Member Blog: Mental Health and SRHR, The Hidden Link

This blog post was written by Youth Coalition member Anna Szczegielniak. Anna graduated from Medical School at the Medical University of Silesia, and holds a MSc in Physiotherapy from Opole University of Technology. She currently works as a psychiatry trainee and conducts PhD research in the field of sexology in Poland.

* Content Warning: The following blog post includes discussions on mental health, depression, suicide, PTSD and self-harm

Those of us who advocate for sexual and reproductive health and rights can no longer ignore the connection between mental health and SRHR.

The global statistics shared by World Health Organization are shocking: up to two in every ten adolescents worldwide suffer from mental disorders, with half of them experiencing their first symptoms at the beginning of the second decade of their life, at the stage of late childhood or early adolescence[1]. Mental disorders do not discriminate against anyone when they strike, they affect people across cultures and age groups.

It’s said that up to 80% of all people suffering from mental disorders don’t receive treatment, mainly due to stigma, a lack of sufficient education on mental health and a lack of dedicated healthcare facilities. However, when it comes to children and adolescents, those numbers can be much higher. Adolescents and young people represent a quarter of the world’s population, but the countries with the largest population of people under 19 years old also have the least developed mental health resources[2]. Shortages of qualified healthcare workers in the area of child & adolescent psychiatry and a lack of integration of these issues within primary health care leave people without options. In addition, natural disasters or humanitarian crises only serve to exacerbate these challenges[3].

When not properly addressed, mental disorders can lead to severe health and social consequences. The effects of mental health on the economy speak the loudest: according to data presented at the World Bank/ World Health Organization event “Out of the shadows: Making Mental Health a Global Development Priority” in April 2016 in Washington DC, the overall cost for employers of untreated depression and anxiety of employees equals 1 trillion USD a year. Still, leaders in this field can show no more than 5% of total government spending on health focused on improvements of mental health programs (with as little as 1% and less for many middle/low- income countries).

For young people, the consequences of unaddressed mental health issues can heavily influence their adult life, with mental and substance abuse disorders leading to higher morbidity and mortality.

Further, global suicide rates among adolescents and young adults are on the rise. For those between 15 and 29 years-old, suicide is the second leading major cause of death[4]. In adolescent girls, the two leading cause of death are suicide and complications during pregnancy. In South-East Asia one of every 6 adolescent girls will die because of a suicide, while among boys this numbers are only slightly lower[5]. While discussions over causes of this unfortunate pattern are ongoing, we are still lacking comprehensive data to best assess these trends. However, despite numerous studies that clearly demonstrate that young people are under a serious threat, very little has been done so far to prioritize mental health –either by governments or youth advocates themselves. One of the reasons that the global burden of mental health disorders has been underestimated for decades is the role of stigma and discrimination. These two culprits prevent those most affected, those suffering from mental health disorders and their families, from raising their voice.

The most current scientific research suggests that depression will be the leading cause of disease burden by 2030. Many risk factors associated with depression are directly connected with the most vulnerable groups: people living with chronic health conditions including HIV, people who suffer from addiction, those experiencing poverty, people with intellectual disabilities, adolescents and young people, various minority and indigenous groups, populations experiencing discrimination and human rights violations, the LGBTQI+ community, and people exposed to conflict, natural disasters or other humanitarian crises. The same groups that frequently come up in discussions of sexual and reproductive rights violations also experience high levels of stress and victimization which can lead to a greater risk of development of mental health problems. In fact, almost 30% of gay, lesbian and bisexual students in the United States say they have experienced dating violence, and consequently, studies show that within this group twice as many young people were at risk of attempting a suicide compared to those who identified as heterosexual[6].

Unmet sexual & reproductive needs lead directly to a retreat from social life, high levels of stress and anxiety, possible sleep and eating disorders, deterioration when it comes to performance in school or at work, and challenges in relationships with family and friends. It may lead to self-harm, suicidal ideations and attempted suicide. If we take a closer look at the violation of sexual and reproductive rights, we can observe its direct connection with post-traumatic stress disorder and/or major depressive disorder.

Now, do we really want to wait for the next article discussing these links to understand that maybe it’s high time we started to talk about mental health support when we discuss youth-friendly services?

The intersection of SRHR and mental health issues shows that what we need is a holistic approach to advocating for sexual and reproductive health services. We know that the lack of acceptance of young LGBTQI+ people puts them at risk of developing mental disorders; we know that unwanted pregnancies can lead to self-harm. We also know that those who don’t get the proper support are more likely to partake in substance abuse and develop addictions[7].

It’s time to grow up, shake off the stereotypes and stigma, and loudly say: SRHR and mental health discussions belong together. It is only through comprehensive health education, adequate investment in mental health, and well-trained health professionals that young people will be able to access the care they need.

________________

 

[1] Charara R, Forouzanfar M, Naghavi M, et al. The Burden of Mental Disorders in the Eastern Mediterranean Region, 1990-2013. Maulik PK, ed. PLoS ONE. 2017;12(1):e0169575.
Merikangas, K. R., Nakamura, E. F., & Kessler, R. C. (2009). Epidemiology of mental disorders in children and adolescents. Dialogues in Clinical Neuroscience, 11(1), 7–20.
World Health Organization: Health for the World’s Adolescents.

[2] The Power of 1.8 Billion Adolescents, Youth and the Transformation of the Future. UNFPA state of the world population. 2014.

[3] The Global Strategy for Women’s, Children’s and Adolescents’ Health (2016 – 2030).
World Health Organization: Adolescent mental health. Mapping actions of nongovernmental organizations and other international development organizations.

[4] Wasserman D, Cheng Q, Jiang G-X. Global suicide rates among young people aged 15-19. World Psychiatry. 2005;4(2):114-120.
World Health Organization: Mental Health Suicide Data. 2017.

[5] Petroni S, “Suicide, Not Maternal Mortality, Now Leading Killer of Adolescent Girls,” accessed at www.trust.org/item/ETC, on Sept. 23, 2014.

[6] Birkett M, Espelage DL, Koenig B. LGB and questioning students in schools: The moderating effects of homophobic bullying and school climate on negative outcomes. Journal of Youth and Adolescence 2009;38:989–1000.
Centers for Disease Control and Prevention. Sexual identity, sex of sexual contacts, and health-risk behaviors among students in grades 9-12—Youth Risk Behavior Surveillance, selected sites, United States, 2001-2009. MMWR. 2011.
Russell ST, Fish JN. Mental Health in Lesbian, Gay, Bisexual, and Transgender (LGBT) Youth. Annual review of clinical psychology. 12: 465-487. 2016.

[7] Birkett M, Espelage DL, Koenig B. LGB and questioning students in schools: The moderating effects of homophobic bullying and school climate on negative outcomes. Journal of Youth and Adolescence 2009;38:989–1000.
Sahoo S, Khess CR. Prevalence of depression, anxiety, and stress among young male adults in India: a dimensional and categorical diagnoses-based study. J Nerv Ment Dis. 2010 Dec; 198(12): 901-4.

Mental Health Conditions image licensed under CC BY-SA 2.0. It is attributed to amenclinicsphotos ac.