Building resilience and resources to overcome depression and anxiety in young people from urban neighbourhoods in Latin America

Low and Middle Income Countries (LMICs) are increasingly urbanised. It is estimated that already 55% of the world¿s population live in cities, a figure set to rise to 68% by 2050. Urban regions, predominantly large cities, account for approximately 80% of the population in Latin America, making it the most urbanised region in the world. People within these environments are frequently exposed to risk factors for poor mental health, including those linked to depression and anxiety. These include social fragmentation, poverty, poor education, low employment rates, gang warfare, victimisation, violence, and wide spread substance misuse.The WHO has identified reducing adolescent depression and anxiety as a key priority in order to promote sustained economic and social development. Globally, depression and anxiety are leading causes of disability. Up to 4.4% of the global population suffer from depression and 3.6% suffer from anxiety disorders. Higher and rising prevalence of both conditions are evident in adolescents, with 75% of all mental health conditions developing before the age of 18 years. Both depression and anxiety are associated with high levels of distress and disability, future physical and psychiatric morbidity and educational and social impairment. Furthermore, more than half of all adolescent suicides are attributable to depression, making it the leading cause of mortality for this age group.Depression and anxiety during adolescence and youth are a particular concern within LMICs, where surveys have indicated that the burden of common mental disorders (CMDs) is greatest. This includes Latin America, where young people represent one quarter of the population. Estimated levels of depression and/or anxiety for adolescents within the region range from 17% in Colombia to 26% in Argentina. Those exposed to adversities such as conflict, internal displacement and poverty are at an even greater risk. Despite all the risk factors, the majority of young people do not suffer from depression and/or anxiety. Due to the scarcity of financial and human resources, young people in Latin America rarely receive formal treatment for depression and/or anxiety. Yet, evidence suggests that 50-60% of young people and adolescents experience symptomatic recovery within one year, despite the often accumulated and ongoing adversity and the lack of formal mental health care. This raises the question as to which resilience factors individuals in these contexts can mobilise either to prevent depression and/or anxiety or to overcome them once they suffer from episodes of mental distress. Previous research has predominantly focused on risk factors for developing mental disorders. However, ascomplete primary prevention of depression and/or anxiety among young people, particularly in adverse urban environments, is unrealistic, research on the factors that help young people recover from depression and/or anxiety may be particularly relevant and lead to future interventions to reduce the burden of poor mental health.The recent Lancet commission on global mental health emphasised the importance of promoting resilience and recovery. Resilience has been defined as overcoming adversity, trauma and stress and rebounding back from illness. Thus, it covers the two processes of avoiding depression and/or anxiety in the face of risk factors and recovering from them if and when they have developed.