Adolescent Mental Health: Understanding and Supporting Teen Well-being

 Immediate Past Chairperson –Indian College of
OB/GY-ICOG
 National Corresponding Editor-Journal of OB/GY of
India JOGI
 National Corresponding Secretary- Association of
Medical Women, India
 Joint Secretary-Indian Menopause Society
 President –ISOPARB Vidarbha Chapter 2019-21
 Chairperson-IMS Education Committee 2021-23
 Chairperson-fertility enhancement Committee-
ISOPARB
 Member-SAFOG Education Committee
 President-Association of Medical Women, Nagpur
AMWN 2021-24
 Senior Vice President FOGSI 2012
 President Menopause Society, Nagpur 2016-18
 President Nagpur OB/GY Society 2005-06
Dr. Laxmi Shrikhande
MBBS; MD(OB/GY);
FICOG; FICMU; FICMCH
Medical Director-
Shrikhande Fertility Clinic
Nagpur, Maharashtra
 Nagpur Ratan Award @hands of
Union Minister Shri Nitinji
Gadkari
 Received Bharat excellence Award
for women’s health
 Received Mehroo Dara Hansotia
Best Committee Award for her
work as Chairperson HIV/AIDS
Committee, FOGSI 2007-2009
 Received appreciation letter from
Maharashtra Government for her
work in the field of SAVE THE
GIRL CHILD
 Delivered 22 orations and
450 guest lectures
 Publications- 42 National &
21 International
 Sensitized 2 lakh boys and
girls on adolescent health
issues
Awards
Positions

Mental health in Adolescent
Dr Laxmi Shrikhande
Consultant-Shrikhande Hospital & Research Centre Pvt Ltd
NAGPUR

The WHO constitution states:
"Health is a state of complete physical, mental and
social well-being and not merely the
absence of disease or infirmity."
What is mental health?
 Mental health includes our emotional, psychological, and social
well-being.
 It affects how we think, feel, and act.
It also helps determine how we handle stress, relate to others,
and make healthy choices.

Children and adolescents constitute approximately 40% of our
national population, which is approximately 300 million.
On one hand, it is a phase of tremendous growth in preparation
of adults’ roles and skills to sustain pressures and challenges,
whereas on the other, it is transition phase that can increase
risk of various psychological disorders, adjustment problems,
and suicide.
Positive and promotive mental health in this period ensures a
smooth progress to later adult life.

Future impact
These include future emergence of mental health illnesses such
as depression, anxiety and substance use disorders.
It has an adverse impact on academic performance and
functional outcomes into adulthood.
Violence, aggressive behaviour, child safety/abuse and
excessive use of gadgets, gaming disorders etc, are the
contemporary issues in this vulnerable age group need
immediate public health attention.

Common Child and Adolescent Psychiatric
Disorders
The common child and adolescent mental health issues may be
broadly classified into three groups:
a) Neuro-developmental disorders: Intellectual Developmental
Disorder, Speech and language-related disorders, Autism spectrum
Disorder (ASD), Specific Learning Disorder.
b) Emotional disorders: Depression, Anxiety spectrum disorders
(generalised anxiety disorder, separation disorder, phobias),
somatoform disorders and conversion disorder.
c) Behavioural disorders: Attention deficit hyperactivity Disorder,
Oppositional disorders, and conduct disorders.

Emotional disorders
In milder forms, these experiences are helpful to
the child’s healthy growth.

Adolescent Mental Health: Understanding and Supporting Teen Well-being

Emotional disorders
3. Conversion Disorder:
Conversion disorder refers to a clinical condition in which the child
presents with loss of function, or altered function or dysfunction of one or
more bodily parts with no explainable medical cause; rather associated
with a psychological cause.
This is a common condition among children and adolescents in India.
The most common symptoms are pseudo-seizures, fainting spells (attacks
of unresponsiveness), and abnormal movements (shaking of the limbs,
tremulousness, hyperventilation).
Motor weakness, aphonia, amnesia and possession attacks are less
common clinical presentations.

Emotional disorders
4. Somatoform disorders:
Somatoform disorders are characterized by recurrent physical
symptoms (gastrointestinal, pain related, neurological) that
cannot be explained by a medical condition.
The most common somatic symptoms are head-aches, recurrent
abdominal pain, and Musculo-skeletal pain.
These conditions are usually associated with
psychological/emotional issues; however they are not
intentionally produced by child.

Eating disorders
Eating disorders, such as anorexia nervosa and bulimia nervosa,
commonly emerge during adolescence and young adulthood
mostly in females

Self-injury and suicidal behaviour in
adolescents
Self-Injury
Self-injury (SI) means deliberate destruction or alteration of
body tissue without suicidal intent”.
It can also be described as Non-suicidal self-injury.
Self-cutting (SC) is the most common method of SI; other
methods are biting, carving, scratching, pinching, burning, head
banging and hair pulling.
It is more common in females than in males.

Self-injury
Consequences of SI
1. Long term consequences: in a small number of adolescents the SC
behaviour may become repetitive and persistent. This group of children
need continued care from mental health professionals.
2. Medical consequences- Increased risk of blood-borne disease
transmission in adolescents who attempt self-cutting, especially with shared
use of sharp objects
3. Impact on parenting: Caring for an adolescent indulging in SI behaviour is
difficult and tends to have huge negative emotional impact on caregivers.
Negative emotions like sadness, shame, embarrassment, shock,
disappointment, self-blame, anger, and frustration are common among
parents, due to their child’s SI behaviour.
SI in adolescents affects parents’ employment, their usual life style, and
family dynamics in a negative way.

Suicidal behaviour among adolescents
Suicidal behaviour in children can be differentiated from other
forms of self-injury by the presence of intent to die in suicide.
Among adolescents prevalence of moderate to high suicidal
risk is about 1.3%.
Suicidal behaviour in adolescents cannot be pinpointed to a
single cause.
It is rather due to interplay of multiple biological and psycho-
social risk factors in a vulnerable/ stressful situation.

Risk factors for Suicide among
adolescents:

Protective factors against suicide
These are focus areas which should be strengthened to reduce the
risk of suicide. Some of these include:
1) Positive family environment- with positive regard, warm and loving
environment, healthy parent- adolescent interaction
2) Good social support- including friends, teachers and community
support
3) Good problem-solving skills and conflict resolution
4) Access to mental health care services - providing opportunity for
psychological support and early management of depression, anxiety
and substance use disorder
5) Cultural and religious beliefs which discourage suicide

Substance use in children and
adolescents
How big is the problem?
World Health Organisation (WHO) has estimated that globally, 25 to 90
percent of children and adolescents have ever used at least one substance
of abuse.
The most common substances ever used by children in this study were
Tobacco (83.2%) and alcohol (67.7%), followed by cannabis (35.4%),
inhalants (34.7%), pharmaceutical opioids (18.1%), sedatives (7.9%) and
heroin/smack (7.9%).
A significant proportion of injectable substances (12.6%) were also found.

Substance use in children and
adolescents

Impact of social media on adolescent mental
health

The influence of social media on
adolescent mental health
In recent times, the emergence of social media platforms has
indelibly altered the landscape within which adolescents
navigate these critical transitions.
Social media, with its expansive virtual realms, has ushered in
unprecedented ways of communication and interaction,
dramatically altering the dynamics of relationships and self-
presentation.
Adolescents increasingly find it difficult to picture their lives
without social media.

Cyberbullying and its impact
The emotional consequences of cyberbullying are profound and far-
reaching.
Victims of cyberbullying often experience heightened levels of stress,
anxiety, and depression
Addressing the menace of cyberbullying requires a multifaceted
approach.
Schools, parents, and policymakers must collaborate to implement
stringent anti-bullying measures, educate adolescents about
responsible online behavior, and create safe reporting mechanisms
for victims.
Online complaint

Body image concerns and social media
The advent of social media platforms has ushered in an era of unprecedented
visual exposure, which has in turn significantly influenced body image
perceptions among adolescents.
Social media platforms are flooded with images that project idealized and often
unrealistic body standards.
Adolescents are bombarded with pictures of perfectly sculpted bodies, flawless
skin, and curated appearances that propagate a narrow definition of beauty.
This relentless exposure cultivates an environment where young individuals
internalize these unrealistic standards, leading to heightened body dissatisfaction
and a skewed self-perception
Adolescents who internalize these unrealistic beauty ideals are at a higher risk of
developing body dimorphic tendencies, low self-esteem, and symptoms of
depression and anxiety.

Fear of missing out (FOMO)
The pervasive nature of social media platforms has given rise to a unique
phenomenon known as the Fear of Missing Out (FOMO), which
contributes significantly to feelings of inadequacy and anxiety among
adolescents.
FOMO is driven by the incessant updates and posts on social media
platforms that showcase peers’ activities, experiences, and social
interactions.
Adolescents experience a gnawing fear of being excluded from the events
and moments that others seem to be enjoying.
The constant stream of images depicting social gatherings, outings, and
adventures can make adolescents feel left out and disconnected.
The implications of FOMO on adolescent mental health are far-reaching.
The fear of being excluded can evoke feelings of loneliness, inadequacy,
and sadness.

Social media Addiction and
Mental health
The rise of social media addiction has sparked concerns about its impact
on adolescent mental health.
The allure of social media lies in the instantaneous gratification it offers
through notifications, likes, and comments.
This constant feedback triggers dopamine responses in the brain, creating
a reward loop that fosters addictive behaviors.
Excessive social media use can lead to a neglect of real-world
relationships, hinder academic performance, and exacerbate feelings of
social isolation.
Moreover, the addictive cycle can disrupt sleep patterns, impact
concentration, and contribute to heightened stress levels.

Healthy use of digital technology
for children and adolescents
Current trends of mobile phone usage in adolescents
In India, 95% of Indian children live in a household with mobile phones and
at least 76% of children in the range of 7-11 years have access to mobile
phones.
Most adolescents own their own handsets by the age of 16 years.
Indian adolescents use mobile devices for at least 2 hours a day.
In India, there are at least 800 million mobile users of which 36% use
smart-phones.

Positive impacts of digital technology
Tool for communication with family, friends, and improve social
connections.
Many educational apps and videos
As a medium to supervise the child’s whereabouts and can be
immediately contacted in case of any emergency, thus providing a
sense of safety.
These digital spaces offer a sense of belonging, where individuals
can share their experiences, fears, and triumphs without fear of
judgment.
Social media also serves as a powerful platform for mental health
awareness campaigns.

Assessment of Emotional Disorders:

Assessment of child/adolescent:
Both clinical interview and observation of the child are necessary in
assessing for mood state/ irritability/ fears / anxiety / psychological wellbeing
and overall nature of the child.
 Is often feeling sad and irritable, easily annoyed?
Is often unhappy, dejected or tearful?
Has lost interest in or enjoyment of activities?
Has many worries or often seems worried?
Has many fears or is easily scared?
Often complains of headaches, stomach-aches or sickness?
 Avoids or strongly dislikes certain situations (e.g. separation from parents,
meeting new people, or closed spaces)?

Assessment of family and related risk factors:
Poverty and parental job loss
Family dysfunction / Marital discord in parents / divorce / Single
parent
Parental mental illness: History of mental illness, substance
abuse
Relationship between child and parents: Parent–child conflict,
poor communication
Significant loss: e.g., death of a parent, sibling, or friend;
separation from parents

Assessment of school
environment/academics/peer groups and
related risk factors:
School refusal / academic difficulties / high academic
expectations
Bullying, corporal punishment and discrimination etc.
Conflict with peers; romantic relationship issues, experience of
insult
Academic setbacks, upcoming exams

Assessment to rule out medical/ physical
conditions:
Rule out any signs/symptoms suggestive of:
Thyroid diseases/ other endocrine disorders
Nutritional disorders: Anaemia, vitamin deficiencies
Chronic medical conditions
Malnutrition and any other medical/neurological
conditions

Management: emotional disorders
Psycho education of child and parents:
Psycho-education should be done early and thoroughly.
The parents and child should be psycho-educated regarding the
nature of illness, diagnosis, severity, factors contributing to the
occurrence of disorder and management plan.
For milder form of EDs, only psychological interventions are provided.
For moderate to severe condition, both pharmacological and
psychological interventions are preferred.
The treatment process usually lasts for weeks to few months and
most children with these disorders recover well.

Pharmacological management:
Selective serotonin reuptake inhibitors (SSRI’s) are safe to use
in children above 12 years and adolescents.
Fluoxetine and Escitalopram are most commonly used for
treating anxiety disorders and depression.
The child and parents should be explained regarding the
treatment targets, effects, and side effects.
The symptom severity should be assessed at baseline, and
progress should be monitored during follow-up- to look for
response and side effects.

Child-focused psychological interventions
Cognitive behavioural therapy (CBT) is the preferred psychological
intervention for EDs, especially for depression and anxiety disorders.
 In this, the therapist helps the child to recognize and unlearn unhealthy
behavioural and thinking patterns, which lead to occurrence and
maintenance of negative emotional state.
Further, the child will be guided to learn healthy thinking patterns and
healthy behaviours.
In Indian context, parents can also be involved in the therapy process as
co-therapist(s) to impart necessary training to the child.
Especially in adolescents who lack emotional regulation and interpersonal
sensitivity, dialectic behavioural therapy has been found to be effective.
 These psychological therapies are conducted by psychologists/
psychiatrists.

For Conversion and Somatoform disorder:
Family should be educated that child has real symptoms and sufferings,
but the reasons could be psychological and not physical
Reassure parents/ caregivers- educate caregivers about non-life-
threatening nature of illness
Parents should be guided to acknowledge the child’s symptoms and to
reassure the child
Encourage the child to return to normal daily activity and school.
Encourage the child to talk to his parents about his feelings, thoughts and
concerns.

Barriers in the Service Delivery
Stigma about mental health and lack of education and
awareness forms one of the factors for seeking psychiatric
consultation.
In India, only one-third of the families (37.5%) of children and
adolescents with mental disorders perceived that their children
had any psychiatric problem.

Role of Parents
Positive parenting and a supportive family environment
will positively impact mental health development in
children.

Role of Schools
After the home, schools are the best place to promote mental health.
Teachers can serve as gatekeepers to mental health issues among
students.
Sensitization and training of teachers and counsellors to handle
adolescent mental health issues can further help in early identification of
mental health problems.
Management of academic difficulties in school - Teachers should focus on
strengths of the child in other areas to encourage holistic development and
promote self-esteem
Adolescent health education programmes- It is important to educate
adolescents about safe sexual practices, consent and boundaries in
intimate relationships and responsible decision making.

Role of schools
School bullying
Bullying is very common in many schools throughout the world.
Many children who are bullied may suffer from depression and anxiety as
well.
Schools should be encouraged to have a zero-tolerance policy towards
bullying.
Playgrounds should be well supervised and a system can be in place
wherein children can report episodes of bullying anonymously.

Types of bullying
Physical bullying- consists of any type of physical violence, no
matter how small. This type of bullying makes up 30.5% of
school bullying.
Verbal bullying- name calling, teasing, making fun of others,
and threats of violence. 46.5% of bullying incidents in school.
Cyber bullying- most dangerous type of bullying as it can be
done anonymously. many mediums such as email, text
messaging, and social networks such as Facebook .consist of
threats of violence, verbal abuse, and spreading false
information for the purpose of embarrassing someone or hurting
their reputations.

Life skills training
• The World Health Organization (WHO) defines Life Skills as “‘adaptive and positive
behaviour that enable individuals to deal effectively with the demands and challenges of
everyday life.’
• Core life skills include:

Life Skills
For whom - All children are meant to acquire life skills.
By whom – It can be used by all persons who work with children,
including doctors, teachers, counsellors, child protection staff,
special educators i.e. persons working with children in
education, health and welfare agencies.

The General Role of the Obstetrician–
Gynaecologist
Obstetrician–gynaecologists should ask about any mental
illness diagnoses and treatments, especially medications and
family history, and coordinate care with the patient’s mental
health care providers.
Obstetrician–gynaecologists who care for minors should be
aware of federal and state laws that affect confidentiality, state
statutes on the rights of minors to consent to health care
services, and the regulations that apply to their practice.

National Policies and Programmes:
The National Mental Health Programme envisioned scaling up of
mental health care services in the country.
A gradual shift in the focus of the national health programmes from
nutrition and infectious diseases to developmental needs, life skills,
and general wellbeing of children and adolescents.
 National Programmes like Rashtriya Bal Swastha Karyakram
(RBSK), Rashtriya Kishore Swastha Karyakram (RKSK),Kishori
Shakthi Yojna increasingly focus on developmental and mental
health care needs.

Key Take Aways
Increasing prevalence of mental health disorders such as anxiety, depression, drug
abuse, social media addiction and eating disorders among adolescents.
Mental health issues during adolescence can have long-term consequences on physical
health, educational outcomes, and socioeconomic status in adulthood.
Parents & teachers play Crucial in promoting positive mental health.
We also have a significant role as we get Opportunity to identify and address mental
health concerns early
We can encourage open communication and provide a non-judgmental space for
adolescents to discuss mental health issues.
Understanding and addressing unique challenges faced by adolescent girls, including
body image issues, menstrual health, and sexual health.
Preventive measures such as stress management techniques, healthy lifestyle choices,
and resilience building by life skill training to all adolescents.

My World of sharing happiness!
Shrikhande Fertility Clinic
Ph- 91 8805577600 / 8805677600
shrikhandedrlaxmi@gmail.com

The more you give, the more you
will get.
Then life will become a sheer
dance of love.
H. H. Sri. Sri. Ravishankar
The Art of Living

Adolescent Mental Health: Understanding and Supporting Teen Well-being

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