The personal yet global struggle with mental health may be more visible today than ever before. Yet many people still find it difficult to access the support they need. In Japan, suicide is sadly the leading cause of death among young people. Researchers, including those from the University of Tokyo, conducted a six-year study to better understand the myriad factors that can affect adolescent mental health. After surveying 2,344 young people and their carers, and using computer-based deep learning to process the results, they were able to identify five categories into which the young people could be grouped. Nearly 40% of the participants were classified as having some problems. Of these, almost 10% were living with mental health problems that had not been identified by their carers. This group was most at risk of self-harm and suicidal thoughts. Identifying the factors that can lead young people to suicide and who is most at risk is key to supporting prevention efforts and early intervention.
Last year in Japan, 514 young people and children aged 18 and under tragically lost their lives to suicide. This was the highest number for this age group since records began in 1978. According to the Japanese Ministry of Health, Labour and Welfare, suicide is the leading cause of death for people aged 15 to 34. While suicide rates among adults have generally declined over the past 10 to 15 years, the opposite is true for adolescents. Officials speculate that school-related problems, difficult personal and family relationships and the lingering effects of the pandemic may have contributed to the high number of deaths.
The World Health Organization (WHO) identifies suicide as a major global public health problem, but says it is preventable through evidence-based interventions and by addressing factors that can lead to poor mental health. Researchers from the University of Tokyo and the Tokyo Metropolitan Institute of Medical Science are analysing data on a range of adolescent problems, assessed both by the adolescents themselves and by their caregivers, in order to identify young people who may be at risk of suicide.
The team surveyed adolescents and their caregivers in Tokyo over a period of six years. Participants completed self-report questionnaires, answering questions about psychological and behavioural problems such as depression, anxiety, self-harm and inattention, as well as their feelings about family and school life. The team also looked at factors such as the mother’s health during pregnancy, involvement in bullying and the mental health of the carers. The study started when the children were 10 years old and they were followed up at 12, 14 and 16. A total of 3,171 adolescents took part, with 2,344 pairs of adolescents and their caregivers participating throughout the study.
“Psychiatry faces challenges in understanding adolescent psychopathology, which is diverse and dynamic. Previous studies have typically classified adolescents’ psychopathological development based on the trajectories of only two or three indicators. In contrast, our approach allowed us to classify adolescents based on a number of symptom trajectories at the same time, using deep learning techniques to provide a more comprehensive understanding,” explained Nagaoka.
Deep learning, a computer program that mimics the learning process of our brains, enabled the team to analyse the large amounts of data they collected to find patterns in the responses. By grouping the trajectories of the psychological and behavioural problems identified in the survey, they were able to classify the adolescents into five groups, which they named according to their key characteristic: unaffected, internalising, discrepant, externalising and severe.
The largest group, at 60.5% of the 2,344 young people, was made up of young people who were classified as ‘unaffected’ by suicidal behaviour.
The remaining 40% were found to be negatively affected in some way. The “internalising” group (16.2%) had persistent internalised problems and showed symptoms of depression, anxiety and withdrawal. The “discrepant” group (9.9%) experienced depressive symptoms and “psychotic-like experiences” but were not recognised as having such problems by their carers. The “externalising” group (9.6%) showed hyperactivity, inattention and/or conduct problems, but few other problems. Finally, the smallest group was classified as “severe” (3.9%) and had chronic difficulties that were known to their carers, particularly psychotic-like experiences and obsessive-compulsive behaviour.
Of all the groups, young people in the ‘discrepant’ category were at the highest risk of self-harm and suicidal thoughts. The researchers found that they could significantly predict who would be in this group by whether the child avoided seeking help for depression and whether their carer also had a mental health problem. The researchers suggest that the mental health of the caregiver could affect the mental health of the adolescent through both genetic factors and the parenting environment, such as the caregiver’s ability to be alert to the difficulties an adolescent might face. Although this research has some limitations, the team was still able to identify a number of risk factors that could be used to predict which groups adolescents might fall into.
“In my daily practice as a psychiatrist, I have observed that existing diagnostic criteria often do not adequately address the diverse and fluid difficulties experienced by adolescents,” says Nagaoka. “We wanted to better understand these difficulties so that appropriate support could be provided. Next, we want to better understand how adolescents’ psychopathological problems interact and change with the people and environments around them. Recognising that many adolescents face challenges and serious problems but are reluctant to seek help, we as a society need to establish supportive systems and structures”.
