The increase in the prevalence of mental health problems among children and adolescents transcends what is merely a medical issue to become a social concern.
The significant rise in the prevalence of mental, behavioural, and emotional disorders in children and teenagers is due to multiple interacting factors and variables that have tripled or quadrupled since the pandemic, primarily because of restricted socialisation and excessive use of screens and social media, with inadequate regulation at the international level.
This rise in emotional disorders has taken healthcare managers by surprise, who have been slow to respond with resources, units, services, and specialised personnel. There is enormous demand for care, with long waiting lists and delays in both public healthcare (over seven months for a first appointment) and private consultations (over three months).
They acknowledge that they are “overwhelmed”, with the main problem being “there isn’t enough capacity to train specialists in child and adolescent mental health quickly enough,” lamented Pedro Rodríguez Hernández, a paediatrician specialised in Child Psychiatry at the Doctor Guigou Child and Youth Day Hospital, and co-director of the book on Child and Adolescent Psychiatry, among others on self-harm and suicidal behaviour.
-With 30 years of experience, did you expect such a significant rise in this issue?
“Before the pandemic, we had already detected a progressive increase in the prevalence of mental disorders in children and adolescents. However, after the pandemic, there was a substantial increase in mental, behavioural, and especially emotional disorders in children and adolescents, with prevalence rates that have tripled or quadrupled in some disorders, particularly anxiety, depression, eating disorders, sleep disorders, self-harm, suicidal ideation, and attempts. Many of my colleagues are scared and concerned because we are overwhelmed in consultations. Most post-pandemic studies indicate that 30% of children and adolescents up to 18 years old could develop a mental disorder.”
-They have found that there is not a single cause behind this alarming increase?
“That’s correct; the analysis of the variables is complex because there are about 10 or 12 that interact and reinforce each other. The causes are multiple, involving factors such as the deterioration of parenting patterns limited by difficulties in work-life balance, and reduced family support and bonding in that upbringing. There are also significant genetic factors; we are having children at older ages, which affects genetic load and quality. Additionally, the older the parents, the less energy they have to nurture and play with their children. There is also an increase in preterm births (10% of births are premature), and the survival rates of these babies have skyrocketed, which greatly impacts neurodevelopment. We talk about specific diseases such as neonatal meningitis, metabolic syndromes, and certain metabolic disorders that previously had fewer conditions for long-term survival. Socio-economic factors of the family also play a role, such as difficulties making ends meet, paying the mortgage or rent, or if a parent is unemployed. We need to be careful about the information we convey to children with developing brains.”
-So, factors such as parenting, limited socialisation, and excessive use of social media are behind this?
“The dedication to child-rearing is increasingly restricted by work-life balance challenges, and there is diminishing family support. Grandparents or uncles are leading separate lives now. We have shifted from children being raised by the tribe (family) to being raised by the house key they wear around their neck, coming home at 2 pm, eating, and remaining alone until 8 pm when their parents return. Much time is spent watching television or engaging in endless hours of video games, and overuse of screens, the internet, and social media. The use of screens and devices is known to interfere with neurodevelopment. We need to take preventive measures against overexposure, which are not currently clear, and many of the plans being implemented by child psychiatry and paediatrics societies relate to regulating excessive screen time and social media use. During the pandemic lockdown and the following months, socialisation was limited, which is very serious for neurodevelopment as it is a crucial protective factor and contributes significantly to human happiness. There has also been the emergence of post-traumatic stress, which can occur years later in children and adolescents.”
-Are you concerned about the increase in violence and suicides among children and youth?
“Through social media, all types of bullying and behaviours such as self-harm and suicide attempts are appearing more frequently. We have studies indicating that up to 25% of adolescents self-harm at some point in their development. These behaviours are contagious and reinforced through social media. Suicidal ideation has also increased, reflecting the rise in emotional disorders, depression, and anxiety. A child who comes home and remains alone all afternoon is more vulnerable, especially if they may have issues with peers from their class or school, or on social media, and who see and attempt to replicate self-harm patterns; they begin to experience anxiety, depressive symptoms, or may want to self-harm because a peer has already taken their own life.”
-Do minors come to your practice due to substance use and mental disorders?
“Yes, these cases have continued to rise, but it might now be slightly more stable. The severity of high consumption, especially of alcohol and cannabis among adolescents, is concerning to us paediatricians, but we are also worried about emerging substances, such as vapes, whose consumption has increased and for which we currently lack data on their toxicity, as the pace of usage often exceeds our ability to investigate how these substances affect the body.”
-There is also a high prevalence of eating disorders.
“We are very concerned about eating behaviour disorders, the rise of anorexia and bulimia nervosa, binge eating disorders, dieting, food restriction, and fasting influenced by social media, occurring much more in girls, but also increasingly in boys. Additionally, we have to consider the high rates of obesity in the child and youth population, which can sometimes be a symptom of anxiety leading to excessive consumption of unhealthy foods.”
-How has the response of health authorities been to these increases?
“There have been improvements. Twenty-one years ago, when we started, there were two child and adolescent psychiatrists in this province; now there are ten, and it is expected to increase in the short term as we expand intervention facilities. For example, home hospitalisation is pending and a medium-stay centre for child and adolescent psychiatric disorders is in development. It is noteworthy that we now have a child and adolescent psychiatry specialty and the first resident of this specialty in the province, linked to the University Hospital of the Canary Islands (HUC). This is the third year for residents in Spain; in the first year, there were 18 places, in the second, 40, and this year, there are already 48 for all of Spain, and it is logical to expect these numbers to rise each year. However, much remains to be done, particularly because youth psychotherapy involves not just child and adolescent psychiatrists but also psychologists, teachers, and educational professionals, as well as social services, etc. Many times, we are overwhelmed, leaving little time for coordination. A fundamental aspect is the paediatrician or family doctor in primary care, as they are the gateway; we must be well coordinated and ensure they have adequate training for early detection. The earlier these disorders are detected, the more likely effective intervention will be. The involvement of educators and schools is also essential.”
-Many parents report waiting seven months or more for a first appointment. How can care be improved?
“Gradually, more facilities and personnel are being added. When we sum up all the professionals currently working in child and adolescent mental health within the Canary Health Service in the province of Santa Cruz de Tenerife, we could be talking about around 80 professionals. At the Doctor Guigou Child and Youth Day Hospital, we are about 20, and there are units in La Orotava, HUC; Arona-Adeje, Santa Cruz Tenerife, and La Palma, as well as an admission unit at HUC. In mental health, we must also include nursing auxiliaries, clinical nurses, social workers, occupational therapists, psychomotor therapists, clinical psychologists, clinical psychiatrists, administrative staff, orderlies, etc. So, if 20 years ago there were four of us and now we are around 80, that is a significant increase. However, the demand is so high that we are overwhelmed and can’t attend to everyone. The pandemic delayed some treatments, and cases have since quadrupled. Consequently, waiting lists are long, and as resources grow, there is also a need for considerable organisation and planning. It is true that there is a wait, but the problem is that everything is overwhelmed, both in public care and in private consultations. The main issue is that there is not enough capacity to train specialists quickly. This surge in cases has taken managers somewhat by surprise.”
-How many patients do you attend to at Doctor Guigou?
“At the day hospital, we care for approximately 75 children and adolescents each week who come from all over the province. Some come for an hour, others for several days, and others daily for five hours. While they work and participate in group activities with the psychomotricist, occupational therapist, or mental health nurse, the psychiatrist and psychologist intervene with them, sometimes spending ten minutes with some, and two hours with others. Furthermore, we also have to attend to and work with the family. I focus more on neurodevelopmental disorders, learning difficulties, ADHD, autism, behaviour problems… It is essential to work with the family, just as in school, as children spend half their time in class. When working with the developing and malleable minds of children and adolescents, it is crucial to involve the whole environment.”
-Is the creation of a specific general directorate positive?
“Anything that helps in planning and organisation is extremely important, especially as mental health disorders are on the rise and this is a priority area regarding new resources. You must have a structure and people who can develop programmes, secure funding, analyse data, and assess what resources are lacking in each area. Moreover, we now need a National Suicide Prevention Plan and a plan for regulating new technologies.”
