HIGH RISK BEHAVIOR AND MENTAL

PROBLEM AMONG ADOLESCENT

INTRODUCTION

HIGH RISK BEHAVIOR & MENTAL HEALTH

TREATMENT

HEADSS ASSESSMENT
CONTENT
CONCLUSION

REFERENCE
INTRODUCTION
• Adolescence is a period during which youth experience physical, neurological, and cognitive
transformations, as well as shifts in the nature of relationships by developing new social ties and
roles across social domains (Moretti, 2004; Weisz & Hawley, 2002)
• As a consequence of such dynamic transformations, youth may become easily vulnerable to
multiple forms of risks related to poor mental health and health-risk behavior during this period.
• Research contends that various health-risk behaviors and mental health conditions that are
developed at an early life-stage may often result in elevated risks of experiencing severe levels of
morbidity or mortality in adulthood (CDCP, 2010; Kessler et al., 2005; Merikangas et al., 2010)
• Adolescent mental health and risky behaviour that are unattended may have bad consequences
for personal and social wellbeing in the long run.
• Examination of their mental health condition and observation of their health risk behaviour is
important and critical as it can present knowledge to effectively guide prevention and
intervention program.
INTRODUCTION
Early adolescent Middle adolescent Late adolescent
(ages 11-14) (ages 15-17) (ages 18-21)
• first stages of • further distancing • fully identify one’s
separation from from parents and own moral code,
parents, desire to allying with peers, more confident
look and act like feelings of and better able to
peers, difficulty omnipotence and delay gratification,
with impulse immortality can can be protective
control lead to dangerous factors
behaviors
INTRODUCTION

Courtesy of :
https://healthyfamilies.beyondblue.org.au/images/default-
source/5.resources/youth-suicide-parent-page-images/risk-
factors.jpg?sfvrsn=55bd70ea_0
HIGH RISK BEHAVIOUR IN
ADOLESCENT
HIGH RISK BEHAVIOR

Exercise /
Dietary Smoking Alcohol
Physical
behaviour behaviour intake
inactivity

Drug use Sex behaviour Road safety

Source : Malaysia Youth Behaviour Risk factor Surveillance Report, 2011

HIGH RISK BEHAVIOUR : DRUG USE
3,000
2,610

2,500

2,000
1,595

1,500 1,425
1375

1,173

1,000 855 847

500

0
2010 2011 2012 2013 2014 2015 2016

No. of substance user age 16 – 19 y/o

Source : AADK
HIGH RISK BEHAVIOUR : DRUG USE
6,000
5,572
5,467

5,000 4,986
4,729

4,000
3,751

3,212
3,000 2,836

2,000

1,000

0
2010 2011 2012 2013 2014 2015 2016

No. of substance user age 20 – 24 y/o

Source : AADK
HIGH RISK BEHAVIOUR : DRUG USE

Source : AADK
HIGH RISK BEHAVIOUR : DRUG USE
0%
5%
2% 6% 12%
0%

For fun
Peer influence
Wan to know feeling
18%
Stimulation
Pain relieve
Unintentional
Stress
Others
57%

Reason why take drugs, 2016

Source : AADK
 HIGH RISK BEHAVIOUR : DRUG USE
• Drugs associated with
– unwanted sexual activity
– unprotected sexual activity
– violence perpetration and
victimization
– problems with the law
– school failure
– Psychiatric co-morbidity
HIGH RISK BEHAVIOUR : ROAD SAFETY
• Data from NYC YRBS
– 16 % students reported they never or rarely wore a seat belt
– 18 % students who in past 30 days rode in car with driver who had been
drinking
– 4 % students who in past 30 days drove a car after drinking
– 90 % students who rode a bicycle reported they never or rarely wore a
helmet
American experience on road safety
Source : Elyse Olshen Kharbanda, MD, MPH, N.D
HIGH RISK BEHAVIOUR : ROAD SAFETY
• Data from Malaysia YBRF,
2011
 26.2% Practice of wearing
seatbelts
 30.9% wearing helmet while
riding motorcycle
 Others ???

Malaysian Experience
Source : YBRF, 2011
HIGH RISK BEHAVIOUR : SMOKING AND
ALCOHOL INTAKE
• Alcohol and tobacco are commonly used by adolescents and one out of 10 adolescents
worldwide is known to smoke (Cohen 2013). The 2009 Global Youth Tobacco Survey for
adolescents aged 13–15 years revealed that the prevalence of tobacco use was about 20 %, of
which 18 % smoked cigarettes (International Tobacco Control Malaysia 2012). However, in
Malaysia, 20 % of the estimated 5 million smokers are under the age of 18 years (Al-Sadat et al.
2010).
• As for alcohol consumption, the WHO Global Survey on Alcohol and Health reported a
growing trend among underage adolescents between 2004 and 2008 (World Health
Organization 2011). In Malaysia, 45 % of the youths under the age of 18 years consume alcohol
regularly (World Health Organization 2011)
HIGH RISK BEHAVIOUR : SMOKING AND
ALCOHOL INTAKE

Lead to
HIGH RISK BEHAVIOUR : SMOKING AND
ALCOHOL INTAKE

Lead to
HIGH RISK BEHAVIOUR : SEX
BEHAVIOUR
EVERYDAY !!!!

Source : MOH (2014) , MOH (2015), Women centre for change of Penang (2015)
HIGH RISK BEHAVIOUR : SEX
BEHAVIOUR
• The proportion of Malays and
Muslims(Islam) engaging in sex was higher
than that of adolescents from other
ethnicities and religions (p < 0.001, results
not shown). Source : Nik Farid et al. 2016
M E N TA L P R O B L E M I N
ADOLESCENT
MENTAL PROBLEM IN ADOLESCENT
• Every 3 in 10 adults aged 16 years and above have some sorts of
mental health problems (29.2%).
• The prevalence of mental health problems among adults increased
from 10.7% in 1996, to 11.2% in 2006, to 29.2% in 2015.
• The prevalence in Kuala Lumpur is 39.8%!
• The prevalence in females was slightly higher than in males but the
difference was not significant (30.8% vs 27.6%).
• Risk factors (adults): females, younger adults, other Bumiputras, and
adults from low income families.
Source : NHMS, 2015
MENTAL PROBLEM IN ADOLESCENT
• By occupation, the prevalence was lowest among government/semi-government
employees (2.6%) (?!).
• The overall prevalence of mental health problem among children was 12.1% (children = 5
to 15 years old).
• Risk factors (children): boys, younger age group and from rural areas.
• Prevalence of mental health problems in children: peer problem (32.5%), conduct
problems (16.7%), emotional problems (e.g. anxiety, depression, 15.7%), pro-social skill
(11.2%) and hyperactivity (4.6%).
• There are 360 registered psychiatrists registered in the public and private sectors. The
ratio of psychiatrists to the Malaysian population is 1:200,000 (1:10,000 is recommended
by WHO).
• Mental illness is expected to be the second biggest health problem affecting Malaysians
after heart diseases by 2020.
Source : NHMS, 2015
MENTAL PROBLEM IN ADOLESCENT

ANXIETY STRESS

DEPRESSION
MENTAL PROBLEM IN ADOLESCENT :
ANXIETY
• Anxiety is a normal reaction to stressful situations.
• Yet, people with anxiety disorder respond to such situations or even seemingly normal
situations in an excessive manner.
• Anxiety disorder is among the commonest mental disorders experienced by many people.
• However, all anxiety disorders are characterized by persistent and excessive fear or worry that
is distressing and interferes with daily living.
MENTAL PROBLEM IN ADOLESCENT :
ANXIETY

PANIC
GAD AGORAPHOBIA
DISORDER

PTSD OCD

Source : Miller, 2008

MENTAL PROBLEM IN ADOLESCENT :
ANXIETY

Source : NHMS, 2011

MENTAL PROBLEM IN ADOLESCENT :
STRESS
PETALING JAYA: The work environment in the country has contributed to poorer health among Malaysians
which in turn has led to lower productivity, according to a workplace survey by an insurance giant.

The study revealed that Malaysian employees were overworked, stressed, led unhealthy lifestyles, and as a result,
were at high risk of health problems and loss of productivity.

The “Malaysia’s Healthiest Workplace by AIA Vitality Survey 2017”, which surveyed a total of 5,369 employees
from 47 organisations, also revealed that more than half of employees surveyed were found to be at risk of
mental health issues.

“Some 53% of Malaysian employees reported at least one dimension of work-related stress, while 12%
experienced high levels of anxiety or depression.

“High work stress and a sedentary lifestyle had also contributed to 84% of employees reporting at least one
type of musculoskeletal disorder,” the report said.

Source : http://www.freemalaysiatoday.com/category/nation/2017/11/18/poor-health-among-msians-due-to-work-stress-says-survey/
MENTAL PROBLEM IN ADOLESCENT :
STRESS
MENTAL PROBLEM IN ADOLESCENT :
DEPRESSION

Source : NHMS, 2011

MENTAL PROBLEM IN ADOLESCENT :
DEPRESSION

Source : NHMS, 2011

MENTAL PROBLEM IN ADOLESCENT :
DEPRESSION

Source : NHMS, 2011

MENTAL PROBLEM IN ADOLESCENT : DEPRESSION
Core Symptoms
Consistently depressed or down for two
Depression
weeks
Loss of interest in, or unable to enjoy, most
Anhedonia
activities for two weeks
Secondary Symptoms
Low Energy Low energy, frequently tired
Sleep Oversleeping, insomnia, wakefulness
Appetite Appetite or weight decrease or increase

Concentration Problems concentrating or making decisions

Slow/Restless Talk/move slowly, or were fidgety/restless

Guilt/Worthless Feelings of low self-worth and/or guilt
Suicidality Suicidal ideation, death wishe

By : DSM-IV major depressive disorder symptoms, APA

T R E AT M E N T
TREATMENT

DRUGS SOCIAL REHAB

PSYCHOTHERAPY
TREATMENT : DRUGS
Advantage
• Citalopram (Celexa) • High tolerance level
• Escitalopram (Lexapro) • Low side effect
• Fluoxetine (Prozac) • Lack of need for blood level
1st Line monitoring
• Paroxetine (Paxil, Pexeva)
• Sertraline (Zoloft)
Best for :
• Vilazodone (Viibryd)
• Anxiety

SSRI • Depression
• Social phobia

If all fail, then consider Benzodiazepine

TREATMENT : DRUGS
TREATMENT : PSYCOTHERAPY
Psychoanalysis
Behaviour Humanistic
/ Psycho dynamic
• Therapist work • Desensitizing • Gestalt therapy
close with • CBT • Existantial
patient • Classical therapy
• Freud method conditioning,
Pavlov method
TREATMENT : SOCIAL REHAB
• A set of measure aimed at
maximum adaptation the adolescent
/ professional who are mentally ill
into society and their restoration of
professional / respective function
HEADSSS(S) ASSESSMENT
HEADSSS(S) ASSESSMENT
• 1/10 adolescents suffers from a mental disorder, but less than one in five receives adequate
treatment (Fleitlich & Goodman, 2001; OPS/OMS, 1995). 1
• The reduced time for evaluation, the excessive number of patients, the scarcity of psychiatric
services for referral, and the absence of simple assessment instruments may delay early
intervention, which would have a significant impact on morbidity and mortality in adolescence,
improving prognosis for the individual and for society as well (Barker et al., 2007; Connor et al.,
2006; Dopheide, 2006; Goldenring & Cohen, 1988; Goldenring & Rosen, 2004; Osgood &
Schreck, 2007; Reijneveld et al., 2003; Scubiner & Robin, 1990; Williams, Klinepeter, Palmes,
Pulley, & Foy, 2004).
 HEADSSS(S) ASSESSMENT

• No time to evaluate all

Lead to development
• Few numbers of psychiatrist
of HEADSS
• Excessive number of patients Goldenring & Cohen, 1988
• Absence of simple assessment instrument

Latest Update :
HEEADSSS 3.0 The psychosocial interview for adolescents updated for a new century fueled by media,
by Dr. goldenring, Dr Klein & Dr.Adelman, 2014
HEADSSS(S) ASSESSMENT
• The HEEADSSS psychosocial interview is a practical, time-tested strategy that pediatricians can
use to evaluate how their teenaged patients are coping with the pressures of daily living,
especially now in the context of electronic and social media.

ACTIVITY /
EDUCATION / EATING /
HOME PEER
EMPLOYMENT EXERCISE
RELATIONSHIP

DRUG /
CIGARETTE / SEXUALITY SUICIDAL SAFETY
ALCOHOL

SPIRITUALITY
HEADSSS(S) ASSESSMENT
ITEM SAMPLE QUESTION
Home Who lives with you? Where do you live?
What are relationships like at home?
Can you talk to anyone at home about stress? (Who?)
Is there anyone new at home? Has someone left recently?
Do you have a smart phone or computer at home? In
your room? What do you use it for? (May ask this in the
activities section.)
Education Tell me about school.
and Is your school a safe place? (Why?) Have
employment bullied at school?
Do you feel connected to your school? Do
you belong?
Are there adults at school you feel you could
about something important? (Who?)
Do you have any failing grades? Any recent
What are your future education/employment
goals?
Are you working? Where? How much?
HEADSSS(S) ASSESSMENT
ITEM SAMPLE QUESTION
Eating Does your weight or body shape cause you any stress? If
so, tell me about it.
Have there been any recent changes in your weight?
Have you dieted in the last year? How? How often?

Activities What do you do for fun? How do you spend time with
friends? Family? (With whom, where, when?)
Some teenagers tell me that they spend much of their
free time online. What types of things do you use the
Internet for?
How many hours do you spend on any given day in
front of a screen, such as a computer, TV, or phone? Do
you wish you spent less time on these things?
HEADSSS(S) ASSESSMENT
ITEM SAMPLE QUESTION
Drugs Do any of your friends or family members use
tobacco? Alcohol? Other drugs?
Do you use tobacco or electronic cigarettes?
Alcohol? Other drugs, energy drinks, steroids, or
medications not prescribed to you

Sexuality Have you ever been in a romantic relationship? Tell

me about the people that you’ve dated.
Have any of your relationships ever been sexual
relationships (such as involving kissing or
touching)?
Are you attracted to anyone now? OR: Tell me
about your sexual life.
Are you interested in boys? Girls? Both? Not yet
sure
HEADSSS(S) ASSESSMENT
ITEM SAMPLE QUESTION
Suicide/ Do you feel “stressed” or anxious more than usual
depression (or more than you prefer to feel)?
Do you feel sad or down more than usual?
Are you “bored” much of the time?
Are you having trouble getting to sleep?
Have you thought a lot about hurting yourself or
someone else?
Tell me about a time when someone picked on you
or made you feel uncomfortable online.

Safety Have you ever been seriously injured? (How?) How

about anyone else you know?
Do you always wear a seatbelt in the car?
Have you ever met in person (or plan to meet) with
anyone whom you first encountered online?
When was the last time you sent a text message
while driving?
Tell me about a time when you have ridden with a
driver who was drunk or high. When? How often?
Is there a lot of violence at your home or school? In
your neighborhood? Among your friends?
HEADSSS(S) ASSESSMENT
Refer adolescent
/ walk in
Responsibility :
Screening form Clinical AMO
1SKR I&II presentation SN
CN
MO
Assessment

Yes No
HEADSSS 2Problem Health
promotion

3Urgent
Yes
Refer

No
Appointment Responsibility :
Counselling date AMO
SN
CONCLUSION
REFERENCE
• Ahmed, Y., Yaakob, Z., Akhtar, P., & Sopian, K. (2015). Production of biogas and performance evaluation of existing treatment processes in palm oil mill effluent
(POME). Renewable and Sustainable Energy Reviews, 42, 1260–1278. https://doi.org/10.1016/j.rser.2014.10.073
• Aneziris, O. N., Papazoglou, I. A., Konstantinidou, M., & Nivolianitou, Z. (2014). Integrated risk assessment for LNG terminals. Journal of Loss Prevention in the
Process Industries, 28, 23–35. https://doi.org/10.1016/j.jlp.2013.07.014
• Baesi, S., Abdolhamidzadeh, B., Hassan, C. R. C., Hamid, M. D., & Reniers, G. (2013). Application of a multi-plant QRA: A case study investigating the risk impact
of the construction of a new plant on an existing chemical plant’s risk levels. Journal of Loss Prevention in the Process Industries, 26(5), 895–903.
https://doi.org/10.1016/j.jlp.2012.11.005
• Biomass Department, F. P. I. S. B. (2014). Biomass Department, Felda Palm Industries Sdn Bhd , Oil Palm Based Resources for Bioenergy: Sustainability and
Challenges. IRENA: Bioenergy Forum 2014, 1–24.
• Casson Moreno, V., & Cozzani,V. (2015). Major accident hazard in bioenergy production. Journal of Loss Prevention in the Process Industries, 35, 135–144.
https://doi.org/10.1016/j.jlp.2015.04.004
• Casson Moreno, V., Guglielmi, D., & Cozzani,V. (2018). Identification of critical safety barriers in biogas facilities. Reliability Engineering and System Safety,
169(July 2017), 81–94. https://doi.org/10.1016/j.ress.2017.07.013
• Casson Moreno, V., Papasidero, S., Scarponi, G. E., Guglielmi, D., & Cozzani,V. (2016). Analysis of accidents in biogas production and upgrading. Renewable
Energy, 96, 1127–1134. https://doi.org/10.1016/j.renene.2015.10.017
• Chin, M. J., Poh, P. E., Tey, B. T., Chan, E. S., & Chin, K. L. (2013). Biogas from palm oil mill effluent (POME): Opportunities and challenges from Malaysia’s
perspective. Renewable and Sustainable Energy Reviews, 26, 717–726. https://doi.org/10.1016/j.rser.2013.06.008
• Chu, B., Lee, S., & Chang, D. (2017). Determination of design accidental fire load for offshore installations based on quantitative risk assessment with treatment
of parametric uncertainty. Journal of Loss Prevention in the Process Industries, 45, 160–172. https://doi.org/10.1016/j.jlp.2016.11.015
• DOSH. (2016). Guidelines on Occuppational Safety and Health in Construction, Operation and Maintenance of Biogas Plant, (i), 1–76.
•
REFERENCE
• Engelhard, W. F. J. M. (2005). Heat Flux from Fires. Yellow Book - Methods for the Calculation of Physical Effects due to Releases of Hazardous Materials (Liquids and
Gases), 6.1-6.127
• Findeisen, C. (2015). The importance of safety standards , risk assessment and operators training for a successful biogas market development Content. Biogas for
Productive Uses, Industrial and Mobility Applications.
• Heezen, P. A. M., Gunnarsdttir, S., Gooijer, L., & Mahesh, S. (2013). Hazard classification of biogas and risks of large scale biogas production. Chemical Engineering
Transactions, 31, 37–42. https://doi.org/10.3303/CET1331007
• Joost Siteur. (2016). Accidents and Safety at Biogas Plants : Introduction (Vol. 1).
• Khan, F. I., Sadiq, R., & Husain, T. (2002). Risk-based process safety assessment and control measures design for offshore process facilities. J Hazard Mater, 94(1), 1–36.
https://doi.org/S0304389402000043 [pii]
• Khan, F., Rathnayaka, S., & Ahmed, S. (2015). Methods and models in process safety and risk management: Past, present and future. Process Safety and Environmental
Protection, 98, 116–147. https://doi.org/10.1016/j.psep.2015.07.005
• Kheang, L. S., Dazhi, L. L., Sukiran, M. A., & May, C. Y. (2011). A Biogas Trapping Facility for Handling Palm Oil Mill Effluent (POME)MPOB TT No. 491. Malaysian Pome Oil
Board.
• Kozani, S. (2014). Basics of the Biogas Production Process, 26. Retrieved from http://peebpe.eu/wp-content/uploads/2014/06/Kozani_Workshop_SJunne.pdf
• Lam, M. K., & Lee, K. T. (2011). Renewable and sustainable bioenergies production from palm oil mill effluent (POME): Win-win strategies toward better environmental
protection. Biotechnology Advances, 29(1), 124–141. https://doi.org/10.1016/j.biotechadv.2010.10.001
• Logistics, L., & Operations, M. (2010). ADVANCED QUANTITATIVE RISK ASSESSMENT OF OFFSHORE GAS PIPELINE SYSTEMS A Thesis Submitted to Liverpool John
Moores University, (March).
• Mohtar, A., Ho, W. S., Hashim, H., Lim, J. S., Muis, Z. A., & Liew, P. Y. (2017). Palm oil mill effluent (pome) biogas off-site utilization Malaysia specification and legislation.
Chemical Engineering Transactions, 56, 637–642. https://doi.org/10.3303/CET1756107
• Naja, G. M., Alary, R., Bajeat, P., Bellenfant, G., Godon, J. J., Jaeg, J. P., … Zdanevitch, I. (2011). Assessment of biogas potential hazards. Renewable Energy, 36(12), 3445–
3451. https://doi.org/10.1016/j.renene.2011.05.025
•
REFERENCE
• Nikolic, S. S. and V. (2013). Risk Analysis in A Biogas Production Plant: Case Study. Communications in Dependability and Quality Management, 16(2), 28–37.
• Nwaoha, T. C. (2011). Advanced risk and maintenance modelling in lng carrier operations, (June).
• Paper, C., Universit, V. T., Universit, S. C., Cristina, E., Universit, R., Assessment, R., … Rada, E. C. (2015). Safety and reliability in biogas plants, (May).
https://doi.org/10.2495/SAFE150201
• Pietrangeli, B., Lauri, R., & Bragatto, P. A. (2013). Safe Operation of Biogas Plants in Italy, 32, 199–204.
• Ramsay, C. G., Bolsover, A. J., Jones, R. H., & Medland, W. G. (1994). Quantitative risk assessment applied to offshore process installations. Challenges after the piper alpha disaster.
Journal of Loss Prevention in the Process Industries, 7(4), 295–304. https://doi.org/10.1016/0950-4230(94)80042-1
• Salvi, O., Delsinne, S., & Evanno, S. (2011). Biogas - A European Perspective on Safety and Regulation. Journal of Risk Analysis and Crisis Response, 1(1), 1.
https://doi.org/10.2991/jracr.2011.1.1.1
• Salvi, O., Delsinne, S., & Evanno, S. (2011). Biogas – Safety and Regulations. Journal of Risk Analysis and Crisis Response, 1, 1–6.
• Scarponi, G. E., Guglielmi, D., Moreno, V. C., Cozzani, V., Dipartimento, L., & Studiorum, A. M. (2016). Assessment of Inherently Safer Alternatives in Biogas Production and
Upgrading, 0(0). https://doi.org/10.1002/aic
• Schroeder, V., Schalau, B., & Molnarne, M. (2014). Explosion protection in biogas and hybrid power plants. Procedia Engineering, 84, 259–272.
https://doi.org/10.1016/j.proeng.2014.10.433
• Sciences, A. M. (2014). BiogasAgriAtex , new methods of risk assessment explosion on biogas plants BiogasAgriAtex , New Methods of Risk Assessment Explosion on Biogas Plants,
(January). https://doi.org/10.12988/ams.2014.46449
• Spouge, J. (1999). A Guide To Quantitative Risk Assessment for Offshore Installations Principal Author
• Thesis, K. (2011). Advanced Risk Management in Offshore Terminals and Marine Ports, (December).
• TNO - Netherlands Organisation for Applied Scientific Research. (2005). Purple Book - Guidelines for Quantitative risk assessment. Purple Book, 237.
• United States Environmental Protection Agency (USEPA). (2011). Common Safety Practices for On-Farm Anaerobic Digestion Systems, 1–21. Retrieved from
http://www.epa.gov/outreach/agstar/documents/safety_practices.pdf
THANK YOU FOR YOUR ATTENTION