Mental Health and Saudi Adolescents’
The area of concern for World Mental health day 2018 is ‘young people and mental health in a changing world' by the World Health Organization. The area of interest is very sensitive as well as important because youth/adolescent is a vital part of the world. In other words, we can say "YOUTH = THE FUTURE LEADER”. Unfortunately, in the current scenario adolescents are surrounded by issues such as bullying, cyber-crimes, playing violent games, different types of addictions, isolation, anxiety, depression, substance abuse, and suicidal ideation. All these factors are associated for the rapid changes in mental health.
Mental health is an integral part of individuals’ wellbeing that is influenced not only by individual attributes or behaviors but also by the overall social and economic circumstances and environmental factors (WHO, 2012).
Mental health and Youth
World Health Organization (WHO) defines adolescents as young people between the ages of 10-19 years [WHO]
In the Arab region, the majority of the population is below the age of 25 years (UNPY, n.d). Likewise, in the Kingdom of Saudi Arabia (KSA), 20% out of a 28 million population is between the ages 10–19 years (US Census Bureau, 2017).
During the period of adolescence, several biological, cognitive, physiological, psychological, emotional and social changes emerge, and certain risky behaviors arise and are linked to adolescents’ health (Sawyer, Afifi, Bearinger, Blakemore, Dick, & Ezeh, 2012) and with mental health too.
According to WHO, adolescence is the period of many changes like changing schools, leaving home, and starting university or a new job. For many adolescents, these are exciting times. However, in some cases, this could be the times of stress and apprehension, if this not recognized and managed, these feelings can lead to mental illness. The study stated that adults who suffer from depression during adolescence are at higher risk of developing major depressive disorders (Pine, Cohen, Gurley, Brook, Ma, 1998).
Consequences of mental health problems in Saudi
Worldwide 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. (WHO, 2017)
While mental disorders, in general, account for 45% of the burden of disease in 10– 24-year-olds (Gore, Bloem, Patton, Ferguson, Joseph, Coffey, 2011), depression and anxiety are considered to be among its leading causes (Patel, 2013)
By the analysis of the Global School-based Student Health Survey (GSHS) reports students from 19 low and middle-income countries including Arab countries such as Jordan, United Arab Emirates, Lebanon and Morocco showed that around 35% of students reported having symptoms of depression (Fleming & Jacobsen, 2010). Likewise, a number of studies reported a high prevalence of depression and anxiety.
Similarly, an investigation about the prevalence of any psychiatric disorder was 36.3% (39.2% for children and 34.1% for adolescents) and behavioral disorders were more common than emotional disorders (25.7% vs. 21.7%) were found in Riyadh city, of Saudi Arabia (Al-Modayfer & Alatiq, 2015)
A study by Mahfouz, Al-Gelban, Al Amri, Khan, Abdelmoneim, Daffalla, Shaban, Mohammed (2009) most frequent mental symptoms were phobic anxiety (17.3%), interpersonal sensitivity (14.7%), and obsessive-compulsive (14.5%). Interesting factors were also highlighted, which was socio-demographic conditions of father education, mother working status, ranking among brothers and sisters, and type of school was significantly affecting mental health.
A study carried out in a city of Saudi Arabia, revealed that most important problems in adolescent were anxiety (13.5%), somatic disorders (12.2%) obsession (10.8%), aggression (8.1%), delinquency and depression (4.1%) (Aleissa, 2001).
Study on Saudi youth, examined psychiatric symptoms in high school students ages 14 to 19, reporting that fifty-nine percent had significant levels of either depression, anxiety or stress; Overall, 36% reported stress, 38% depression, and 49% anxiety in males. Apart, investigation on female has reported the most frequent symptoms were phobic anxiety (16%), psychoticism (15%), anxiety (14%), somatization (14%), and depression (14%). (Gelban a 2006, & Al-Gelban,b 2009 ) Interestingly, the prevalence of these symptoms in youth is similar as compared to the adolescents in the U.S. at that period (Merikangas, 2010)
Similarly, Body image is also ranked as one of the main issues among young people. Kirkcaldy, Shephard, & Siefen (2002) reported that adolescents who engaged in regular physical activities were characterized by lower Body Image concerns. Slater and Tiggemann (2011) concluded that Body Image concerns might contribute to adolescent girls’ reduced rates of participation in sports and other physical activities. Therefore, Khalaf, Westergren, Berggren, Ekblom, & Al-Hazzaa, (2015), gave the campaigns recommendation to improve adolescent self-image.
Source: Google
The pieces of evidence of bullied victims has found to be associated with mental health problems such as depression, anxiety, deprived health, inferiority, guilt/sham and suicidal ideation.
Studied showed that students who were both victims and bullies had the lowest self-concepts in all areas (Houbre, Tarquinio, & Thuillier, 2006).
Poor families bonds (Sheeber, Hops, & Davis, 2001) smoking and addictions (internet addiction, gaming, gambling) are also one of the top concern issues of mental health. Addiction is also one of the critical aspect identified by various studies in adolescents like early studies in 1990’s on addiction highlighted that patient admitted to the hospital in eastern KSA mostly were young (83% ages 21 to 32 years), all were male, and 97% were Saudi nationals. Among the substances used, 49% injected heroin alone, 35% used heroin in combination with other drugs or alcohol, 11% used only alcohol, and an additional 20% used alcohol in combination with other drugs ( Hafeiz, 1995).
Research on alcohol use in KSA in 2009, by college student ages 18 to 24, of whom 4% admitted using alcohol (Al-Rethaiaa, Fahmy, & Al-Shwaiyat, 2010).
Hard to believe, a study reported 1,778 Saudi male secondary school students in eastern KSA reported that 5.3% used volatile solvents such as petrol/benzene, paints, or lighter fluid at some point in their lives (Al-Umran, Mahgoub, & Qurashi, 1993).
Unfortunately, one of the main barriers between substance abuse especially tobacco and adolescent dependence is a permissible environment in Saudi. In a survey of 1,830 boy's ages 13 – 15 in secondary schools in Riyadh, researchers found that 35% had, smoked cigarettes at some time in the past and 11% admitted to having smoked within the past 30 days (Al-bedah, & Qureshi, 2011). Moreover, these estimations are similar among adults in KSA (WHO, 2011).
What causes mental health issues?
• Conflictual interactions within a family are correlated with depressive symptoms (Sheeber, et.al. 2001)
• Excessive parental expectation
• Chronic physical illnesses had higher levels of depressive symptoms as compared to their healthy peers(Pinquart & Shen, 2011)
• Lack of sleep is also related to the depression and excessive use of electronic devices
• Inappropriate diet & body image
• Academic stress, failures and wrong peer pressure
• Isolation, failures in a relationship and inappropriate company
• Smoking, substance use, physical violence and other violence (Bullying, cyberbullying, cyber-crime)
Facilitating steps for improvement:
Although a number of the initiative has already been discussed and implemented to achieve better results but due to some gaps we have not reached the destination of the outcome, which we considered. Therefore, specific aspect such as age, cultural, gender, exposure etc. need to be identified in relation to fill the gaps. Few implemented action especially for youth:
• Awareness programmes and workshops for parents and community
• Awareness Workshops and Role Play for adolescents/Youth
• Antismoking Campaign
• Special lectures and information in schools
• Early screening training for parents, schoolteachers, and staff.
• Short Movies, videos & outdoor games
• Training on Stress management
• Identify the new dimensions in the area of childhood education
• Professional counseling services
• Promote resilience and problem-solving skills in young people
Supportive hands
Contact professional advisers for support and help:
• School/College counselor
• Psychologist, a Child Psychologist
• Child Psychiatrist
Apart, parents, peers, and teachers can also be the first person to give his/her hand for support
References:
1 Al-Umran, K., Mahgoub, O.M. and Qurashi, N.Y. (1993) Volatile Substance Abuse among School Students of Eastern Saudi Arabia. Annals of Saudi Medicine, 13, 520-524.
2 Aleissa, E.l., (2001). The frequency of health-related behaviors among Saudi adolescents visiting primary health care centers in Riyadh city. Journal of Family Community Med; 8: 19-26
3 Al-Gelban, K.S. (2006) Depression, Anxiety and Stress among Saudi Adolescent School Boys. Journal of the Royal Society for the Promotion of Health, 127, 1-5.
4 Ahmed A. Mahfouz, A.A., Khalid S. Al-Gelban, S., K., Hasan Al Amri, A., H., Mohamed Y. Khan, Y., M., Ismail Abdelmoneim, I., Asim A. Daffalla, A., A., Hosny Shaban, H., Amany A. Mohammed, A., A. (2009) Adolescents' Mental Health in Abha City, Southwestern Saudi Arabia.
The International Journal of Psychiatry in Medicine, 39 (2), page(s): 169-177
5 Al-Gelban, K.S. (2009) Prevalence of Psychological Symptoms in Saudi Secondary School girls in Abha, Saudi Arabia. Annals of Saudi Medicine, 29, 275-279. http://dx.doi.org/10.4103/0256-4947.55308
6 Al-Rethaiaa, A.S., Fahmy, A.A. and Al-Shwaiyat, N.M. (2010) Obesity and Eating Habits among College Students in Saudi Arabia: A Cross-Sectional Study. Nutrition Journal, 9, 39. http://dx.doi.org/10.1186/1475-2891-9-39
7 Al-bedah, A.M. and Qureshi, N.A. (2011) The Global Youth Tobacco Survey: 2001-2002 in Riyadh Region, the Kingdom of Saudi Arabia. Substance Abuse and Rehabilitation, 2, 197-204.
8 Al-Modayfer, O., & Alatiq, Y. (2015). A Pilot Study on the Prevalence of Psychiatric Disorders among Saudi Children and Adolescents: a Sample from a Selected Community in Riyadh City, The Arab Journal of Psychiatry (2015) Vol. 26 No.2 Page (184 -192) (doi: 10.12816/0014485)
9 Fleming, L.C., Jacobsen, K.H., (2010). Bullying among middle-school students in low and middle-income countries. Health Promot Int. 25:73–84. doi:10.1093/heapro/dap046
10 Gore, F.M., Bloem, P.J., Patton, G.C., Ferguson, J., Joseph, V., Coffey, C., et al. (2011) Global burden of disease in young people aged 10–24 years: a systematic analysis. Lancet. pp2093–102
11 Houbre, B., Tarquinio, C., Thuillier, I. et al. (2006). Bullying among students and its consequences on health. Eur J Psychol Educ, https://doi.org/10.1007/BF03173576
12 Hafeiz, H.B. (1995) Socio-Demographic Correlates and Pattern of Drug Abuse in Eastern Saudi Arabia. Drug and Alcohol Dependence, 38, 255-259. http://dx.doi.org/10.1016/0376-8716(95)90001-X
13 Kirkcaldy, B. D., Shephard, R. J., and Siefen, R. G. (2002) “The relationship between physical activity and self-image and problem behavior among adolescents,” Social Psychiatry and Psychiatric Epidemiology, vol. 37, no. 11, pp. 544–550, 2002.
14 Khalaf, A., Westergren, A., Berggren, V., Ekblom, O., Al-Hazzaa, M., H. (2015). Perceived and Ideal Body Image in Young Women in South Western Saudi Arabia. Journal of Obesity.
15 Merikangas, K.R., He, J.P., Burstein, M., Swanson, S., Avenevoli, S., Cui, L., Benjet, C., Georgiades, K., Swensen, J. (2010) Lifetime Prevalence of Mental Disorders in U.S. Adolescents: Results from the National Comorbidity Survey Replication-Adolescent Supplement (NCs-A). Journal of the American Academy of Child and Adolescent Psychiatry, 49, 980-989. http://dx.doi.org/10.1016/j.jaac.2010.05.017
16 Pine, D.S., Cohen, P., Gurley, D., Brook, J., Ma, Y. (1998). The risk for early-adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders. Arch Gen Psychiatry.55:56–64.
17 Patel, V. (2013). Why adolescent depression is a global health priority and what we should do about it. Journal Adolescent Health; 52:511
18 Pinquart, M., Shen, Y. (2011). Depressive symptoms in children and adolescents with chronic physical illness: an updated meta-analysis. Journal Pediatr Psychol, pp375–84
19 Sawyer, S.M., Afifi, R.A., Bearinger, L.H., Blakemore, S.-J., Dick, B., Ezeh, A.C., et al. (2012) Adolescence: a foundation for future health. Lancet. 379:1630–40
20 Sheeber, L., Hops, H., Davis, B. (2001). Family processes in adolescent depression. Clinical Child Fam Psychol Rev. 4:19–35.
21 Slater, A., and Tiggemann, M. (2011). "Gender differences in adolescent sports participation, teasing, self-objectification and body image concerns," Journal of Adolescence, vol. 34, no. 3, pp. 455–463, 2011.
22 UNPY. (n.d). Regional overview: youth in the Arab region. New York: United Nations Economic and Social Commission for Western Asia and the United Nations Programme on Youth (UNPY).
23 US Census Bureau (2017). International Programs. International Data Base. Accessed 23 Feb.
24 World Health Day. (2017) on depression.
25 World Health Organization (2012). Risks to mental health: an overview of vulnerabilities and risk factors. Geneva: WHO
26 World Health Organization Eastern Mediterranean Region (2011) Saudi Arabia: Country Statistics. http://rho.emro.who.int/rhodata/?theme=country
27 Picture source: Google