Welcome back to the third and

final video of this week.

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.