The Voices of Jamaican Youth - SOWC 2021 (Jamaica)

Dr. Abigail Harrison

Senior lecturer - University of the West Indies

Adolescent Medicine Physician - University Hospital of the West Indies

Jamaica

• English-speaking, middle-income island nation

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• Population – 2.7M (STATIN 2019)

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• Adolescents (10-19y) - 21%of population

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Introduction

• Prevalence of mental health issues and disorders among adolescents has increased in the past 20–30 years

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• Currently 10-20% prevalence of mental illness in children and adolescents → significant portion of disability adjusted life years (DALYS) in youth (Kieling 2011).

Kieling 2011

Background

Pilgrim 2012

Background

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• COVID-19 pandemic and its attendant social and other restrictions
• increased difficulties with coping among adolescents with pre-existing mental health concerns
• increased incidence of newly diagnosed mental health concerns in adolescents

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Background

• Health officials in low- and middle-income countries have acknowledged the human and economic costs of child and adolescent mental health challenges

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• A deeper understanding of the drivers and protectors against development of mental illness is crucial to informing culturally relevant and appropriate interventions

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• Jamaica invited to participate in adding youth voices to the global data on child and adolescent mental health compiled by UNICEF as part of their 2021 State of the World’s Children (SOWC) report.

Hearing the Voices of the Jamaican Youth

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• Local co-investigators: Abigail Harrison; Caryl James Bateman University of the West Indies

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• Aim: To hear the voices of the Jamaican adolescents regarding adolescent mental health in Jamaica – their opinions and lived experiences

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Methodology

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• A snow-balling technique was used to identify adolescents (school and community)

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• Parental consent; adolescent consent/assent (<18 years)

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• Ethics Board approval

Methodology

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• FGDs were held virtually using Zoom® platform

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• Participants used aliases

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• Qualitative data analysis using an inductive thematic analysis approach (JHU)

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N=70; Male 37(53%); Rural 30 (43%)

Themes highlighted for Jamaican adolescents

• Depression as a major concern among adolescents
• Adolescents’ perception their voices are not being ‘heard ‘
• Gender-based differences in how adolescents manage stress and their emotions
• Gender-based violence
• Impact of Covid-19 pandemic

Theme (1) – Depressive symptoms

• Adolescents were willing and able to discuss their emotional concerns

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• Alluded to the pervasive nature of mental health concerns

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• Depressive symptoms featured frequently

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• Triggers
• Financial challenges
• Academic expectations from family
• Abandonment by family

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GSHS 2017

• % students seriously considered suicide in previous 12 months
• Total 25. 0 (22.7-27.3)
• males 17.2; females 32.3

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• % students who attempted suicide in previous 12 months
• Total 18.0 (15.3-21.2)
• males 14.8; females 21.1

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Theme (2) - Adolescents’ voices not being heard

Perception that their concerns went unnoticed/ unheard

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Parents unable to connect with extent of adolescent’s psychological pain

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• “The mentality of most Jamaican parents is that depression is not a real thing or the mental state of a child is not a real thing..” (older rural boy)

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• “some [adolescents] have actually spoken to their parents and their parents kinda dismissed it, ….. so now just nobody confides in their parents anymore because that message is going around- that they just won't understand”. (younger urban girl)

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Theme (3) �Differences in emotional responses by gender

Male adolescents spoke of

• Reluctance to show emotions for fear of being perceived as weak

“its okay for girls to express their feeling(s) right, more than boys, where as to be men to be tough to keep our feelings inside” (Older urban boy)

• Reluctance to seek help

“Boys...have...pride or...confidence. So they feel like they [should] handle [problems] on their own. They don't need any help and...if they talk about emotions they make themselves vulnerable or weak”. (Younger rural boy)

• Being unappreciated

“Our mental health and our feelings aren't really appreciated or given any consideration” (Older rural boy)

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Theme (4) - Gender-Based Violence

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“[Girls worry about] coming home alive or even safe or even making it home...most times I don't even leave my road because you have some perverts in my community and sometimes I feel very uncomfortable, you know? And even if you tell somebody or say it to somebody like an adult, they will not believe you.” (older urban girl)

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Impact of Covid-19 pandemic

• Many secondary effects
• Losses – academic, friendships, opportunities
• Increased responsibilities at home
• More free time

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Impact of Covid-19 pandemic

Lack of connection

“we have become more distant from each other, miss, less connected you know?” (rural older male)

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Unearthing hidden concerns

“you also have way too much time to sit down by yourself and think, ….you're stuck in your room, by yourself, thinking about everything that you've been dismissing and that's how everything comes up so yeah” (younger urban girl)

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Improved family connection

“for me I'm not really used to being around my family because I'm like at school and with my school hours and their working hours so like it's kind of good to like be around them a bit more, so that I can like you know bond with them, and spend time that I wouldn't usually have” (urban older female)

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Other significant findings

Coping strategies

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• Self-harm

“I think the reason why people do self-harm like not suicide but self-harm by itself, I think it is because they are feeling so much emotional and mental pain that they think the physical pain is going to help block the emotional and mental [pain]….” (younger urban girl)


• Substance use
• An escape

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Substance Use

• Cigarette use 2006 4.4%

2010 4.4%

2017 14.9%

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• Alcohol 2006 33.3%

2010 33.6%

2017 48.9%

• Marijuana use 2006 7.7%

2010 6.2%

2017 21.5%

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• Any substance use (2017) before:
• 14y 69.2%
• 13-15y 77.4%
• 16-17y 61.1%

Global School Health Survey

Other significant findings

• Social media

“But what I see is that some of my peers ….are finding their escape from reality with their technology….” (older rural boy)

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Social media and body image

“One of the biggest issues is insecurities and also...how you visualize yourself. So a lot of it is with social media now, we have so many different platforms: TikTok, Instagram. We have certain images that we see as “the it” image and if people don’t fit into that...they have a bit of difficulty. (older urban girl)

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1 in 5 adolescents

At risk

Other significant findings

• Need for family and community support

“having one person who is willing to help and show interest can go a long way” (older urban girl)

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• Persistent stigma within the community
• mocking behaviours invalidate their emotional and behavioral challenges

“… some people in the community mock you…they laugh at what you [have] been through…. People always find fun out of people being in bad situations. (older rural girl)

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Summary

• Jamaican adolescents openly discuss their psychological distress and the support and lack thereof received
• Greater desire for parent and community support
• Knowledgeable about the psychological challenges that adolescents face
• There is a strong desire for connection, especially considering that this is a strong part of our culture
• When given the chance , adolescents are open to sharing

Recommendations

Getting help

MOHW �CALL 888 NEW LIFE (639 5433)

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Mental Health & Suicide Prevention Helpline

Tele-substance abuse counselling - NCDA

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• Helpline Mon-Fri
• 876 564 HELP(4357)

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Thank you