In conversation with Dr Swati Bhave
As per WHO estimates, globally 10-20% of children and adolescents experience mental disorders. Half of all mental illnesses begin by the age of 14 and three-quarters by mid-20s. But most cases are undetected and untreated. If not tackled early, their impact extends to adulthood, impairing both physical and mental health and adversely affect the adolescent’s development, education and consequently their potential to live fulfilling and productive lives.
The World Mental Health Day, observed on 10th October has also focused on adolescent mental health with its theme as “Young people and mental health in a changing world”.
I spoke to Dr Swati Bhave, who is a renowned expert in adolescent health, for her views on mental health issues in adolescence.
Dr Swati Bhave is Executive Director AACCI, Adjunct Prof in Dr DY Patil Medical College and Dr DY Patil Vidyapeeth in Pune and Head of Adolescent Clinic, Jehangir Hospital Pune. She is also the Editor of our Asian Journal of Paediatric Practice.
Here are the 10 salient points on adolescent mental health.
1. In the past, it was thought that at 18 years the brain is fully mature and hence driving, voting etc. were permitted at this age.
2. Now it is known by MRI and functional MRI, PET etc. adolescent brain is under development right up to 25 years.
3. The “emotional brain” or the limbic system is normally under control of the “thinking brain” i.e. the prefrontal cortex and the impulsive behavior is controlled in adults.
4. In adolescents, the limbic system is well-developed, while prefrontal cortex matures much later. This is the reason adolescents are prone to high risk behavior and experimentations like drinking, smoking, substance abuse, driving under alcohol influence.
5. They are also very prone to labile emotions and need help to stabilize and handle failures or rejections.
6. This is done by proper parental, teacher or other adult guidance.
7. WHO has a program called the Life Skill Education (LSE). This is also under UNFPA and UNICEF. The ten life skills empower adolescents to deal with all problems, they can face during normal adolescent development.
The ten core life skills are: Self-awareness, empathy, communication skills – interpersonal relationships, decision making, problem solving, critical and creative thinking, coping with stress and emotions and negotiating skills.
8. Unless an adolescent learns the coping skills, there is a high risk of depression in this age group. Severe depression leads to high rates of suicides in this age group on very trivial triggers. We need to empower adolescents to prevent suicides by becoming resilient.
9. The dopamine reward pathway is also very highly developed in adolescents, which makes their brain very vulnerable to substance abuse, tobacco and alcohol. Children who start smoking and drinking below age 12 years are more likely to be adult-addicts.
10. NCDs or noncommunicable diseases are increasing globally. WHO has identified four behavioral risk factors in adolescent age group: Consumption of junk food, increased sedentary lifestyle, tobacco and alcohol. If these behaviors are checked in adolescence, we will prevent adult-onset NCDs.
Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA