Identifying the gaps between science, policies, services, and the needs of youths affected by mental disorders

Abstract

Second, there is a lack of solid empirical evidence for the treatment of a variety of conditions, and frequently the available evidence is not incorporated by the health systems [10]. The gap between interventions that are available in community settings and interventions that are evidence-based is even larger in low-resource settings [11]. Pharmacological interventions are commonly preferred because they are more easily delivered, with high fidelity if adherence is good. However, attributes of medications and patients' and families' preferences are usually not addressed by clinicians and have important implications on adherence [7]. On the other hand, psychotherapeutic approaches available in the health system usually lack consistency and are directed by the professional's theoretical affiliation, not by patient needs. Also, treatments are frequently delivered by professionals with limited training in inadequate formats. For example, nationally representative survey data from visits to office-based physicians in the US revealed that visits with a prescription of antipsychotic medications per 100 persons increased from 0.24 to 1.83 for children and 0.78-3.76 for adolescents between 1993-1998 and 2005-2009 [8]. Only 6 % of children and 12.7 % of adolescents' antipsychotic visits included a FDA clinical indication, and disruptive behavior disorders were the diagnosis for 63 and 33.7 % of visits for children and adolescents, respectively, despite the limited evidence for this indication and the urgent need of short-and long-term studies assessing its efficacy and safety, as addressed by the article from the Paediatric European Risperidone Studies Consortium in this issue [16]. Noteworthy, mean duration of antipsychotic visits was approximately 25 min and only approximately 30 % of them included psychotherapy [8], despite solid evidence on the efficacy of psychosocial interventions for several mental disorders, such as disruptive behavior disorders, for example in [15]. Children aged 2-5 years have also been Mental disorders are estimated to affect 10-20 % of children and adolescents around the world and are major causes of morbidity among youth [10]. Evidence from different countries suggests that the number of youths with reported diagnoses of mental disorders in the community has increased substantially during the past decades [1,17], although there is no evidence to indicate that the actual prevalence of disorders has increased [12]. Surprisingly, despite the fact that mental disorders have been increasingly recognized by professionals and the community, associated morbidity and mortality have remained stable [3].There are several possible explanations to explain why increasing rates of diagnoses do not translate into broad benefits to the health of the population. First, although rates of diagnoses have increased over time, the absolute number of youths affected by disorders who did not receive a diagnosis or treatment is still large. This is the case in the National Comorbidity Survey Adolescent Supplement (N...

Preventive strategies for mental health

“…While there is increased interest in early detection to prevent progression to severe mental disorders such as schizophrenia and recurrent major depression, knowledge of risk factors and developmental trajectories has not yet been widely applied to clinical practice and public health. 1 Psychiatry has traditionally been based on treatment and prevention of progression and disability in individuals with established illness (i.e. tertiary prevention).…”

Child and adolescent mental health policy in South Africa: history, current policy development and implementation, and policy analysis

“…However, this recognition alone is not enough to influence policy development and implementation for CAMH services. There are other contextual factors that are influential in determining policy development and implementation, given that mental disorders represent the greatest burden of disease in children and adolescents around the world, affecting 10–20% of them [ 4 , 5 ]. Furthermore, the majority of adult mental disorders develop during childhood or adolescence [ 6 , 7 ] when they could potentially be prevented, or identified and treated early.…”

Development of national capabilities in low and middle income countries for research in child mental health

“…The complete picture, with national data from low and middle income countries (LMICs) included, would certainly depict a more vulnerable scenario. In fact, due to population growth and under-resourced health care systems, the burden of mental health and substance-use disorders is expected to further increase worldwide in the next decades, and the steepest rise is predicted to occur in LMICs [7].Considering the evolving adverse scenario of child mental health across the globe, international calls and initiatives have been proposed and implemented aiming to foster the development of preventive and treatment interventions, health-system strengthening, and policymaking [12,13]. Importantly, in LMICs, the development and consolidation of in-country research capabilities that are able to identify local specificities and connect to commonalities across countries, both in terms of etiology, biological substrate, clinical presentation, treatment response, long-term trajectories of disorders, and also health system organization, are…”

“…Considering the evolving adverse scenario of child mental health across the globe, international calls and initiatives have been proposed and implemented aiming to foster the development of preventive and treatment interventions, health-system strengthening, and policymaking [12,13]. Importantly, in LMICs, the development and consolidation of in-country research capabilities that are able to identify local specificities and connect to commonalities across countries, both in terms of etiology, biological substrate, clinical presentation, treatment response, long-term trajectories of disorders, and also health system organization, are and refine the identification process of children with SLDs in specific contexts, the authors suggest that normative data based on local representative samples are urgently required.…”