Evolution of adolescent mental health in a rapidly changing socioeconomic environment: A review of mental health studies in adolescents in India over last 10 years

Highlights

• Systematic review of mental health studies in Indian adolescents in last 10 years.

• Female gender, academic difficulties, school absenteeism are risk factors.

• Parental fights and strained familial relationships are additional risk factors.

• Interventions using local resources and terminology were successful.

• More studies are needed to establish time trends in psychiatric morbidity.

Abstract

Background

Significant changes in the economic, familial and social support aspects in India have occurred in recent times, making it an interesting naturalistic setting to observe the effects of a dynamic socioeconomic environment on behavioral and emotional disorders in adolescents.

Objective

This systematic review attempts to synthesize and evaluate the available evidence on mental health disorders and interventions in adolescents in India in last 10 years as well as identify conceptual trends and methodological lacunae in these studies.

Method

A systematic search of electronic databases was performed in March 2014 and 27 school and community based studies evaluating behavioral problems, psychiatric morbidity, stress, suicide-related behaviors, depression, anxiety, aggression, self concept in adolescents in India were reviewed.

Conclusion

There is a wide variation in the reported prevalence of psychiatric morbidity and behavioral problems in Indian adolescents. Some of the risk and protective factors are similar to those identified by other International studies in this age group. These include female gender, academic difficulties, parental fights, strained familial relationships, school absenteeism, school dropout and other school related factors. However, there are certain variables that appear to be context specific and need further investigation. These are mother's working status, studying in Government institutions or belonging to a nuclear family as risk factors and praying as a coping skill, parental involvement as a protective factor for psychiatric disorders. The suspected upward trend in the psychiatric morbidity in this age group needs more studies to be established.

Introduction

India's population now exceeds 1.2 billion people. Of these, 243 million people, or 23% of the total population, are estimated to be in the age range of 10–19 years (India UNDAF, 2017a, India UNDAF, 2017b). During last 10 years there have been dramatic changes in the socioeconomic context of the country. These changes include, rapid urbanization (United Nations World Urbanization Prospects, 2003, 2007, 2010), changes in familial structures with 50% of households having 4 or less members (Census of India, 2011a, Census of India, 2011b), rise in literacy levels from 64.8% in 2001 to 74.0% in 2011 (India UNDAF, 2017a, India UNDAF, 2017b), and significant economic growth averaging at 13.7% in last 10 years (Census of India, 2011a, Census of India, 2011b). The economic transformation of the country post liberalization in 1991 has been paralleled by transformation in traditional family relationships. There has been an increase in the number of dual earning nuclear families and greater work demands linked to the increased number of economic advancement opportunities (Deb et al., 2010). This has had its own major consequences. It has resulted in a more materialistic social milieu with a highly competitive environment for children and a rise in expectations of the parents (Kaila, 2005), reduced contact with and support from extended families (Census of India, 2011a, Census of India, 2011b), and reduced parental involvement in children's life (Deb et al., 2010) (Fig. 1). Additionally, the traditional lifestyles have been replaced by modern lifestyles to suit the need of time (Pillai et al., 2008), with a change in cultural identities and a reduced involvement in religious practices (Nakassis, 2010). Such changes in western societies are linked to rising rates of common mental disorders (Bor et al., 2014). These contextual changes provide an interesting naturalistic setting to observe its effects on behavioral and emotional disorders as well as suicidal behavior in adolescents. We undertook a review of community and school-based mental health studies conducted in adolescents in India in last 10 years with an aim of collating the information regarding the prevalence and psychosocial correlates of psychiatric morbidity in Indian adolescents, to identify context specific risk and protective factors for mental illness in this population and to identify any conceptual trends during this period.

There has been an absence of adolescent specific studies conducted in India till very recently. Most of the earlier studies were either restricted to younger children or merged an adolescent population with a younger age group. Such studies reported prevalence rates of psychiatric disorders among children ranging from 2.6% to 35.6% (Lal and Sethi, 1977). In the last 10 years, there has been an increase in the mental health studies conducted in this population.