Measurement of Mental Health among Adolescents at the Population Level (MMAP) Conceptual Framework and Roadmap

Measurement of Mental Health among Adolescents at the Population Level (MMAP) Conceptual Framework and Roadmap

The Roadmap to the Measurement of Mental Health among Adolescents at the Population Level (MMAP) Background Mental health issues constitute one of the greatest burdens of disease for adolescents globally. An estimated one in five adolescents will experience a mental disorder. Self-harm is the third leading cause of death for adolescents, and depression is among the leading causes of disability in this age. 1 Adolescence is a crucial period of development, where exposures and behaviors can set the trajectory for an individual s mental and physical health in later life. 2 Fully half of individuals who will suffer from a mental disorder in their lifetime will face its onset during adolescence. 3 Mental disorders can be severe and disabling, and are associated with grave social and economic impacts. Yet, adolescent mental health has often been overlooked in global health programming. During the SDG period, however, mental health is taking an important place in the global health agenda. This is a key step toward reducing preventable deaths among adolescents, and reducing the global burden of disease attributable to mental disorders. Currently, data concerning mental health conditions among adolescents, especially in low and middle- income countries, is lacking and is urgently needed. The data used to extrapolate estimates for the prevalence and burden of adolescent mental disorders are based on few studies, offering a very narrow snapshot of the situation for adolescents globally. The true burden of mental health disorders among adolescents could be direr than estimates suggest. SUSTAINABLE DEVELOPMENT Ensure healthy lives and promote well-being for all at all ages, in collaboration with key partners, is working to fill this crucial data gap by creating a methodological framework for the development of tools for data collection on adolescent mental health. Improved data and evidence on the prevalence and burden of mental ill health among adolescents, as well as on exposure to risk factors and access to interventions, is an essential step towards planning more effective and supportive programming and identifying vulnerable populations at higher risk. 1. WHO and partners (2017) Global Accelerated Action for the Health of Adolescents (AA-HA!). Geneva 2017 2. Sawyer SM, Afi fi RA, Bearinger LH, Blakemore SJ, Dick B, Ezeh AC, Patton GC. Adolescence: a foundation for future health. Lancet 2012; 379: 1630 40. 3. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005; 62:593 602. 2

Conceptual Framework Draft for Discussion A conceptual framework for the measurement of mental health among adolescents has been developed to illustrate concepts and factors concerning adolescent mental health, to ensure the goals and approach are designed with appropriate consideration of their context. Conceptual Framework: Measurement of Mental Health among Adolescents at the Population Level (MMAP) Risk Factors Outcomes Societal Familial Individual Protective factors Preventive and risk-reduction interventions Adolescent Mental Ill-Health meeting a level of Functional Impairment Access to Interventions, Treatment, Support Impacts on the individual s health, including neglect of self-care and health-risk behaviors Early mortality resulting directly or indirectly from mental disorders or associated factors, or self-harm and suicide Impacts on developmental, educational, financial and social outcomes for the individual Greater societal impacts Risk factors The conceptual framework features risk factors on the individual and family levels, as well as broad societal circumstances. In many situations, an interplay of risk factors, and a lack of buffers or protective factors, will convey the risk for an individual to have mental ill-health. Interventions, treatment and support There are many effective treatments for individuals with mental disorders including therapies as well as medications. On the broader societal level, programs can be tailored for specific populations and targeted to those in need. Protective Factors Outcomes individual and societal burden There are many factors, as well as numerous effective interventions, that can increase likeliness for positive mental health outcomes, or that may reduce or buffer risks for mental disorders. Mental disorders among adolescents are critical to address due to their prevalence, early onset and lasting impact. The burden on individuals, families, and society may include long-term effects on productivity and quality of life, in addition to disability caused directly by mental disorders. The measure of adolescent mental ill-health with associated functional impairment The measure of adolescent mental ill-health will capture mental disorders or associated symptoms meeting a threshold of functional impairment at home, school or among peers. This measure may capture mental disorders, as well as self-harm and suicidal behaviors. 3

Roadmap to the Measurement of Mental Health among Adolescents at the Population level (MMAP) The proposed roadmap that will lead to the development of a tool for the measurement of adolescent mental health consists of the following steps: 1 Desk review of existing instruments and of prevalence 5 Creation of a Technical Advisory Group (TAG) on mental health measurement among adolescents A desk review was conducted to assess the current level of evidence in peer-reviewed literature. Epidemiological studies concerning prevalence of mental disorders among children and adolescents in low- and middle- income countries were evaluated. Subsequently, a mapping of existing data collection tools was undertaken to document the attributes of validated scales and instruments used to measure adolescent mental health. A small group of advisors will be assembled to provide technical expertise throughout the selection, adaptation, and finalization of a tool for the measurement of adolescent mental health. The TAG will also guide the refinement of the conceptual framework, as well as the development of key indicators on adolescent mental health. 2 Development of a conceptual framework 6 Selection of instrument A conceptual framework was developed by to illustrate relevant factors in regards to measurement of mental ill-health of adolescents at the population level, risk and protective factors, and access to mental health support or treatment. This model will be further refined to inform various aspects of this work. 3 The First Technical Experts Group meeting was held at Headquarters in New York, in March 2018, to convene key partners and experts and present the roadmap to the measurement of adolescent mental health at the population level. 4 Technical consultation with key partners and experts Development of indicators on adolescent mental health The development of indicators of adolescent mental health was begun at the First Technical Experts Group meeting. The proposed indicators put forth will be further developed and refined with input from the Technical Advisory Group. The TAG will provide input and recommendations including criteria to inform the selection of a validated scale or instrument to measure adolescent mental health at the population level. 7 8 Translation, validation and piloting of the instrument The selected scale or instrument to measure adolescent mental health at the population level will be translated, adapted, and piloted in selected test countries. The final protocol for instrument translation and validation, and evaluation of its psychometric properties will be refined in consultation with the TAG. Finalization of a tool to measure adolescent mental health in national-level surveys Upon completion of the steps listed above, the tool for measurement of adolescent mental health will be disseminated and promoted for use in national household surveys. Data collection may begin in each country, followed by compilation of results in global databases. These population-level data, collected as a component of comprehensive household surveys, will allow disaggregation of the findings by demographic and socio-economic characteristics, as well as subnational geographic areas. 4

Roadmap 2018-2019 - Timeline for the development of a tool to measure adolescent mental health at the population Level Activities JAN FEB MAR APR MAY 2018 2019 JUN JUL AUG SEP OCT NOV JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV Desk review of instruments and prevalence of mental ill-health in low and middle income countries Technical Experts Group meeting - face-to-face New York (March 1-2 2018) Webinar to share the findings from the first meeting of the Technical Experts Group Call for nominations to form the Technical Advisory Group (TAG) Development of indicators, based on recommendations from first Technical Experts group meeting Finalize selection criteria, evaluate and select instrument(s) Adaptation, Pre-testing and Cognitive interviewing in select countries Field testing of the new AMH module Reliability and Validity testing and analyses of the new AMH module Finalization for Launch of the AMH module Work led by Data and Analytics Section/Division of Data Research of Policy Contact: data@unicef.org 5