Science, medicine and policy have often focused on childhood and adulthood as the most important phases of human development, glossing over the years in between.

 

A second chance in the second decade

Mental Health Month  -- May -- presents a great opportunity to think about how we can use the full definition of mental health, in connection with evidence-informed policy and practices, to enhance the emotional, social, and psychological wellbeing of the nation’s adolescents.  

Adolescence – which, based on brain development, is now believed to last from around age 10 (when puberty  begins) to age 25  -- encompasses elements of rapid and often asynchronous biological growth as well as major social role transitions with profound new demands, opportunities, and experiences.  High-school-aged adolescents feel perhaps the worst pressures and often display psychological distress. 

Positively- and moderately- framed adolescent wellbeing indicators, national averages, various years, various sources.

Figure 1. Positively- and moderately- framed adolescent wellbeing indicators, national averages, various years, various sources.

Negatively framed adolescent wellbeing indicators, by percentages reporting, national averages, various years, various sources.

Figure 2. Negatively framed adolescent wellbeing indicators, by percentages reporting, national averages, various years, various sources.

Selected local high-school-aged adolescent wellbeing indicators, 3 U.S. Counties and 3 U.S. States.  Note: County A is located in State A, etc

Figure 3. Selected local high-school-aged adolescent wellbeing indicators, 3 U.S. Counties and 3 U.S. States. Note: County A is located in State A, etc.

Whether these adolescents “flourish” depends in part on how their social, natural, built, political, educational, community, and familial environments are structured.  In addition, adolescents can benefit psychologically and socially by gaining skills related to self-regulation, positive relationships, community engagement, and resiliency.  

Growing knowledge about the role of social determinants in adolescent psychological wellbeing, evidence from research on social and individual interventions , and emerging findings from the field of adolescent brain science have potentially profound implications for how youth can be helped to thrive, taking a mental health promotion, or upstream, approach.

Selected potential social determinants of adolescent emotional, social, and psychological wellbeing.

Figure 4. Selected potential social determinants of adolescent emotional, social, and psychological wellbeing. Notes: • Positively framed data were converted to be framed negatively to be consistently across indicators. • This is not a complete picture. Other social determinants not reported here (e.g., built environments, natural environments, income inequality) have been posited or to affect adolescents’ wellbeing.

These other factors and strategies to overcome them will be considered as part of the AcademyHealth/ACT for Health partnership on adolescent wellbeing.

AcademyHealth and Adolescents and Children Together for Health (ACT for Health)  are working together at enhancing adolescent wellbeing.  The partnership is in keeping with AcademyHealth’s mission of Moving Evidence to Action and will support ACT for Health to achieve its own mission, “To bring together organizations and individuals to promote a holistic and coordinated approach to improving the mental health of children and adolescents.”  
    
 The partnership builds on environmental scans and scoping literature reviews conducted to date by ACT for Health, to select a limited number of promising community-based interventions for more rigorous review, using AcademyHealth’s Rapid Evidence Review approach. These could include interventions such as parenting strategies aimed at improving family-adolescent relationships; strategies aimed at helping teachers and schools support adolescent flourishing; policies and programs related to improving natural and built environments; as well as other changes to federal, state and local legal and regulatory contexts.  Once the evidence is reviewed, we will work with local stakeholders in at least three communities to support implementation and spread. Throughout this process, AcademyHealth and ACT for Health will engage stakeholders at the community- and national- levels to ensure that the evidence-based approaches are relevant and feasible.
    
We welcome comments and expressions of interest; these can be added below for those logged in to the AcademyHealth site or in an email to [email protected].   

Denise Dougherty photo

Denise Dougherty, Ph.D.

Adjunct Professor, Pediatrics - Case Western Reserve University and Rainbow Babies and Children’s Hospital Center for Health Policy and Research