THE HEALTH | MARCH-APRIL , 2022

BY DR ROZANIZAM ZAKARIA

Sarah ( not her real name ), a 15-yearold secondary school student who has lost interest in her schoolwork , was not one of them . Her mother took her to the child psychiatry clinic for help instead of bringing her to school on the first day . For the past few months , she had been hiding in her room , skipping meals , staying up late at night and napping all day .

Her mother noticed that she had been irritable , sensitive to comments , and appeared disinterested in everything . She has abandoned her schoolwork , online lessons , and even her best friends . Her mother felt that she needed nothing else at this stage other than psychological help when her friend informed her regarding the good-bye messages that she had sent earlier . This was the red flag . She needed urgent help .

During this pandemic , everyone was suffering from online fatigue from too much distance learning .

The pandemic and its consequences

We are used to seeing groups of colourful and active adolescents hanging around in school grounds , retail malls , recreational parks , and other public places . It ’ s hardly surprising , given that they ’ re at a time in their development where socialising with peers is a key component of their personality development . They learn about connectedness , the value of support , how to model resilience , and , most significantly , it is an excellent antidote to their daily stress through socialisation .

Unfortunately , for a very significant duration , this was no longer a viable option for some adolescents . The Covid-19 pandemic , a global public health crisis , has seen dramatic changes in the landscape of citizens ’ lives .

We faced a series of national quarantine measures , namely

Movement Control Orders ( MCOs ), and cordon sanitaire measures , implemented by the government in response to the pandemic starting on March 18 , 2020 , until the end of 2021 . One of the most momentous impacts of this action was the school closure and the implementation of full online and distance learning , which involved every layer of our education system .

Many people , including adolescents , were caught off guard by these shifts . Family dynamics were disrupted , social connectivity was a major difficulty , and many people experienced various life uncertainties .

These abnormalities have unquestionably contributed to a propensity to various mental health concerns . Mental health issues , such as depression , anxiety , stress , selfharm , suicidal behaviour , substance abuse , and domestic violence are on the rise around the world . These patterns are not new as we have seen them before during previous pandemics and global economic downturns in prior decades .

A meta-analysis of 29 studies including 80,879 youth globally reported that the pooled prevalence estimates of clinically elevated child and adolescent depression and anxiety were 25.2 per cent and 20.5 per cent respectively . What is more worrying is depression and anxiety symptoms during Covid-19 has doubled , compared with pre-pandemic figures . The study also highlighted that the prevalence rates were higher at the later stage of lockdown , in older adolescents and in girls .

What are the signs to look for ?

Two of the most frequent mental health issues among teenagers are depression and anxiety . Early warning indicators can vary based on the child ’ s appearance , developmental stage , temperament , or personality features .

Changes in behaviour , such as social withdrawal and avoiding family and friends ; changes in mood , such as moodiness , irritability , and increased sensitivity ; altered sleep and appetite ; and difficulty coping with academic demands , such as poor concentration , memory , and falling grades , are just a few of the changes that parents should expect to see . They may also have non-specific somatic symptoms , including headaches and stomach pain .

Many physiological conditions can resemble symptoms of mental illness ; thus , these changes may not be exclusive to depression or anxiety . Early diagnosis of these alterations , on the other hand , is critical since it allows for quick detection and intervention if necessary .

Psychological and social stressors can cause depressive symptoms , which include low mood , lack of interest and pleasure in activities and disruptions in biological circles like sleep and food . Biological predispositions such as hereditary factors and medical disease , on the other hand , play an important effect . Adolescents with worrisome tendencies , a history of abuse and trauma , the loss of major social support , low self-esteem , loneliness , and isolation are among those who are at risk .

Anxiety may also affect adolescents in a similar way to depression . Unlike depressive disorders , anxiety may predominantly manifest as physiological disturbances such as heart palpitations , shortness of breath , tremors , sweating , and abdominal discomfort . Adolescents may also be preoccupied with a lot of worrying thoughts , such as fear , doubts , and irresistible apprehension .

Over time , they may become withdrawn socially and discouraged from doing activities they previously had no problem completing . Anxiety may be present in the form of panic disorder , generalised anxiety , or more specific situation-driven anxiety , such as social anxiety and agoraphobia .

One of the main reasons why emotional disturbances in this population need to be addressed early and effectively is because of the chronicity of the problem . An episode of depression can last up to seven to nine months if left untreated , with 40 per cent having a high recurrence rate .

Adolescents with depression also have a high risk of developing another episode of depression in adulthood . Given that 60 per cent of depressive patients have suicidal ideation and that up to 30 per cent attempt suicide , efforts to address these issues must be taken seriously and holistically .

How do we prevent and manage ?

Prevention should be looked at from primary and secondary perspectives . Primary prevention involves all adolescents , where concerted effort needs to be made by every layer , from individuals to policymakers .

This includes consistent psychoeducation for adolescents and all stakeholders to improve awareness regarding this problem . This will in turn reduce the impact of stigma and barriers to treatment that usually contribute to late detection and intervention .

Adolescents need to be taught about the importance of healthy lifestyles , effective stress management , good social support , and how to normalise help-seeking behaviour . Parents need to be supported , educated , and empowered since problematic parenting styles and communication problems within the family usually perpetuate the problem further .

Therapy for depression and anxiety in teenagers includes a wide range of therapeutic approaches , based on the diagnosis , severity level , and risk status . The treatment can be broken down into pharmacological and non-pharmacological components in general .

The use of antidepressants in combination with other psychosocial support is recommended in most guidelines , including those of the American Psychiatric Association ( APA ). This includes general supporting psychological interventions such as teaching the afflicted persons with problemsolving and coping skills .

In most circumstances , more specialised treatment , such as cognitive behavioural therapy ( CBT ) and interpersonal psychotherapy ( IPT ), is also recommended . Most cases would have an excellent prognosis with early treatment , good compliance , and strong support . — The Health

Dr Rozanizam Zakaria is Assistant Professor in Psychiatry , International Islamic University of Malaysia ( IIUM ). He is also Clinical Fellow in Child and Adolescent Psychiatry , Ministry of Health .