Review Article Improving Positive Mental Wellbeing among Adolescents: Current need LR Anuradha 1, Yagnik 2, Vibha Sharma 3 1,2 Department of Psychology, S.P. University, Vallabh Vidyanagar (Gujarat) 3 Department of Clinical Psychology, IHBAS, Delhi I am stressed out is a phrase that has been echoed by teens down through the ages. The level of stress experienced by teens on a daily basis has been described in lay and professional literature. Adults often underestimate this level of stress and may not always be cognizant of the potential consequences of stress on teens and young adults. This lack of appreciation of the stress experienced by adolescents may be partially related to a lack of awareness of the sources of stress in teen life, the changing nature of stressors through time, the everevolving complexities of adolescent life, and the tendency for adults to minimize their own personal stress during the teen years or compare their teen years to the experiences of others. Physiological development, cognitive differences, pubertal changes, immature coping mechanisms, slower recovery from stressful events, and lack of experience in dealing with stress may intensify the stressful events experienced by adolescents 1. Teens can experience a spectrum of stresses ranging from ordinary to severe 2. Stress has been associated with a variety of high-risk behaviors, including smoking, suicide, depression, drug abuse, behavioral problems, and participating in high-risk sexual behaviors 3,4. In addition, long-term exposure to stress is associated with a variety of chronic psychological and physical illnesses. High-risk teens, or those who live in social disadvantage, may be at increased risk for illness related to chronic exposure to stress, discrimination, stigma, and a harsh social environment 5. It has also been purported by the researchers that assessing adolescent stressors and the impact of stress is the first step in the prevention and treatment of its associated chronic diseases 6. The latest research work showed a clear increase in stress consequences for adolescent related to experience, behavior and health (among other things, fear to fail and psychosomatic disorders). In contrast, only a few stress handling programmes are available specifically for adolescents; a large part covers stress handling training courses orientated to behavior and cognition. Adolescents of today s world are living in a world of competition and there is cut throat competition in every sphere of life. The theory of SURVIVAL OF THE FITTEST applies to each and every walk of the society. Adolescent today are living in an increasingly anxiety ridden atmosphere. In today s competitive world, it is not uncommon to find academic achievement playing the most important role in an adolescent s growing up. Being academically successful and making a place for oneself in the society is their priority. Social problems can be a significant stressor for adolescents. Disturbed youth often experience negative outcomes to social problems, solve problems poorly, and display distortions in reasoning about social problems. The social experiences of adolescence have an impact on identity formation. Peer pressure to use drugs or have intercourse can affect a teen s life in significant ways, depending on the behavioral choices made in response to these social problems. Recent incidents of school shootings and the high rate of teen suicide underscore the potentially devastating outcomes of ineffective social problem solving. Disturbed adolescents were found more likely to select negative alternatives to social problems such as alcohol abuse, isolation, and running away 22 Delhi Psychiatry Journal 2012; 15:(1) Delhi Psychiatric Society
from home. Disturbed youth with internalizing problems such as stress, depression, anxiety, loneliness, and social withdrawal perceive and process social problems differently from those who are normal or those with externalizing problems such as aggression. Depressed adolescents were found more likely to select negative alternatives to social problems such as alcohol abuse, isolation, and running away from home. Internalizing problems have been associated with cognitive distortions in perceiving and solving social problems, including selective abstraction, personalizing, overgeneralization, and catastrophizing 7. Involvement in prosocial activities is a protective factor against problem drinking among teenagers 8. Various stresses and their impact on life of an adolescent can be understood with the help of the following diagram. T he figure shows the consequences of stress among adolescent which makes them highly vulnerable and they are at high risk to face various physical, psychological and social problems in life. Mental health problems affect 10 20% of children and adolescents worldwide. Despite their relevance as a leading cause of health-related disability in this age group and their long lasting effects throughout life, the mental health needs of children and adolescents are neglected, especially in low-income and middle-income countries. Mental Health and Wellbeing in Adolescence Mental health is an essential part of holistic wellbeing. The general well-being of adolescents has been the topic of considerable debate in recent years. Evidence has suggested that the current level of behavioral and emotional problems in teenagers is higher than in the past. Mental health is a way of describing social and emotional wellbeing. Good mental health is central to the adolescent s healthy development. It is associated with: Feeling happy and positive about yourself and enjoying life Healthy relationships with family and friends Participation in physical activity and eating a healthy diet The ability to relax and to get a good night s sleep Community participation and belonging. Risk and Protective Factors of Adolescent s Mental Health A mental health risk factor is an internal (e.g. temperament) or external (e.g. environment) condition that increases the likelihood of the development of a mental health problem. Alternatively, a mental health protective factor is an internal or external condition that mitigates against the development of mental health problems and helps to promote resiliency. While no single risk factor can predict the development of mental illness nor any single protective factor assure immunity, the following chart identifies risk and protective factors that are known to correlate with mental health functioning in children and youth. 9 Delhi Psychiatry Journal 2012; 15:(1) Delhi Psychiatric Society 23
Mental Health Risk Factors Individual Factors Prenatal brain damage Prematurity Birth injury Low intelligence Chronic illness Poor health in infancy Insecure attachment in infancy/childhood Low birth weight, birth complications Difficult temperament Physical and/or intellectual disability Poor social skills Low self-esteem Impulsivity Family Factors Absence of either parent in childhood Anti-social role models Marital discord in parents, divorce Long term parental unemployment Parental criminality and disharmony Parental substance abuse Parental mental health disorder Poor supervision and monitoring Family social isolation Lack of warmth and affection Death of a family member School Factors Poor attachment to school Bullying Peer rejection Inadequate behavior mgmt Deviant peer group School failure Frequent school transitions Community and Cultural Factors Socio-economic disadvantage Social /cultural discrimination Neighborhood violence &crime Overcrowded housing conditions Lack of recreational opportunities Lack of support services Mental Health Protective Factors Easy temperament Adequate nutrition Above average intelligence Problem solving skills Internal locus of control Social competence Social skills Good coping style Optimism Moral beliefs Values Positive self regard Good physical health Attachment to family Supportive, caring parents Family harmony Secure and stable family Small family size More than 2 years between siblings High level of family responsibility Strong family norms and morality Economic security School achievement Sense of belonging at school Positive school climate Pro-social peer group High expectations Required responsibility & service to others Opportunities for success & recognition of achievement Sense of connectedness to community Attachment to community networks Strong cultural identity and ethnic pride Access to support services Community norms against violence Caring neighborhood 24 Delhi Psychiatry Journal 2012; 15:(1) Delhi Psychiatric Society
Adolescent mental health is a concern for health professionals as the prevalence of mental health problems appears to peak in adolescence and early adulthood because of the biological and psychosocial transitions that are occurring in this age group. Adolescence is a major transitional period between childhood and adulthood and many changes physical, emotional and social occur during this time. These changes can precipitate and perpetuate mental health difficulties in young people. Due to the amount of changes that occur in adolescence, younger and older adolescents are at quite distinct life stages and are biologically, cognitively, socially and emotionally distinct. There are also differences between younger and older adolescents in the prevalence of different disorders and in how they express their difficulties. It is, therefore, important for healthcare professionals to be mindful of the development level of the adolescents with whom they are working and the impact that this can have on the young person s presentation, understanding of their problems and in their ability to use different therapeutic interventions. Mental wellbeing can be improved The Mental wellbeing can be improved by focusing on the fundamentals of the way we live our life. It is not just whether we are exercising, eating well and not getting stressed, but what is underneath that impacts on the real change. The Mental Wellbeing Model takes into account existing and new research and suggests the following stages to wellbeing: Values The rules by which one live one s life, the very core of one s being. It is values that affect the decisions we make, the life choices and how we respond to situations we experience. Beliefs These are more than beliefs in the religious sense; it is something that we believe to be true about ourselves and about the world that we live in. Beliefs are fundamental in either helping or hindering us to achieve what we want from life. Figure-2. Mental Wellbeing Model Delhi Psychiatry Journal 2012; 15:(1) Delhi Psychiatric Society 25
Goals/Life Purpose This is the target we are aiming for and ultimately, what we need to do in our lives to feel fulfilled. Someone living to their life purpose will have their beliefs, values and goals aligned and are in accordance with how they want to live their life, it is at the very cornerstone of wellbeing. Cognitions This is the way we collect, store and process information. It is about the mood we wake up with in the morning and how we manage ourselves during the day, what emotions we are holding and whether they are serving us well. Happier people tend to have healthier lifestyles 9, more friends, and also more positive interpersonal experiences 10. Emotional Intelligence Emotional intelligence as described refers to our ability to manage our emotions, respond to the emotions of others and how we emotionally cope with life. It affects our ability to stay resourceful, build and improve successful relationships, manage ourselves and to create the conditions of happiness, success and fulfillment in our lives. These points have been briefly explained with the help of Mental Well Being Model. In which the inter-connectedness of the above mentioned stages has been depicted to achieve the ultimate goal of Mental Well Being through developing ongoing processes viz. Personal Growth, Self Acceptance, Personal Relations & Environmental Mastery. The area of mental health has long been debated and is not a simple field to understand, there is not only the impact of mental wellbeing but also illbeing. Wellbeing is about alignment and that is exactly what coaching does, it takes account of the whole life and bases goals on this. Through improved intelligence around your emotions, beliefs and values, you can set meaningful goals, align yourself to your life purpose and as a result, you will then achieve the ways to wellbeing: you will know how to connect with others and benefit from the exchange, you can achieve your physical wellbeing goals, you will be more aware of yourself and others around you, you will be better placed to learn from your experiences and take on additional learning should you choose, and you will be more accepting of yourself and able to give to others as a result. Importance of Promoting Adolescent Mental Well Being In the short term: Interrupting poor mental health as soon as possible in the childhood and adolescent years will reap instant rewards for young people. Those who are supported and have more positive mental health can learn better and are more likely to fulfill their social, academic and training potential. It is likely that intervening more effectively and imaginatively could significantly reduce adolescent mortality (through reducing suicide rates) and improve life experiences. If we can accurately assess mental health problems, and we know both how to intervene and also that intervention may work, then there is an ethical imperative to do something as soon as we can. In the longer-term Enhancing health and educational outcomes will benefit young people in the shorter term, but will of course benefit all of us in the longer term as well. A significant proportion of young people with mental health problems will go on to be adults with not just ongoing mental health problems, but also range of other poor outcomes as well difficulties with relationships, unstable employment histories, involvement in crime, and social exclusion. Research has shown that by age 28, people with continuing high levels of antisocial behavior have cost society up to 10 times more than those with no problems these are the costs of public services such as extra educational provision, foster and residential care, and unemployment benefits, quite apart from the personal costs to the individual (11). References 1. Denise EL, Herrman J. Adolescent stress through the eyes of high-risk teens. Pediatr Nurs 2008. 2. Lau BWK. Does the stress of child-hood and adolescence matter? A psychological perspective. J Royal Soc Promotion Health 2002; 122(4) : 238-244. 3. Finkelstein DM, Kubzansky LD, Capitman J, and Goodman E. Socioeconomic differences in adolescent stress: The role of psychological 26 Delhi Psychiatry Journal 2012; 15:(1) Delhi Psychiatric Society
resources. J Adolesc Health 2007; 40(2) : 127-134. 4. Finkelstein DM, Kubzansky LD, Goodman E. Social status, stress, and adolescent smoking. J Adolesc Health 2006; 39(5) : 678-675. 5. Goodman E, McEwen BS, Dolan LM et al. Social disadvantage and adolescent stress. J Adolesc Health 2005; 37 : 484-492. 6. Chandra A, Batada A. Exploring stress and coping among urban African-Amer ican adolescents: The shifting the lens study. Preventing Chronic Disease: Public Health Res Practice Policy 2006; 3(2) : 1-10. 7. Leung PW, Wong MM. Can cognitive distortions differentiate between internalising and externalising problems? J Child Psychol Psychiatry 1998; 39 : 263-269. 8. Costa FM, Jessor R, Turbin MS. Transition into adolescent problem drinking: the role of psychosocial risk and protective factors. J Studies Alcohol Drugs 1999; 60(4) : 480-90. 9. Watson D, Clark LA, Tellegen A. Development and validation of brief measures of positive and negative affect: The PANAS scales. J Personal Soc Psychol 1988; 54 : 1063 1070. 10. Diener Ed, Eunkook M, Suh, Robert E. Lucas and Heidi L. Smith. Subjective Well-Being: Three Decades of Progress. Psychol Bull 1999; 125 (2) : 276-302. 11. Scott S et al. Financial cost of social exclusion: follow-up study of antisocial children into adulthood. Br Med J 2001; 323 : 191 196. Delhi Psychiatry Journal 2012; 15:(1) Delhi Psychiatric Society 27