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Questions

How common and how significant are mental health problems in teenagers?

Epidemiology and burden of disease – main points:

Risky and protective activities

Risky activities Protective activities
  • Drug abuse
  • Being a crap friend
  • Not exercising
  • Poor diet
  • Social isolation
  • Exercise regularly
  • Support network
  • Flamboyant love life

Consider the balance needed to run a straight course between risky vs. protective activity.

  • Why is this so hard?
  • Do you have some ideas how family, friends, work colleagues and health care workers help individuals with this?

Genetic predisposition and the interaction between genetic predisposition and environmental risk factors

  • Polygenic nature of psychiatric disorders
  • Heritability
  • Concordance in twins
    • Concordance is the presence of the same trait in both members of twins
  1. Why don’t monozygotic (MZ) twins growing up in the same family environment have a higher concordance of incidence of depression?
    • Genetic concordance is only 46% for depression. Environmental factors play an important role in the incidence of depression
  2. Which mental illness has the highest heritability index? Which the lowest? (according to the table)
    • Highest = schizophrenia
    • Lowest = panic disorder and obsessive traits
  3. So, which has the biggest influence - nature vs nurture?
    • Can't tell. Both have major influences.

Answers

Burden of psychiatric disease compared to other health conditions in young people

  • Table 2.4: Main disabling condition of young people aged 15–24 years with a disability, 2003
    • Psychiatric disorders are the second most prevalent type of disabling condition in the
    • 15-­‐24 age group (at 17.9%). Intellectual and other mental disorders are ahead with a prevalence of 19.7%.
  • Table 2.5: Burden (YLL, YLD and DALYs) of major disease groups for 15–24 year olds, 2003
    • % of total YLL (premature mortality)
      • Injuries highest (67.5%), then cancers (8.9%) cardiovascular disease (5.2%), neurological and sense disorders (4.9%) and mental disorders (4.2%) o % of total YLD (non-­‐fatal disease outcomes)
      • Mental disorders highest (60.7%)
    • % of total DALYs (total burden of disease and injury)
      • Mental disorders highest (48.9%)
  • Summary, psychiatrist disorders are one of the most prevalent disabling conditions in the 15-­‐24 age group in Australia (~18%). Whilst mental disorders are only the fifth highest cause of premature mortality in this age group, they contribute greatly to non-­‐fatal disease outcomes and the total burden of disease and injury

Risk factors for depression in young people

FAMILY HISTORY AND ENVIRONMENT

  • Family History
    • The occurrence of psychopathology in parents increases the risk of major depressive disorder, depression and depressive symptoms in adolescent and young adult offspring.
  • Family Environment
    • Risk factors
      • Childhood sexual abuse in both males and females
      • Childhood physical abuse
      • Parental divorce may be a predictor of depressive symptoms in adolescents.
      • Parental support is a protective factor
  • Adolescents and young adults with a poor perception of their family role have an increased risk for major depressive disorder and depression, in particular for males.
  • Adolescents residing with fewer than two of their biological parents have an increased risk of depression and depressive symptoms in adolescence and young adulthood.

STRESSFUL LIFE EVENTS: LIFE EVENTS

Negative life events may be a mediator between living in a single parent household and having a depressive mood in adolescence and young adulthood. Children with a negative problem solving orientation who experienced a negative life event are more likely to develop depressive symptoms in early adolescents than their peers with a positive problem solving orientation and experienced a negative life event.

STRESSFUL LIFE EVENTS: BULLYING

Being bullied is strongly associated with a wide range of psychosomatic symptoms and depression. These associations are similar to the complaints known to be associated with child abuse. Therefore, when such health complaints are presented, pediatricians and other health care workers should also be aware of the possibility that a child is being bullied to take preventive measures.

DRUGS AND ALCOHOL

  • Alcohol use
    • There is insufficient evidence to suggest that alcohol abuse increases the risk of depressive symptoms and the development of major depressive disorder in adolescence and young adulthood
    • Odds Ratios of developing depressive disorder in adolescence
      • Those who had been intoxicated by alcohol in the past year compared to those who haven’t (OR = 1.01)
      • Those with a past history of alcohol abuse compared to those without (OR 2.0)
      • Those who consumed alcohol in the past week compared to those who hadn’t (OR = 1.52)
      • Insignificant results: multiple studies showed that alcohol use or abuse was not a significant predictor for depression
  • Drug use
    • The evidence suggests that cannabis use might predict the development of depressive symptoms, suicidal ideation and suicide attempt in adolescence and young adulthood, particularly in those of younger age or in females.
    • The evidence on drug use (other than cannabis) as risk factor for development of depressive symptoms, suicidal ideation and suicide attempt in adolescence and young adulthood was too limited and inconsistent to make conclusions.
    • Odds Ratios of developing depressive disorder in adolescence
  • High school students who had used cannabis 1-­‐10 times during their lives were twice as likely to develop depressive symptoms (OR = 2.13)
  • Cannabis use less than once a month during adolescence increased risk compared to those who had never used (OR = 1.2)
  • Cannabis used at least monthly and suicide attempts (OR = 1.8)
  • Adolescents who have tried drugs compared to those who have never (OR = 1.79)
  • Use of inhalants (glue, paint etc) increased suicide attempts in females compared to non-­‐ users (OR = 2.2)
  • Insignificant results: high school students who used cannabis more than 10 times in their lives, contradictory evidence in studies that drug use (other than cannabis) increased probability of developing depressive symptoms and attempting suicide)

HEALTH PROBLEMS AND SLEEPING

  • Health problems
    • Evidence suggests that adolescents who experience health problems (other than psychological problems), or perceive their health as poor, are more likely to develop major depressive disorders, depression, depressive symptoms and suicide ideation in adolescence and young adulthood.
  • Odds Ratios of developing depressive disorder in adolescence
    • Those several physical symptoms (broken bones, ucers, double vision etc.) were marginally more likely to develop depression than those without or with one symptom (OR = 1.03)
    • Onset of illness considerably increased risk in females (OR = 5.53)
    • Illness or hospitalisation between ages of 0 and 5 increased the odds in males by more than 7x (OR = 7.26) and considerably increased risk of suicidal ideation (OR = 5.61)
    • Children with hay fever were 2.5 times more likely than those without (OR = 2.68)
    • Females who perceived their health at poor had almost double the odds than those who had general good health (OR = 1.94)
    • Insignificant results: Asthma, onset of serious illness in the ages 6-­‐9
  • Sleeping problems
    • Sleeping problems might be a predictor for major depressive disorder, depression or symptoms of depression in adolescence. Adolescents with sleep difficulties might have an increase in risk for major depressive disorder in late adolescence
    • Odds Ratios of developing depressive disorder in adolescence
      • Sleep disturbance increased risk (OR = 1.83)
      • Those who reported a loss of energy or felt fatigue compared to peers without these symptoms (OR = 2.26)
      • Insomnia approximately doubled the risk (OR = 2.2)
      • Insignificant results: Getting enough sleep prevents developing a depressive disorder

Images

Additional information

The major health concerns of adolescents

  • Physical health (fitness, food, physical state, hygiene, keeping your body in good condition)
  • A broad range of situations, conditions or behaviours that impact on health, particularly sexual health issues, limited employment and educational opportunities and relationships

Barriers to accessing health services

  • Personal concerns, especially confidentiality and trust
    • Confidentiality
      • Difficulty in disclosing personal health concerns
      • Fears around what health providers might tell parents and teachers
      • Concerns about being seen when accessing a service
  • Young people often feel self-conscious, embarrassed, vulnerable or ashamed that they need help
  • Young people often believe they will be judged negatively by providers
    • Nevertheless, some young people did state that if they knew a provider and had a trusting relationship with them they would be far more willing to access services
  • Lack of knowledge of the existence of services or what they provided
  • (Not as major) Structural issues concerning the operation of services, such as operating hours, inadequate transport, cost and waiting lists

Ideal service model

Health service providers and young people generally agree on most aspects of an ideal service model such as needing to become more flexible with more accessible outreach components as well as creating improved awareness of services.

  • To serve adolescents appropriately, services must be available in a wide range of health care settings, including:
    • Community-­‐based adolescent health
    • Family planning and public health clinics
    • School-­‐based and school-­‐linked health clinics
    • Physicians' offices
    • HMOs
    • Hospitals

Meta analysis

  • Improves the strength of evidence by reducing the heterogeneity of the data
  • Prospective study with no internal bias give the best evidence

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