Mental health in youth can uplift society

By Carol Aloysius

Young people worldwide and in Sri Lanka have never been exposed to so many problems that undermine their health emotionally, mentally and physically than they are today.

Growing up in violent surroundings, crumbling family units that separate them from at least one or both parents, physical abuse from people they trust, it is hardly surprising that many of them go astray, align themselves with anti social elements in society and inflict more violence on the community and society they live in. Lacking in social skills, and still immature due to changes taking place in their bodies, they lack the mechanisms to cope with their stressful situations, which makes them vulnerable to such anti social predators who exploit their inexperience for their own ends.

International Youth Day, August 12, has been declared as a day for raising awareness of these gaps in youth welfare by the UN which will focus world attention on Mental Health of Youth on this day, starting from the time they enter school and upwards.

The Sunday Observer spoke to a few experts in the field to find out more about problems that school going children including adolescents face and the new strategies recently introduced by the Health and Education Ministries to help empower them.

Excerpts ...

Community Physician and Head of the School Unit on Mental Health and Youth, Family Health Bureau, Dr Ayesha Lokubalasuriya:

Q. Judging by the large number of reports in newspapers of acts of violence including suicides involving young people, it appears that the youth today are exposed to many problems that the generations before never experienced. Your comments?

A. I agree, there's a growing trend in violence that is currently affecting most young people all over the world including Sri Lanka.

Q. Why?

A. If you look around in many countries the culture of violence seems to be the norm when young people want to escape from their problems.

This is because they are growing in an environment of violence - where they see violence on the television, read about violent deeds in newspapers, and even witness violence on the streets where many live.

Today this has spread to schools as in the US and even Asian countries like India. School children from primary classes up, watch cartoons that promote violence. Films that make villains heroes. All this creates violent images in their minds and leaves a huge impression on their young minds that can continue into adulthood.

Q. In your own experience of dealing with school kids, what do you think is the biggest problem they face right now?

A. Stress - mostly academic stress especially in the case of students in secondary and tertiary level. Recent studies done by researchers in our country have proved this. One study has shown that 48 percent of students in a school in the Western province had admitted they had academic stress.

Q. Why?

A. It is because studying in Sri Lanka has now become extremely competitive. Consider the case of any average school child from primary stage up.

How much time do they have to relax, play games, chat with friends, and even have their meals at the proper time? Their day starts off with a rushed meal or without a meal in many cases, and after six and a half hours of school, they are rushed to tuition classes, or forced to engage in some extra curricular activity they dislike.

Ambitious parents constantly pushing their children to do better in schools and even teachers doing the same, can cause immense strain and stress on children. What they need is time and space for themselves; do things they like doing for a change and go out and play games that will keep them physically fit. The present education system does not give them much room for this, especially when you consider they have such large syllabuses to study.

Q. So you think there should be changes in the school curricula?

A. There should be more periods for sport and physical exercise.

The number of subjects students study can also be reduced, e.g. the curriculum of science students following the Grade 10 curriculum contains certain subjects which we learned only when we entered medical college!

Q. What do you suggest as an alternative?

A. There seems to be too much emphasis on academic performance with very little preparation for students to face other challenges they face.

Students should also be taught to study for an exam and given guidelines. While we do have guidelines on vocations, students lack knowledge on how they should study, what kind of food they should eat when studying to give them good nutrition to achieve better academic results, and reduce their stress levels especially before an exam. This will help them perform better academically.

Q. What else can cause mental problems in students, especially very young students?

A. Bullying. Stress caused by bullying by peers or older students is still high in schools.

Children who can't deal with this problem may drop out of school or refuse to go to school.

There are cases of even teachers bullying students. This too has to stop.

Q. Violence in schools is on the rise. Your comments?

A. Two years ago a selected study by a community physician in a school outside Colombo city, stated that physical violence was around 30 percent and verbal violence was 60 percent.

Children must know that they have a right to protect themselves from such acts of violence as it is enshrined in our Acts on child rights.

Q. What about health problems that can cause stress?

A. Developmental problems affect some 10 percent of children who have hyperactive disorders or slow brain development.

Sometimes development gets delayed when children are under extreme stress like violence at home and not having basic need that they require.

Q. How big is the problem of mental stress in adolescents?

A. Older students like adolescents sometimes experience depression and anxiety because their bodies are changing and they are unable to tolerate these changes.

They need to be prepared for these changes in their Reproductive Health classes.

Life events like divorce, love affairs, deaths of a close family member can also cause stress.

Failure at exams can also be a stressful event. Most young people unlike older persons who get depressed, don't go into depression.

They become aggressive and show it in other ways, such as not eating or studying.

But parents should be very watchful as if these signs are not detected it can even result in them trying to commit suicide.

Only ten percent think this is a solution to their problems, but their parents have to be alert especially if they have tried doing it before.

Q. Your suggestion?

A. We have to improve their skills in facing them by giving them better Life Skills.

Sources at the Education Co-curricular Guidance and Counselling Unit of the Education Department agreed with her view grades 6-19 students were among the most vulnerable to academic stress .” They rarely engage in play or sports activities and only concentrate on their studies. This makes them physically and mentally unfit for their exams”.

The sources also noted that adolescents lacked adequate knowledge on Reproductive health and the facts of life. “We're trying to empower our teachers by training them in these subjects so that they can teach their students. As students outside the school system also require this knowledge we are trying to join hands with the Youth Ministry and Vocational Centres to train teachers and lecturers in this subject so that they can include Reproductive Health into their curricular well. “They said that the services of Medical Officers of Health too had agreed to visit any school or vocational centre to talk to students on the subject, on request from the authorities.

“ The program is now under way in most parts of the island. That it is already producing good results is seen in the fact that the number of teen pregnancies which was 11 percent four years ago , is now down to four percent”, they said.

The School and Adolescent Health Unit of the Family Health Bureau, Ministry of Health

Last November this Unit in collaboration with several government and non government agencies including the WHO and UNICEF put out a National Strategic Plan for Adolescent Health.

Following are extracts…

Secretary of Health Dr Y.D Nihal Jayathilaka:

Launching the publication, the Secretary of Health said the formulation of strategic directions to improve adolescent health for 2013-2017 was a timely exercise, in achieving the Millennium Developmental Goals and also in reducing the Non Communicable Disease burden in Sri Lanka.

These strategic directions to improve health of adolescents in this country were a collaborative effort of various programs, professional groups and departments within and outside Ministry of Health.

Director General Health Services, Dr PG Maheepala

In his foreword to the National Strategic Plan of Health of Adolescents, the Director General of Health Services said, “As child mortality declines, the elderly live longer and the family sizes decrease, the contribution of adolescents become more important as they would become the productive work force in future”. He said, Sri Lanka, was in the middle of a non communicable disease (NCD) epidemic, and as such health of adolescents had assumed greater significance. He noted that two thirds of premature deaths due to NCD could only be prevented by intervening at the life stage of adolescence.

“Adolescents need to be given the necessary information, skills, resources and opportunities to succeed through quality education, access to health care, adequate nutrition, supportive families, social networks, and employment, “ he said.

So how does the report define adolescence?

According to the publication, Adolescence is defined as the period of life between 10 and 19 years of age (as described by the World Health Organization).

The estimated number of adolescents in Sri Lanka is 3.8 million comprising one fifth of the population1. Nearly 70 percent of our adolescents attend school.

It goes on to explain that it was recently that the period of adolescence has recently gained recognition as a critical phase of life, with wider impact on adult health and economic development.

“Health in adolescence is the result of interactions between perinatal, natal and early childhood period. Specific biological and social role changes during puberty are influenced by health and social determinants, also play a key role in this regard.

Adolescence is a time of transition, exploration, and experimentation.

Associated risk behaviours not only account for morbidity and mortality among the adolescent population, but also have a long-lasting impact in determining future adult lifestyle. It further pointed out that global evidence showed the necessity of treating adolescents as a special group which need to be supported.

Brain maturation

The report also gave lie to old beliefs about brain maturation in adolescents. “Contrary to long-held view that the brain was mostly grown-up by the end of childhood, it is now clear that adolescence is a time of profound brain growth and change.

In fact, the brain of an early adolescent is significantly differing to that of a late adolescent in anatomy, biochemistry, and physiology.

Adolescents have limitations in a variety of key areas such as the ability to make sound judgements when confronted by complex situations, the capacity to control impulses, and the ability to plan effectively compared to adults. Current research highlights that the human brain development and maturation continues up to third decade of life. Empowering adolescents with life skills becomes very important in this scenario to reduce risk behaviours in this vulnerable period and beyond.

The Adolescent Health Strategic Plan is based on a positive adolescent development perspective and tries to improve the competencies and capabilities of adolescents.

As the editors note, “It is vital to include adolescents as partners in improving their own health; however one should not disregard the fact that responsibility for ensuring adolescent well-being also lies with parents, families, policy makers, professionals, and communities.”

They also cited the UNICEF (2004) survey, where 40 percent of in school adolescents felt their parents were not supportive; nearly 50 percent of them had a key worry, 40 percent found that academic pressure is too stressful, 35 percent had poor life skills and 31 percent felt that they lacked skills useful to live in the society.

Nutrition

The publication also stressed that Nutrition had become a major problem in adolescents in Sri Lanka, despite various interventions.

“Accelerated physical growth increases the nutritional requirements of adolescents while unhealthy dietary patterns, appreciation of slim feminine figure by the society and media affect food habits resulting many nutritional problems.

“The school curriculum does include nutrition information for adolescents. Yet, putting theory into practice seems to have many obstacles”, it said.

Asian-American breast cancer survivors benefit from expressive writing

Writing down fears, emotions and the benefits of a cancer diagnosis may improve health outcomes for Asian-American breast cancer survivors, according to a study conducted by a researcher at the University of Houston (UH).

“The key to developing an expressive writing intervention is the writing instruction. Otherwise, writing is just like a journal recording facts and events. Writing a journal can be therapeutic, but often times we don't get the empirical evidence to determine whether it's effective or not,” said Qian Lu, assistant professor and director of the Culture and Health Research Center at UH.

“In my research study, I found long-term physical and psychological health benefits when research participants wrote about their deepest fears and the benefits of a breast cancer diagnosis,” she said.

“Cancer patients, like war veterans in Iraq, can experience post-traumatic stress symptoms. Many times when cancer patients get diagnosed, they face lots of emotional trauma. There's a sense of loss, depression, anxiety; about going into treatment and how they are going to face the future,” said Lu. “They have a lot of emotional events going on in their life.”

In her research, Lu, found little attention paid to Asian-American breast cancer survivor's psychological needs. Previous studies largely focused on non-Hispanic white samples, and she found a need to research this understudied population. Some of the challenges she noted with this population were feeling stigmatised, shame associated with cancer, cultural beliefs of bearing the burden alone to avoid disrupting harmony, suppressing emotions, and a lack of trained mental health professionals with cultural and linguistic competency.

“We thought of a very interesting way to help this problem. It's actually fairly basic. It's to express emotions using writing,” she said. “What's so interesting is that it has been proven as a scientific paradigm.”

According to Lu, previous research found that writing about emotionally difficult events for just 20 to 30 minutes at a time over three or four days increased the immune function. The release offered by writing had a direct impact on the body's capacity to withstand stress and fight off infection and disease.

“I based my study for Chinese-speaking breast cancer survivors on Pennebaker's research paradigm, and we have conducted a series of studies to modify the paradigm for Asian-Americans” said Lu. Rather than going to a hospital, Lu worked with a community-based partner to recruit participants. Lu's research team asked participants to complete a standardised health assessment and then they were asked to write 20 minutes each week for three weeks. Three sealed envelopes were mailed simultaneously to the participants with each envelope containing different writing instructions for the corresponding week. Questionnaires assessing health outcomes were mailed to participants at three and six months after the completion of the writing assignments. Semi-structured phone interviews were conducted after the six-month follow-up.

“The findings from the study suggest participants perceived the writing task to be easy, revealed their emotions, and disclosed their experiences in writing that they had not previously told others. Participants reported that they wrote down whatever they thought and felt and perceived the intervention to be appropriate and valuable,” said Lu.

Lu added that health outcomes associated with the expressive writing intervention include a decrease of fatigue, intrusive thoughts, and reducing post-traumatic stress after three months. She also noted a decrease of fatigue, post-traumatic stress, and the increase of qualify of life and positive affect after six months.

Lu notes this research study contributes to the growing literature of expressive writing by illustrating the feasibility and potential benefits among Chinese-speaking breast cancer survivors using a community-based participatory research approach and a mixed method design. The results of the intervention demonstrate that writing was associated with health benefits at long-term follow-ups and how to adapt and utilise expressive writing intervention for minorities.

MNT

HIV drugs could help prevent Multiple Sclerosis

Drugs taken by HIV patients could also be used to prevent and treat multiple sclerosis, scientists say.

Researchers have discovered that people with HIV have a significantly lower risk of developing MS, a debilitating neurological condition. It is not yet clear whether the lowered risk is caused by the HIV virus itself, or by the antiretroviral drugs taken by sufferers. But if future research shows antiretrovirals to be key, it raises the possibility that they could one day be used to help MS sufferers.

The research was prompted by the discovery of a patient who had HIV and MS, and who stayed clear of any MS symptoms for more than 12 years. An analysis of English Hospital Episode Statistics of HIV sufferers between 1999 and 2011 found a “negative association between HIV and MS” which was “statistically significant”.

Data for more than 21,000 people infected with HIV was analysed and compared against a wider group of more than five million non-HIV patients. Those with HIV were 62 percent less likely to develop MS than those who did not have the virus.

The researchers reported: “If subsequent studies demonstrate there is a causal protective effect of HIV [and/or its treatment], and if the magnitude of it proves to be similar to our rate ratio of 0.38, this would be the largest protective factor yet observed in relation to MS.”

They suggested that the weakening of immune systems in those with HIV “may prevent development of MS” and that “antiretroviral medications” could “suppress other viral pathogens implicated in MS”.

Researchers concluded that having HIV and being on antiretroviral drugs “provided a significant and potentially protective effect”.

- The Independent