Throughout the course of a life, a man undergoes various stresses. While social and economic issues like exposure to poverty, discrimination and violence are detrimental to mental health, problems like substance abuse, old-age loneliness and work-related stress add to the overall burden. While it is a global phenomenon, the situation in India is worrisome. According to a recent survey by the National Institute of Mental Health and Neurosciences (NIMHANS), a staggering 150 million Indians require mental health care services. However, less than 30 million are seeking care. What is even more alarming is that 1% of the survey’s sample size was found to be at high risk of suicide.
Mental health issues and disorders have economic repercussions too. According to the Indian Council of Medical Research (ICMR), expenditure on mental health disorders is not only shooting up families’ budgets but also pushing a staggering 20% of households, with a member suffering from a disorder, into poverty.
Care is crucial and so is awareness. Addressing mental health issues requires not only basic knowledge but also how they impact as a person ages, as issues at 15 years are starkly different than those at 50 years, and so is the coping mechanism.
Teen troubles
Teenage is a formative phase—a person undergoes physical, emotional and social changes. However exciting, it can be a challenging, confusing time. Stresses can be immense too, which may have a detrimental impact on a person’s mental health.
While one might view these years as a time without any worries and problems, the reality is different. According to the WHO, one in seven 10-19-year-olds experiences a mental disorder globally. This accounts for 13% of the global burden of disease in this age group. Alarmingly, suicide is the fourth leading cause of death among 15-29 year olds.
“The most common mental illnesses in adolescents are anxiety, mood, attention and behaviour disorders. We are seeing more and more cases of emotional instability which, if not guided, can evolve into personality disorders,” says Dr Jyoti Kapoor, senior psychiatrist and founder of Manasthali. “Substance abuse has also become very common,” she adds.
Among the factors that have a detrimental impact on a teen’s mental health include peer pressure, academic stress, uncertainty, parental pressure and technology, she explains.
Factors such as living conditions, stigma, discrimination and lack of access to quality support and services can increase a teen’s risk. On top of these, chronic illnesses, autism spectrum disorder, an intellectual disability, or other neurological conditions, too, have a detrimental impact, according to the WHO.
Recently, social media has also emerged as a big culprit. While it is a strong avenue for expressing oneself, the mental health impact of this medium cannot be ignored.
For example, studies have shown that Instagram pictures of thin and attractive celebs and peers were linked to higher levels of body dissatisfaction. Another study found a similar link between social media usage and poor mental health, which includes body image issues, lower self-esteem and even eating disorders.
“Social media has exposed young minds to so much that there is hardly any time to understand and integrate all the stimuli making adolescents vulnerable to stress,” explains Dr Kapoor.
In a first-of-its-kind lawsuit earlier this year in the US, Seattle’s public school district sued major social media companies— TikTok, Instagram, YouTube, Snap, and Facebook. It argued that by “exploit (ing) the vulnerable brains of youth” for profit, the companies had created a mental health epidemic in the US, according to reports.
Earlier this year, in January, Meta, which owns Facebook and Instagram, announced that advertisers on these platforms would not be able to target kids below 18 years with advertisements based on their social media activity. In a blog post, it said that the company recognises “that teens aren’t necessarily as equipped as adults to make decisions about how their online data is used for advertising.”
India is an education-obsessed society, where academic and parental pressure and expectations can have a huge impact on kids’ mental health.
According to the data released by the National Crime Records Bureau (NCRB) in August, last year, 13,089 students died by suicide in 2022, up from 12,526 in 2020. Failure in exams and family problems were found to be among the reasons.
“Excess of everything is bad,” says Dr Kapoor. “When one focuses only on academic performance, other aspects of personality development are undermined,” she says. Our education system, with a skewed focus on marks over knowledge, plays a huge role in fuelling anxiety. It makes for an “unwholesome experience and causes issues with self-esteem, fear of failure, anxiety and disturbed interpersonal relationships,” explains Dr Kapoor. Also, high-pressure exams such as IIT-JEE and NEET leave little time for recreation.
While some take the extreme step, there are some who develop self-harm tendencies. “Self-harm behaviour is an impulsive act of distraction when one feels that extreme emotional pain or physical pain is an outlet. This carries significant risk of future suicide attempts as the pain tolerance increases and fear of self-harming reduces,” Dr Kapoor adds.
While every mental health disorder manifests differently, some signs that show a teen is in distress are feeling sad or down, extreme mood changes of highs and lows, excessive fears or worries or extreme feelings of guilt, confused thinking or reduced ability to concentrate, deteriorating academic performance, significant tiredness, low energy or problems sleeping, withdrawal from friends and activities and falling sick often.
It is crucial to address any mental health disorder in time as, if left unaddressed, “issues persist through life and cause difficulties in dealing with routine life stressors. Untreated mental health conditions can result in unnecessary disability, unemployment, substance abuse, homelessness, inappropriate incarceration, suicide and poor quality of life,” explains Dr Kapoor.
Can work harm?
Plum, an employee health insurance platform, said earlier this year that in the past seven months, over 77% of its mental health consultation bookings came from young adults, those aged between 21 and 30 years. They were followed by 17% of millennials, those between 31 and 40 years of age. About 60% of the bookings came from women for issues such as depression, stress and anxiety, along with those related to relationships. Also, 69% of the bookings were made from metro cities.
It is crucial to note that in 2022, several offices resumed work-from-office post a two-year Covid-induced hiatus, putting mental pressure on many.
However, mental health issues were a concern among working professionals even before the pandemic hit. According to the WHO, in 2019, about 15% of working-age adults were estimated to have a mental disorder. Not only health, but this has economic repercussions as well, as the loss of productivity due to depression and anxiety leads to an estimated loss of 12 billion working days costing a whopping $1 trillion globally, every year.
While multiple factors can play a role, work, at times, can be a factor too. “Work can be a protective factor for mental health, but it can also contribute to worsening mental health. Poor working environments—including discrimination and inequality, excessive workloads, low job control, and job insecurity—pose a risk to mental health,” says Dr Kapoor. Under-use of skills or being under-skilled, understaffing, long, unsocial or inflexible hours, limited support from colleagues or authoritarian supervision, unclear job role, under- or over-promotion and conflicting home/ work demands are some of the risks to mental health at work that the WHO enumerates.
At times, the usual scenario of multiple work engagements and deadlines can make work professionals lose their moorings, says S Venkatesh, a mindfulness coach, author, founder of leadership coaching firm Mainspring and a member of the Forbes Coaches Council. In such a situation, “it helps to take some time off every day to engage in activities that help to centre oneself like meditation, yoga, a sport or music”, adds Venkatesh .
Speaking on practising mindfulness at the workplace, he says it “helps us to be self-aware, so that we can realise when we are getting overwhelmed or carried away by external circumstances. Allowing space between this awareness and our reaction to the stimulus, helps us handle conflicts and stresses better.”
The role of employers is crucial too. They must understand how the work environment might be impacting the employees. This includes realistic goals, workloads, schedules, absent leadership and toxic culture. Dr Kapoor recommends employers “encourage everyone to develop a fulfilling life beyond office responsibilities and spend time with loved ones, reduce the stigma related to mental health issues at your workplace, and invest in mental health training and resources.”
Midlife crisis
A less-talked-about phase in one’s life, when one undergoes monumental changes, is the middle age. Mid-life crisis, during which one can face inner turmoil regarding one’s life choices, identity and even mortality, is one thing. There is a decline in one’s physical abilities compounded by the responsibility of taking care of an ageing parent, which can take an emotional toll. Kids also move out for study or work, leading to what is called an empty nest syndrome. Those working are also near retirement, which can pose financial concerns. For women, menopause can be a period that can take both physical and emotional tolls.
According to a study by UK-based University College London (UCL), 20% of those born in 1970, who are a part of Generation X, experienced their highest levels of psychological distress, which includes symptoms of anxiety and depression, in their 40s and 50s.
“Change is difficult, especially when your body is also ageing rapidly,” says Shruti Suhas Padhye, psychologist at Mpower Cell that provides clinical interventions for specific target audiences. While children moving out can leave a parent feeling lonely, “understand that this transition is a part of life and no matter how heartbreaking it must be for you to see your children leave, it’s important for their growth and development,” she says. Here, making a ritual of meeting with friends and family once a week can help.
Similarly, simultaneously taking care of ageing parents and kids can be a challenge that can feel draining. Here, it is important to understand that “one can take care of others only if they can take care of themselves first. Hence, exercise and take time off for yourself. Building healthy boundaries and acknowledging your limitations as a parent or child also help,” she adds.
Regarding women undergoing menopause, the psychologist says “there is a direct connection between mild depression, mood changes and hormonal changes.” Here, one must focus on building and maintaining a healthy lifestyle, and understanding that this change is only temporary.
Ageing population
The global population is ageing rapidly. According to WHO, the world’s population over 60 years will double, from 12% to 22%, between 2015 and 2050. In absolute terms, this means a rise in the old-age population from 900 million to 2 billion.
Old age brings along with it not just physical ailments but mental and psychological ones too. According to the world health body, about 50% of those aged 60 years and above suffer from a mental disorder. Alarmingly, mental and neurological disorders account for 6.6% of the total disability (DALYs) among older adults.
Dementia and depression are the most common mental and neurological disorders, affecting 5% and 7% respectively, of the world’s older adults. Anxiety disorders impact 3.8% of them, while substance use problems are also prominent affecting almost 1% of the world’s older adults. Staggeringly, about one-fourth of deaths due to self-harm happen among those aged 60 and above. Often, substance abuse among them is overlooked or misdiagnosed, the world health body states.
“Some of the concerns that the elderly reach out to me for include loneliness, low mood, fears around the death of their close friends and partner, dealing with grief, anxiety, sleep issues and often around their physical health and ageing,” says clinical psychologist Sonali Gupta.
According to the WHO, older adults not only experience physical problems such as reduced mobility, chronic pain and frailty, but emotional issues too, such as bereavement or a drop in socioeconomic status that comes with retirement. Such stressors can culminate into “isolation, loneliness or psychological distress,” it says. Adding to that, they are also susceptible to abuse—physical, verbal, psychological, financial and sexual, and neglect along with loss of respect and dignity. Alarmingly, about one in six older adults experience elder abuse, as per estimates. “When it comes to social support and infrastructure, the support is not there,” says Gupta. Sadly, symptoms of mental health distress are often overlooked as they occur along with other old-age-related issues.
Institutions and the community need to step up, too, to prevent and deal with elder abuse, providing social support to elders along with their caregivers and taking care of vulnerable groups.
“Having an open dialogue about the challenges that the elderly face, whether it’s through conversations, podcasts or even documentaries, is important,” says Gupta. “We need to re-examine how we look at the elderly and ask ourselves how we can create more compassionate and open spaces where the needs of the elderly are received with empathy,” she adds.