/ 16 June 2024

Mental health of South African youth needs urgent attention

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On 16 June every year, Youth Day is celebrated to commemorate the courageous young people involved in the 1976 Soweto uprisings.  Their defiance against oppression and injustice played a crucial role in paving the way towards a democratic South Africa. As we observe Youth Day, we reflect on the well-being of the young people in our country. 

Although 1994 brought hope and positive change, the socioeconomic status of our country has progressively deteriorated, leading to some of the highest rates of unemployment, poverty and inequality in the world. The youth, in particular, bear the brunt of these worsening conditions. In addition to navigating these obstacles, they also face significant mental health problems. 

Mental health refers to a state of well-being that also includes biological, psychological or social factors that contribute to an individual’s mental state. Common mental health disorders such as depression, anxiety, and trauma-related disorders can affect a person’s thoughts, emotions, and behaviours, which can lead to distress and impaired daily functioning.

The burden of poor mental health in South African youth is unique, with children being exposed to multiple risk factors such as violence, childhood maltreatment, food and income insecurity and poverty. About three quarters of mental health conditions emerge before the age of 25 years.

This is a major cause for concern, because South Africa has a young population, and the presence of mental health disorders during youth is a strong predictor of mental health problems in adulthood. This can result in unemployment, increased risk of substance abuse, potential involvement in criminal activities and the development of physical health conditions, the latter compounding the burden on personal wellbeing and financial stability. Addressing mental health in youth offers the possibility for early intervention

The neglect of mental health issues, particularly among South Africa’s youth, persists because of several barriers and systemic problems. The stigma surrounding mental illness continues to be a significant obstacle, driven by cultural misunderstandings, the fear of being judged or lack of mental health literacy, which in turn prevents individuals from seeking the support they need.

Moreover, limited access to mental health services, worsened by socioeconomic differences and underinvestment in mental health infrastructure, leaves many young people without timely and affordable care. The importance of better understanding the contributors to poor mental health and ideally focusing on not only intervention but also prevention efforts is underlined by the estimated 92% treatment gap in the country. This means that fewer than one in 10 people, including the youth, who need mental healthcare services will actually be able to receive them. 

Mental health disorders are complex disorders, with many factors that contribute to their development. As part of our efforts to treat these disorders, we must also take a closer look at their molecular basis as our brains orchestrate several molecular interactions that influence our mental well-being. Understanding these molecular mechanisms shows us that they are not simply a matter of “mind over matter” but are influenced by complex interactions at the molecular level.

This understanding opens doors for more effective treatments, reduces stigma and highlights the importance of holistic approaches to mental health care for young people that consider both biological and environmental factors.

Genes represent “biological blueprints” that are found in each cell of the body. They code for specific proteins that control information pertaining to our health, appearance and personality traits in a process known as gene expression. Decades of observational research on families and twins has shown that psychiatric disorders are incredibly complex and arise from intricate interactions between a combination of genetic and environmental factors. 

It is important to note that mental health disorders are polygenic, meaning that many genetic variants will play a role in their development. Each of these genetic variants will have a small effect on risk for the disorder, making it difficult to identify risk variants unless you have hundreds of thousands of individuals to study. These kinds of numbers in research are only possible through large, global collaborative consortia, such as the Psychiatric Genomics Consortium (PGC).

The PGC is indeed making strides towards identifying causal risk variants in psychiatric disorders, such as schizophrenia and depression, although there is much that remains to be discovered. Many of these studies have been conducted in North America and Europe, with very few carried out in Africa, limiting the generalisability of the results to individuals of European ancestry, and widening the health inequalities between the Global North and South.

In recent years, mental health research has progressed past studying just our genetic makeup. Researchers are now also investigating how biological mechanisms that are influenced by the environment, such as epigenetics (which involves changes in the activity of genes without any alteration of the DNA sequence) and the microbiome (the microbial communities that live within and upon our bodies), influence our mental health.

Stressful or traumatic experiences can alter our epigenetic markings and gene expression, increasing the likelihood of developing psychiatric disorders. Understanding these changes offers insights into the development and progression of disorders, potentially leading to useful biomarkers (measurable indicators of some biological condition or disease) and more effective treatment strategies. 

Moreover, the gut-brain axis, a powerful, two-way communication system between the gut and the brain, has been found to influence neurodevelopment, mood and behaviour. Microbiome imbalances, typically caused by a poor diet, antibiotic use or stress, have been linked to a greater risk of psychiatric disorder development. Understanding these effects may enhance mental health through the identification of interventions, such as prebiotics, probiotics or microbial compounds that target the gut-microbiome axis.

The Neuropsychiatric Genetics research group at Stellenbosch University, led by Professor Sian Hemmings, attempts to unravel the complex biological and environmental interactions that contribute to the development of psychiatric and neurodevelopmental disorders, including anxiety, depression, post-traumatic stress disorder and foetal alcohol spectrum disorders. 

Through our close collaboration with clinicians and psychiatrists and our genetic, epigenetic and microbiomic investigations, we try to better understand psychiatric disorders and uncover new avenues for treatment and intervention. In doing so, we can hopefully help to address some of the mental health challenges faced by the youth and improve their lives. 

Lauren Martin, Jacqueline Womersley, Matsepo Ramaboli, and Sian Hemmings are members of the Neuropsychiatric Genetics Research Group and the South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Extramural Research Unit based in the Department of Psychiatry at Stellenbosch University. The contributions of Morne du Plessis, Aqeedah Roomaney, Kabelo Maloka, Carlien Rust, Thando Shabangu, Chloe McDonald, Dineo Madikgetla, Nto Johnson Nto, and Kayleigh Filton to this article are hereby acknowledged.