A Perspective on Interventional Practices and Engagement of Adolescents for Their Overall Development and Well-Being

Abstract

Purpose of Review:

Adolescence is marked by rapid neurodevelopmental changes, including a significant shift in self-perception and worldview. Factors such as rapid urbanization, technological advancements, excessive social networking, media influences, and unfiltered information overload contribute to acute confusion among adolescents. This is exacerbated by peer pressure, a lack of essential life skills, and an urge to move away from traditional family values, resulting in mental health challenges. Objective of the review is to describe intervention practices, policies, and engagement of adolescents for development and well-being.

Collection and Analysis of Data:

The study adopts a narrative review approach, focusing on the adolescent population (aged 10–19 years) with specific emphasis on India. Literature published from 2015 onward is reviewed, and thematic analysis is conducted using electronic database searches with keywords aligned to Medical Subject Headings (MeSH). The findings are categorized into three thematic areas: family level, school level, and state level.

Adolescent mental health is recognized, yet there remains a gap in addressing the full spectrum of mental health issues and overcoming barriers to implementing interventions across all levels. Effective family communication has been shown to significantly impact adolescents’ psychological well-being. Integrating life skills education, including yoga, into school curricula can further support preventive efforts through awareness campaigns, workshops, and peer-led programs. These integrated approaches can enhance understanding of how family and school environments influence adolescent mental health.

Conclusion:

Sustainable preventive intervention practices targeting social capital and social cohesion development for adolescent development and mental well-being are imperative and needed to be effectively delivered.

Keywords

Adolescent mental health behavior change substance use yoga India

Introduction

Adolescence, a transition phase from childhood to adulthood, is highlighted by specific physical and mental health needs propelled by significant physical and emotional surges.^1,2 Adolescents strongly feel the need for independence, and autonomy,³ exhibit curiosity about the unknown, and search for their identity.⁴ Additionally, peer pressure, unsupervised access to harmful social media content,⁵ and challenges to traditional parental values can create emotional distancing from the family, lead to family dysfunction, reduce parental involvement and guidance, and bonding.⁶ Furthermore, the lack of positive mentorship in educational institutions⁷ also influences adolescent development. This results in conflict, rebellious and risky behavioral tendencies driven by sensation and reward-seeking and impulsive attitude,⁸ low self-esteem and self-concept, violence, and substance abuse among them and creates serious mental health issues.

Mental health problems are the leading cause of dysfunction resulting in adverse impacts on families, and society, significantly contributing to the global burden of mental health disorders. Out of 1.3 billion adolescents, one in seven experiences a mental disorder, accounting for 13% of the global disease burden.⁹ Depression, anxiety, and behavioral disorders are among the leading causes of illness and disability in this age group.¹⁰ Behavioural challenges, including heightened suicidal tendencies¹¹ and psychiatric disorders, are significant aspects of adolescence.¹² Adolescents and young adults are particularly vulnerable to sexually transmitted infections (STIs)¹³ and substance abuse due to their propensity for experimentation. Studies have shown a sharp rise in adolescent sexual and reproductive health (SRH) challenges, such as unintended teenage pregnancies and abortions,¹⁴ substance and drug abuse,¹⁵ birth complications, and juvenile delinquency. Contributing factors include a lack of reliable and accurate information, unchecked exposure to pornography and explicit violence in media,¹⁶ and taboos surrounding open discussions of these sensitive topics with parents and guardians.

India has the largest adolescent population in the world, with 253 million individuals, constituting 21% of the country’s population.¹⁷ It is estimated that 7.3% of adolescents (7.5% males and 7.1% females) aged 13-17 years have clinical mental health illnesses,^18,19 with higher prevalence rates among urban residents.²⁰ Furthermore, there is considerable stigma and ignorance regarding mental health among adolescents, parents, and teachers.^21-23 This is compounded by unidentified and unmanaged mental illnesses in the community and a lack of support frameworks,²⁴ such as qualified healthcare professionals, infrastructure, and timely treatment interventions,²⁵ to address poor mental health conditions. Additionally, there is a scarcity of mental health intervention programs in India, with even fewer evaluations of their effectiveness.²⁶ Mental health literacy is perceptibly low among adolescents, with depression affecting nearly 30% of respondents in South India.²⁷ Other studies have shown that persistent family problems can lead to high rates of intentional self-harm and suicide attempts,²⁸ a higher prevalence of bullying behavior in Northern Indian schools,²⁹ and high rates of social media addiction. Ever or lifetime alcohol consumption among adolescents in India ranges from 3.9% to 69.8%.³⁰

Conceptual Framework

From a developmental and mental health intervention perspective, the models of cognitive and psychosocial development are crucial. Equally significant is the ecological perspective, highlighting the positive influences families can exert on identity and social development. In elaborating on the ecological framework, several studies have measured different dimensions of adolescent development influenced by family, peers, and community or culture. Bronfenbrenner’s ecological model³¹ proves invaluable understanding adolescent development, encompassing influences from family, school, peers, culture, and public policy. This calls for a collective effort to address well-being issues and socio-environmental factors affecting this population cohort, which forms the foundation of society’s future demographic dividend. Protecting adolescents from adversity, promoting socio-emotional learning and psychological well-being, and ensuring access to mental healthcare are critical for their health and development. Based on the theoretical perspective, this study aims to describe intervention practices, policies, and engagement of adolescents for development and well-being.

Methodology

We use the narrative review to summarize the literature, focusing on a specific research question regarding adolescents’ interventional practices and engagement in their overall development and well-being. This review includes a comprehensive examination of studies, recent research articles, policy papers, gray literature, and reports published from 2015 onward, with a particular emphasis on policy documents and programs related to adolescent mental health. A qualitative content analysis was conducted to identify major themes and perspectives associated with interventional practices and engagement in adolescent mental health and well-being, especially in the context of India. The findings are classified into three thematic levels. Considering that adolescents primarily interact and engage within family and school environments, these contexts are pivotal.

Search Strategy

A comprehensive search was performed using multiple electronic databases, including PubMed, Google Scholar, and Scopus. The search utilized specific keywords and their combinations, such as “Adolescent,” “Communication,” “Parent-adolescent communication,” “Family,” “Yoga,” “School,” “Policy,” “Program,” “Life skill education,” “Intervention,” “Engagement,” and “India.” These keywords were mapped to the Medical Subject Headings (MeSH) to ensure comprehensive coverage of relevant articles. The search results yielded 108 articles from electronic databases, which were imported into reference management software to remove duplicates. The titles and abstracts of the remaining 84 articles were screened to determine their relevance to the study’s objectives. Full texts of 76 articles were then retrieved and assessed for final inclusion in the review (Figure 1). This article does not claim to be comprehensive but aims to illustrate some important features underlying the policy perspective.

Figure 1.

Layout of Search Strategy.

Analysis

The analysis contextualizes adolescent practices and engagements as follows:

Family level: Communication in the family

Role of parents as behavioral change agents for adolescent

Family as a counselling unit for adolescent

Changing communication style between the parents and their adolescents

School level: Promoting life-skill education in schools for enhanced self-regulation

Self-regulation across the cognitive domain

Self-regulation of emotions

Self-regulation of behavior

State level: Policy and program level

Initiatives by Ministry of Youth Affairs & Sports

Initiatives by Ministry of Women and Child Development

Initiatives by Ministry of Human Resource Development

Initiatives by Ministry of Health and Family Welfare

Results

Family Level: Communication in the Family

Role of Parents as Behavioral Change Agents for Adolescent

Communication is an essential tool, a spontaneous and symbolic process, and acts as the catalyst for improved cohesiveness in a family, which impacts the well-being of adolescents.³² Parents aim to impart good values and norms, and positive parent–adolescent communication encourages trust and support. A Swedish study reported that a positive family emotional climate benefits adolescents’ psychosocial well-being.³³ Adolescents’ perspectives on their relationship with parents also affect their mental well-being.³⁴ Adolescence is a time of stress and confusion as they navigate their identity and fit into the world.³⁵ They receive new information and need accurate knowledge about biological, psychological, and social changes. Parents provide advice and support with clarity, though sometimes authoritarian. During adolescence, emotional distance and conflict with parent’s increase,³⁶ and communication ease declines.³⁷ Hormonal changes contribute to impulse control issues, anxiety, rebelliousness, and distancing from family.³⁸ Urban Indian adolescents perceive their physical environment as poor³⁹ with low social cohesion and capital perception. “Home” is the primary source for socialization and enculturation of the adolescent. Adolescents question values and need logical answers for abstract thinking, and failure to get these from positive sources leads to adverse outcomes. Effective parent–child interaction builds trust and provides a space to discuss sensitive issues,^40,41 ensuring they are not misled. Without open communication, adolescents can’t discuss sensitive issues, especially with those they have no bond with. Friends often face similar situations, lacking proper guidance at home. In the absence of alternatives, adolescents may help each other in antisocial activities, turning harmful sources into role models. This results in embracing negative behaviors, leading to psychological, social, and health problems like drug abuse and STIs.

Family as a Counselling Unit for Adolescent

Effective family communication fosters comfort in sharing thoughts and feelings, strengthens relationships, and equips members to handle life situations. Effective communication builds trust, intimacy, and openness, encouraging family members to confide in sensitive issues without fear. Families provide role models, support, love, moral development, education, set expectations, and counteract harmful influences. This requires parents to be available, listen patiently, and spend time with their adolescents. Parents should shift from an authoritarian to an authoritative style, using “Socratic dialogue” to guide adolescents to solutions through their thinking. Bonding time is crucial for adolescents’ positive socialization. Family bonding builds relationships, promotes sharing, and fosters togetherness, confidence, and social interaction skills.⁴²

Adolescents’ social environments influence their decisions, with protective factors reducing adverse outcomes and risky factors increasing them. A friendly family environment supports adolescents in seeking information on SRH issues, empowers them to initiate SRH dialogues, and helps parents communicate receptively, reducing SRH service uptake barriers.⁴³ Family connections protect against substance abuse and harmful behaviors, while positive parent–adolescent communication prevents depression.^44-46 The parent’s role is to restore unity with adolescents through effective communication, fostering emotional attachments, structural solidarity, and family cohesion.⁴⁷ In joint families, guardians like mothers, aunts, and uncles guide adolescents. With the rise of nuclear families, parents had to take their role in complementing that structure.

Changing Communication Style Between the Parents and Their Adolescents

Studies reveal that despite sharing the same home, emotional distance and conflicts persist among family members.⁴⁸ Industrialization, technology, and employment contribute to this detachment. Children and adolescents are absorbed in screens, while parents are preoccupied with work or household tasks. This lack of interaction prevents adolescents from discussing their problems, fearing judgment or negative reactions from parents. According to the Standard Guidelines on Friendly Adolescent Sexual and Reproductive Health Service Provision,⁴⁹ parents must fully educate their children about these services. Challenges include parents’ ineffective communication due to lack of information and cultural taboos. Girls often lack proper menstrual education without good bonding. Fathers should actively guide sons on personal and sexual behavior, while mothers should bond with daughters to help them understand their changing needs.

School Level: Promoting Life-Skill Education in Schools for Enhanced Self-Regulation

The scientific evidence suggests that yoga-based physical and mental training methods enhance self-regulation⁵⁰ and self-esteem, increase resilience, and improve mood among adolescents. The practices enable two-directional feedback and enhance assimilation and efficacy of high-level (e.g., central executive brain network) and low-level brain networks (e.g., autonomic systems, vagal complex) together with viscera-somatic, musculoskeletal, coronary, respiratory, and sensory information from the margin. Successful self-regulation via bottom-up mechanisms is suggested to accelerate improved function in a network of low-level brain structures liable for peripheral physiological activity and restructurization integration with homeostatic physiology. Enhancing self-regulation across cognitive, emotional, behavioral, and autonomic domains reflects this.

Self-Regulation Across Cognitive Domain

Yoga interventions, including controlled breathing, meditation, and relaxation exercises, are an effective form of preventive mechanism and treatment for mental health concerns among adolescents,^51,52 and they improve attention, affect cognition, and the procedures fundamental to its regulation in children and adults. Ten days of uni-nostril or alternate nostril breathing increased spatial memory in children aged 10-17.⁵³ Kapalabhati (high-frequency yoga breathing practice) and Pranayama (breathing awareness) have improved cognitive activity and memory performance.⁵⁴ A study of teenagers noticed that a three-months yoga program improved memory and concentration.⁵⁵ These preliminary conclusions are coherent with the view that yoga can assist in better cognitive regulation.

Self-Regulation of Emotions

Research writings demonstrating yoga’s effects on emotion regulation strategies are though sparse but are accruing, both for acute (i.e., immediately following a yoga practice) and longer-term outcomes. With yoga, an inexpensive intervention technique, high-school adolescent students could achieve emotional regulation, mindful attention, control impulses, and anger management.⁵⁶ Yoga uptake increased self-compassion, nonjudgmental self-reflection, and improved emotion regulation skills among college students.⁵⁷ Similarly, relative to physical education, yoga interventions improved emotion regulation strategies among adolescent participants.⁵⁸ Practice of yoga may also enhance cognitive reappraisal,⁵⁹ a form of emotion regulation that engages the ability to replace an emotional response by reinterpreting the meaning of the stimuli. Sudarshan Kriya (regulated breathing) has been reported to be beneficial for treating depression, anxiety, stress, and post-traumatic stress disorder.⁶⁰ Yoga postures may also influence emotion regulation at an anatomical level. Data investigating different effects of asanas (body positions in yoga) on peripheral physiology advocates that simple body postures may influence psychophysiological reactivity to interceptive threats.

Self-Regulation of Behavior

Investigative studies suggest that yoga can help with behavioral regulation. A 10-week, bi-weekly yoga intervention with previously inactive participants increased their longer-term obedience to a physical activity regimen.⁶¹ A systematic review showed that yoga and mindfulness courses significantly improved goal-directed self-regulation of behavior postintervention.⁶² Investigations of nicotine addiction have shown that yoga can have impact on behavioral regulation, such as smoking abstinence.⁶³ In a convenience sample of yoga practitioners, the time spent on yoga practice was moderately and inversely related to dysfunctional coping, a coping style characterized by disengagement, venting, and substance use. A yoga workshop increased participants’ ability to recognize and respond to emotional states and to reduce mood instability, impulsivity, recklessness, and self-destructive behaviors.⁶⁴

State Level: Policy and Program Level

To ensure the holistic development of the adolescent population, the National Education Policy 2020 recognizes the importance of life skills, lifelong, skill cum value-based learning and experiential learning in the Indian education system.⁶⁵ In alignment with this, the Ministry of Health and Family Welfare (MoHFW) and the GoI launched the holistic flagship health program Rashtriya Kishor Swasthya Karyakram (RKSK) in 2014. This initiative aims to address the health and well-being needs of adolescents by providing preventive, promotive, curative, and counselling services across all levels of healthcare facilities across the country.⁶⁶

In India, various Ministries and Departments have programs for the development of Adolescents. Key departments include the Ministry of Youth Affairs & Sports (MoYAS), Ministry of Women and Child Development (MoWCD), Ministry of Human Resource Development (MHRD), and Ministry of Health and Family Welfare (MoHFW). Government of India (GoI) initiatives through MoWCD include the are Nutrition Programme for Adolescent Girls (NPAG), Kishori Shakti Yojana (KSY), Balika Samriddhi Yojana (BSY), and others scheme of assistance to Educational Work for Prevention of Atrocities on Women, Integrated Programme for Street Child, Scheme of Prevention and Control of Juvenile Social Maladjustment, Scheme for Welfare of Working Children in Need of Care and Protection. MoYAS administers programs such as the Rajiv Gandhi Adventure Scheme, National Programme for Youth Adolescent Development, Development and Empowerment of Adolescents. MHRD initiatives include Sarva Shiksha Abhiyan, Mid-Day Meal Scheme, National Programme for Education of Girls at Elementary Education.

Additionally, under the Reproductive, Maternal, Neonatal, Child, and Adolescent Health strategy launched by MoHFW in 2013, the adolescent reproductive and sexual health (ARSH) services have been implemented to address the SRH needs of adolescent boys and girls. Functional adolescent friendly health clinics offer counseling, referral, and medical treatment services tailored to this demographic. Concurrently, India has achieved significant milestones in national health indicators that positively impact adolescent health. The United Nations Population Fund (UNFPA) ARSH toolkit underscores the importance of SRH information and the provision of youth-friendly services by healthcare providers.⁴⁹

Discussion

While adolescent mental health is recognized, there remains a lack of comprehensive addressing of the full spectrum of mental health issues and overcoming the main barriers to implementing proposed interventions across all three levels. Preventive strategies target families, providing psychosocial support through enhanced and effective parental communication and school curricula. This integration improves understanding of how family and school environments influence adolescents. The review has demonstrated family communication and their interactions in the family are important in influencing adolescents’ psychological health.^67,68 Additionally, life skills education in schools can include awareness campaigns, workshops, peer-led programs, and participatory educational programs. Often, parental communication is less on sexual education⁶⁹ and focuses on routine questions, may lead to monotony, while ineffective guidance from family, school, and programs can result in negative outcomes.

From a cultural and scientific viewpoint, yoga has enormous potential to foster social sensitivity and achieve overall physical and mental well-being. Yoga teaching can be easily tailored to adolescent age groups and can be a part of the school curriculum. A dynamic, interactive teaching method for adolescents is essential, integrated with existing life skills education programs and facilitated by peer trainers. Effective communication strategies are crucial for encouraging young people to embrace yoga and incorporate it into their daily lives. Research focusing on how young individuals can adopt and maintain yoga practice is imperative. However, there’s a lag in incorporating yoga into educational systems. Recommendations are needed to culturally integrate yoga into the lives of young people, considering the developmental context of adolescence. This approach includes integrating wellness practices like sports, yoga, and exercise, along with life-skills tutorials covering various aspects such as self-care, self-awareness, handling peer pressure, responsible decision-making, coping mechanisms, sex education, gender identity sensitization, time management, and self-defense.

Existing policies and programs face limitations due to misalignment and fragmented governance across ministries, budget constraints, and a lack of qualified personnel.² These challenges mirror those in other health policies, including poor inter-sectoral collaboration and governance issues.^70,71 A review found that despite mental well-being being a priority in RKSK, school-based interventions are limited and fragmented.²⁵ These challenges stem from weak technical capacity, poor motivation, inefficient management, insufficient resources, and fragmented health governance.⁷² This causes unclear mandates and delivery gaps, especially in community-based interventions. India’s decentralized health governance requires horizontal and vertical coordination. Addressing these systemic issues, as outlined in the National Health Mission (NHM), is crucial for improving adolescent mental health.

Limitations of the Study

The article only covers literature from 2015 onward, missing important studies prior to that, potentially limiting its scope. Additionally, it did not address the impact of the coronavirus disease 2019 (COVID-19) pandemic on adolescent mental health to maintain a focus on prepandemic analysis. It also did not delve into specific vulnerabilities within the adolescent population, which could have provided deeper insights.

Conclusion

As access to traditional mental health services remains limited, family communication and yoga play crucial roles in bridging this gap. The stigma surrounding mental illness further impedes timely help-seeking from formal sources. We advocate for a comprehensive life-skill approach starting with family support and extending into schools, engaging diverse sectors in prevention and treatment efforts. Encouraging regular open dialogues with mentors and peers is essential for effective implementation. Despite existing programs and schemes, policies need to create an interphase to improve ease of access for cumulative outcomes. Policies must integrate mental health across all national initiatives targeting adolescents and youth, coordinating efforts across sectors and stakeholders. Regular mental health screening of adolescents, along with physical health at the school level, should be done. Screening and early risk detection are crucial steps in capacity-building and awareness programs aimed at addressing mental health concerns among adolescents, families, and teachers.

Footnotes

Declarations of Conflicting Interest

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

Ethics Statement

The research study uses publicly available secondary literature and data; thus, it did not require any ethics approval or participant consent.

Funding

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

References

World Health Organization. Adolescent health. World Health Organization. October 27, 2021. https://www.who.int/health-topics/adolescent-health#tab=tab_1. Accessed December 16, 2023.

Sivagurunathan

, Umadevi

, Rama

, Gopalakrishnan

. Adolescent health: present status and its related programmes in India. Are we in the right direction? J Clin Diagn Res JCDR. 2015;9(3):LE01-LE06. doi:10.7860/JCDR/2015/11199.5649

Muhammad

, Maurya

, Thakkar

. The cross‑sectional correlates and longitudinal predictors of involvement in violent and bullying behavior among adolescents and young adults: evidence from India. J Public Health (Berl.). 2023; doi:10.1007/s10389-023-01945-x

Lakhdir

MPA

, Rozi

, Peerwani

, Nathwan

. Effect of parent-child relationship on physical aggression among adolescents: global school-based student health survey. Health Psychol Open. 2020;7(2):2055102920954715.

Shannon

, Bush

, Villeneuve

, Hellemans

, Guimond

. Problematic social media use in adolescents and young adults: systematic review and meta-analysis. JMIR Mental Health. 2022;9(4):e33450.

Benner

, Boyle

, Sadler

. Parental involvement and adolescents’ educational success: the roles of prior achievement and socioeconomic status. J Youth Adolesc. 2016;45:1053–1064.

Remes

, Moustgaard

, Kestilä

, Martikainen

. Parental education and adolescent health problems due to violence, self-harm and substance use: what is the role of parental health problems? J Epidemiol Community Health. 2019;73(3):225–231.

Maslowsky

, Owotomo

, Huntley

, Keating

. Adolescent risk behaviour: differentiating reasoned and reactive risk-taking. J Youth Adolesc. 2019;48(2):243–255.

World Health Organization. Mental health of adolescents. Key facts. World Health Organization. November 1, 2021. https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health. Accessed December 6, 2023.

10.

GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet (London, England). 2020;396(10258):1204–1222. doi:10.1016/S0140-6736(20)30925-9

11.

Senapati

, Parida

, Badamali

, . The patterns, trends and major risk factors of suicide among Indian adolescents: a scoping review protocol. PloS One. 2022;17(11):e0277422.

12.

Hossain

, Purohit

. Improving child and adolescent mental health in India: Status, services, policies, and way forward. Indian J Psychiatry. 2019;61(4):415–419.

13.

Maheswari

, Kalaivani

. Pattern of sexual behaviour in adolescents and young adults attending STD clinic in a tertiary care centre in South India. Indian J Sex Transm Dis AIDS. 2017;38(2):171–175.

14.

Jonas

, Crutzen

, van den Borne

, . Teenage pregnancy rates and associations with other health risk behaviours: a three-wave cross-sectional study among South African school-going adolescents. Reproductive Health. 2016;13(1):50. doi:10.1186/s12978-016-0170-8

15.

Srivastava

, Kumar

P Rashmi

. Does substance use by family members and community affect the substance use among adolescent boys? Evidence from UDAYA study, India. BMC Public Health. 2021;21:1896.

16.

Ogboru

, Olugbamigbe

, Olarewaju

, Adedeji

. The influence of exposure to internet pornography on sexual behaviour of adolescents. Sci Technol. 2016;2(6):147–155.

17.

United Nations Children’s Fund. Adolescent development and participation. UNICEF India. 2021. https://www.unicef.org/india/what-we-do/adolescent-development-participation. Accessed November 12, 2023.

18.

Gururaj

, Varghese

, Benegal

, . National Mental Health Survey of India. 2015-16. Mental health systems. Ministry of Health and Family Welfare, Government of India. Bengaluru, India, National Institute of Mental Health and Neuro Sciences: NIMHANS Publication No. 130, 2016. https://main.mohfw.gov.in/sites/default/files/National%20Mental%20Health%20Survey%2C%202015-16%20-%20Mental%20Health%20Systems_0.pdf-

19.

Gautham

, Gururaj

, Varghese

, . The National mental health survey of India (2016): prevalence, socio-demographic correlates and treatment gap of mental morbidity. Int J Soc Psychiatry. 2020;66:361–372.

20.

Aggarwal

, Berk

. 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. Asian J Psychiatry. 2015;13:3–12.

21.

Venkataraman

, Patil

, Balasundaram

. Stigma toward mental illness among higher secondary school teachers in Puducherry, South India. J Family Med Prim Care. 2019;8:1401–1407.

22.

Venkataraman

, Patil

, Balasundaram

Why mental health literacy still matters: a review. Int J Community Med Public Health. 2019;6:2723–2729.

23.

Parikh

, Parikh

, Vankar

, . Knowledge and attitudes of secondary and higher secondary school teachers toward mental illness in Ahmedabad. Indian J Soc Psychiatry. 2016;32:56.

24.

Parikh

, Sapru

, Krishna

, . “It is like a mind attack”: stress and coping among urban school-going adolescents in India. BMC Psychology. 2019;7:31. doi:10.1186/s40359-019-0306-z

25.

Mehra

, Lakiang

, Kathuria

, Kumar

, Mehra

, Sharma

. Mental health interventions among adolescents in India: a scoping review. Healthcare (Basel, Switzerland). 2022;10(2):337. doi:10.3390/healthcare10020337

26.

Mahajan

, Rajendran

, Sunderamurthy

, Keshavan

, Bazroy

. Analyzing Indian mental health systems: reflecting, learning, and working towards a better future. J Curr Res Sci Med. 2019;5:4–12.

27.

Ogorchukwu

, Sekaran

, Nair

, Ashok

. Mental health literacy among late adolescents in South India: what they know and what attitudes drive them. Indian J Psychol Med. 2016;38(3):234–241.

28.

Grover

, Sarkar

, Chakrabarti

, Malhotra

, Avasthi

. Intentional self‑harm in children and adolescents: a study from psychiatry consultation liaison services of a tertiary care hospital. Indian J Psychol Med. 2015;37:12‑16.

29.

Rana

, Gupta

, Malhi

, Grover

, Kaur

. Prevalence and correlates of bullying perpetration and victimization among school-going adolescents in Chandigarh, North India. Indian J Psychiatry. 2020;62(5):531–539.

30.

Nadkarni

, Tu

, Garg

, . Alcohol use among adolescents in India: a systematic review. Glob Ment Health (Cambridge, England). 2022;9:1–25.

31.

Bronfenbrenner

Ecological models of human development. Int Encycl Educ. 1994;3:1643–1647.

32.

Deng

, Lin

, Zhang

, . Relations between family cohesion and adolescent-parent’s neural synchrony in response to emotional stimulations. Behav Brain Funct. 2022;18:11.

33.

Kapetanovic

, Skoog

. The role of the family’s emotional climate in the links between parent-adolescent communication and adolescent psychosocial functioning. Res Child Adolesc Psychopathol. 2021;49(2):141–154. https://doi.org/10.1007/s10802-020-00705-9

34.

McKenna

, Olsen

, Pasalich

. Understanding strengths in adolescent–parent relationships: a qualitative analysis of adolescent speech samples. J Res Adolesc. 2021;32(3):1228–1245.

35.

Buchanan

, Romer

, Wray-Lake

, Butler-Barnes

. Editorial: adolescent storm and stress: a 21st century evaluation. Front Psychol. 2023;14. doi:10.3389/fpsyg.2023.1257641

36.

Mastrotheodoros

, Van der Graaff

, Deković

, Meeus

WHJ

, Branje

. Parent-adolescent conflict across adolescence: trajectories of informant discrepancies and associations with personality types. J Youth Adolesc. 2020;49(1):119–135.

37.

Ehrlich

, Richards

, Lejuez

, Cassidy

. When parents and adolescents disagree about disagreeing: observed parent–adolescent communication predicts informant discrepancies about conflict. J Res Adolesc. 2016;26:380–389.

38.

Pfeifer

, Allen

. Puberty initiates cascading relationships between neurodevelopmental, social, and internalizing processes across adolescence. Biol Psychiatry. 2021; 89(2):99–108.

39.

Ramadass

, Gupta

, Nongkynrih

. Adolescent health in urban India. J Fam Med Prim Care. 2017;6:468–472.

40.

Usonwu

, Ahmad

, Curtis-Tyler

. Parent-adolescent communication on adolescent sexual and reproductive health in Sub-Saharan Africa: a qualitative review and thematic synthesis. Reprod Health. 2021;18(1):202. doi:10.1186/s12978-021-01246-0

41.

Ndugga

, Kwagala

, Wandera

, Kisaakye

, Mbonye

, Ngabirano

. “If your mother does not teach you, the world will…”: a qualitative study of parent-adolescent communication on sexual and reproductive health issues in Border districts of eastern Uganda. BMC Public Health. 2023;23(1):678. doi:10.1186/s12889-023-15562-6

42.

Stein

, Dalton

, Rapa

, . Communication with children and adolescents about the diagnosis of their own life-threatening condition. Lancet. 2019;393(10176):1150–1163.

43.

Habte

, Dessu

. The uptake of key elements of sexual and reproductive health services and its predictors among rural adolescents in Southern Ethiopia, 2020: application of a poisson regression analysis. Reprod Health. 2023;20(1):15.

44.

Carver

, Elliot

, Kennedy

, Hanley

. Parent–child connectedness and communication in relation to alcohol, tobacco and drug use in adolescence: an integrative review of the literature. Drugs Educ Prev Policy. 2017;27(2):119–133.

45.

Mills

, Mann

, Smith

, . Parental support and monitoring as associated with adolescent alcohol and tobacco use by gender and age. BMC Public Health. 2021;21:2000.

46.

Kapetanovic

, Rothenberg

, Lansford

, . Cross-cultural examination of links between parent-adolescent communication and adolescent psychological problems in 12 cultural groups. J. Youth Adolesc. 2020;49(6):1225–1244. doi:10.1007/s10964-020-01212-2

47.

Alavi

, Latif

, Ninggal

, Mustaffa

, Amini

. Family functioning and attachment among young adults in western and non-western societies. J. Psychol. 2020;154(5):346–366. doi:10.1080/00223980.2020.1754153

48.

Branje

. Development of parent–adolescent relationships: conflict interactions as a mechanism of change. Child Dev Perspect. 2018;12(3):171–176.

49.

UNFPA & Save the Children. Adolescent Sexual and Reproductive, Health (ASRH) Toolkit for Humanitarian Settings. New York: United Nations Population Fund, 2009. https://www.unfpa.org/sites/default/files/pub-pdf/UNFPA_ASRHtoolkit_english.pdf

50.

Janjhua

, Chaudhary

, Sharma

, Kumar

. A study on effect of yoga on emotional regulation, self-esteem, and feelings of adolescents. J Fam Med Prim Care. 2020;9(7):3381–3386.

51.

Kim

, Wee

, Gilbert

, Choi

. Young children’s physical and psychological well-being through yoga. Child Educ. 2016;92(6):437–445.

52.

Tamilselvi

, Mala

. Yoga: a boon to the adjustment problems and behavioural disorders of adolescent students. I-Manager’s J Educ Psychol. 2016;10(2):1–8. doi:10.26634/jpsy.10.2.8274

53.

Chethan

, Kavana

. A study on effect of nadi-shodhana pranayama on verbal and spatial memory scores. Int J Healthc Sci. 2016;3(2):6–9.

54.

Campanelli

, Tort

ABL

, Lobão-Soares

. Pranayamas and their neurophysiological effects. Int J Yoga. 2020;13(3): 183–192. doi:10.4103/ijoy.IJOY_91_19

55.

Purohit

, Pradhan

. Effect of yoga program on executive functions of adolescents dwelling in an orphan home: a randomized controlled study. J Tradit Complement Med. 2017;7(1):99–105. doi:10.1016/j.jtcme.2016.03.001

56.

Felver

, Butzer

, Olson

, Smith

, Khalsa

. Yoga in public school improves adolescent mood and affect. Contemp Sch Psychol. 2015;19(3):184–192. doi:10.1007/s40688-014-0031-9

57.

Centeno

RPR

, Fernandez

KTG

. Effect of mindfulness on empathy and self-compassion: an adapted MCT program on Filipino college students. Behavioural Sci (Basel, Switzerland). 2020;10(3):61.

58.

Daly

, Haden

, Hagins

, . Yoga and emotion regulation in high school students: a randomized controlled trial. Evid Based Complement Alternat Med. 2015;eCAM:794928. doi:10.1155/2015/794928794

59.

Sahni

, Singh

, Sharma

, Garg

. Yoga an effective strategy for self-management of stress-related problems and wellbeing during COVID19 lockdown: a cross-sectional study. PloS One. 2021;16(2):e0245214. doi:10.1371/journal.pone.0245214

60.

Banas-Zqbczyk

, Jakubczyk

, . Breathing-based meditation (Sudarshan Kriya Yoga) increase sense of coherence. No-cost stress prevention. Adv Integr Med. 2022;9(4): 214-220.

61.

Bryan

, Pinto

Zipp G

, Parasher

. The effects of yoga on psychosocial variables and exercise adherence: a randomized, controlled pilot study. Altern Ther Health Med. 2012;18:50–55.

62.

Sun

, Lamoreau

, O’Connell

, Horlick

, Bazzano

. Yoga and mindfulness interventions for preschool-aged children in educational settings: a systematic review. Int J Environ Res Public Health. 2021;18(11):6091. doi:10.3390/ijerph18116091

63.

Kim

, Kim

, Woo

, Kim

. Changes in inhibitory control, craving and affect after yoga vs aerobic exercise among smokers with nicotine dependence. Front Psychiatry. 2022;13:940415. doi:10.3389/fpsyt.2022.940415

64.

Rashedi

, Rowe

, Thompson

, . A yoga intervention for young children: self-regulation and emotion regulation. J Child Fam Stud. 2021;30(8):2028–2041. doi:10.1007/s10826-021-01992-6

65.

Ministry of Human Resource Development. National Educational Policy 2020. New Delhi, India: Ministry of Human Resource Development, Government of India, 2020. https://www.education.gov.in/sites/upload_files/mhrd/files/NEP_Final_English_0.pdf

66.

Ministry of Health and Family Welfare. Operational Framework. Rashtriya Kishor Swasthya Karyakram. Translating Strategy into Programmes. New Delhi, India: Ministry of Health and Family Welfare, Government of India, 2014. https://nhm.gov.in/images/pdf/programmes/RKSK/RKSK_Operational_Framework.pdf

67.

Bekele

, Deksisa

, Abera

, Megersa

. Parental communication on sexual and reproductive health issues to their adolescents and affecting factors at Asella town, Ethiopia: a community-based, cross-sectional study. Reprod Health. 2022;19(1):114.

68.

Scull

, Carl

, Keefe

, Malik

. Exploring parent-gender differences in parent and adolescent reports of the frequency, quality, and content of their sexual health communication. J Sex Res. 2022;59(1):122–134.

69.

Byers

, O’Sullivan

, Mitra

, Sears

. Parent-adolescent sexual communication in India: responses of middle-class parents. J Fam Issues. 2021;42(4):762–784.

70.

Berman

, Ahuja

, Tandon

, Sparkes

, Gottret

. Government health financing in India: challenges in achieving ambitious goals. Health, Nutrition and Population Discussion article. Geneva, World Bank, 2010.

71.

Petersen

, Marais

, Abdulmalik

, . Strengthening mental health system governance in six low- and middle-income countries in Africa and South Asia: challenges, needs and potential strategies. Health Policy Plan. 2017;32:699–709.

72.

Kansara

, Saxena

, Puwar

, . Convergence and outreach for successful implementation of Rashtriya Kishor Swasthya Karyakram. Indian J Comm Med. 2018;43(Suppl 1):S18–S22.