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According to the World Health Organization (WHO), a mental disorder is characterized by a clinically significant disturbance in an individual’s cognition, emotional regulation, or behaviour. It is usually associated with distress or impairment in important areas of functioning. There are many different types of mental disorders. Mental disorders may also be referred to as mental health conditions. The latter is a broader term covering mental disorders, psychosocial disabilities and (other) mental states associated with significant distress, impairment in functioning, or risk of self-harm.
Adolescent mental health disorders have a significant impact on the health, education and wellbeing of these young people and the society at large. Mental health disorders in this critical age group have been neglected in the past decades, although evidences have shown that these disorders can prevent adolescents from reaching their full potential as well as participating effectively in their community. The United Nations Children Fund (UNICEF) in its State of the World Children Report for 2021, titled: On My Mind - Promoting, protecting and caring for children’s mental health, stated as follows: “When we ignore the mental health of children, we undercut their capacity to learn, work, build meaningful relationships and contribute to the world.
This statement by UNICEF is very profound because of the widespread suffering mental health problems can cause. Mental health disorders can impair health, as well as educational and societal development. There is therefore an urgent call for prompt and concerted actions in holistically addressing mental health challenges of children with the urgency that it requires; because failing to do so can have dire consequences not only on the affected children, but their families and the society at large.
The prevalence of mental health disorders is higher among young people than persons at any other stage of the development (Aguirre Velasco et al., 2020)3, with up to 20% of adolescents suffering from mental illness. Research suggests that adolescence is a vulnerable stage of development with about 50% of mental health disorders starting before the age of 14 and about 75% before the age of 18 (Aguirre Velasco et al., 2020). Adolescents experiencing mental health disorders often face numerous challenges such as isolation, stigma, prejudice, and difficulty in accessing health services.
It is estimated that more than 13 per cent of adolescents aged 10–19 live with a diagnosed mental disorder. This represents 86 million adolescents aged 15–19 and 80 million adolescents aged 10–14; which disaggregated by sex represents 89 million adolescent boys aged 10–19 and 77 million adolescent girls aged 10–19 living with a mental disorder.
In 2019, 14 million people experienced eating disorders including almost 3 million children and adolescents and about 40 million people, including children and adolescents, were living with conduct-dissocial disorder. An estimated 45,800 adolescents die from suicide each year, or more than 1 person every 11 minutes. Suicide is the fifth most prevalent cause of death for adolescents aged 10–19; for adolescent boys and girls aged 15–19, it is the fourth most common cause of death, after road injury, tuberculosis and interpersonal violence. For girls aged 15–19, it is the third most common cause of death, and the fourth for boys in this age group.
The World Health Organization (WHO) estimates that more than 13 per cent of adolescents aged 10–19 years live with a diagnosed mental disorder. This prevalence amounts to an estimated 166 million adolescents with a mental disorder: 86 million adolescents aged 15–19 years and 80 million adolescents aged 10–14 years. Emotional disorders are the most prevalent in the adolescent age group, representing over 11 percent of the mental health burden. These disorders have significant implications for school attendance and schoolwork. They can also lead to social withdrawal, which can exacerbate isolation, loneliness, and suicidal thoughts. An estimated 45,800 adolescents die from suicide every year, and suicide is the fourth most common cause of death for adolescents aged 15–19 years.
The consequences of failing to address adolescent mental health problems may have a ripple effect that may extend to adulthood, thereby impairing both physical and mental health milestones with attendant dysfunctional development that can limit opportunities and undermine the leading of fulfilling lives in adulthood.
Mental health is a public health problem that is highly stigmatized and has been neglected for several decades in Nigeria. Nigeria currently faces a mental health crisis, especially among her adolescent population. The most common mental disorders in children and adolescents are depressive disorders, with a prevalence of 15-21%, which increases the risk of suicide, moreover in children aged 10 to 19 years, suicide is the second leading cause of death.
Ogbonna et al (2020) in a retrospective assessment of 1255 adolescents within the age of 15–18 years diagnosed with mental illness at the Federal Neuro-psychiatric Hospital, Enugu Nigeria, from 2004 to 2013, reported as follows: the prevalence of mental illness within the 10-year period was 9.9%. Males 752 (59.9%) reported a higher prevalence of mental illness, compared to females 503 (40.1%). Schizophrenia spectrum and other psychotic disorders 384 (76.3%); depressive disorders 20 (4.0%) were more common among female adolescents while substance-related and addictive disorders 84(11.2%) and neurodevelopmental disorders 48(6.8%) were more common among male adolescents; while 90 (7.2%) was due to drug induced psychosis.
DadeMatthews et al. (2024) carried out a study to determine the prevalence and correlates of depressive disorders among 225 senior secondary students aged 12–18 years attending secondary schools in Abeokuta, South West Nigeria. The study was conducted in five randomly selected schools and the GHQ-12 was used to assess the mental health status of the participants. The mean age of the respondents was 15.3 years (SD = 1.27). The males comprised 48.8% of the respondents. The researchers reported a twelve-month prevalence of major depression to be 11.3% while 1.4% of the patients had dysthymia.
A study by Abdulmalik and Saleh (2012)10 titled “Pathways to Psychiatric Care for Children and Adolescents” conducted at a tertiary facility in Northern Nigeria, involving a total of 242 new patients aged 1-18 years (mean=12.3; SD=5.2), who presented at the out=patient clinic of the facility over a 6-month period January – June 2019, reported that the males accounted for 51.7% (125) of the patients. Two thirds (64.5%) of the patients had been ill for longer than 6 months prior to presentation. Majority, 144 of the subjects (59.5%) had received no care at all, while 36.4% had received treatment from traditional/religious healers prior to presentation. The most disabling conditions were ADHD (80%), mental retardation (77.8%), epilepsy (64.1%) with 50% having psychotic disorders.
Mbanuzuru et al. ((2021) in their cross-sectional analytic study involving a total of 1187 urban and rural in-school adolescents in Anambra State (South-East Nigeria), used the Nigeria. A total of 1187 secondary school adolescents in government-owned schools in Anambra State used the Patient Health Questionnaire-9 (PHQ-9) to study depressive disorders among the respondents. The mean age of the participants was 15±2 years and the overall prevalence of depression was 12.5%, with a significantly higher prevalence of depression observed among urban participants compared to their rural counterparts (14.5% versus 9.6%).
Many factors contribute to the high prevalence of mental health problems among adolescents in Nigeria, which include socio-economic and cultural circumstances, family disharmony, substance abuse, stress from peer pressures, violence -especially sexual violence and bullying. Most importantly, poverty and joblessness create significant stress for adolescents and their families, which can result in increased school drop-out rates, loss of focus and the tendency to engage in high risk behaviours that are deleterious to their mental health. The sense of hopelessness resulting from an inability to keep pace with their contemporaries, can create a sense of anxiety or depression.
Confronted with this unprecedented upsurge in the global mental health burden, the World Health Organization in recognition of the essential role of mental health in achieving health for all people, initiated the WHO’s Comprehensive Mental Health Action Plan 2013-2030. The plan includes 4 major objectives:
These are laudable intervention strategies, realistic and feasible; however, it would require the willingness and commitment of the governments of member nations to adopt both the letter and spirit of this initiative and to ensure its full implementation. For resource constrained countries like Nigeria, that have committed to implementing this initiative there would be need to prioritize the interventions that can be implemented in the short, medium and long term within the limits of available resources.
Schools are seen as an important platform for promoting mental well-being during the developmental stage of adolescence where adolescents are most vulnerable. It has therefore been asserted that schools are a natural and veritable environment for nurturing adolescents, and the integration of health and other related services within the education system can facilitate the identification of latent and emerging mental health problems, thereby providing a conducive platform for the crucial early detection, intervention and support required.
The various studies conducted in these geo-political zones of the country highlight the need to focus on the mental health of adolescents by creating awareness on mental health issues, the predisposing risk factors preventive measures for mitigating these risks factors and the adoption of strategies for the promotion of sound mental health among children and adolescents in Nigeria. The high prevalence of mental disorder among children and adolescents in Nigeria is also a call for the introduction of child and adolescent psychiatric health services in the study setting.
The adoption of implementation strategies that are tailored to the ever-evolving needs of today’s youth is very apt. These interventions could include school-and community-based mental health literacy programs, the use of dramas and role play, as well as community dialogues. There is also an urgent need to extend mental health services into the community so as to improve access to care and increase awareness about effective and affordable interventions.
The pervasive stigma and discrimination surrounding mental illness in Nigeria often construed as a curse or plague to be avoided can pose a serious barrier that can hinder or discourage adolescents with mental health problems from seeking early care, thereby fostering the age-long culture of silence around mental health issues prevalent in the contemporary Nigerian religious, social and cultural contexts. There is need therefore to address the mental health problem in Nigeria holistically, taking cognizance of the different factors that impinge on mental health issues including the religious and socio-cultural dimensions.
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