Collecting minimally sufficient data on child and adolescent mental health disorders in Indonesia

Adolescence is the usual time of onset of most major mental disorders. Despite this, there is insufficient information on the subject to allow policy-makers in many low and middle income countries to effectively set priorities and guide investments.

This project aimed to evaluate the availability of minimally sufficient data on major mental and behavioural problems in Indonesia and other countries in the Southeast Asia region. It also examined the range of existing studies that could inform preventive action, in order to determine which risk factors should be prioritised in data collection and mental health policies in Indonesia.

Further objectives were to establish contacts with leading experts on adolescent mental health globally, engage with both academic and civil society partners in Indonesia and develop a proposal for collecting minimally sufficient data on mental disorders in Indonesia.

The work was split into two smaller projects. The first analysed the available prevalence data for child and adolescent mental disorders. The data were sourced from systematic reviews conducted for the Global Burden of Disease Study 2017. Coverage was calculated for each study and country, and the region.

It was found that the coverage of prevalence data for mental disorders in children and adolescents was 4.9 per cent for Southeast Asia. Depression had the highest coverage (3.1 per cent) while eating disorders had no available prevalence data. Of the 13 countries in Southeast Asia, only eight had any prevalence data for mental disorders in children and adolescents and only three had data for more than one disorder. Malaysia had the greatest coverage (9 per cent) while Sri Lanka (less than 0.01 per cent) had the lowest coverage of countries with available data. Coverage has increased since similar analyses were conducted on data available from GBD 2013 (0.3 per cent). However, coverage remains low compared to other nearby countries such as Australia, which had an average coverage of 69.1 per cent.

Indonesia has effectively no data coverage for child and adolescent mental disorders. This carries a number of implications:

• Difficulty in planning service and efficiently allocating resources for child and adolescent mental health policy and programming.
• Difficulty highlighting mental health as an area for investment by the Indonesian government or other stakeholders.
• Inability to determine whether existing programs or policies may have been effective in reducing the burden of mental disorders.

Work is currently underway to address these gaps through upcoming National Adolescent Mental Health Surveys in Indonesia and Vietnam.

The second part of the project mapped evidence gaps in the study of risk factors for depression and anxiety disorders in low and middle income countries, particularly those relevant to Indonesia. We used a review of reviews methodology to identify primary studies, and analysed every available study on risk factors for those aged 5 to 24 years for all country income groupings. We classified studies by design, place, age group, diagnosis and risk factors assessed.

Notable findings included:

• From the 289 studies of risk factors for major mental disorders in children and adolescents, the overwhelming majority (70 per cent) have been in high-income countries. There have been only 22 studies (8 per cent) in low and lower middle income countries
• The most commonly studied problems have been conduct disorder in younger children, followed by anxiety and depression
• Family risk factors, including a family history of mental disorder, have been the most studied group of risk factors. Again, the great majority of relevant studies have been in high income settings.
• Other risk factors with multiple studies include educational attainment and exposure to natural disasters. Surprisingly, these studies have all taken place in high and upper middle income countries.

We concluded that there is a rationale for undertaking a full-scale gap map of risk factors for some mental disorders, and that there is a strong case for examining existing cohort studies in low income countries to explore the availability of risk factors and relevant mental health outcomes.

We also concluded that new studies should be extending the range of risk factors examined in their work, and that there is a need for population-based surveys and cohort studies in Indonesia to examine not just the prevalence of common mental disorders, but also risk factors that are relevant for that setting.