditions. In developmental disorders, there are successful prevention strategies as well as programs that bring children out of isolation and improve their independence. Some classroom-based interventions for adolescents have reduced symptoms of common mental disorders as well as risk taking behaviors.
A systematic review of the effectiveness of mental health promotion interventions for young people in low and middle income countries
This systematic review provides a narrative synthesis of the evidence on the effectiveness of mental health promotion interventions for young people in low and middle-income countries (LMICs). Commissioned by the WHO, a review of the evidence for mental health promotion interventions across the lifespan from early years to adulthood was conducted.
Increasing enrollment rates could place schools in a crucial position to support mental health in low-income and middle-income countries. In this Review, we provide evidence for mental health interventions in schools in accordance with a public mental health approach spanning promotion, prevention, and treatment. We identified a systematic review for mental health promotion, and identified further prevention and treatment studies. Present evidence supports schools as places for promotion of positive aspects of mental health using a whole-school approach. Knowledge of effectiveness of prevention and treatment interventions is more widely available for conflict-affected children and adolescents. More evidence is needed to identify the many elements likely to be associated with effective prevention and treatment for children exposed to a range of adversity and types of mental disorders. Dissemination and implementation science is crucial to establish how proven effective interventions could be scaled up and implemented in schools.
This review links practice, funding, and evidence for interventions for mental health and psychosocial wellbeing in humanitarian settings. We studied practice by reviewing reports of mental health and psychosocial support activities (2007–10); funding by analysis of the financial tracking service and the creditor reporting system (2007–09); and interventions by systematic review and meta-analysis. In 160 reports, the five most commonly reported activities were basic counselling for individuals (39%); facilitation of community support of vulnerable individuals (23%); provision of child-friendly spaces (21%); support of community-initiated social support (21%); and basic counselling for groups and families (20%). Most interventions took place and were funded outside national mental health and protection systems. 32 controlled studies of interventions were identified, 13 of which were randomized controlled trials (RCTs) that met the criteria for meta-analysis. Two studies showed promising effects for strengthening community and family supports. Psychosocial wellbeing was not included as an outcome in the meta-analysis, because its definition varied across studies. In adults with symptoms of post-traumatic stress disorder (PTSD), meta-analysis of seven RCTs showed beneficial effects for several interventions (psychotherapy and psychosocial supports) compared with usual care or waiting list. In children, meta-analysis of four RCTs failed to show an effect for symptoms of PTSD, but showed a beneficial effect of interventions (group psychotherapy, school-based support, and other psychosocial support) for internalizing symptoms. Overall, research and evidence focuses on interventions that are infrequently implemented, whereas the most commonly used interventions have had little rigorous scrutiny.
Mental health and psychosocial interventions for children and adolescents in street situations in low- and middle-income countries: A systematic review
This article reviews the available quantitative literature on mental health and psychosocial interventions among children and adolescents in street situations (CASS) in low- and middle-income countries (LAMIC). PRISMA standards for systematic reviews were used to search five databases as well as grey literature. There were four inclusion criteria; studies had to involve a description of an external (i.e. outside of the home) mental health or psychosocial intervention/treatment, must be focused in LAMIC, must be focused on CASS, and must empirically evaluate the effectiveness of the intervention described. A quality assessment tool was used to assess the risk of bias in included articles. A multidisciplinary care approach was significant in reducing psychological distress, substance use and improving sleeping arrangements. Residency step programs were on average 52% successful in reintegrating children back into communities. Resilience training significantly increased psychological well-being components. Emotional regulation training had a beneficial improvement in emotional regulation. FORNET (Forensic Offender Rehabilitation Narrative Exposure Therapy) (n = 32) reduced the number of self-reported offenses committed. There are not enough credible studies available to develop a firm conclusion on the effectiveness of mental health and psychosocial interventions delivered to CASS in LAMIC. The limited amount of studies, inconsistent outcome measures, interventions and imperfect study designs maintain that this is an area in need of greater attention and research focus.