Non-communicable diseases in adolescents in Indonesia

Non-communicable diseases (NCD) such as diabetes, cardiovascular disease and mental disorder are now the prevailing cause of death and disability in most countries, including Indonesia.  

Adolescents represent an important population group in terms of NCD response. This is because many risk factors for adult NCD (including tobacco use, physical inactivity and poor diet) arise and are potentially modifiable during adolescence. As well, adolescents experience significant preventable NCD including mental disorder, asthma and chronic pain. 

Objective

Currently, there is limited data documenting the prevalence of priority NCD risks and outcomes among Indonesian adolescents, and the determinants that underpin them. How young people perceive NCD risk and outcomes remains poorly described. These understandings are critical to informing effective preventive and treatment interventions.

The overarching aim of this study was to measure the prevalence of common mental disorders (a key NCD outcome) and metabolic syndrome (a key risk) amongst Indonesian adolescents with the goal of informing future NCD policy and programming.

Specifically, we aimed to:

• qualitatively explore how in and out of school Indonesian adolescents conceptualise mental disorders and metabolic risk (separately), their perceptions of the determinants, and their recommendations around appropriate responses

Timeline

2016–2026. 

Approach

Using a mixed-method design, we sampled 16-18-year-old adolescents from schools and community-based settings across Jakarta and South Sulawesi.

Initial formative qualitative enquiry used focus group discussions to understand how young people conceptualise mental health and body weight; what they perceive as determinants; and what responses should involve.

These findings informed the design of a quantitative survey that adolescents self-completed electronically. Mental health was measured using the Centre for Epidemiologic Studies Depression Scale-Revised (CESD-R) and Kessler-10 (both validated against formal psychiatric interview in a subsample), with the metabolic syndrome measured using biomarkers and anthropometry.

The survey also included scales relating to victimisation, connectedness, self-efficacy, body image and quality of life.

Adolescents were sampled from schools using a multistage cluster design, and from the community using respondent-driven sampling (RDS). In total 16 focus group discussions were conducted, and 1,337 students completed the school-based survey, and 824 the community-based survey.

Subsequently, UNICEF funded additional in-depth interviews with policy makers and other stakeholders, and a workshop with young people, to understand how policies and actions should address NCD risks and how to meaningfully engage adolescents.