Investigation and Analysis of the Current Situation of Mental Health Problems among Chinese Adolescents

Abstract

What is key information

China is a developing country with a large population base. Mental Health Problems (MHP) have become a major disease burden among Chinese adolescents. Especially, to decrease the incidence of mental health problems the article highlighted some viewpoints from the clinical perspective and put forward relevant considerations and suggestions.

What does the study adds

The survey of adolescent mental health problems in various regions of analyzed and discusses preventive mental health strategies. The relevant factors of adolescents’ mental health are complex and diverse, and mainly closely related to family environment, parent-child relationship, study stress and suicidal ideation, Internet addiction and depressive symptoms to analyze the psychological problems of Chinese adolescents; in addition, the current situation of Chinese doctors’ mental health services and countermeasures.

What are implications for clinical practice, public health and/or research

By providing some suggestions on the current situation of child psychological problems in China, it is hoped that other countries with similar national conditions can learn from them to support the urgent need of mental health interventions for young people in middle school, and truly enhance their mental health literacy, and cultivate young adults with healthy physical and mental development.

Keywords: Adolescents; Mental health problems; Depression; Prevalence; Countermeasures; China

Impact

The article focused on the development and progression of mental health problems during the transition from childhood to adolescence, emphasized possible determinants on the association between physical and mental health, and presented causality in psychiatry and related models. Hope to give children a good social atmosphere, in order to facilitate their physical and mental development.

Introduction

According to the data of the United Nations Children's Fund and the World Health Organization, about 20 % of children and adolescents worldwide have mental health problems [1]. Adolescents are in the period of youth development and have certain experience needs for society and emotion. However, due to the serious impact of personal and environmental risk factors, such as high academic and family pressure, delayed psychological development, immature personality, and insufficient social experience, they are prone to cause unstable emotions and psychological disorders. For adolescent mental health problems, refer to the standard definition and diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) issued by the American Psychiatric Association (APA) [2]. Common adolescent mental health problems include: anxiety disorders, mood disorders, attention deficit and hyperactivity disorders, disruptive behavior disorders, and even self-injury and suicide behavior. Common adolescent mental health problems include: anxiety disorders, mood disorders, attention deficit and hyperactivity disorders, disruptive behavior disorders, and even self-injury and suicide behavior. China is a developing country with a large population base, with a total population of 1.4 billion. It is difficult to carry out large-scale epidemiological investigations of psychological and behavioral problems, and the research on adolescents is more limited. In the past 20 years, the relevant reports are mostly scattered regional flow modulation studies. Among them, China's Shandong Provincial Mental Health Center conducted a survey on the mental health of 63060 adolescents in China from January 2008 to December 2020 and found that the detection rate of mental sub-health was 15.50%, of which the detection rate of high school students was 18.99%, which was significantly higher than that of college students and junior high school students. Although the region, time and grade span of this study was large, the results were still representative [3-7]. In the face of this increasingly prominent situation, this paper analyzes the current survey of adolescent mental health problems in various regions of China and makes a summary as follows:

Home Environment

Family is the main environment for teenagers to grow up. At present, the environmental factors that can be evaluated and judged by quantitative indicators, including family conditions and family structure, are called hard environment; The family's psychological and moral environment, including family members' behavior patterns, family atmosphere, and parents' behavior patterns, is called soft environment. Research shows that the socioeconomic status of the family and the educational level of parents are negatively correlated with the occurrence of adolescent depression [8]. Generally, families are mostly composed of a couple and children, which is the most common and stable family structure. Many families in rural areas in China go out to work in cities, resulting in the family structure of left-behind children and migrant families. With the development of the economy and the opening of the mind, China's divorce rate has increased from 0.72 ‰ in 1991 to 2.01 ‰ in 2021, and single-parent families have also continued to increase. In these unstable family structures, it is more likely to lead to the lack of security of teenagers and psychological problems. In December 2014, a survey of 2906 adolescents in Xinxiang City, Henan Province found that 247 adolescents (8.50 %) had suicidal ideation [9]. The research shows that the single parent/remarried family model, the decrease of family environment intimacy and the increase of contradiction can increase the risk of suicidal ideation of adolescents. In addition, suicidal ideation of female adolescents is also related to emotional expression and knowledge, while suicidal ideation of male adolescents is also related to family organization and family contradiction. The study found that the bad relationship between parents will bring emotional stress to teenagers and increase the risk of depression [10].

Parent-Child Relationship

Parent-child relationship is the basic interpersonal relationship that individuals first come into contact with in the family, and it reflects the degree of emotional connection between parents and children. The parent-child relationship in the family environment has a significant impact on the mental health development of adolescents. Parent-child communication and parent-child attachment can directly affect the life satisfaction of middle school students. Extreme parental behavior, especially abuse and neglect, can cause impaired emotional regulation in adolescents. Emotional abuse, physical abuse and sexual abuse are common types of bad childhood experiences. It is difficult for abused adolescents to establish attachment relationship with their parents, which affects their mental health development and increases the risk of depression, anxiety, insecurity, aggressive behavior and other psychological problems.

Learning Stress and Suicidal Ideation

It is well known that in Chinese culture, parents often regard academic achievement as a direct indicator of children's future success. Learning pressure can produce intuitive emotional experience. Faced with the external stimulation of academic pressure, the vulnerable psychological quality of teenagers often becomes a strong force to generate negative emotions and suicide. By constructing multiple mediating models, it is found that both positive and negative emotions of adolescents play a partial mediating role in the relationship between learning stress and suicidal ideation, indicating that learning stress can not only directly affect suicidal ideation, but also indirectly affect suicidal ideation through positive or negative emotions. Junior high school students are in the stage of psychological and physiological immature development, and the accumulation of learning pressure to a certain extent often makes the mentally vulnerable middle school students unbearable. They want to choose suicide as a way to escape or solve the pressure, but with the growth of age, their psychological endurance becomes stronger, and there are more ways to release and solve the learning pressure, so the score of suicide ideation shows a trend of gradual decline after grade 9 [11]. In the case of increased learning pressure, Physical Activity is relatively reduced. Social psychological mechanism proposes that Physical Activity (PA) participation can affect individuals' social psychological perception, and ultimately affect their mental health outcomes. There is sufficient evidence that, Physical Activity (PA) is positively correlated with adolescent depression, and the use of mild to moderate PA can improve depressive symptoms [12].

Internet Addiction and Depressive Symptoms

In the Internet era, teenagers, as one of the main users of social media, smart phones, personal computers and other electronic devices, are more than normal for social learning. Excessive and uncontrolled Internet use may bring many negative effects and potential adverse risks, and accompanied by withdrawal symptoms. It is reported that 2.41 % of teenagers in China spend more than 5 hours/day on the screen on weekends [13]. A large sample of 11,831 Chinese adolescent students in Shandong, China, using CES-D and YSR to measure depression, found that prolonged mobile phone use (=2 hours on weekdays, =5 hours on weekends) increased the prevalence of self-reported depressive symptoms. Using the association between screen time, exercise time, and self-assessed psychological symptoms, 7200 Chinese adolescents aged 13-18 from six regions in China found the highest detection rates of emotional symptoms, behavioral symptoms, social adjustment difficulties, and psychological symptoms among adolescents with screen time >2h.

Current Situation of Mental Health Services for Doctors in China

At present, most clinicians in China still continue the biomedical model, pay less attention to patients' sub-health psychology, and the mental health service resources in various regions are generally in a serious shortage. Under the unbalanced development of China's economic regions, the proportion of medical and health resources in urban and rural areas is seriously unbalanced, and the number of psychiatric departments is small, especially children's psychiatrists. At present, there are less than 500 children's psychiatrists in China, Unable to meet the needs of child psychotherapy. At present, the treatment of Chinese psychologists is mainly focused on the adult period, and different degrees of emotional and psychological disorders in China's infancy and adolescence are ignored by psychologists, especially the lack of clinical psychological professionals in grassroots hospitals.

Counter Measures

First of all, family members, especially parents, play an important role in forming a correct lifestyle and forming good habits for teenagers. Although the government and medical institutions can not significantly improve the level of parents' cultural knowledge, they can timely hold lectures on popular science psychological education, calling on parents to pay more attention to their children, communicate effectively with them, and timely discover their abnormal behavior. Good parent-child relationship is an important basis for individual psychological and social adaptation, which directly affects the way individuals treat the world and others. Parents often express emotions to their children, increase the time spent with them, give encouragement and affirmation, can help children self-acceptance and affirmation, trust in the outside world. In view of the current development of electronic technology and information dissemination, it is necessary and effective for teenagers to properly use mobile phones, television and other media to obtain knowledge in all aspects for their physical and mental health development [14]. Parents should guide their children to correctly plan the time of using electronic products, as well as the time of physical exercise activities, develop a good life and rest, alleviate potential psychological stress, and reduce the incidence of psychological symptoms. China has carried out relevant measures, for example, the Mental Health Law of the People's Republic of China has been implemented since May 1, 2013, and the Healthy China Action - Mental Health Action Plan for Children and Adolescents (2019-2022) was issued in 2019 to further strengthen the mental health work of children and adolescents. In the future, the government will issue and implement relevant laws and regulations to strengthen the training of professionals such as pediatricians, health care doctors, psychological assessors, psychotherapists, etc., improve the child health care service system, establish a long-term talent training mechanism, make up for the vacancy of professionals, integrate the medical model, actively carry out mental and behavioral assessment, and provide an important guarantee for early identification and early detection of children's psychological and behavioral development problems.

Adolescents are basically middle school students, and school plays an important role in the formation of their mental health during adolescence. In Shenzhen, China, 18.1 % of children aged from 0 to 14 receive mental health services, and the proportion of local children receiving mental health services is higher than that of migrant children [15]. School staff must also carry out mental health education training, build a youth mental health service platform, provide students with mental health education and support, and ensure and promote the future growth and development. The above is an analysis of the current situation of adolescent mental health problems in China, the strong need for adolescent mental health intervention faced by China as a developing country, and the discussion of preventive mental health strategies. This article hopes to provide some suggestions through the discussion of the current situation of children's psychological problems in China, and hope that other countries with similar national conditions can learn from it to support the urgent need for mental health intervention of young people in middle schools.

Author Statements

Funding

This study was funded by National Natural Science Foundation of China (General Program; No.81973904).

Conflicts of Interest

There is no potential conflict of interest in our paper.

Authors Consent

All of the authors participated in the study and they have agreed to the content of the manuscript.

Authors’ Contributions

Xue-yuan Zhang,Ya-min Kong, Bing-xiang Ma are all have made substantial contributions to this research, and Xue-yuan Zhang design of the work, Ya-min Kong have drafted it; Bing-xiang Ma have substantively revised it. All authors have seen the manuscript and approved to submit to your journal.

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