Daily Times

The mental health of adolescents in the 15 to 19 age group, according to the latest World Health Organisation (WHO) Mortality Database, is the number two cause of illness and disability. With depression named as the number one cause in this age group, a rising trend of suicide in young males is observed. The rate of adolescent suicide has also increased in Pakistan in the past few decades, prompting several interventions to curb the increase. Unfortunately, many intervention efforts have not worked because of the poor support for integrated primary prevention efforts. The development of depression in adolescence may be understood as a bio-psychosocial, multi-factor process influenced by risk and protective factors including temperament, genetic heritability, parenting style, cognitive vulnerability, stressors (e.g. trauma exposure or poverty), and interpersonal relationships. Two major sets of questions emerge. First, how can we best characterise normative family relationships during adolescence, and, more specifically, is adolescence a time for examining any parent and child conflict? Second, how do variations in parent-child relationships affect the developing adolescent? The answer to the first question depends on what is meant by conflict and, more importantly, a need for a new perspective on the family, one that emphasises the different viewpoints and stakes that parents and adolescents bring to their relationship with each other. It is argued that there is enough evidence to conclude that adolescents benefit from having parents who are authoritative: warm, firm, and accepting of their needs for psychological autonomy.

Poverty, parental conflicts, mental illness and family violence are all strongly associated with higher rates of probable psychiatric disorders among Pakistani 10 to 19 year olds. Though it is tempting to conclude that social adversities can cause children’s behavioural problems, another possibility is that the social adversities and behavioural problems both arise from the above mentioned unmeasured factors. The possible role of social capital and social networks in buffering the impact of these social adversities is likely to have the additional benefit of improving child mental health. Research continues to indicate that vulnerable youth are susceptible to the influence of reports and portrayals of suicide in the mass media. The evidence seems to be stronger for the influence of reports in the news media than in fictional formats. Dramatic televised portrayals can lead to increased rates of suicide and suicide attempts using the same methods used in shows. One approach to reducing the harmful effects of media portrayals is to educate journalists and media programmers about ways to present suicide so that imitation will be minimised and help seeking encouraged. Television and wider media exposure in adolescence are associated with increased odds of depressive symptoms in young adulthood, especially in young men. It is plausible that exposure to electronic media may be one of the factors that influences development of depression. This illustrative exposure is massive. Even when accounting for multitasking, current adolescent media use is estimated at nine and a half hours per day. There are many different mechanisms by which media exposure may influence the development of depression. In terms of the sheer volume of exposure, adolescents who spend excessive time engaging with media may not have as much opportunity as their peers to cultivate protective experiences that require active social, intellectual, or athletic engagement. Media content may also lead to depression more directly and cultural messages transmitted through media may affect other behaviours related to mental health such as eating disorders and aggressive behaviour. Having said that, a therapeutic advantage cannot be ignored, however, which is that adolescents often use media in social settings that may offer a social outlet that protects against depression.

Media exposure may similarly contribute to development of depression through reinforcement of depressogenic cognitions. For example, certain electronic media exposures are saturated with highly idealised characters and situations, and constant comparison of one’s self with these unattainable images may result in depression. Because adolescence is an important time of self-definition, exposure to such simplistic portrayals can interfere with normal identity development, potentially producing depression. Other media exposures are highly negative and anxiety provoking, and repeated exposure to these messages may engender a negative and fearful perception of the world, which can also result in depression. In addition, media commonly used by adolescents contain multiple references to risky behaviour including substance use or abuse, violence, and sex, and adolescents who engage in these behaviours may come to regret them and become prone to depression. Related to this, excessive media exposure often occurs at night and can displace sleep, which is valuable for normal cognitive and emotional development. It has also been suggested that early media exposure can interfere with optimal development of executive function, potentially contributing to vulnerability to cognitive distortions that have been associated with depression. When assessing empirically the association between electronic media exposure in adolescence and subsequent development of depressive symptoms in young adulthood, one a priori hypothesis is that excessive volume of television viewing during the adolescent years is associated with increased development of depression in young adulthood.

We still have only a limited understanding of some key questions. Are children less resilient to life’s ups and downs — and if so, why? Is it right to point the finger at a pathological form of social anxiety that is inflamed by electronic media, and if so, do elements such as growing inequality, poverty and celebrity culture propel that social anxiety? To be fair, concern that excessive internet and electronic media use is accelerating some very disturbing trends in child and adolescent mental health is not new, and to suggest that it is all the fault of the media is also misleading. But it is absolutely right to highlight growing concerns in child and adolescent mental health. Frankly, when things are as bad as they seem to be, one needs to search every alleyway not knowing what may be hiding within. Digital disruption is often used in relation to businesses and institutions, but we need to be much more alert to its impact on the mental health of children and adolescents in our home. Crucially, the home is expected to provide children with protection from such transactional relationships until they reach maturity. However, the flood of electronic media has blown apart privacy, turning our homes into stock markets where we are expected to trade ourselves. Is it possible that what electronic media grooms in us are a malignant desire, and an ability, to exploit our wonderful lives, family and friends? Justifying its use as a form of entertainment and education for children strikes me as disastrous. Only those with considerable alternative resources, strong attentive and content parents, basic moral and religious attitude and good schools alert to their well being as well as achievement will manage to get through to adulthood relatively unscathed. It goes without saying that poverty reduces the chances of all these ameliorative factors. So this is an epidemic that will fall disproportionately on the poorest, with consequences that will last a lifetime. I hate to admit it, but we have created a cruel lottery for our children.

The writer is a member of the Diplomate American Board of Medical Psychotherapists Dip.Soc Studies, member Int’l Association of Forensic Criminologists, associate professor Psychiatry and consultant Forensic Psychiatrist at the Huntercombe Group United Kingdom. He can be reached at fawad_shifa@yahoo.com