The World Health Organisation defines mental health as ‘a state of well-being in which an individual realises their own potential, can cope with the stresses of life, work productively, and contributes to the community’ (Vietch et al 2008).
Recent data suggests that approximately 20% of young people experience mental health problems within any six month period. Adolescent girls show the highest prevalence of depressive symptoms, and are twice as likely as boys to experience mental health disorders (Ashdown-Franks et al. 2019).
The Lancet Psychiatry (June 2019), reports the frequency of young people self harming has tripled in Australia over the last 10 years, mainly amongst women and girls aged 16–24 years. Self harm has become prevalent to the point where it risks being normalised. For those presenting to general practitioners the cause is generally stated as a coping mechanism. A way to manage unpleasant emotions that include anger, tension, anxiety and depression. Experts suggest self harm can be a marker for other risk behaviours effecting social and emotional development throughout young adulthood with wide-reaching and potentially lifelong implications. A population-level intervention to improve emotion regulation and increase emotional resilience in young people has been suggested (McManus et al. 2016).
While causes of adolescent mental health conditions range widely from abuse, social stress, life dissatisfaction and low self esteem. Other cited causes include childhood poverty, neglect, exam pressure, bullying, social media and body image as issues driving up rates of self-harm. The complexities of this health concern can no way can be trivialised or simplified.
Anecdotally, having had teenage children, coached teenagers and young adults, and by simply being, a mother, sister, aunt, a colleague, a neighbour, a student, and teacher, I have known girls and young women from a variety of backgrounds, culture, religion, privilege, socioeconomic disadvantage and at every level of education to self harm. Feeling compassion and helplessness simultaneously is challenging for those living and working with young people deliberately harming themselves. Parents, teachers, counsellors and friends often end up at a complete loss, frustrated and saddened, not knowing how to help.
Without being too reductive or simplistic, but rather examining potential elements of support and relief, it may be beneficial to look at the emerging evidence suggesting that sedentary behaviour and physical inactivity contribute to and compound adolescent feelings of low self esteem and poor life satisfaction. Recent studies report the more time spent sedentary in adolescents can be associated with a higher risk for developing depressive symptoms (Edwards & Loprinzi 2017; Hrafnkelsdotti et al. 2018). Individual levels of inactivity and time spent on screens for school, work, entertainment, gaming and social media have shown to impact a variety of mental health disorders.
While it is widely accepted that structured and supervised physical activity, including aerobic and resistance training, can improve outcomes in major depression, pre and postnatal depression, anxiety, stress disorders and schizophrenia, findings from adult studies do not necessarily apply to adolescents. Adolescent girls with depressive symptoms may withdraw from social activities and mandatory sports classes may be less likely to be a positive physical activity experience like adult voluntary participation (Ashdown-Franks et al. 2019; Veitch et al. 2008).
Given the established benefits, low cost and low risk of physical activity it is suggested that clinicians and health professionals treating inactive adolescent patients experiencing anxiety and depressive symptoms recommend a physical activity program in addition to any other prescribed or adjunctive treatment. Even low doses of moderate and vigorous-intensity physical activity can protect against depression. A 1-week sedentary behavior-inducing intervention showed to have negative effects on depression and mood on adolescents suggesting consistent regular physical activity that is not part of the curriculum may prevent mental health decline (Edwards & Loprinzi 2017).
A 2018 Icelandic study examining both the separate and interactive associations of adolescent sedentary behaviour and physical activity with self-reported mental health found that less screen time; less than 5 hours per day, and more frequent vigorous physical activity; 4 times per week, were associated with less depression, anxiety, low self-esteem, and life dissatisfaction for both male and females (Hrafnkelsdotti et al. 2018). The authors suggest that by “limiting screen time and increasing participation in vigorous physical activity may separately, but especially in combination, have beneficial effects on mental health in adolescents.”
Of course the other benefits of regular physical activity such as improved self esteem, self-efficacy and cognitive and psychological function also assist in reducing stress and increase social connection and interaction. Through on-going research and by providing adolescents with a suite of interventions, care, advice, therapies and medical support, hopefully preventative and protective measures will start to be implemented and young people will be able to get mental health support before they reach crisis point.
Ashdown–Franks, Sabiston & Stubbs 2019, The evidence for physical activity in the management of major mental illnesses, Current Opinion Psychiatry
Biddle & Asare, 2011 Physical activity and mental health in children and adolescents: a review of reviews doi.org/10.1136/bjsports-2011-090185
Edwards & Loprinzi 2016, Effects of a Sedentary Behaviour-Inducing Randomized Controlled Intervention on Depression and Mood Profile in Active Young Adults doi:10.1016/j.mayocp.2016.03.021
Hrafnkelsdotti et al April 26, 2018 Less screen time and more frequent vigorous physical activity is associated with lower risk of reporting negative mental health symptoms among Icelandic adolescents.
The Lancet Psychiatric 2019, Responding to the rising prevalence of self-harm doi.org/10.1016/S2215-0366(19)30210-X
Vietch et al. 2008, Mental health and physical activity among adolescents Summary Report
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