Aryal Nirmal, Regmi Pramod R, van Teijlingen Edwin, Simkhada Padam, Mahat Pashupati
Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom of Great Britain and Northern Ireland, United Kingdom.
Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom of Great Britain and Northern Ireland; Chitwan Medical College, Tribhuvan University, Nepal; Datta Meghe Institute of Medical Sciences, India.
WHO South East Asia J Public Health. 2019 Apr;8(1):38-41. doi: 10.4103/2224-3151.255348.
Over the past two decades, the unique health needs associated with the second decade of life have been recognized, not least the mental health of adolescents. In parallel, the negative health impacts of parental migration on the children and adolescents who are "left behind" in low- and middle-income countries (LMICs) is beginning to be acknowledged. Nepal is a growing supplier of labour migrants - an estimated 3.5 million Nepali individuals are working abroad - resulting in families being separated and thousands of adolescents being left behind. This can increase psychological and emotional stress and feelings of loneliness and abandonment, and reduce self-esteem among left-behind adolescents, which in turn may have a negative impact on their psychosocial health. Globally, mental health and neurodevelopmental disorders are one of the top three causes of disability-adjusted life-years lost among adolescents. The devastating earthquake in Nepal in 2015 brought into sharp focus the lack of prioritization of mental health services and spurred development of the Community mental health care package Nepal, 2074 in 2017. This package, together with the upcoming revised National Mental Health Policy, emphasizes the need to (i) ensure the availability and accessibility of basic mental health and psychosocial support services for all; and (ii) facilitate integration of mental health services into the primary health-care system. Recognizing that mental health and psychosocial support services have been predominantly focused on the adult population only, the package includes a component on childhood and adolescent mental and behavioural disorders. It will be essential for policy-makers to ensure that strategies are in place to ensure that left-behind adolescents, especially those who are not in school, have access to these community-based services. Given the paucity of research on mental health interventions among adolescents in LMICs in general, monitoring and assessment of what works for this special group of young people in Nepal may have broader implications for implementation in other countries where migration has resulted in significant populations of left-behind adolescents.
在过去二十年里，与生命第二个十年相关的独特健康需求已得到认可，尤其是青少年的心理健康。与此同时，父母移民对低收入和中等收入国家（LMICs）中“留守”的儿童和青少年的负面健康影响也开始得到承认。尼泊尔是劳动力移民的输出国，且移民数量不断增加——估计有350万尼泊尔人在国外工作——这导致家庭离散，成千上万的青少年被留守。这会增加心理和情绪压力、孤独感和被遗弃感，并降低留守青少年的自尊，进而可能对他们的心理社会健康产生负面影响。在全球范围内，心理健康和神经发育障碍是青少年残疾调整生命年损失的三大主要原因之一。2015年尼泊尔发生的毁灭性地震凸显了心理健康服务缺乏优先级的问题，并促使在2017年制定了《2074年尼泊尔社区精神卫生保健包》。该保健包以及即将修订的《国家精神卫生政策》强调需要：（i）确保为所有人提供基本心理健康和心理社会支持服务，并使其易于获得；（ii）促进将心理健康服务纳入初级卫生保健系统。认识到心理健康和心理社会支持服务主要仅关注成年人群体，该保健包包括一个关于儿童和青少年心理及行为障碍的部分。政策制定者必须确保制定相关战略，以确保留守青少年，尤其是那些未上学的青少年，能够获得这些基于社区的服务。鉴于一般而言低收入和中等收入国家对青少年心理健康干预的研究较少，对尼泊尔这一特殊青年群体有效的措施进行监测和评估，可能对其他因移民导致大量青少年留守的国家的实施工作具有更广泛的意义。
