Adolescence (10-19 years) is a unique and formative time. Multiple physical, emotional and social changes, including exposure to poverty, abuse, or violence, can make adolescents vulnerable to mental health problems. Promoting psychological well-being and protecting adolescents from adverse experiences and risk factors that may impact their potential to thrive are critical for their well-being during adolescence and for their physical and mental health in adulthood.
Mental health determinants
Adolescence is a crucial period for developing and maintaining social and emotional habits important for mental well-being. These include adopting healthy sleep patterns; taking regular exercise; developing coping, problem-solving, and interpersonal skills; and learning to manage emotions. Supportive environments in the family, at school and in the wider community are also important. An estimated 10-20% of adolescents globally experience mental health conditions, yet these remain underdiagnosed and undertreated(1).
Multiple factors determine mental health outcomes. The more risk factors adolescents are exposed to, the greater the potential impact on their mental health. Factors that can contribute to stress during adolescence include a desire for greater autonomy, pressure to conform with peers, exploration of sexual identity, and increased access to and use of technology. Media influence and gender norms can exacerbate the disparity between an adolescent’s lived reality and their perceptions or aspirations for the future. Other important determinants include the quality of their home life and relationships with peers. Violence (including harsh parenting and bullying) and socioeconomic problems are recognized risks to mental health. Children and adolescents are especially vulnerable to sexual violence, which has a clear association with detrimental mental health.
Some adolescents are at greater risk of mental health conditions due to their living conditions, stigma, discrimination or exclusion, or lack of access to quality support and services. These include adolescents living in humanitarian and fragile settings; adolescents with chronic illness, autism spectrum disorder, an intellectual disability or other neurological condition; pregnant adolescents, adolescent parents, or those in early and/or forced marriages; orphans; and adolescents from minority ethnic or sexual backgrounds or other discriminated groups.
Adolescents with mental health conditions are in turn particularly vulnerable to social exclusion, discrimination, stigma (affecting readiness to seek help), educational difficulties, risk-taking behaviours, physical ill-health and human rights violations.
Emotional disorders
emerge during adolescence and young adulthood. Eating disorders affect females more commonly than males. Conditions such as anorexia nervosa, bulimia nervosa and binge eating disorder are characterised by harmful eating behaviours such as restricting calories or binge eating. Eating disorders are detrimental to health and often co-exist with depression, anxiety and/or substance misuse.
Psychosis
Conditions that include symptoms of psychosis most commonly emerge in late adolescence or early adulthood. Symptoms can include hallucinations or delusions. These experiences can impair an adolescent’s ability to participate in daily life and education and often lead to stigma or human rights violations.
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). Nearly 90% of the world’s adolescents live in low-or middle-income countries and more than 90% of adolescent suicides are among adolescents living in those countries. 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.
Risk-taking behaviours
Many risk-taking behaviours for health, such as substance use or sexual risk taking, start during adolescence. Risk-taking behaviours can be both an unhelpful strategy to cope with poor mental health and can severely impact an adolescent’s mental and physical well-being.
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% of 15-16-years-olds using it at least once in 2018. Many adult smokers have their first cigarette prior to the age of 18 years.
Perpetration of violence is a risk-taking behaviour that can increase the likelihood of low educational attainment, injury, involvement with crime or death. Interpersonal violence was ranked the second leading cause of death of older adolescent boys in 2016.
Promotion and prevention
Mental health promotion and prevention interventions aim to strengthen an individual’s 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.
These programmes require a multilevel approach with varied delivery platforms – for example, digital media, health or social care settings, schools or the community, and varied strategies to reach adolescents, particularly the most vulnerable.
Early detection and treatment
It is crucial to address the needs of adolescents with defined mental health conditions. Avoiding institutionalization and over-medicalization, prioritizing nonpharmacological approaches, and respecting the rights of children in line with the United Nations Convention on the Rights of the Child and other human rights instruments are key for adolescents. WHO’s mental health Gap Action Programme (mhGAP) provides evidence-based guidelines for non-specialists to enable them to better identify and support priority mental health conditions in lower-resourced settings.