Abstract
Despite their burden and high prevalence, mental health disorders of children and adolescents remain neglected in many parts of the world. In developing countries, where half of the population is younger than 18 years old, one of every five children and adolescents is estimated to suffer from a mental health disorder. It is then essential to detect these conditions through screening in a timely and accurate manner. But such screening is fraught with considerable ethical, social, and cultural challenges. This study systematically identifies, for the first time, these challenges, along with potential solutions to address them. We report on the results of an international multi- and inter-disciplinary three-round Delphi survey completed by 135 mental health experts from 37 countries. We asked these experts to identify and rank the main ethical, social, and cultural challenges of screening for child and adolescent mental health problems in developing nations, and to propose solutions for each challenge. Thirty-nine significant challenges emerged around eight themes, along with 32 potential solutions organized into seven themes. There was a high degree of consensus among the experts, but a few interesting disagreements arose between members of the panel from high-income countries and those from low- and middle-income nations. The panelists overwhelmingly supported mental health screening for children and adolescents. They recommended ensuring local acceptance and support for screening prior to program initiation, along with careful and comprehensive protection of human rights; integrating screening procedures into primary care; designing and implementing culturally appropriate screening tools, programs, and follow-up; securing long-term funding; expanding capacity building; and task-shifting screening to local non-specialists. These recommendations can serve as a guide for policy and decision-making, resource allocation, and international cooperation. They also offer a novel approach to reduce the burden of these disorders by encouraging their timely and context-sensitive prevention and management.
Highlights
Children and adolescents (C&A) constitute one-third of the world’s population and half of the population of low- and middle-income countries (LMICs)
MNSDs represent 13% of the global burden of disease, surpassing both cardiovascular disease and cancer [2,5,6,7]. They are the major contributor to disease burden in the 15–24 age group and are probably the most neglected aspect of health care [3,8,9,10]. These disorders account for almost one-third of disability-adjusted life-years (DALYs) lost during the first three decades of life [2,5] and most begin during childhood, adolescence, and early adulthood [4,8,11,12]
We considered including C&A suffering from MNSDs and their caregivers but decided against it due to the considerable ethical challenges of identifying such a group and the difficulty in obtaining a representative sample
Summary
Children and adolescents (C&A) constitute one-third of the world’s population and half of the population of low- and middle-income countries (LMICs). MNSDs represent 13% of the global burden of disease, surpassing both cardiovascular disease and cancer [2,5,6,7] They are the major contributor to disease burden in the 15–24 age group and are probably the most neglected aspect of health care [3,8,9,10]. These disorders account for almost one-third of disability-adjusted life-years (DALYs) lost during the first three decades of life [2,5] and most begin during childhood, adolescence, and early adulthood [4,8,11,12]. Half of MNSDs first appear before age 14, and 75% before age 24, persisting into adulthood and negatively affecting future health and quality of life [2]
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