Unipolar depression, schizophrenia, bipolar disorder and alcohol use are among the neuropsychiatric disorders that represent 45% of the disease burden among teenagers and young adults worldwide. Unfortunately, these disorders are glaringly absent from too many health programs, researchers from the World Health Organization, Geneva, Switzerland, reported in the medical journal The Lancet.

The authors added that the main worldwide risk factors impacting on health later in life include unsafe sex, iron deficiency, lack of contraception and alcohol use.

The 10-to-24 year age group is more and more driven by conditions that cause disability instead of death. There is a growing need to concentrate resources on prevention of, and health promotion against non-communicable and non-lethal causes of illnesses in adolescence.

The authors say that their findings will pose a serious challenge to the political willingness of those in charge to invest heavily on long-term prevention programs that do not give instant results, such as levying extra taxes on tobacco products, and promoting the vaccination of adolescent girls with the HPV (human papillomavirus) vaccination.

27% of the world’s population, a total today of 1.8 billion people, are aged 10 to 24 years. The authors warn that by 2032 this population will rise to around 2 billion.

Risk factors for disease can emerge later in life from behaviors and other factors during adolescence and early adulthood, even though these years are generally seen as healthy ones for most humans. Not enough is being done to protect them from injury and subsequent diseases.

Most reports on young people have generally focused on global patterns of death, rather than risk factors that start during one’s teenage years and can have an impact on future disability risk.

Fiona Gore and team gathered data from the 2004 Global Burden of Disease to work out the cause-specific DALSYS (disability-adjusted life-years) for those aged 10-24 years. They wanted to specify what major worldwide and regional risk factors for the burden of disease might be. DALYs are a “combined measure of Years of Life Lost due to premature deaths (YLLs) and Years Lost due to Disability (YLDs), with one DALY representing the loss of the equivalent of 1 year of full health.”

They estimated that the total DALYs for the global 10-24 year aged group were approximately 236 million – about 15.5% of DALYs for all age groups. Africa’s rate of DALYs is 2.5 times higher than industrialized nations’. The disease burden on girls globally is 12% higher than for boys 15-19 years of age.

The three major causes of global disability for adolescent and young adult males and females:

  • 45% – neuropsychiatric disorders, including alcohol use, unipolar major depression, schizophrenia and bipolar
  • 12% – unintentional injuries
  • 10% – infectious and parasitic diseases

The major risk factors worldwide for future disability in all age groups are:

  • Unsafe sex
  • Underweight
  • Untreated water
  • Lack of sanitation and hygiene
  • Alcohol use

The main risk factors worldwide for future disability during adolescence are:

  • Lack of contraception
  • Unsafe sex
  • Iron deficiency
  • Alcohol use

The researchers wrote:

“The disease burden arising in early adolescence from major risk factors is low. However, rates rise sharply in late adolescence and early adulthood for both alcohol use and unsafe sex. For other risk factors that commonly start in adolescence such as tobacco use, low physical activity, high blood pressure, and overweight and obesity, their contribution to disease becomes apparent only in mid-to-late adulthood.

(conclusion) Our risk factor data suggest that preventive strategies should adopt a life-course approach whereby the focus on the adolescent and young-adult years is prominent.”

John S Santelli and Sandro Galea from Columbia University, New York, USA wrote:

“Health promotion and efforts for disease prevention in young people aged 10-24 years should recognise both the burden of disease in this age group and the influence of risk behaviours on health in later life. Interventions should address the behaviours and social conditions that have both short-term and long-term health consequences.

Interventions that increase resilience-eg, efforts for increasing the connections of adolescents to communities, schools, and families-are crucial for health promotion in young people. Furthermore, targeted public health interventions, including enforcement of seatbelt laws, redesign of cars, implementation of tobacco taxes, and distribution of condoms, are essential for reducing morbidity and mortality.”

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Written by Christian Nordqvist