World Children: Risk Factors Associated With Mental Health

Unicef recently published a report with the title “The State of the World’s Children 2021”

“The COVID-19 pandemic has raised concerns about the mental health of a generation of children. But the pandemic may represent the tip of a mental health iceberg we’ve long overlooked. State of the World’s Children 2021 examines child, adolescent, and caregiver mental health. It focuses on risks and protective factors at critical moments in the life course and explores the social determinants that shape mental health and well-being.

It calls for commitment, communication, and action as part of a comprehensive approach to promoting good mental health for every child, protecting vulnerable children, and caring for the children facing their greatest challenges.” 1


Here you will get the summary of Chapter 4, “The Worl at Large” Section


Poverty is not just about a lack of money – it is multidimensional, involving deprivations in education, health, food, water, and sanitation. The relationship between poverty and mental health can be a two-way street: Poverty can lead to mental health conditions, and mental health conditions can lead to poverty.

The stress of poverty can interfere with caregivers’ capacity to consistently provide positive parenting, as one of the primary effects. Time also matters. The longer a child lives in poverty, the greater the risks to mental health. Poverty can also have a profound psychological impact on children’s and adolescents’ capacity to seek opportunities and realize their dreams. It also affects long-term decision-making, depriving young people’s attention to their immediate needs.

The main elements of poverty, access to opportunity, and income inequality can also impact mental health and behavior. The most common association is between income inequality and depression, as income inequality erodes social trust and social interactions.

Poverty and mental health demand complex and multisectoral responses that protect and promote good mental health. Cash transfer programmers, for example, have shown promising results for educational attainment, use of health-care services, food security, and child labor.


Recognizing the intersectionality of different kinds of discrimination can help highlight interlocking disadvantages that affect the experience of discrimination and mental health.

Gender – Discrimination based on gender can define roles and responsibilities that limit opportunity, restrict behavior, and constrain expectations and self-expression – all of which can affect mental health and, in most societies, puts girls at a disadvantage. Boys also face restrictive gender roles. Harmful concepts of masculinity can hamper boys’ ability to express emotions or seek support.

Race – In general, racism exposes children and young people to discrimination, disadvantage, prejudice, stereotyping, microaggressions, and social exclusion based on race or ethnicity. Experiences of racism can cause a ripple effect through families and communities, transmitting trauma from caregiver to child. The bottom line is this: Tackling racism and the roots of discrimination is essential to safeguarding mental health for many children and young people.

Disability – Far too often, children and young people with disabilities face discrimination based on multiple and intersecting identities. They are often victims of pervasive practices such as segregation from other children and young people, over-medicalization, and institutionalization. Addressing these forms of discrimination demands a human rights model that recognizes the complexity of intersecting forms of discrimination and considers the child’s best interest.

LGBTQ+ – A meta-analysis of mental health for LGBTQ+ young people showed elevated suicide attempts, anxiety, and depression rates. Young people who identify as non-binary can experience worse mental health outcomes, less social support, and a greater risk of abuse and victimization. Especially males are at greater risk of school-based victimization, which affects development.

Indigenous groups– Indigenous groups worldwide also face discrimination-based risks to mental health, facing racism, disparities, etc. A 2018 systematic review of studies from 30 countries and territories found that many indigenous adult populations have elevated rates of suicide compared to non-indigenous people.


The impact of the humanitarian crisis on children’s and young people’s mental health involves a complex mix of risks. Crisis can mean that school is disrupted, poverty, others move in, and children are orphaned or separated from primary caregivers. The specific characteristics of experiences with a crisis can have different consequences, as incidents can accumulate. The result is a dose-effect: the greater the exposure, the greater the risk to mental health.




Surveyed migrants described the dissolution of community and family support networks during transit, disruptions to their education, persistent feelings of limited autonomy, and a lack of viable future career options. The migration experience can cause severe stress, anxiety, and trauma at critical moments of child development. However, children’s and young people’s narratives also show their resilience and a sense of purpose as they pursue aspirations for a better future through migration.




Globally, at least one in seven children has been directly affected by lockdowns. Children and adolescents who faced the most significant mental health risks came from disadvantaged families, had pre-existing mental health conditions, or had a history of adverse childhood experiences. There was a difference in response: girls were at greater risk of depressive symptoms, anxiety, and behavior issues, and boys were at greater risk of substance abuse. Overall, the review indicates that the pandemic did fuel some increases in depression, although, in most studies, these symptoms were only mild to moderate.

Less noticed is that the pandemic may have improved life satisfaction for some children and families by relieving them of school pressure or allowing them to spend more time together.

To conclude, the COVID effects include:

  • Stress and anxiety;
  • Depression and suicidal behavior
  • Behavior problems
  • Alcohol and substance use
  • Lifestyle changes
  • Positive mental health

Digital technologies and mental health

The COVID-19 pandemic brought home, as never before, the digital technologies for a vivid connection with school or entertainment purposes. For many other families, the absence of digital access was never more acutely felt. However, there is a concern about digital technologies among parents and young people. How justified are these concerns? Two key issues, social media and screen time, can help illustrate some of the broader themes in this research.

Overall, there is now a substantial body of research indicating only a minimal association between social media use and mental health, including depression, anxiety, and well-being. There is only limited evidence of a strong association between poor mental health outcomes with screen time. As more of the world becomes digitally connected in the years to come, it’s hard to disentangle offline experiences from those online.

In the focus group discussions directed by JHU, participants described how digital technology was both helpful and harmful to well-being. The main arguments include the impact of social media on self-esteem, cyber-violence, the damaging effect of receiving hurtful comments, and how digital technology helped their mental health.

Digital technology for mental health

Digital technology can be used in capacity-building. Among the promising digital interventions in use is EMPOWER, a digital training platform that uses digital technology to train and provide real-time guidance for community health workers, including nurses, social workers, and midwives.

In addition, digital technology is also being used to provide treatment. For example, computerized cognitive behavioral therapy (c-CBT) can moderately effectively treat depression and anxiety in young people aged 10–24, particularly when coupled with in-person components to encourage adherence.


Climate change will profoundly impact young people’s futures. Extreme weather events such as floods and heatwaves raise food insecurity, water insecurity, and conflicts. In essence, these dangers expose young people to significantly stressful experiences. But will their mental health be affected?


What makes a child or young person resilient in the face of adversity? Evidence shows that resilience is fundamental to mental health. In a cross-cultural study of strength published in 2007, Michael Ungar and colleagues interviewed 89 young people at 14 sites in 11 countries. They concluded that stability requires the ability to navigate seven tensions:

  1. Access to material resources
  2. Healthy relationships
  3. Identity
  4. Power and control
  5. Cultural adherence
  6. Social justice
  7. Cohesion

Evidence has shown that multiple factors combine to bolster resilience and mental health:

  • On cultivating resilience, some themes point to critical elements for action include:
  • The importance of supporting the needs and well-being of parents and caregivers
  • Adopt a multisystem, multidisciplinary approach to equitably providing services that bolster resilience
  • Understand and tailor interventions to multiple diverse contexts
  • Support schools as protective, inclusive environments for child learning and development


Children and young people are deprived of their human rights and subjected to detention and treatment that, in many cases, can undermine their mental health or aggravate an existing condition. Mental distress in such settings may be interpreted as a reflection of underlying mental health issues, although it can often respond to ill-treatment itself. Of particular concern for mental health are the care institutions. There are multiple reports of abuse of children in institutions. There is also extensive evidence of ill-treatment in homes, prayer camps, and religious institutions.

Furthermore, far too often, mental health services perpetuate stereotypes of people with mental ill-health as dangerous. But, people with psychosocial disabilities are much more likely to be victims of violence than perpetrators.


Mental health legislation based on the rights of individuals with mental health conditions is essential. Children and young people with mental health conditions must not only be treated as patients but as individuals with rights, individuals who, under their evolving capacities, can play an active role in their care through direct or supported decision-making. In addition, communication, advocacy, and collaboration are required with community leaders, including faith healers.


By Xhina Çekani



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