Mental Health

According to the current State of the World's Children report, issued this week by the United Nations children's organization UNICEF, at least 13% of people between the ages of 10 and 19 have a diagnosed mental-health disorder. This flagship study is the first in the organization's history to address the difficulties and opportunities for preventing and treating mental health problems among young people. It illustrates how complicated, understudied, and underfunded adolescent mental health is. A series of review articles released this week in a variety of Springer Nature journals echoes these conclusions.Anxiety and sadness account for more than 40% of mental-health issues in children and adolescents (ages 10–19). Suicide is the fourth most prevalent cause of mortality among adolescents (ages 15–19) worldwide, according to UNICEF (after traffic injuries, TB, and interpersonal violence). Suicide is the biggest cause of death for young people in Eastern Europe and Central Asia, and it is the second-highest cause in Western Europe and North America. Unfortunately, psychological suffering among young people appears to be on the rise. Depression rates among a nationally representative sample of US adolescents (aged 12 to 17) increased from 8.5 percent to 13.2 percent between 2005 and 2017, according to one study1. In several nations, there is also preliminary evidence that the coronavirus pandemic is worsening this trend. Adolescents (ages 13–18) reported significantly greater symptoms of mental ill health during the pandemic than their peers before it, according to a statewide study2 from Iceland. Girls were more likely than males to experience these symptoms. Despite the fact that the majority of mental-health illnesses begin during adolescence, UNICEF estimates that only one-third of mental-health research funding goes to young people. Furthermore, the research is fragmented – scientists participating tend to work within a few major fields, such as psychiatry, paediatrics, psychology, and epidemiology, and linkages between research and health-care services are sometimes strained. This means that effective preventative and treatment options are limited, and there is a lack of understanding of what works, when, and why. This week's roundup of review papers delves into the current state of knowledge about interventions for preventing and treating anxiety and depression in young people aged 14 to 24 - both those that work and those that don't. Young people with lived experience of anxiety and depression were co-investigators in some of the studies, helping to design and implement the reviews as well as analyze the results. Selected serotonin reuptake inhibitors, which increase serotonin levels in the brain and are meant to improve emotion and mood, are the most popular treatment for anxiety and depression around the world. However, their limited efficacy and significant side effects3 have prompted researchers to investigate alternative physiological processes that may be involved in juvenile depression and anxiety in order to create new treatments. Researchers have been looking into the possible links between depression and inflammatory illnesses like asthma, cardiovascular disease, and inflammatory bowel disease, for example. This is because many adults with depression also suffer from anxiety disorders. Furthermore, there is evidence that altering the gut microbiota during development in mice reduces behaviors linked to anxiety and depression in humans4. This shows that focusing on the gut microbiota throughout adolescence could be a potential way to help young people cope with anxiety. Kathrin Cohen Kadosh and colleagues from the University of Surrey in Guildford, UK, analyzed current evidence of therapies that changed diets to target the gut microbiome. These were found to have a negligible effect on the anxiety of young people5. However, the authors advise caution before drawing such a conclusion, citing methodological flaws (such as small sample sizes) in the research they examined. They believe that the next round of research will require larger-scale clinical trials. Researchers, on the other hand, have discovered that, under certain conditions, boosting young people's cognitive and interpersonal abilities can be more helpful in avoiding and treating anxiety and depression - though the explanation for this is unknown. According to Marc Bennett of the University of Cambridge, UK, and colleagues6, a concept known as 'decentring' or 'psychological distancing' (that is, encouraging a person to adopt an objective perspective on negative thoughts and feelings) can help both prevent and alleviate depression and anxiety, though the underlying neurobiological mechanisms are unknown. Furthermore, Alexander Daros and colleagues from the Campbell Family Mental Health Institute in Toronto, Canada, present a meta-analysis of 90 randomized controlled studies. They discovered that assisting young people in improving their emotion-regulation abilities, which are required to moderate emotional responses in challenging situations, helps them cope better with anxiety and depression7. However, it is still unclear whether these changes are the result of greater emotion management or the cause of them.