OBJECTIVE: Bronfenbrenner's ecological systems theory, a multisystem framework, was used to identify risk and protective factors associated with adolescent mental and physical health (AMPH) in the English-speaking Caribbean. METHODS: A structured literature review, using the online databases of Medline, PsychInfo, and Scopus, was conducted to identify peer-reviewed studies published between January 1998 and July 2011 focused on adolescents ages 10-19 years. RESULTS: Sixty-eight articles were examined: 40 on adolescent mental health (AMH), 27 on adolescent physical health (APH), and 1 on both topics. Key individual factors included gender and age. Religiosity and engagement in other risk behaviors were associated with AMH, while the presence of other chronic illnesses affected APH. Significant determinants of AMH in the microsystem included family and school connectedness, family structure, and socioeconomic status. Maternal obesity, parental education, and school environment influenced APH. Studies that investigated macrosystem factors reported few consistent findings related to AMPH. A history of family mental health problems and physical and sexual abuse was significantly associated with AMH in the chronosystem, while a family history of diabetes and low birth weight were associated with APH. Studies did not examine the exosystem or the mesosystem. CONCLUSIONS: AMPH in the English-speaking Caribbean is affected by a variety factors in developing adolescents and their surroundings. Gender, family, and early exposure to negative environments are salient factors influencing AMPH and present potential avenues for prevention and intervention. A fuller understanding of AMPH in this region, however, requires scientifically rigorous studies that incorporate a multisystem approach.
OBJETIVO: Se empleó la teoría de sistemas ecológicos de Bronfenbrenner, un marco conceptual multisistémico, para identificar los factores de riesgo y de protección asociados con la salud mental y física de los adolescentes en el Caribe de habla inglesa. MÉTODOS: Se llevó a cabo una revisión bibliográfica estructurada usando las bases de datos en línea MEDLINE, PsychInfo y Scopus, para identificar estudios con revisión externa publicados entre enero de 1998 y julio del 2011 centrados en adolescentes de 10 a 19 años. RESULTADO: Se examinaron 68 artículos: 40 sobre salud mental en adolescentes, 27 sobre salud física en adolescentes y 1 sobre ambos temas. Los factores individuales clave incluyeron el sexo y la edad. La religiosidad y la participación en otros comportamientos de riesgo se asociaron con la salud mental, mientras que la presencia de otras enfermedades crónicas afectó a la salud física. Los determinantes significativos de la salud mental en el microsistema incluyeron la vinculación con la familia y la escuela, la estructura familiar y la situación socioeconómica. La obesidad materna, la educación parental y el ambiente escolar influyeron en la salud física. Los estudios que investigaron los factores del macrosistema informaron pocos resultados consistentes relacionados con la salud mental y física en los adolescentes. Los antecedentes familiares de problemas de salud mental, y el maltrato físico y el abuso sexual presentaron una asociación significativa con la salud mental en el cronosistema, mientras que los antecedentes familiares de diabetes y peso bajo al nacer se asociaron con la salud física. Los estudios no examinaron el exosistema o el mesosistema. CONCLUSIONES: La salud mental y física de los adolescentes en el Caribe de habla inglesa está afectada por varios factores de su desarrollo y su entorno. El género, la familia y la exposición temprana a un entorno negativo son factores destacados que influyen en la salud mental y física de los adolescentes y representan posibles caminos para la prevención y la intervención. No obstante, para alcanzar una comprensión más integral de la salud mental y física de los adolescentes en esta región se requieren estudios científicamente rigurosos que incorporen un enfoque multisistémico.
INTRODUCTION: Violent acts in young people constitute one of the most serious forms of violence in any society. Violence by young people in schools, on the streets, and in their families has been documented in many studies worldwide. Homicide and non-fatal assaults involving young people have been reported as a great global burden of premature death, injury and disability. Adolescents and young people are both the main victims and perpetrators of such violence. In Vietnam, an emerging pattern of health problems in adolescents related to intentional injury and violence is drawing increasingly more attention from government and the public. OBJECTIVE: Describe the situation of intentional injury among Vietnamese youth, including risk and protective factors, in order to suggest policy implications. METHODS: The 2003 Survey Assessment of Vietnamese Youth was used as a data source, providing a nationally representative sample of 7584 youth aged 14-25 years, resident in 42 of the country's 61 provinces. This sample was drawn from the 45,000 households in the 2002 Vietnam Living Standards Survey, with a multi-staged and stratified design, using the probability-proportional-to-size method to maintain representativity. Data were analyzed using bivariate and multivariate statistical techniques. RESULTS: Of the sample of young people, 2.2% reported injury resulting from violent behavior by a family member and 8.0% by non-family members, the latter demonstrating a significantly higher rate among males than females (13.6% vs. 2.4%). Characteristics of youth most likely to hurt others included: male sex, inebriation at some point, victims of intentional injury, group riot participants and carriers of weapons. Youth who had been members of mass social organizations or clubs in the community were half as likely to hurt other people as those who were unaffiliated with such groups. Females were almost four times more likely than males to attempt suicide. Other risk factors for suicide attempts were past inebriation (OR 2.7, 95% CI 1.3-5.4), ever having been a victim of intentional injury by a family member (OR 3.3, 95% CI 1.1-11.5) or ever having had feelings of hopelessness (OR 6.5, 95% CI 3.3-13.6). CONCLUSIONS: Prevalence of violence and self-harm among Vietnamese youth is comparatively less than in Western and other Asian countries. Risk and protective factors appear similar to those found in most populations. In particular, this study indicated a possible protective effect of membership in social groups. National policy for injury prevention should include strategies to reduce violence and self-harm within this population group.