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.
Mental disorders are a leading burden of disease for adolescents. Yet, data on the prevalence of adolescent mental health conditions remain 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, among others. 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
To address the global lack of data on adolescent mental health, United Nations Children’s Fund (UNICEF), in collaboration with the World Health Organization and other key institutional and academic partners, is leading the development of a suite of tools for Measurement of Mental Health Among Adolescents at the Population Level (MMAP). The principal goal of the MMAP is to enable monitoring of adolescent mental health conditions across countries through a rigorous approach.
Since 2019, the MMAP initiative has been advised by a group of technical advisors on adolescent health, mental health, measurement and household survey experts to work towards closing the data gap.
This work has entailed the following:
1) Developing a list of prioritized key indicators on adolescent mental health;
2) Developing a protocol for transcultural adaptation and gold standard validation processes for adolescent mental health tools at the population level;
3) Implementing the protocol in selected low- and middle-income countries; and
4) Learning from these experiences and creating a new brief module of validated tools informed by data results that can be integrated in ongoing surveys across countries. Fieldwork for transcultural adaptation and gold standard validation of the proposed adolescent mental health tool took place in Belize, Kenya, Nepal and South Africa between 2019 and 2021.
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 with 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. Domains considered in the indicator set include: mental health disorders, specifically, symptoms of anxiety and depression, functional limitations, suicidality (thoughts and behavior), careseeking and connectedness.
Access the list of indicators here
MMAP Technical Advisory Group
The MMAP effort counted with the technical advice of prestigious scholars and experts from a variety of institutions, the MMAP Technical Advisory Group (TAG). The TAG advised the MMAP work in terms of development of protocol, indicators and methodological development during the 2019-2021 period:
MMAP TAG advisors (2019-2021)
- Abiodun Adewuya, Professor of Public Mental Health, Lagos State University College of Medicine, Nigeria
- 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
- Chisina Kapungu, WomenStrong International, Washington DC, USA
- Christian Kieling, Associate Professor of Child & Adolescent Psychiatry, Universidade Federal do Rio Grande do Sul, Brazil
- Brandon Kohrt, Professor of Global Psychiatry, George Washington University, USA
- Vikram Patel, Professor of Global Health, Harvard University, USA
- George Patton, Professor of Adolescent Health Research, University of Melbourne, Australia
- 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, Sweden
MMAP Coordinator: Liliana Carvajal, Statistics and Monitoring Specialist, UNICEF HQ (DAPM/D&A)
MMAP consultant: Jill Witney Åhs, Mental Health/Measurement Specialist, UNICEF consultant
References
Carvajal, L., Harris Requejo, J., Ahs, J. W., Idele, P., Adewuya, A., Cappa, C., Guthold, R., Kapungu, C., Kieling, C., Patel, V., Patton, G., Scott, J. G., Servili, C., Wasserman, D., & Kohrt, B. A. (2021). Increasing Data and Understanding of Adolescent Mental Health Worldwide: UNICEF’s Measurement of Mental Health Among Adolescents at the Population Level Initiative. Journal of Adolescent Health. https://www.jahonline.org/article/S1054-139X(21)00151-8/fulltext
Guthold, R., Carvajal, L., Adebayo, E., Azzopardi, P., Baltag, V., Dastgiri, S., Dua, T., Fagan, L., Ferguson, B. J., Inchley, J. C., Mekuria, M. L., Moller, A.-B., Servili, C., & Requejo, J. (2021). The Importance of Mental Health Measurement to Improve Global Adolescent Health. Journal of Adolescent Health. https://www.jahonline.org/article/S1054-139X(21)00238-X/fulltext
Azzopardi, P., Hijazi, Z., Wulan, N., Requejo, J., Lai, J., Carvajal, L., & Patton, G. (2021). Bringing a Wider Lens to Adolescent Mental Health: Aligning Measurement Frameworks with Multisectoral Actions. Journal of Adolescent Health. https://www.jahonline.org/article/S1054-139X(21)00153-1/fulltext
Hayes, J., Carvajal, L., Hijazi, Z., Ahs, J. W., Doraiswamy, P. M., El Azzouzi, F. A., Fox, C., Herrman, H., Gornitzka, C. P., Staglin, B., & Wolpert, M. (2021). You Can’t Manage What you do not Measure – Why Adolescent Mental Health Monitoring Matters. Journal of Adolescent Health. https://www.jahonline.org/article/S1054-139X(21)00221-4/fulltext
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/
Patel V, Saxena S, Lund C et al. 2018 The Lancet Commission on global mental health and sustainable development. http://dx.doi.org/10.1016/S0140-6736(18)31612-X https://www.thelancet.com/commissions/global-mental-health
Patton G et al. 2018 – Our future: Lancet commission on adolescent health and wellbeing. 2016 Jun 11; 387(10036): 2423–2478.
