Measurement of Mental Health

among Adolescents at the

Population Level (MMAP)

Conceptual Framework and Roadmap

© UNICEF/UNI99797/Siddique
Measurement of Mental Health among Adolescents at the Population Level (MMAP) UNICEF

The Roadmap to the Measurement of Mental Health

among Adolescents at the Population Level (MMAP)

Background
Mental health issues constitute one of the greatest
burdens of disease for adolescents globally. An estimated
one in five adolescents will experience a mental disorder.
Self-harm is the third leading cause of death for
adolescents, and depression is among the leading causes
of disability in this age.1

Adolescence is a crucial period of development, where

exposures and behaviors can set the trajectory for an
individual’s mental and physical health in later life.2 Half
of all lifetime mental disorders will start by adolescence.3
Mental disorders can be severe and disabling, and are
associated with grave social and economic impacts.
Yet, adolescent mental health has often been overlooked
in global health programming. During the SDG period,
however, mental health is taking an important place in the
global health agenda. This is a key step toward reducing
preventable deaths among adolescents, and reducing the
global burden of disease attributable to mental disorders.
Currently, data concerning mental health conditions among
adolescents, especially in low‐ and middle- income
SUSTAINABLE DEVELOPMENT GOAL 3
Ensure healthy lives and promote
well-being for all at all ages
© UNICEF/UNI106569/Crouch
countries, is lacking and is urgently needed. The data used
to extrapolate estimates for the prevalence and burden of
adolescent mental disorders are based on few studies,
offering a very narrow snapshot of the situation for
adolescents globally. The true burden of mental health
disorders among adolescents could be direr than
estimates suggest.
UNICEF, in collaboration with key partners, is working to fill
this crucial data gap by creating a methodological
framework for the development of tools for data collection
on adolescent mental health. Improved data and evidence
on the prevalence and burden of mental ill‐health among
adolescents, as well as on exposure to risk factors and
access to interventions, is an essential step towards
planning more effective and supportive programming and
identifying vulnerable populations at higher risk.

1. WHO and partners (2017) Global Accelerated Action for the Health of Adolescents (AA-HA!). Geneva 2017
2. Sawyer SM, Afi fi RA, Bearinger LH, Blakemore SJ, Dick B, Ezeh AC, Patton GC. Adolescence: a foundation for future health. Lancet 2012; 379: 1630–40.
3. Kessler RC, Amminger GP, Aguilar‐Gaxiola S, Alonso J, Lee S, Ustun TB. Age of onset of mental disorders: A review of recent literature. Current opinion in
psychiatry. 2007;20(4):359-364. doi:10.1097/YCO.0b013e32816ebc8c.

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Measurement of Mental Health among Adolescents at the Population Level (MMAP) UNICEF

Conceptual Framework
Draft for Discussion

A conceptual framework for the measurement of mental health among adolescents has been developed to illustrate concepts
and factors concerning adolescent mental health, to ensure the goals and approach are designed with appropriate consideration
of their context.

Conceptual Framework: Measurement of Mental Health among Adolescents at the Population Level (MMAP)

Risk Factors Outcomes

Societal Protective Access to Impacts on the individual’s health,

Adolescent
factors Interventions, including neglect of self-care and
Mental Ill-Health
Treatment, health-risk behaviors
meeting a level
Familial of Functional Support
Preventive and Impairment Early mortality resulting directly or
risk-reduction indirectly from mental disorders or
Individual interventions associated factors, or self-harm
and suicide

Impacts on developmental,
educational, financial and social
outcomes for the individual

Greater societal impacts

Risk factors Interventions, treatment and support

The conceptual framework features risk factors on the individual
and family levels, as well as broad societal circumstances. In
many situations, an interplay of risk factors, and a lack of buffers
or protective factors, will convey the risk for an individual to have
mental ill-health.
There are many effective treatments for individuals with
mental disorders including therapies as well as medications.
On the broader societal level, programs can be tailored for
specific populations and targeted to those in need.

Protective Factors Outcomes – individual and societal burden

There are many factors, as well as numerous effective
interventions, that can increase likeliness for positive mental
health outcomes, or that may reduce or buffer risks for
mental disorders.
Mental disorders among adolescents are critical to address
due to their prevalence, early onset and lasting impact.
The burden on individuals, families, and society may include
long-term effects on productivity and quality of life, in
addition to disability caused directly by mental disorders.

The measure of adolescent mental ill-health

with associated functional impairment

The measure of adolescent mental ill-health will capture

mental disorders or associated symptoms meeting a threshold
of functional impairment at home, school or among peers. This
measure may capture mental disorders, as well as self-harm
and suicidal behaviors.

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Measurement of Mental Health among Adolescents at the Population Level (MMAP)
Roadmap to the Measurement of Mental Health among Adolescents at the Population level (MMAP)
The proposed roadmap that will lead to the development of a tool for the measurement of adolescent mental
health consists of the following steps:
Desk review of existing
1 instruments and of prevalence
A desk review was conducted to assess the current level
of evidence in peer-reviewed literature. Epidemiological
studies concerning prevalence of mental disorders among
children and adolescents in low- and middle- income countries
were evaluated. Subsequently, a mapping of existing data
collection tools was undertaken to document the attributes
of validated scales and instruments used to measure
adolescent mental health.
2 Development of a conceptual
framework
A conceptual framework was developed by UNICEF to
illustrate relevant factors in regards to measurement of
mental ill-health of adolescents at the population level,
risk and protective factors, and access to mental health
support or treatment. This model will be further refined to
inform various aspects of this work.
Technical consultation with
3 key partners and experts
The First Technical Experts Group meeting was held at
UNICEF Headquarters in New York, in March 2018, to
convene key partners and experts and present the roadmap
to the measurement of adolescent mental health at the
population level.
Creation of a Technical Advisory
4 Group (TAG) on mental health
measurement among adolescents
A small group of advisors has been assembled to provide
technical expertise throughout the selection, adaptation,
and finalization of a tool for the measurement of
adolescent mental health.
UNICEF
Development of indicators on
5 adolescent mental health
The development of indicators of adolescent mental health
was begun at the First Technical Experts Group meeting.
The proposed indicators put forth are being further
developed and refined with input from the Technical
Advisory Group.
6 Selection of instrument
The TAG will provide input and recommendations including
criteria to inform the selection of a validated scale or
instrument to measure adolescent mental health at the
population level.
Translation, validation
7 and piloting of the instrument
The selected scale or instrument to measure adolescent
mental health at the population level will be translated,
adapted, and piloted in selected test countries. The final
protocol for instrument translation and validation, and
evaluation of its psychometric properties will be refined
in consultation with the TAG.
Finalization of a tool to measure
8 adolescent mental health in
national-level surveys
Upon completion of the steps listed above, the tool for
measurement of adolescent mental health will be
disseminated and promoted for use in national household
surveys. Data collection may begin in each country, followed
by compilation of results in UNICEF global databases.
These population-level data, collected as a component of
comprehensive household surveys, will allow disaggregation
of the findings by demographic and socio-economic
characteristics, as well as subnational geographic areas.
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Measurement of Mental Health among Adolescents at the Population Level (MMAP) UNICEF

Roadmap 2018-2019 - Timeline for the development of a tool to measure adolescent mental health
at the population Level

2018 2019
Activities

MAR

MAR
AUG

AUG
MAY

MAY
NOV

NOV
JUN

JUN
OCT

OCT
JAN

JAN
DEC

APR

DEC

APR

DEC
JUL

SEP

JUL

SEP
FEB

FEB
Desk review of instruments and
prevalence of mental ill-health in
low and middle income countries

Technical Experts Group

meeting - face-to-face
New York (March 1-2 2018)

Webinar to share the findings

from the first meeting of the
Technical Experts Group

Call for nominations to form the

Technical Advisory Group (TAG)

Development of indicators, based

on recommendations from first
Technical Experts group meeting

Finalize selection criteria, evaluate

and select instrument(s)

Adaptation, Pre-testing and

Cognitive interviewing in select
countries

Field testing of the new

AMH module

Reliability and Validity testing

and analyses of the new
AMH module

Finalization for Launch of the AMH

module

Work led by Data and Analytics Section/Division of Data Research of Policy

Contact: data@unicef.org