Many people see the pre-teen and teen years as naturally being fraught with "angst'" and "growing pains." All too often, behavioral and mood issues in children and young adults are brushed aside because "they'll grow out of it." But a study published recently in The Lancet, suggests young people are not dealing just with angst, and that the implication of disability at a young age from mental disorders is staggering.
According to the study, which took a comprehensive look at the World Health Organization's 2004 Global Burden of Disease report, neuropsychiatric disorders such as depression, substance abuse and schizophrenia account for nearly half (45 percent) of disability in young people between ages 10 and 24. This is approximately four times as much as that caused by unintentional injuries and infectious and parasitic diseases.
The study added up the lost years of healthy living due to disability or death and found that young people were responsible for nearly 16 percent of total number of years lost for all age groups. Out of these, many of the lost years were due to psychiatric conditions, such as major depression and substance abuse, rather than disease or injury. Two of the major risk factors for disability in young people included alcohol abuse and unsafe sex.
What should we take away from this report?
Disability, like the majority of diseases, is years in the making. Health concerns and behavioral issues that start to develop in pre-teen and teen years should not be disregarded.
We should place heavy emphasis on preventive strategies to help pre-teens and teens learn to cope with environmental and mental stressors, to address mental health and behavioral concerns as they emerge in early years and to focus on health promotion regularly with children and young adults. Waiting until they are adults to address problems that took years to develop is akin to waiting for the leaky faucet to overflow onto the floor before fixing it, especially when we saw the faucet was leaking long before it overflowed.
Similar to heart disease and diabetes, mental disorders have a significant impact on overall functionality and health, and thus should be given as much attention by health insurance companies, medical community and the general public. No matter the age of the person battling mental disease, the issue should be considered relevant and be addressed with as much urgency and concern as that of infectious or systemic diseases.
Ignoring neuropsychiatric issues and waiting a few more months or years will not make it better; in actuality, waiting will likely just make it worse by allowing the impact of the medical issue to extend into adulthood, leading to lifelong disability.
All too often, infectious and somatic diseases are seen as the only predominant issues that need to be addressed in the health management of young people. This study suggests the behavioral and neuropsychiatric disorders need to be given as much attention as that paid to infectious and systemic diseases in childhood, due to mental disorders' significant impact on overall lifelong disability.
I am not proposing we jump to the conclusion that every "moody" episode is a red flag for mental disorder. I am merely proposing we not sweep repetitive, concerning behavioral or mental symptoms under the rug in young adults and assume that "they will just grow out of it." It seems from this study they will not "just grow out of it" -- rather, the impact can have lifelong negative effects.
So what are the potential early steps in evaluation and management for behavioral and mental health concerns for children and young adults?
It is important to have a discussion with the child or young adult about what your concerns are and also to have a discussion with the school guidance counselor or teachers. Seeing how he or she behaves or interacts in different environments is important in getting a full picture of what's going on.
Then, start the discussion and evaluation with a trusted pediatrician or therapist, if one is already in place. Groundwork of a trusting therapeutic relationship needs to be laid down as a network for support as you move the child or young adult toward healing. The main take-home point is to not just ignore it. Take those necessary steps toward seeing the full picture of what's going on and have him or her be fully evaluated by a trained professional.
With looming concerns of rising childhood obesity, earlier onset of Type 2 diabetes and hypertension, this study further emphasizes the idea that waiting until they are older is really not a viable option in terms of instilling concepts of healthy living, learning healthy coping skills, guiding young adults on neuropsychiatric disorder management and disease prevention.
As a physician where a vast majority of my practice is based on the idea of "fixing the leaky faucet before it overflows," it concerns me that health promotion and disease prevention is not always at the forefront of our minds when we think about our health.
My second proposal is that we treat mental disorders with the same compassion and objective concern as we do cardiovascular heart disease and cancer. What I mean by that is we start to shift mental disease into a category of health care that prompts us to include mental health coverage in all health insurance plans, and that we spend as much time, money and energy on it as we do with other systemic diseases. The far-reaching health and economic implications of mental diseases warrant this. Mental health care should not be a "luxury," but rather an essential component to overall wellness and health inherent in all health care coverage and management.
As we see from this study, what happens in our mind doesn't just affect our mind -- it affects our lifelong quality of functionality and health. Even though our current Cartesian model of health care classifies physicians into the segmental body parts of their specialty (e.g., nephrology, cardiology, pulmonology, etc.), that doesn't mean we should approach health care in this segmental fashion. Our body is interconnected, and thus so is our health. Because we are not segmental creatures, but rather a whole living being, what happens in our mind and how we cope with life's stressors directly impacts our body's physiology and functionality.
What's great about this study is it will hopefully spur the medical community and the general public to take a more in-depth look at what we deem important in regard to health care. It reminds us that change is most effective when implemented early on, and that mental and behavioral health is a necessary ingredient for all young people to achieve a long, healthy, functional life. By helping younger generations to learn how to cope with environmental stressors and manage mental illness, we may be able to help give these young adults the tools necessary to live a healthy, "carefree" life long into their years of adulthood.
Follow Julie Chen, M.D. on Twitter: www.twitter.com/makinghealthyez
Mental Health America: Children's Mental Health: Resource List
Mental Health: Mental Illness in Children
Article quote" "We should place heavy emphasis on preventive strategies to help pre-teens and teens learn to cope with environmental and mental stressors, to address mental health and behavioral concerns as they emerge in early years"
The problem with that statement is that so many PARENTS themselves cannot cope with mental or emotional stressors, so how on earth can they pass this on to their children when they themselves are ill equiped to deal with it !!?
The way children are treated in the uk, compared to the continent is that " parents" here shout,and smack their tiny children in the streets, often using the " f" word.
These mothers have NO self control, yet expect their 2 year olds to show it! they often have low self esteem, and were probably brought up the same way themselves.
Contrast this to the way children are treated in Germany and Holland,
There, children are treated with kindness and respect, things are talked about or explained in a calm way and the children, in turn respond calmly.
The lead has to come from the adults, and the love, if they don`t give that first to the children then they can expect problems with their children.. All actions have consequences, and we have to live with them if we make wrong choices.
The trick is recognizing when it's the normal kind of difficulty all kids have, or if it's something more. As parents, we want to make things all better all the time. But we can't. Sometimes kids just have to struggle and work things out on their own.
That said, I wrote in a separate post about how valuable counseling was for my own child. It's important for parents to listen, understand that their child's 'normal' may not be the same as another child's, and to never shy away from being their advocate.
Kate is doing OK now, but she is still dealing with the aftermath of how serious depresssion distorted her life. Please, get people help! They may not ask twice, or even once.
Even now, decades later, I hate it when someone has to tell me how *wonderful* those years were for them after I tell them how miserable that time was for me. It's like they are rubbing my nose in my misery once again.
(and they will be saying something completely different in 5 years time, which will be again accepted by certain gullible members of society)
l have travelled to many countries in Europe, and Thailand and Bali, and l can assure you that the children in Thailand and Bali in particular are so calm and friendly, even the little ones, and have happy, smiling faces. The reason: they see it in the adults all around them, all the time and they just copy, as children do, what they see.
The article mentioned obesity,and then say that it is not a " viable option" to leave it unchecked, till the child is older! What ARE they on about, this is not the childs fault,or the govenments fault or Macdonalds fault, it is the fault of the stupid adults who buy unhealthy food for their children.
As a mental health specialist employed at a correctional institution in eastern Oregon, I daily see the results of untreated mental illnesses in young people first hand. More and more young (18-20), mentally ill offenders are arriving at the prison everyday, with diagnoses ranging from Major Depressive Disorder to Schizophrenia. This, to me, supports the statistics alluded to in this article.
As far as the credibility of the statistics mentioned in the article, many people know that The Lancet is one of the most prestigious publications in the world, on par with the likes of The New England Journal of Medicine and The Journal of the American Medical Association. Every article must be "juried" (scrutinized by a panel of judges) before it can be publicized in the magazine. Therefore, the implication that the statistics mentioned in the article were "garbage" is, no doubt, an almost laughable assumption.
Thank you, Dr. Chen, for writing this informative article. Hopefully, more and more people will realize the importance of early intervention for young people suffering from mental illnesses.
I am so glad that I grew up before all the hysteria of raising kids right or wrong, and I am so glad I raised mine out of that hysteria. I have never read a book or taken any professional advice about parenting, but stuck to the old way, and my kids grew up beautifully with no phychological problems at all.
Adults have to stop thinking that the most important thing on earth is to manipulate the children right out of their childhood. It's no wonder there are messed up young people.
Now retired I'm in my worst of times! Living on a fixed income, if my dog or cat gets sick, I have to count my penneys and scrimp on something else to pay for it! Every day I have to pray that the government doesn't cut my Social Security, or my 401k lasts until I die!. If I get sick ,it's a hassle with either my insurance company or the hospital over who pays the bills! I cringe each week when I see the grocery or utility bills! Painting the house is exhausting but I can't afford someone to do it for me! My back and legs hurt for weeks just changing the oil in our two cars!
Yes, I wish I could hop in a time machine and be 15 again! You don't know how much I wish!
Gee, where do you suppose the problem comes from, and why won't anyone admit it?