Adolescence is a critical stage in the life course, shaping the chances of a productive and fulfilling future for girls, boys and the societies they live in. Investments in adolescents can improve their lives today, tomorrow as they mature into adults, and can have positive effects on the next generation of children. The Maternal, Newborn, Child and Adolescent Health (MNCAH) team in the Data and Analytics Section at UNICEF-HQ takes a comprehensive approach to adolescent health and well-being. We have expanded our areas of focus from reproductive and maternal health issues to include mental health and well-being, injuries, and risk factors for non-communicable diseases and other poor health outcomes (e.g., lack of physical activity, tobacco, alcohol and drug use). One area of innovative work that we are leading on is a methodological approach to measure adolescent mental health at the population level.
Measuring sensitive topics – the case of adolescent mental health
Mental disorders are a leading burden of disease for adolescents. Yet, data on prevalence of adolescent mental health conditions remains sparse, especially in low- and middle-income countries (LMICs). These data are urgently needed to guide strategic actions to address the burden of mental health problems among adolescents through effective policies and programs. The consequences of not addressing adolescent mental health conditions include the risk of suicide, which is currently a leading cause of mortality among boys and girls aged 15-19, lower uptake of sexual and reproductive health interventions, and lower educational achievement. Longer term impacts of neglecting adolescent mental health range from reduced opportunities for girls and boys to individually lead meaningful, happy lives as adults, to broader social consequences, including higher rates of unemployment, drug use and exposure to violence.
Addressing the adolescent mental health data gap
UNICEF is working to fill the gap on information on the prevalence of adolescent mental health conditions by designing a data collection tool to capture data on adolescent mental health at the population level . Since 2018 we have been working closely with technical and household survey experts to: 1) design a conceptual framework and develop a list of prioritized key indicators on adolescent mental health 2) identify existing validated tools to capture information on mental health, and 3) adapt these tools to create a new brief module of validated tools that can be used at the population level. Field work for validation of the tool has taken place in Belize and is in progress in South Africa and Kenya.
Adolescent mental health Indicators
An important priority of measurement for adolescents’ mental health at the population level has been the development of a priority set of indicators. This has been done through a process that included literature review and consultations with stakeholders bringing together the voices and expertise of over 40 experts in the field of adolescent health, child psychiatry, epidemiology, gender, and youth-focused programming. A technical advisory group was assembled, to refine and carry forward the process, incorporating support and evidence from the literature, experience and existing indicators. Guided by a set of priority attributes, the following set of indicators was refined over subsequent consultations. The indicator selection was also discussed during the February 2020 meeting of the Global Action for Measurement of Adolescent health (GAMA) Advisory Group. (for additional information about GAMA’s role refer to this commentary).
These indicators are a preliminary list and are in the process of being tested through a rigorous validation process.
MMAP Technical Advisory Group
The MMAP effort has counted with the technical advice of prestigious scholars and experts from a variety of institutions:
Abiodun Adewuya, Professor of Public Mental Health, Lagos State University College of Medicine
Claudia Cappa, Senior Adviser, Statistics and Monitoring, Data and Analytics Section, UNICEF
Regina Guthold, Maternal, Newborn, Child and Adolescent Health and Ageing (MCA) Department, WHO
Christian Kieling, Associate Professor of Child & Adolescent Psychiatry, Universidade Federal do Rio Grande do Sul
Brandon Kohrt, Professor of Global Psychiatry, George Washington University
Vikram Patel, Professor of Global Health, Harvard University
George Patton, Professor of Adolescent Health Research, University of Melbourne
David Ross, Maternal, Newborn, Child and Adolescent Health and Ageing (MCA) Department, WHO
Catherine Sebastian, Mental Health Priority Area,The Wellcome Trust
James Scott, Professor of Psychiatry; QIMR Berghofer Medical Research Institute, Australia
Chiara Servili, Department of Mental Health and Substance Use, WHO
Danuta Wasserman, Professor in Psychiatry and Suicidology, Karolinska Institutet
MMAP Coordinator: Liliana Carvajal, Statistics and Monitoring Specialist, UNICEF
MMAP consultant: Jill Witney Åhs, Mental Health/Measurement Specialist, UNICEF consultant
References
[i] Patton G et al. 2018 – Our future: Lancet commission on adolescent health and wellbeing. Lancet. 2016 Jun 11; 387(10036): 2423–2478.
[ii] World Health Organization 2017 Global Accelerated Action for the Health of Adolescents (AA-HA!): guidance to support country implementation. https://www.who.int/maternal_child_adolescent/topics/adolescence/framework-accelerated-action/en/
[iii] Patel V, Saxena S, Lund C et al. 2018 The Lancet Commission on global mental health and sustainable development.
Lancet. 2018; (published online Oct 9.) http://dx.doi.org/10.1016/S0140-6736(18)31612-X
[iv] UNICEF. 2019. Measurement of Mental Health Among Adolescents at the Population Level (MMAP). Overview document https://data.unicef.org/resources/mmap-august-2019/
