Today, I brought you here to beautiful meadows. Here, right at the heart of the University of Edinburgh. In the first video, I have given you an overview of adolescent mental health. In the second video, we have talked specifically adolescence as a transitional period between childhood and adulthood. In today's video, I'm planning to explore with you some of the common mental health difficulties experienced by adolescents. The first thing you may ask is, how common exactly mental health problems are amongst young people? It is very difficult for me to give you an exact figure. When you read research papers and reports you will find a range of prevalence rates, depending on how mental health were defined, how they were measured, and what mental health difficulties were included. But have a look at this table here I'm showing you. And as you see, this table shows the prevalence rate of mental health difficulties in young people in different countries. You will find more detail in the paper I put for you in the recommended reading list. I just want to point out to you a few obvious things here. Number one, obviously mental health difficulties are prevalent in both developing and developed countries, so it's really a global health challenge. Number two, you can see there are substantial differences between different countries, and sometimes even within a single country. And number three, even when you look at a smallest figure in the Netherlands, 8%, 8% of young people experiencing mental health difficulties. Still translate to a lot of young people. Indeed, adolescence is a developmental stage in which we see a sudden increase in mental health difficulties. It is estimated that 75% of the adults who have mental health difficulties had the first onset by the age of 24. Take depression as a specific example. 50% of the depressed people report that their first depressive difficulties start as young as 25 years old or younger. And 25% of the depressed people had their first depressive onset by the age of 18. When we talk about depression, we very often think about people feeling really sad. But actually depression is also about not being able to enjoy things we usually enjoyed. It's a bit like walking in a dark tunnel in which everything seems so dark and dour and distressing. It also affects our sleep, our eating, and our memory and concentration. And of course, for young people, it has a particular negative impact on their academic studies, their work, and their social relationships. Not only is depression the kind of difficulties that start early in life, it is also what we call, a recurrent condition, meaning that once you have one depressive episode in life, you're more likely to experience more. Because of that I think it's particularly important that we conduct more research to try to understand the risk factors and protective factors of depression. With the ultimate goal to help develop more effective preventive measure and early intervention for a vulnerable young people. Related to depression is another condition we call anxiety. Like depression which is like walking in a dark tunnel, anxiety's a bit like a rubber band that you feel really tense, just feeling really anxious, a lot of worries. And one of the types of anxiety is social anxiety, which is particularly prevalent in young people. The median onset age is about 13 years old. When people have social anxiety, as the term suggests, they're more likely to be anxious in social situations. They become more self-focused and more self-conscious. And they constantly worry about what people may be thinking of them in social situations. As we have already talk about that in the last video, adolescence is a developmental stage in which peer relationships become very important in their well-being. Because of that, I think we can all appreciate how hard it must be for a young person to have social anxiety and having to cope with that on an everyday basis. Well, I have talked to you about depression and anxiety, but there are other mental health problems that adolescents may experience too. I'm not expert in this areas, so I'm going to take you back to the university and talk to some of my colleagues about that. Hi, Matthias. I know some of your research about psychosis. Could you tell us something about psychosis? >> Well, psychosis describes a kind of major mental health problem. It's when people experience voices or visual hallucinations. Sometimes other hallucinations as well. But people experience very strong negative beliefs about persecutions or being followed, having implants, in your head that allows others to transmit their thoughts. So a set of pretty scary experiences. What we now describe as psychosis, traditionally has been associated with schizophrenia or dementia precox. And it's probably the kind of picture book of, of, of mental illness. So what people associate with long term asylums or straight jackets or ice baths things like that. >> Is this something that will affect adolescents? >> Very much so, and most of our research is concerned with adolescent onset psychosis. And we know that the main period when psychosis occurs, is between so, 14, 15, and then 21 or 22 years of age. So that late adolescent period seems to be the most vulnerable period in terms of a first episode of psychosis. Curiously, we also find in adolescents are a high level of acceptance of these psychotic experience. So there seems to be something to that, that that's linked to, to the adolescent experience. >> What sort of help available for adolescents who are experiencing this kind of difficulties? >> The most scary the most scary fact about this is that most people take years to actually seek help for these kinds of experiences. So even if they had high levels of distress, and they have very frequent intrusive experiences like that. It can on average take three to five years before they seek appropriate help, and receive treatment. Once somebody presents with these symptoms, or difficulties, to their GP, or guidance teacher. There's a range of help available, but specialist services and specialist help is very thin on the ground. Usually what's recommended by, by NICE or, or assigned in this context is a mixture of medical, pharmacological, and psychological treatment. That seems to be most effective for this group. >> Thank you. >> Hi, Paul. I've heard something called at-risk mental state. Could you tell us what is it? >> What the at-risk mental state is? Yeah I mean it returns to a sort of set of experiences, and beliefs that a young person might hold that they don't quite meet criteria for established psychosis or schizophrenia. They're also a sort of intensities and severity. There's a little bit less than that. But which research has shown means that there are greatly increased risk of them developing psychosis or schizophrenia at some point. So the experiences we're talking about are things like maybe sort of seeing things that aren't there. Hearing things that aren't there or maybe having kind of potentially somewhat unusual beliefs other people don't share and being preoccupied and anxious and distressed by that. We've just done some research recently with, my colleague Peter Taylor from the University of Liverpool and Lisa Woods from Greater Manchester L.H.S.. And that's shown that suicidal libation and suicide risk is actually quite high as well. Comparable to people who already developed psychosis. >> Is it can you clarify what is the difference between at-risk mental state and say, psychosis? >> Yeah, I mean, the at-risk mental state is really a sort of, attenuated version of, of psychosis. In the sense that experiences that people are having in established psychosis that are really troubling them and are very preoccupied with. That's sort of happening, but just like in a lesser extent in people with the at-risk mental state. And there's, they're, they're distressed by them and they're seeking help for them. So as I say the kind of research shows that people who meet criteria for an at-risk mental state, you know roughly sort of, 20 to 40% of those people might then develop psychosis at some point in the future. >> Is this something that will affect adolescents? >> Yeah, I mean, the, the kind of, period for the, the kind of, risk period for developing psychosis. Or receiving a diagnosis of schizophrenia is for, it's kind of, the young adult kind of, period so. I'd say it's quite rare and unusual in children. So, under 14, I would say it's quite unusual to develop psychosis. From about 14 onwards, your risk sharply increases. Certainly adolescence is a time, nobody really knows why, but adolescence is a time when people are getting particularly at risk. And the risk of developing psychosis tails off again after the age of sort of 35. >> What sort of, treatments are, are available or, evidence based to help young people who may experience this kind of difficulties? >> Well, we've, we've done a review of psych, social treatments for this group and, as have several colleagues of mine, and we've found that, cognitive behavior therapy. I mean, we've looked at all the trials of cognitive behavior therapy for this group. And there's some pretty good evidence that we can sort of halve the risk of developing psychosis in this group if they receive therapy cognitive behavior therapies, typically. People have also looked to use of anti psychotics to prevent psychosis and I think the evidence suggests maybe the harms outweigh the benefits. And, people are also starting to look at things like family interventions. I think the current National Institute for Clinical Excellence guidelines in England and Wales recommends CBT for psychosis prevention now, so. So, that's what people sort of should be getting, and that's what the evidence suggests will help people. Whether they receive it is probably largely a function of where they live. And the health service, that provides them with care and so on. >> Thank you very much. >> Hello Emily. I know some of your research is about eating disorder. I wonder whether you can tell us something about eating disorders. >> So eating disorders aren't a particularly prevalent disorder. I think that the prevalence for anorexia is a little bit under 1% and for Bulimia it's about 1 to 3%. So they're not particularly prevalent disorders, but they can be quite serious. So I think around 5 to 10% of people with anorexia actually have mortality due to associated problems. So, although it's not particularly pervasive, it's quite serious problem. >> And, can you tell us something about how this may affect teenagers? So teenagers, that's often the age of onset for some of the disorders, so, it's quite common for teenagers to be diagnosed with anorexia, but also, eating disorder not otherwise specified. So that's when, that includes things like binge eating disorder, but also when a disorder has lots of features of anorexia or bulimia, but the person wouldn't meet the full criteria. >> What sort of treatments are available for people who suffering from eating disorders? >> Family therapy is quite common. Cognitive behavioral therapy. Sometimes interpersonal therapy. Also other things are emerging such as dialectical behavioral therapy. >> Thank you very much. >> Mental health difficulties are very common in young people. This is also the critical stage in life when we make important choices about finishing education, developing our career and intimate relationships. Because of that, mental health difficulties experienced at this stage of our life could be particularly distressing. And have a long term impact in our life. As I've said it again and again, adolescence is a unique developmental stage. Adolescents are not just larger versions of children or smaller versions of adults. If we genuinely want to improve the well being of young people, we really need to understand mental health difficulties in the context of the unique developmental factors. In fact, this is the message that we're been trying to get across to you throughout our MOOC. Life is a journey. I know it sounds clich, but it is so true. We have easy rides, and sometime we have bumpy rides. And sometimes we can have a puncture. But this important to remember that difficulties are also part of our normal, everyday life experience. And sometimes it is through the most difficult times that we discover some things really precious about ourselves. And gradually we learn how to look after ourselves better and better. I hope you have enjoyed your learning journey with us. As I thoroughly enjoyed preparing the MOOC for you. And on this note I wish you a very pleasant journey in life.