Adolescent Mental Health in The Middle East and North Africa

Childhood and adolescence are time periods for human brain development and growth. Neuroimaging studies show that white matter volume and integrity increases throughout childhood and adolescence, with the frontal and temporal regions of the brain undergoing pronounced changes in adolescence (Tamnes et al. 2010). Decreases in frontal and temporal gray matter volume during adolescence result from environmental influences, as well as increasing white matter, the latter being essential as a transport mechanism of vital brain connections (Giedd et al. 1999). In parallel to these physiologic changes, marked cognitive changes include increases in abstract thought and reasoning (Piaget et al. 1977), improvements in IQ and working memory (Ostby et al. 2011), better problem solving and planning (Squeglia et al. 2013), and maturation of perspective taking (Sebastian et al. 2012). These changes suggest that the human brain exhibits heightened neural plasticity during adolescence, defined as the brain ability to adapt to internal or external changes. Environmental exposures and influences during adolescence determine these changes. For example, contextual neighborhood features such as the absence of opportunities for physical activity or an abundance of vaping stores influence adolescents to exhibit health risk behaviors such as sedentary lifestyles and drug use, which in turn influence the development of health outcomes, such as obesity and mental disorders. Fuhrmann et al. (2015) highlighted adolescence as a sensitive period of development where brain changes may be particularly susceptible to environmental influences, such as drugs, social stress, or cognitive training.

Al Qanun, the medical encyclopedia of Ibn Sina or Avicenna (CE 1037), devotes a whole section to mental illness. His focus on mental ill-health goes way beyond that of the earlier Greco-Roman scholars. Similarly, Ishaq Ibn Imran, an Arab Iraqi physician of the tenth century, is credited with writing the earliest existing treatise devoted entirely to depression. The Middle East and North Africa have, undoubtedly, made considerable contributions to the foundations of our knowledge concerning mental ill-health. A continuation of this focus, however, has never been more necessary. In recent decades, depression, anxiety, and eating disorders have all reached epidemic levels in many parts of the world, and the Middle East and North Africa – MENA – region has not been spared. Major depressive disorder (depression) is now a leading cause of disability globally, and this is also true for many MENA nations. Anxiety and other mental health disorders are also among the leading causes of disability for many MENA nations, significantly contributing to the region’s burden of disease. All of these psychological complaints have a relatively early age of onset, with some of the most substantial and recent increases in prevalence observed among adolescents. This chapter explores the regional research literature on adolescent mental health. Numerous search engines (ScienceDirect, PubMed, PsycInfo) were used for this scoping review, identifying relevant literature between the years 1970 and 2020 in MENA populations. It is, however, not the aim of this chapter to provide an exhaustive systematic review, but rather to highlight some of the literature that best tells the region’s unique story. The chapter pays close attention to depression and eating disorders – conditions which most typically begin in adolescence. The aforementioned conditions can become chronic and costly sources of disability and distress. The relatively youthful population is a reason why such mental health problems should be a priority for the region. This review highlights that and advocates for prevention as a key strategy.

The Middle East and North Africa (MENA) region comprises the highest number of adolescents worldwide. Despite considerable variations in socioeconomic status, as well as social and political conditions, across MENA countries, most of the youth in this particular region suffer from a wide range of psychological problems. For instance, depression, which is highly prevalent among adolescents from the MENA region, had been estimated to be somewhere between 63.4% among adolescents living in areas with severe political conflict and low socioeconomic status, such as Iraq, and 3.7% among those residing in more economically and politically stable countries, such as Kuwait. Several risk factors, including gender, age, social context and family history, and political issues, have been identified. Overall, the current study concluded that the hallmark of depression and its consequences within this region has been the lack of screening rather than the pathophysiology of depression per se. More studies within this region are nonetheless needed given the dearth of available information from applied and randomized control studies involving this region, which are important for improving or establishing services related to mental health issues among adolescents throughout this region.

Mental illness stigma – the fear, rejection, avoidance and discrimination against people with mental illness – exists globally among all cultures and socio-demographic groups. It is one of the toughest barriers for people to seek help, often creating more suffering and isolation than the mental problem itself. For young people with mental health problems, mental illness stigma makes them vulnerable to discrimination, social exclusion, educational difficulties, physical ill-health and human rights violations. Arab youth experience mental health conditions such as anxiety and depression in their everyday lives but silence these issues due to societal and cultural stigma. Arab youth in 15 MENA countries have now broken this silence, stating that mental illness stigma is pervasive in their everyday lives. This chapter firstly discusses the concept of mental illness stigma as a social determinant of mental health. This public health approach shifts the focus from ‘individual patients’ being to blame for their mental issues, to considering environmental factors including interactions between societal (family, social networks, community and neighbourhood), economic, political and cultural conditions overall. Secondly, a rapid literature review of research exploring mental illness stigma for Arab youth is reported, showing the barriers this stigma sets up for them to seek help. Thirdly, the challenges faced by Arab mental health researchers due to mental illness stigma are explored and suggestions are offered based on New Zealand youth public health interventions for ways to engage with Arab young people to combat mental illness stigma.

Youth comprise a quarter of the world’s population, living in a rapidly changing world that is characterized by growing digital economy, changing labor markets, conflicts, and climate change. Although the number of adolescents and youth is expected to continue rising, they remain prevalently neglected and the least served population group. Their rights and needs are often compromised in many parts of the world, particularly countries with a large proportion of a young population. Despite representing a significant and growing number, youth are found to be disempowered, disenfranchised, and disenchanted in the Middle East and North Africa area. It is recognized that involving youth in public decision-making processes plays an important role in ensuring the realization of their rights. However, the demand for recognition of the right of young people to be heard, to have their views considered, and to play an active role in promoting their own best interests is far from respected. Youth tend to feel that their voices are not heard nor do they have any role in the decision-making process. The reason for this is that governments and societies firmly believe that young people are too young to make decisions and to make a difference. Similarly, they are rarely afforded equitable access to opportunities. Among the many other issues facing youth in the Middle East and North Africa region are high rates of youth unemployment, increased rates of child marriage, lack of gender equality, limited access to health services particularly sexual and reproductive health services, and limited roles in civic participation and engagement. Additionally, it is known that investing in youth education has not been imminent, despite many of these emerging issues. This chapter will envisage the importance of developing and implementing youth-friendly public policies that may restore the youth’s trust and belonging to their countries.

Adolescents, the building blocks of society, in the Arabian Gulf region are presently booming to result in a demographic dividend influencing all sectors including health. The Arabian Gulf comprising of Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and UAE is considered as a world resource-rich region; health needs and interventions as well as behavioral modifications are considered to be the upfront initiatives or investments by governments to promote the current and future prosperity of livelihoods and social well-being of the people. This paper focuses on the adolescent population (10–19 years, as defined by the World Health Organization) of Saudi Arabia, with the objectives of (i) consolidating the health needs of adolescents in relation to demand and supply, (ii) changing health interventions to account for adolescents’ priorities, and (iii) appraising the behavioral modification efforts by the governments in line with Sustainable Development Goals (SDGs). This population goes through a transition not only from school to workplace but also in potential health risks, such as aging health status, morbidity, health-damaging habits, attitudes, food and beverages intake, and exposure to pollution and other unhealthy elements of society. Thus, this section deserves special attention of the community and broader policymaking agencies of concerned government, so as to groom them healthy and productive to the nation-building process.