Exploring Common Mental Health Problems among Nigerian Adolescents: Identified Challenges and Recommendations for the Future

03Sep 2024 by Kiara Ekeigwe

The authors—Akinrinde Deborah, Ayeni Samuel, Akande Damilola, and Adegbite Adedapo—are part of a Mentored Child Health Research Project led by the Duke Center for Policy Impact in Global Health and the University of Ibadan Medical Students Association.

Introduction: a neglected global health issue

“When we ignore the mental health of children, we undercut their capacity to learn, work, build meaningful relationships and contribute to the world. When we ignore the mental health of parents and caregivers, we fail to support them to nurture and care for their children to the best of their ability. And when we ignore mental health issues in our societies, we close off conversation, reinforce stigma and prevent children and caregivers from seeking the help they need.”

                                                                       -The State of the World’s Children, UNICEF 2021

Adolescent mental health disorders are a significant and often neglected cause of suffering worldwide that can impair health and education. These disorders can prevent adolescents from reaching their full potential as well as participating effectively in their community. Throughout life, various individual, social, and structural determinants interact to protect or undermine adolescents’ mental well-being. For example, poverty, family disharmony, stress from the pressure to conform with peers, and violence—especially sexual violence and bullying—can cause mental health problems in adolescents.1 Resilience skills, substance use, and genetic susceptibility are examples of individual psychological and biological factors that determine vulnerability to such problems.1

The World Health Organization (WHO) estimates that more than 13 per cent of adolescents aged 10–19 years live with a diagnosed mental disorder.2 This prevalence amounts to an estimated 166 million adolescents with a mental disorder: 86 million adolescents aged 15–19 years and 80 million adolescents aged 10–14 years. Emotional disorders are the most prevalent in the adolescent age group, representing over 11 percent of the mental health burden.2 These disorders have significant implications for school attendance and schoolwork. They can also lead to social withdrawal, which can exacerbate isolation, loneliness, and suicidal thoughts. An estimated 45,800 adolescents die from suicide every year, and suicide is the fourth most common cause of death for adolescents aged 15–19.3 The consequences of failing to address adolescent mental health conditions may extend to adulthood, impairing both physical and mental health and limiting opportunities to lead fulfilling lives as adults.

A mental health crisis in Nigeria

Nigeria currently faces a mental health crisis. A widespread belief in Nigeria is that mental illness originates from supernatural causes, such as being possessed by evil spirits.4 Hence, it is common for individuals with mental illness to be left in the hands of “the gods” or traditional healers for help.4

Our review of multiple studies indicates that the prevalence of mental health disorders among adolescents in Nigeria varies between about 10% and 37%, highlighting mental health disorders as a significant public health concern.5, 6, 7 The most common mental health disorders identified among Nigerian adolescents from available studies are depression, anxiety disorders, attention-deficit/hyperactivity disorder (ADHD), and substance use disorder.8, 9

Many factors contribute to the high prevalence of mental health problems in Nigeria, including social factors, economic circumstances, and cultural contexts. Poverty and unemployment create significant stress for adolescents and their families. Limited access to quality education further diminishes opportunities, potentially fuelling feelings of hopelessness and anxiety.10, 11 Cultural perspectives surrounding mental health also play a critical role. Stigma and discrimination are pervasive, with mental illness often viewed as a sign of weakness or a curse, which discourages adolescents from seeking help and fosters a culture of silence around mental health concerns.12

Schools are a critical platform for promoting mental well-being during the vulnerable developmental stage of adolescence. However, inadequate training of school personnel and a lack of comprehensive mental health programs and services within schools leave adolescents without crucial support during their academic journey.13, 14

Policy initiatives to reduce the burden

Several policies and interventions have been initiated to address mental health issues globally and in Nigeria. An important initiative is the recently revised WHO Mental Health Gap Action Programme (mhGAP) Intervention Guide designed to provide evidence-based clinical protocols for the assessment and management of mental health conditions in non-specialized care settings for children and adolescents.15 The Nigeria Mental Health Act was likewise designed to provide a framework for mental health services. However, this Act and several other initiatives have faced challenges in implementation due to limited resources and inadequate infrastructure for their adoption in schools. Another challenge is the widespread over-dependence on hospital-based care, which can be isolating and inaccessible for many adolescents.16 Investing in and developing school- and community-based care models would provide more accessible and sustainable support within familiar environments for adolescents.

School based mental health programs provide early education and exposure to adolescents on mental health and help them learn the importance of mental well-being, including its nexus with physical health. Such programs may help in early detection of individuals who have mental health disorders that otherwise may be masked by socially disruptive behavior, quietness, or poor academic performance.17 Furthermore, ensuring that young people have access to adequate mental health information and services enhances their learning abilities, ultimately leading to improved academic and behavioral outcomes.18, 19, 20 The establishment of school-based programs may help reduce over-dependence on hospital-based care and may help caregivers reduce their out-of-pocket medical expenses while also removing the transportation and financial barriers adolescents face in accessing mental health services. School-based programs can equip adolescents with knowledge on prevention strategies for mental health disorders. Lastly, these programs provide an easy avenue for follow-up and continued care as students are always mandated to go to school.

A recent research project, led by our team of four medical students from the University of Ibadan, focused on implementing a resilience training program targeting vulnerable adolescents at risk of developing mental health disorders in secondary educational institutions within Ibadan, Oyo State. Supported by funding from The Center for Policy Impact in Global Health, the intervention entailed educating the students on mental health topics, coping strategies, and resilience, with the aim of assessing its effectiveness in improving their psychosocial health. The intervention guide, co-created with professionals from the Child and Adolescent Psychiatry Unit, College of Medicine, University of Ibadan, used cognitive-based skills and resilience training modules adapted from two programs: (i) the UPRIGHT program (Universal Preventive Resilience Intervention Globally implemented in schools to improve and promote mental Health for Teenagers), and (ii) the Youth Thrive Resilience Training program. 21, 22, 23 The results of the study are expected to provide valuable insights and contribute to the development of more effective and sustainable mental health programs in schools.

A holistic approach is needed

There are several critical areas that need to be improved to reduce the burden of adolescents’ mental health problems and their complications. A holistic approach is paramount, as addressing mental health problems will require considering the social determinants of health, cultural perspectives, and the existing healthcare system. The development of innovative and tactical approaches toward the effective integration of mental health promotion strategies into the school curriculum will set the stage, providing a good foundation for future effort. Schools are a natural environment for adolescents, and integrating services within the education system can provide crucial early intervention and support.

In addressing the common mental health problems that adolescents face, robust and forward-thinking policies are crucial. Unfortunately, many current mental health policies are either outdated or poorly executed, failing to meet the evolving needs of today’s youth. To truly make a difference, we must develop comprehensive policies that place adolescent mental health at the forefront. These policies include prioritizing adequate funding for existing mental health programs, and urgently addressing the severe shortage of mental health professionals and services. Additionally, investing in extensive mental health research is essential to inform these policies and ensure they are based on the latest evidence and best practices. Finally, harmonizing school-based mental health initiatives with these broader policies will create a cohesive support system, ultimately leading to significantly improved mental health outcomes for adolescents. By taking these steps, we can foster a healthier, more resilient future generation.

REFERENCES

  1. Viner RM, Ozer EM, Denny S, et al. Adolescence and the social determinants of health. Lancet 2012;379:1641–52.
  2. World Health Organization. Adolescent mental health. 17 Nov 2021. At: https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health#:~:text=Key%20facts
  3. UNICEF. The State of the World’s Children 2021. On My Mind: promoting, protecting, and caring for children’s mental health. Oct 2021. At https://www.unicef.org/reports/state-worlds-children-2021
  4. Ikwuka U. Perceptions of mental illness in south-eastern Nigeria: causal beliefs, attitudes, help-seeking pathways and perceived barriers to help-seeking. PhD thesis. June 2016. At http://hdl.handle.net/2436/621723
  5. Ogbonna PN, Iheanacho PN, Ogbonnaya NP, et al. Prevalence of mental illness among adolescents (15–18 years) treated at Federal Neuropsychiatric Hospital, Enugu Nigeria, from 2004 to 2013. Arch Psychiatr Nurs 2020;34:7–13.
  6. Babasola KM, Okhiria A, Bale SI, et al. Prevalence of mental illness among youths in Ogun State, South West Nigeria. UMYU Scientifica Journal 2024;3:63–70.
  7. Abubakar-Abdullateef A, Adedokun B, Omigbodun O. A comparative study of the prevalence and correlates of psychiatric disorders in Almajiris and public primary school pupils in Zaria, Northwest Nigeria. Child Adolesc Psychiatry Ment Health 2017;11:29.
  8. Stanley N, Chinwe ES. Prevalence of mental disorders in Abakaliki, Ebonyi State, Southeastern Nigeria. J Am Psychiatr Nurses Assoc 2022;28;306-318.
  9. Sonny John Kumbet, Oseni A, Mensah-Bonsu M, et al. Common adolescent mental health disorders seen in Family Medicine Clinics in Ghana and Nigeria. PLOS ONE 2023;18:e0285911–1.
  10. Ogbonna IF, Achor CF, Ezeogu J. Sociodemographic risk factors for mental health disorders among schoolchildren in Umuahia, South-East Nigeria. International Journal of Medicine and Health Development 2024;29:238-246. At https://journals.lww.com/ijmh/fulltext/2024/29030/sociodemographic_risk_factors_for_mental_health.11.aspx
  11. Jörns-Presentati A, Napp AK, Dessauvagie AS, et al. The prevalence of mental health problems in sub-Saharan adolescents: A systematic review. PLOS ONE 2021;16:e0251689.
  12. Lasebikan VO. Cultural aspects of mental health and mental health service delivery with a focus on Nigeria within a global community. Ment Health Relig Cult 2016;19:323–38.
  13. Ibeziako PI, Omigbodun OO, Bella TT. Assessment of need for a school-based mental health programme in Nigeria: Perspectives of school administrators. Int Rev Psychiatry 2008;20:271–80.
  14. Ibeziako P, Bella T, Omigbodun O, Belfer M. Teachers’ perspectives of mental health needs in Nigerian schools. J Child Adolesc Ment Health 2009;21:147–56.
  15. World Health Organization. mhGAP Intervention Guide – Version 2.0. 24 June 2019. At https://www.who.int/publications/i/item/9789241549790
  16. Ozota GO, Sabastine RN, Uduji FC, Okonkwo VC. Nigeria mental health law: Challenges and implications for mental health services. S Afr J Psychiatr 2024;30:2134.
  17. Kim J, Kim D, Kamphaus R. Early detection of mental health through universal screening at schools. Georgia Educational Researcher. 2022;19(1): Article 4. At https://digitalcommons.georgiasouthern.edu/gerjournal/vol19/iss1/4/
  18. Guzmán J, Kessler RC, Squicciarini AM, et al. Evidence for the effectiveness of a national school-based mental health program in Chile. J Am Acad Child Adolesc Psychiatry 2015;54:799-807.e1.
  19. Sanchez AL, Cornacchio D, Poznanski B, et al. The effectiveness of school-based mental health services for elementary-aged children: a meta-analysis. J Am Acad Child Adolesc Psychiatry 2018;57:153–65.
  20. Bella-Awusah T, Ani C, Ajuwon A, Omigbodun O. Effectiveness of brief school-based, group cognitive behavioural therapy for depressed adolescents in south west Nigeria. Child Adolesc Mental Health 2015;21:44–50.
  21. UPRIGHT. Universal Preventive Resilience Intervention Globally implemented in schools to improve and promote mental Health for Teenagers. At http://www.uprightprogram.eu/
  22. Las Hayas C, Izco-Basurko I, Fullaondo A, et al. UPRIGHT, a resilience-based intervention to promote mental well-being in schools: study rationale and methodology for a European randomized controlled trial. BMC Public Health 2019;19:1413.
  23. Carpenter-Williams J. Youth Thrive: Promoting Youth Resilience. Trainer’s Guide. Washington, DC: Center for the Study of Social Policy, 2017. At https://cssp.org/wp-content/uploads/2018/08/youth-thrive-promoting-youth-resilience.pdf