Chapter 3 – Factors that help and harm
Researchers have identified various risk factors known as ‘risk markers’, namely their causes and potential effects on children’s mental health. The results of these risk factors vary significantly from child to child since their experiences, and social, economic, and environmental conditions differ. There is a proportional relationship between the risk factors and their causes. As the duration and intensity of these causes increase, so do the risk factors.
Since understandings of mental health vary culturally, researchers, despite gathering large amounts of data, are still limited in identifying common risks to mental health.
Environments can act as both a risk factor and a protective factor for a child, making it hard to generalize understandings of mental health. For example, a school can prove to be an empowering surrounding for a child where he is motivated by his teachers and teaches courses that broaden his personal and academic horizons. However, in the same settings, a child can experience severe bullying, criticism, and trauma, harming their mental health.
However, despite these complexities, this chapter of the ‘The State of the World’s Children 2021’ identifies three critical factors relevant to understanding children’s mental health. These factors are not biological and can easily be changed. Therefore, they must be understood prudently. These include:
• Nurturing care from parents/ caregivers
• External environment
• Relationships with peers (as they grow older)
This chapter navigates through thoughts presented by adolescents in mental health discussion groups directed by the John Hopkins University.
A life-course approach to prevalent mental health risks
Despite the difficulty in obtaining standardized information regarding mental health factors across regions, a team of experts from Universidade Federal do Rio Grande do Sul in Brazil examined standardized data from the Demographic and Health Surveys (DHS), Multiple Indicator Cluster Surveys (MICS), and the Global School-based Student Health Survey (GSHS), in order to find commonalities in the distribution of risk factors across regions. They did so with the aim to develop and implement better interventions and methods to address mental health risks in children. The experts found 23 factors in the perinatal, early childhood, childhood, and adolescent periods of a person’s first two decades. Some of the factors include bullying, child labor, subject to violence, and lack of proper nutrition.
Risk and protective factors: Parenting (the world of the child)
The role of parents is identified as the most critical and primary role in a child’s mental health development. This is the first point of contact of the child. Particularly with regard to how they go on to view themselves and the world around them. Parents can create a safe, protected, and stable environment for a child as well as provide them with opportunities and platforms to grow in the world. However, the limited world of a child expands greatly during adolescence where other external risks enter.
The world around the child
Some of these risks exist in the world, majorly stemming from poverty and conflicts. Most of the time, parents struggle to help adolescents navigate these external risks, making it difficult for children to cope with the world around them.
Part II – Big changes start small
Not spending on mental health costs England alone £16.13 billion a year. There is a lack of priority and initiative at the early stages of a child where violent behavior that later causes widespread damage and aggression can be curtailed at a significantly lower cost if addressed and prioritized from the beginning. The Royal Foundation gives six recommendations to curtail these £16.13 billion losses per year. These include:
1. Raising awareness on the impact of a child’s early years;
2. Building a more nurturing society;
3. Creating communities of support;
4. Creating a workforce that uplifts families of the affected;
5. Gathering and interpreting more data to improve care for children and their caregivers;
6. Promoting long-term changes that provide stable yearly childhood support.
At the start
Low birth weight and malnutrition can adversely affect a child’s mental health as they grow older. High levels of depression, anxiety, shyness, and low cognitive development often result from a mother’s use of drugs and alcohol or early child marriages. Paternal depression during the early years of a child’s development is an additional cause of emotional distress in a child.
Nutrition, physical activity, and body weight
Nutrition is the basic building block of lifelong mental health stability. Lack of proper nutrition acts as a risk factor to the cognitive development of a child, while adequate nutrition serves as a protective factor. To counter the risk factor of inadequate nutrition, nutrition interventions for mothers during their pregnancy such as Calcium, Vitamin A, and Zinc are provided to reduce the risk of low birth weight and malnutrition.
Lack of physical activity and increased screen time in adolescents is a global cause of impeded brain development. One study of adolescents in the United States of teenagers aged 14–18 showed that, for each hour of sleep lost, the changes of feeling sad and hopeless rose by 38 % to 42 %. Warmth, love and affection, adolescent development, respectful communication, positive discipline, safe environments, provision of basic needs, and caregivers’ and parents’ mental health are a few of the factors identified by UNICEF to bolster children’s cognitive abilities development.
Medication and children
Between 2005 and 2012, prescription rates for antidepressants for children younger than 19 are estimated to have increased as follows:
In Denmark: 60.5%
In Germany: 49.2%
In the Netherlands: 17.6%
In the United Kingdom: 54.4%
In the United States: 26.1%
These results indicate that mental health facilities are readily becoming available in many countries and that the youth are increasingly making use of them. However, the high prices of these drugs entail that many children do not often have access to them. Moreover, these drugs merely aid in countering mental health effects but do not address the root cause of the problems, so issues such as violence, poverty, and inequality that threaten children’s mental health ought to be addressed.
Case study: Ireland
MindOut: Social and emotional learning for adolescent well-being
When Ireland developed its National Youth Strategy in 2015, many young people identified mental health as one of the top three issues. MindOut is an evidence-based universal social and emotional learning (SEL) Programme and part of Ireland’s Health Service Executive. It offers an opportunity to target mental health and general well-being issues important to young people in Ireland. MindOut is provided to 15 to 18-year-olds in schools. It is included in the Social, Personal, and Health Education (SPHE) curriculum, a compulsory part of the school curriculum.
MindOut has helped children develop social and emotional skills, including self-awareness, self-management, social awareness, relationship management, and responsible decision-making.
Violence and mental health
Violence has been identified as one of the major causes of mental distress in children. Often, one or more forms of violence can co-exist in the same family, jeopardizing the child’s mental health. Over a billion children between the ages of 12 and 17 are estimated to be exposed to interpersonal violence with consequences including depression, anxiety, suicide, and behavioral and social problems. Preventing exposure to violence in childhood is crucial to promoting mental health. The World Health Organization (WHO) strongly suggests that healthcare providers must consider exposure to violence while examining children’s health, particularly when facing conditions that may be complicated by maltreatment.
* Summarized by Mahnoor Traiq from Risk and Protection section of The State of the World’s Children 2021