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.
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