Mental Health Concerns of Canadian Adolescents

The article in this issue of the Journal by Kutcher and others (1) on adolescent mental health as seen from the perspective of the adolescents themselves is a refreshing glimpse of our everyday preoccupations seen from a different point of view. The very fact of the brevity of the questionnaire is in sharp contrast to what those of us trained to examine these areas would have done. Yet the results both confirm our general knowledge of the rough prevalence of problems and make us realize that we live in different worlds.

When allowed to pursue what they believe is relevant, the adolescents who constructed this survey instrument chose to ask about stress and coping, not about disorder and treatment. This normative framework represents a healthy approach to ubiquitous stress. At the same time, it may represent a denial of the presence of serious disorder among their age-mates. Because peers are used as the main source of both information and comfort, and are often important in directing troubled adolescents to professional help, further study examining how to help adolescents achieve a healthy balance between their desire to deny mental illness and their wish to perceive stress in a normative or coping framework is important.

What the study cannot address is how representative the population sampled is of the general high school population. There is a likelihood that severely disordered teens may not have been adequately sampled because they constitute a larger number of the school absent group and would not have been adequately represented on any one day at school. If this is true, the numbers experiencing stress, disruption from their family, and substance use might be significantly increased. Our inability to adequately survey the experience of the school dropouts and school absent population tends to leave us with a somewhat more optimistic view of the world of our teens and conspires in the marginalization of those disordered and socially dysfunctional adolescents.

However, what does emerge is a view of teens, about 20% of whom experience moderate levels of stress, who tend to cope with that stress through healthy strategies. The low levels of reported use of substances (less than 10%) for the relief of stress suggests that the population sampled is relatively healthy, although it would contrast with the reports of substance use generally among Canadian teens (2). This is probably due to the wording of the questions which only asked about substance use in the context of whether or not substances were used as coping devices as opposed to social use. The fact that the adolescents did not choose to inquire about substance use suggests that they do not regard it as a problem. Once more the issue of normality versus denial becomes an interesting issue in terms of the perspective taken by these adolescents.

The high level (30%) of the personal experience of violence is disquieting and suggests the need for further exploration in this area. Are these confrontations with peers, family, or others? What is the impact of such exposure? We are constantly confronted with increasing violence in our society. Are we beginning to accept this as a fact of life? The fact that these teens included violence in their questionnaire suggests that they see it as a problem. It would be important to further explore with these teens who are the perpetrators and what do they think we might do to change this situation. The finding that 5% of the sample, projected by the authors to 10% of females, experienced sexual assault raises issues about the adequacy of our outreach to these individuals and the overall adequacy of our services in this area.

Although Dr Kutcher and others express concern that many adolescents experiencing suicidal feelings do not use mental health professionals, it is reassuring that those making suicide attempts do consult professionals. What we don't know is whether or not they found that help useful. Their responses to this question would yield information useful to our planning of crisis intervention services. The authors also express concern that the teens sampled do not use family doctors for information about drugs, AIDS or mental health issues. Lack of reference to family doctors may be partly due to lack of training of family doctors but may also reflect compartmentalized thinking of the adolescents, associating family doctors with physical health and psychiatrists with mental illness. These are issues which we could profitably study if we are to be effective in our outreach to and early identification of troubled adolescents.

For those interested in adolescence, this study raises many interesting questions. It also suggests that collaboration with adolescents may yield a richer response to our questions. Focus groups and other forms of qualitative research, an approach used by Davidson and Manion (3), may be needed to clarify some of these questions and lead the way to more systematic research in adolescent mental health. Congratulations to the authors and to their teen collaborators for stimulating our thinking in this important area.

2. Edlaf MA, Ivis FJ, Smart RG, and others. The Addiction Research Foundation Ontario Student Drug Use Survey 1977-1995, Addiction Research Foundation of Ontario, 33 Russell Street, Ontario M5S 2S1; 1995.