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Abstract

The number of adolescents with mental disorders is becoming a worldwide problem, since it has an influence not only on the health of this generation while they are still in this age group but also on their health as adults. The objective of this review aimed to focus on mental health problem and health promotion program among adolescents. The significance of mental health promotion and intervention programs in enhancing adolescents’ well-being and reducing mental health problems is highlighted in this study. There is an opportunity to apply a whole-school strategy with online curriculums. In the digital era, smartphone applications, social networking sites, and the Internet play an important role in daily life, there is an opportunity to develop a mental health promotion program. In addition, through the implementation of evidence-based programs, schools have been placed at the frontline of promoting positive mental health and well-being. The recommended intervention programs can be implemented in a variety of settings, including schools and communities, as well as through digital platforms. Therefore, adolescents’ mental health problems can be mitigated by using effective mental health promotion programs.

Keywords

Mental health adolescents mental health promotion

Adolescence is characterized by changes in biological hormones, social environment, and brain and cognition changes. Adolescence can be defined as the period of development from childhood to adulthood at ages 10 to 19, which is influenced by personal development and cultural norms.¹ There is pervasive approvement that adolescence starts at puberty and ends with the uptake of mature social positions, such as child rearing and employment.² While the significance of healthy early childhood development has received much attention, the adolescent years are a unique time in their own way.³ The capacity of adolescents to decide things and take responsibility for one’s actions should not be ignored, particularly if they are well educated. Getting involved to support positive health decisions throughout adolescence thus has the potential to reduce the risk of developing a health problem later in life, potentially improving future health-care service and resources. Understanding the complicated mental changes in adolescence that occur within their body during this time, as well as the association between these changes and health-related behaviors, is the first step toward recognizing adolescence as a transitional period that requires special attention. These information can help to develop intervention programs.⁴

The COVID-19 pandemic has brought up significant changes in the lives of adolescents. Social distancing regulations have restricted adolescent interaction with others, potentially increasing isolation and loneliness.^{5, 6} Furthermore, emerging evidence suggests that adolescent psychopathology has grown throughout the COVID-19 pandemic.⁷ Mental health services for young people, particularly in schools, colleges, and institutes, have been greatly interrupted.⁸ Closures of educational institutions at all levels have led to the deterioration of protective factors, such as daily routines and social contacts that help in the maintenance of healthy mental health.⁹ Adolescents should prioritize more mental health support, such as education, mobile phone, or online services, and easier access to face-to-face services.¹⁰ Therefore, it is important to conduct research on mental health promotion and to offer support to distressed adolescents. Long-term monitoring and an intervention program for adolescents’ mental health and well-being are also required.

Mental Health in Adolescents

Mental health is a condition of well-being in which a person appreciates his or her own abilities, can cope with the usual life stresses, can work productively and fruitfully, and can contribute to her or his community.¹¹ Psychological problems in adolescents are a burden for individuals, their families, and social environment that can extend over the lifespan. There is raising evidence and awareness of the prevalence of mental health difficulties, which affect half of the people prior to the age of 14 and have long-term implications on individuals and community.¹² More than half of mental disorders arise in adolescence. Mental health problems affect 1 out of 7 people (10-19 years old) in the worldwide, accounting for 13% of global burden of disease. The problems more likely go unrecognized and are untreated most of the time.¹³ It is approximately that 10% to 20% of adolescents suffer from psychological problems, with a large number of others experiencing symptoms that have negative outcome on their well-being.¹⁴ Understanding the emotional, social, and physical changes during adolescence is necessary in order to develop programs and treatments that support the mental health of adolescents around the world and help prevent mental illness before it begins.¹⁵ The prevalence of young people suffering from mental health difficulties has risen significantly.¹⁶ Family breakdown, rising unemployment, and increasing academic and occupational pressures have all contributed to psychological problems.¹⁷

Moreover, social isolation, stigma, discrimination, educational struggles, risky behaviors, and physical illness are all linked to adolescents with psychological disorders. During adolescence, many mental health issues become apparent.¹⁸ Mental health issues can interfere with a young person’s social, cognitive, and emotional development. In the worst-case scenario, it might lead to death. Suicide is a public health concern in many countries.^{19, 20} Suicides among young people account for one-third of all suicides worldwide and are the second highest cause of mortality in this group.²¹ Adolescent mental health problems are influenced by a range of factors such as family conflict,²² loss of supportive friendships or family relations,²³ bullying,²⁴ sexual harassment,²⁵ and child abuse by parents.²⁶ Adolescents are more likely to experience unfavorable consequences on their mental health if they are exposed to a higher number of risk factors.²⁷ Mental health problems of young people can be difficult to detect, treat, and follow-up. It should be recognized that mental health problems can be complicated, involving sufficient funding and contribution beyond family and school.²⁸ Therefore, considerable efforts in the fields of mental health promotion are urgently needed.

Health Promotion

Health promotion is a process that empowers people to change their own lifestyle and behavior, as well as supports and creates environments that encourage healthy living.²⁹ Integrating health education with economic, environmental, and organizational support can help people and communities adopt healthier lifestyles.³⁰ Health promotion seems to be the art and science of helping people, enhancing their motivation to seek better health, and supporting them in changing their behavior to reach optimal health.³¹ Health promotion has a holistic approach of promoting health intervention to stimulate health and well-being.³² The World Health Organization defines health promotion as the process of empowering individuals to gain more control over and improve their health in order to attain a condition of complete mental, physical, and social well-being.³³

A significant feature of health promotion is that it empowers persons to improve and control their health.³⁴ Health promotion provides a more complicated approach to promoting health by involving several parties and focusing on multisectoral methods. Health promotion has a wide broader perspective. Health promotion is a process that no longer focuses only on health, but rather on the health and well-being of people as well as society as a whole.³⁵ Health promotion should be holistic, including health advocacy to enhance health status, as well as empowering and enabling people to reach their full health potential.³⁶

The majority of health promotion extends over the bounds of personal contexts; the empowerment idea is especially vital among young people when it comes to promoting their health.³⁷ Several of the health promotion approaches used for adolescents are similar to those applied for adults. Adolescent health promotion refers to strategies such as promoting adolescents’ health, preventing illness, and fostering equity within a framework of long-term development. This includes enabling and making adolescents’ voices represented, evaluating health demands, conducting a variety of health intervention programs, viewing adolescents in the context of their communities and families, and working with a diverse group of persons and organizations. Adolescent health promotion should contain 5 components, according to the Ottawa Charter for Health Promotion:

Creating healthy public policy that brings adolescent health issues into consideration.

Providing friendly environments that inspire young people to make healthy choices.

Strengthening communities to help young people feel secure and have a sense of equity.

Obtaining appropriate health information that promotes their physical, emotional, and social development through the development of personal knowledge and skills needs.

Reorienting health services to make things easier for adolescents to access and use care services.³⁸

Mental Health Promotion

The concept of mental health promotion is based on the Ottawa Charter’s definition of health promotion. Mental health promotion has a similar purpose in that it focuses on building capacities and competencies for well-being rather than on sickness and its risk factors. Mental health promotion also advocates a population-based approach that considers the many influences of health determinants. Promoting mental health emphasized strengthening peoples and communities’ abilities, skills, and facilities to give them greater control over their mental health and its determinants.³⁹ Mental health promotion differs from health promotion in 2 ways: power and resilience. Power reaffirms the concept of control but extends it beyond individual control to include group or community control. Resilience refers to the ability of an individual, group, or community to manage with stress or significant adversity through a balance of protective and risk variables.⁴⁰ The aim of mental health promotion is to develop psychological well-being, skill, and resilience while also building supportive living environments and improving communities, families, and people’s coping capacity through the transfer of information, skills, and resources.⁴¹

Mental health promotion aims to benefit the whole population by facilitating and reaching positive mental health. This multisectoral actions aim to improve quality of life and well-being of individuals, groups, and society. Mental health promotion conceives mental health in positive rather than in negative terms and creates effective programs to minimize health disparities in an empowering, participatory, and collaborative method.⁴² Focusing youth mental health early is likely to have immediate advantages by boosting the ability of youth to deal with mental health stressors. Early action may help minimize young people’s risk for poor mental health in the future and allow youth to develop their own health-seeking abilities and practices.⁴³ Adolescent mental health promotion is the most effective proactive technique for preventing mental diseases and disabilities now and in the future. Everyone is related with mental health promotion: parents and caregivers, friends and classmates, schools and communities, and adolescents themselves.⁴⁴

Mental Health Promotion Interventions

The previous study found that several intervention programs focused on promoting positive coping and resilience in young people which has brought to increasing their strength and self-esteem. However, these programs are not particularly considered for promoting mental health in young people.⁴⁵ Therefore, the development of comprehensive programs targeted at adolescents are needed. An effective intervention program should focus on the entire adolescent engaging on achievements that are specific to developmental tasks and stages. The program should be viewed from a variety of viewpoints, including mental and biological well-being, life situation and future plans, interpersonal relations, economic circumstances, living contexts, lifestyle and leisure time activities.⁴⁶

There are several approaches to describing the program implemented in schools to promote mental health and well-being in adolescents, including emotional and social learning, character education, mental health literacy, mindfulness-based interventions, strengths-based education. By focusing on promotion, it is important to recognize the school setting as a natural context in which young people may develop autonomy, security, and personal rights. Clearly, mental health promotion in schools requires the implementation of a continuum of intervention programs. These should emphasize social-emotional learning and active participation of adolescents, schools, and communities. There is significant evidence that school-based mental health promotion programs result in an improvement mental health, well-being, and educational outcomes.⁴⁷ A review of the literature revealed the 5 fundamental strategies listed below.

Social and emotional learning (SEL) interventions: include whole-school and curriculum-based programs with an obvious focus on the student’s development in emotional and social abilities, consisting emotional knowledge and expression, emotional regulation, relationship skills, communication ability, conflict resolution methods, and responsible decision-making. These skills are conducted through a developmentally appropriate program. These 5 skills include:

Self-management encompasses regulating emotions, coping with stress, practicing self-control, and motivating oneself in a productive and conscious way. Understanding personal responsibility in different aspects of life.

Relationship skills such as building relationships with a variety of people and groups, communicating properly, listening actively, resolving problems, resisting in appropriate social pressure, and seeking help when needed.

Responsible decision-making, the ability to make constructive choices about behavior and social interactions. Focusing on the well-being of adolescents and others, recognizing their own responsibility to act ethically, basing decisions on safety, assessing realistic outcomes of several behaviors, choosing appropriate choices for themselves and others.

Self-awareness covers one’s feelings, connecting thoughts and feelings to behavior, self-efficacy, and optimism. It is the ability to focus on actions, thoughts, or emotions.

Social awareness, the capacity to take the perspective of others, respecting diversity, empathy, understanding social and ethical norms for behavior, recognizing family, school, and community resources.

Positive psychology intervention focuses on building positive emotions, relationships, and character strengths in adolescents, as well as improving skills for happiness and well-being. These interventions, like SEL, are usually delivered through a classroom program.⁴⁸

Mindfulness-based intervention has a long history and originally derived from Eastern practices and philosophy, these interventions require adolescents to focus their consciousness on the current situation. Mindfulness-based programs are created to train people to cultivate mindfulness and incorporate its practice into everyday life. Mindfulness can be referred to paying attention in a particular way, in the present time, on purpose, and nonjudgmentally.⁴⁹ Thus, these programs teach mindfulness skills such as improving purposeful attention, developing a distinct relationship with one’s thoughts, and practicing various approaches in response to unpleasant emotions and thoughts in a nonjudgmental manner.⁵⁰

Positive youth development intervention covers the approaches of personal mentoring, engaging adolescents in sports, leisure activities, and youth leadership programs. This program aims to make young people develop positive manners such as confidence and relationships. This intervention is an intentional, prosocial method that interacts youth in productive and constructive ways within their schools, communities, peer groups, families, and organizations.⁵¹

Mental health literacy intervention is an important issue as it has the potential of helping in early detection of mental illnesses. Understanding how to maintain positive mental health, mental disorders and their treatments, reducing stigma associated with mental illness, and improving help-seeking efficacy are all part of the program. It supports adolescents to attain positive mental health, and to facilitate timely access to proper help when psychological problems emerge.⁵²

Furthermore, many studies on mental health promotion among adolescents or students were presented. For example, TEAM program is a school-based intervention in South Africa aimed at promoting mental health among adolescent in schools. Activities in the classroom, the group activity, after-school programs, and evaluation and feedback sessions are all part of the TEAM approach. Using classroom-based social and emotional learning instructional methods, the intervention improved self-awareness, self-regulation, social awareness, interaction skills, and responsible decision-making. Adolescents will be able to form positive gangs as a consequence of this program, which will encourage the use of humor, increase confidence and assertiveness, instill prosocial ideals, and improve conflict resolution abilities. After-school sessions were also implemented. These activities include conducting schoolwork, walking, and chatting. After-school courses will serve as a social support system. Adolescents who are part of a peer network are less likely to be victimized or bullied from others.⁵³ In Germany, online and face-to-face interventions are used to promote mental health in children and adolescents at school. Each activity includes quizzes and exercises, and weekly assignment aiming to increase self-management skills. Furthermore, the curriculum emphasizes coping strategies (such as problemsolving, cognitive reconstruction, relaxing methods, and seeking assistance), the relationship between thoughts, feelings, and behaviors, and mental health/illness concepts and help-seeking. Internet-based delivery would help students to receive health promotion regardless of their geographic location. Additional advantages of Internet-based interventions to promote mental health are evident as programs are attractive, easily accessible, and resource-saving.⁵⁴

All adolescents with mental health difficulties or problems deserve timely, high-quality, comprehensive mental health services to enable successful assessment, assistance, and treatment for themselves and others. The following techniques should be implemented in order to promote mental health: All staff who work directly with adolescents should have adequate knowledge, training, and help to promote the mental health of adolescents and their families, as well as to notice early signs of problems. Referral system, support system, and effective program should be well-developed. Adolescents should be able to receive rapid mental health care, if necessary. When needed, adolescents with a learning disorder and a mental health condition should have access to quality mental health services.⁵⁵

Conclusion and Recommendations

Adolescent mental health is an important issue. Mental health problems that young people may face can have an impact on how they think, feel, and act. Adolescents should also have the ability to increase emotionally, cognitively, and intellectually, as well as a supportive environment in which to cope with challenging situations. Mental health interventions can be delivered in the classroom, in the community, and via digital platforms. The main barrier to successful mental health promotion is that the majority of interventions reviewed were short, with insufficient long-term follow-up. Mental health promotion in this age group is a diverse and complex process which relies on a variety of policies and practices implemented in schools, other academic institutions, parents, peer, and public health and social contexts.

The perspectives of adolescents are critical in shaping policy decisions and identifying priority areas. School mental health programs should engage the family and the community, as well as policymakers, in order to create a comprehensive care system in which mental health promotion and preventive approaches are integrated and provided as a significant component of the school curriculum. Future study on mental health problems is needed through longitudinal research designs addressing multi-level systems. There should also be an emphasis on methos for reducing stigma, which discourages adolescents from seeking mental health treatments even when they are needed. The effects of an integrated preventative strategy that integrates evidence-based mental health and behavioral interventions should be examined in the future. It is essential that adolescents can access services through processes from educational trainings, as well as innovative strategies such as online platforms that can create their capacity for self-reliance to cope with psychological problems. Additionally, contextualized and verified tools are required in local settings. Those who work in school settings and health services also play an important role in providing information and support to adolescents, and their voices need to be heard in decisions made for further directions on mental health promotion.

Footnotes

Declaration of Conflicting Interests

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author received no financial support for the research, authorship, and/or publication of this article.

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Mental Health Promotion in Adolescents