Exploring mental health and potential health assets in young people

Abstract: Young people in Sweden generally claim to have a good quality of life, but also report increasing mental health problems. It is a concern that only a minority of young people seek and/or access support when encountering mental health problems as mental health is a fundamental human right and integral to a positive development in both childhood and throughout the lifespan. There are uncertainties as to how to facilitate help-seeking and promote mental health among young people and previous studies have often focused on risk-reduction. A shift from a pathological view to a resource-based perspective of mental health can be achieved by adopting a health assets’ approach. This approach also ascribes due emphasis to the fact that mental health is developed within a social context, where both individual and structural health assets, such as the support system, are of importance. With this in mind, the overall aim of this thesis was to explore individual and structural health assets in relation to the mental health of young people.This thesis is based on four studies using both quantitative (Studies I and II) and qualitative (Study III) methods as well as a scoping review method with a qualitative synthesis (Study IV). Studies I and II had a cross-sectional design and utilized data from self-reported health-related ratings collected in schools in 2011. The association between socio-economic determinants and self-rated mental health in two age groups (11-13 and 14-16) was explored in Study I, and optimism and pessimism as a bi-dimensional construct, and its impact on health-related quality of life and potential to function as a health asset was explored in Study II. In Studies III and IV, the help- seeking process was explored from the perspective of young people, firstly with constructivist grounded theory in Study III based on interviews of young people seeking help for mental health problems within a local setting, and secondly, through a scoping review examination and qualitative synthesis of national and international literature on help-seeking in Study IV.The results identified potential health assets on both individual and structural levels. The explored health assets on an individual level were socio-economic status and socio-demographic factors (Study I), dispositional optimism (Study II) and individual resources for help-seeking (Studies III and IV), while health assets on a structural level were explored through the experience of and perceptions of young people’s help-seeking process(Studies III and IV). The individual health assets of socio-economic status and migratory background were seen to affect mental health differently for boys and girls with the boys being susceptible to an accumulation of socio-economic risk factors including family wealth affecting their mental health negatively, and the mental health of the young girls with a migratory background being affected positively (Study I).The individual health asset of optimism was found to be potentially supportive for help-seeking and mental health (Study II). Young people were optimistic about their future but there was a significant decrease in optimism and health-related quality of life, and a significant increase in pessimism, with age. Optimism was independently and positively associated with a high level of health-related quality of life among young people, even when adjusting for parents’ marital status, family country background and gender. Knowledge and a desire for self-reliance were identified as potential individual health assets mainly in regard to the help-seeking process (Studies III and IV). Young people expressed how their knowledge of mental health and the support system was inadequate, rendering a feeling of insecurity, however, they also expressed a strong desire for self-reliance in regard to their mental health. Help-seeking was characterised as a dynamic and psychosocial process without sequentially fixed stages. Potential health assets on a structural level were identified as support through social networks, and a responsive, collective and accessible support system. However, young people perceived the support system as unresponsive, focused on protocol instead of person, fragmented and spread, and lacking in accessibility. The results implied that equipping young people with sufficient knowledge would capitalize on the individual health assets of self-reliance and optimism, conducive to help-seeking and mental health, but that the support system needs to improve in order to meet the particular needs of young people.