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3.10 Mental health and substance abuse: a global picture

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3.10 Mental health and substance abuse: a global picture

This week we explore our conceptual framework for adolescent health as it relates to health-related behaviours and states and health outcomes. By that we mean, how do the biological, social, economic and other influences that we have discussed so far play out in terms of adolescent health outcomes (e.g. death and disability) and behaviours (e.g. those relating to sexual activity or substance use)? What are the major health issues affecting young people around the world today, and how does this differ by region, gender and other variables? We will explore the latter question over the course of this week and next, with the focus this week predominantly on sexual and reproductive health and mental health.

This course will explore the dynamic factors affecting the health and wellbeing of young people around the world, and how important it is for individuals, communities and nations that we improve the health and life chances of this important population group. With over 25% of the world’s population aged between 10 and 24 years, today’s generation of young people is the largest in human history. As the future leaders and drivers of growth, productivity and innovation, young people are our greatest assets, and investment in their health and wellbeing has social, economic and other benefits that continue across the lifespan and into the next generation. In this course we will adopt a life-course framework to take a holistic view of youth health and wellbeing. We will explore changing patterns of adolescent health and development, including why adolescence is starting earlier and ending later; how puberty and adolescent brain development may shape future health; and how what happens in adolescence can affect the start to life for the next generation. We’ll also look at the major health and social issues affecting young people and ways of addressing these through policy, practice and programming. COURSE FORMAT: This course comprises short video lectures and interviews, required and recommended readings, online discussion, quizzes and written assignments. There is no required text for this course and all readings are provided. DO I HAVE TO PAY FOR THIS COURSE? No- you may access 100% of material in this course for free. You are also welcome to do as much or as little of the course as you like, including all (or none!) of the assessment tasks- it all depends on your learning goals. The option to pay for this course is there for those who wish to receive a Course Certificate as evidence of completion (which does require you to attempt and successfully pass the assessment tasks). WHO IS THIS COURSE FOR? This course will be relevant for anyone with an interest in the health and wellbeing of young people. You do not need to be of any particular personal or professional background to benefit from this course, but having some basic undergraduate study experience will be helpful to your learning (particularly if in a health related field). WHAT IS THE MOST INTERESTING THING I'LL LEARN IF I TAKE THIS COURSE? You’ll learn how so much of what happens during adolescence can impact not only the future health of individuals, but the health of the next generation as well. You’ll develop a greater understanding of the key factors impacting upon youth health and learn how to be a better advocate for the health and wellbeing of young people. View the MOOC promotional video here: http://tinyurl.com/z5l4mod

Visualizar o programa do curso

Ministrado por

Professor Susan Sawyer
Chair of Adolescent Health
Professor George Patton
Professorial Fellow

Transcrição

I want to begin this lecture by reintroducing the conceptual framework for

this series of lectures.

In terms of considering mental disorders, we are considering some of the most common

adolescent health problems that cause substantial disability during these years.

If we consider the range of adolescent mental disorders,

think through the groups shown here.

Affective disorders include depression and bipolar disorder,

sometimes known as manic depression.

Anxiety disorders include low-level or generalised anxiety,

which is continuous, panic attacks that are episodic, or

anxiety that occurs in relation to specific circumstances.

Examples of some of these more specific anxiety syndromes includes social

anxiety where a young person experiences

intense anxiety when asked to perform in front of other people.

This might be something like giving a talk in front of a class group.

Other examples of specific anxiety syndromes would be

agoraphobia where an individual has a fear of being outside alone.

Anxiety disorders such as these, and depression, commonly occur together.

Adolescence is a time when an individual develops a clear identity.

This may be one of the reasons why problems of body image,

such as anorexia nervosa, or bulimia nervosa, commonly arise at this time.

Other behavioural problems such as deliberate self harm,

typically in the form of cutting or taking repeat overdoses

relate more specifically to difficulties with emotion and emotional control.

There are a range of substance use disorders that also emerge during

adolescence.

Nicotine dependence can arise for

some adolescents soon after the commencement of tobacco use.

Alcohol and

other illicit substance use disorders also commonly emerge during the adolescent and

young adult years, and tend to peak in prevalence around the mid-20s.

The last group of disorders that fairly typically arise during the teens and

early twenties is psychotic disorders.

Of which the commonest is probably schizophrenia.

These are often more severe disorders, and although less common than depression and

anxiety, commonly have a devastating affect on the life course and

adjustment of the individual.

If we look at the age of onset with these disorders,

the great majority have an onset between the ages of 8 and 25 years.

Attention deficit hyperactivity disorder, or ADHD, conduct disorder, and anxiety

disorders tend to have an earlier onset than depressional substance use disorders.

But the overall message remains that the great majority

of mental disorders have their onset before 25, and

most of these have an onset before the age of 14.

The next graph illustrates the points in which these disorders

have their maximal impact in terms of health related disability.

The metric that we're using here is the DALY.

I've mentioned the DALY in a previous lecture.

It's a widely used measure of disease burden that takes into account

years of life lost due to premature death and years of life lived with disability.

And if we look at the age group, 10 through the 24,

it's clear that many mental disorders

peak in terms of their contribution to burden of disease in this window.

Depression and anxiety make the largest contribution to burden of

disease across the life course for the peak in the young adult years.

Alcohol use and other substance use disorders also have a contribution,

which is greatest during the young adult years.

This next graph illustrates the growing contribution of mental disorders

to disease burden across the years from birth through to 24.

The overall burden of disease increases progressively across each five year band.

Having said this, the type of disorder contributing to disease burden

changes markedly across the years from childhood to young adulthood.

In younger children, conduct disorder is a major contributor.

Violence, depression, and anxiety disorders become major contributors,

and by young adulthood substance use and

alcohol abuse disorders are major contributors.

This graph provides an idea of the contribution of mental disorders to

disease burden relative to other health problems across the years from 10 through to 24.

Three of the leading ten causes of disease burden relate to mental health.

Whichever way on looks at mental and

behavioural problems across the adolescent and young adult years,

they are major contributors to disease burden in this age group.

And if we thought these problems were still largely problems of high income

countries we need to think again.

This slide shows the prevalence of DSM disorders in females

aged 18 through to 24.

These data were taken from the World Mental Health Survey, the largest and

most comprehensive survey of global mental health in adults.

The gold colours represent high income countries and the blue low and

middle income countries.

Although a number of high income countries do have higher prevalence rates,

the picture suggests high rates of mental disorder can also occur

in young women in low and middle income countries.

This bubble diagram shows the proportion to of DALYs to the mental

disorders in children and adolescents in high income countries.

And you can see what a large proportion of the burden of disease

mental disorders contribute to.

In contrast, in lower and middle income countries,

the proportion of disease burden that mental disorders contribute is lower,

in large part because of other contributors,

such as infectious disease, nutritional problems, and neonatal problems.

In this last slide, we are looking specifically at 10 to 24 year olds.

The countries of Western Europe are those where mental disorders make the greatest

relative contribution to disease burden.

In contrast, in Sub-Saharan Africa the contribution is proportionately lower.

In this lecture I hope I've illustrated the very substantial contribution that

mental disorders make to health during the adolescent years.

Although the relative contribution is much greater in high income countries,

adolescent mental disorders are a global problem.

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