CME
GUEST EDITORIAL

Mental health of and substance use by adolescents

Almost 40% of the population of sub-Saharan Africa are between the ages of 12 and 24 years. Adolescence is a time of important biological, physiological, neurological, behavioural and social transitions towards adulthood. This period of transition is characterised by higher impulsivity, increased sensation-seeking behaviour, higher risk-taking behaviours relating to substance use and/or sexual experimentation, an increased sense of self-awareness/invincibility, and a higher importance of social relationships involving partners and peers rather than parents and older siblings. Not surprisingly, the psychological stressors of going through adolescence, coupled with major hormonal, physiological and identity development and peer pressure (to fit in with dominant peer norms), result in enormous stress levels that sometimes lead to a variety of mental health disorders, e.g. inadequate coping and/or support structures.

In much of sub-Saharan Africa, this transition is taking place in the context of increased economic stress, high youth unemployment, high levels of crime, increasing access to information through modern technology, and high levels of rape and gender-based violence, where adolescent girls and young women bear a disproportionate burden. The risk of adolescents experiencing mental health and/or substance use disorders has increased. It is estimated that about 20.0% of children and adolescents experience a mental health disorder, while 5.6% of adults and adolescents have alcohol and substance use disorders. Mental health illnesses and substance use disorders often converge, and many adolescents with mental health illnesses also experience poorer academic performance, higher rates of suicide, violence, substance abuse, pregnancy and psychopathology with ageing. In addition to an increased risk of mental health problems, high rates of alcohol dependence and the early initiation of, or participation in, binge drinking may increase the risk of negative sexual health outcomes by increasing the chances of unwanted pregnancy, risky sexual practices, and gender-based violence. In the context of sub-Saharan Africa, where HIV rates remain high, particularly among young women, mental health and substances use disorders could play a mediating role in further enhancing the risk of HIV infection in this already vulnerable group.

In sub-Saharan Africa, there are critical inadequacies with regard to access to and adequacy of the provision of mental health and/or substance use services, which are more evident in adolescents. In addition to the limitations of the adolescent-friendliness of primary healthcare services, there is often insufficient capacity and preparedness of providers to screen, identify and treat mental health or substance use cases. While treatment for substance use is often through specialised non-governmental and private organisations, there remains a gap with mental health issues, exacerbated by social stigma and shame. Adolescents with mental health problems are less likely to disclose substance use to health practitioners. Specialised and targeted screening of adolescents for these disorders, especially when comorbid, is essential to improve adolescent mental health and substance use outcomes. The vulnerability of adolescents to mental health issues, and the increased prevalence of binge drinking and hazardous drinking habits of young people, not only increase the risk of social problems but may also heighten their risk of HIV infection, highlighting the importance of addressing these issues within the rubric of a holistic wellness service targeted at these young people.

In this issue of SAMJ, two articles highlight the challenges of mental health and substance use - individually and in combination. The article by Paruk and Karim^[1] highlights the importance of psychiatric disorders among adolescents, and notes that despite affecting 20.0% of children and adolescents, this group of young people remains poorly detected and treated suboptimally. The authors describe how the majority of psychiatric disorders experienced by adolescents, including mood, anxiety and substance-related disorders, are often linked to a combination of genetic, behavioural and psychosocial factors. The authors provide ways of screening and treating adolescents, which can easily be built into health services.

The article by Morojele and Ramsoomar^[2] focuses on substance use disorders, in particular alcohol abuse. The magnitude of alcohol abuse among young South Africans is highlighted, as are the risk factors associated with the disorder and its comorbid relationship with mental health problems.

An essential component of ensuring the wellbeing of adolescents is being better prepared with adequately trained staff and facilities to meet the needs of adolescents, including mental health and substance use.

Quarraisha Abdool Karim

Guest editor. Centre for the AIDS Programme of Research in South Africa, Durban, South Africa quarraisha.abdoolkarim@caprisa.org

References

1. ParukS, Karim E. Update on adolescent mental health. SAfr Med J 2016;106(6):548-550. DOI:10.7196/SAMJ.2016.v10616.10943        [ Links ]

2. Morojele NK, Ramsoomar L. Addressing adolescent alcohol use in South Africa. S Afr Med J 2016;106(6):551-553. DOI:10.7196/SAMJ.2016.v106i6.10944        [ Links ]