Till Örebro universitet

In this cross-sectional study, we aimed to I) investigate the dual-factor model of mental health by forming and describing four participant groups and II) examine associations between mental health status and background factors, school-related factors, stress, and resilience among adolescents in a community population in Sweden. Data were collected through a survey completed by 2,208 students in lower and upper secondary school on the Swedish island of Gotland. After missing data were removed, a total of 1,833 participants were included in the study. The survey included the Mental Health Continuum Short Form (MHC-SF) for the assessment of mental well-being and the Strengths and Difficulties Questionnaire (SDQ) for the assessment of mental health problems. These two measures were combined into a dual-factor model, forming four mental health status subgroups: Vulnerable (47.5%), Complete mental health (36.2%), Troubled (13.9%), and Symptomatic but content (2.5%). Associations between these groups were explored regarding background factors, school-related factors, stress, and resilience through chi-squared tests and logistic regressions. Girls (OR: 1.88) and participants with high stress levels (OR: 2.23) had elevated odds for Vulnerable mental health status, whereas higher resilience (OR: 0.87) and subjective social status in school (OR: 0.76) were factors associated with reduced odds for this mental health status classification. Female gender (OR: 5.02) was also associated with Troubled mental health status. Similarly, a high level of stress (ORs: 4.08 and 11.36) was associated with Symptomatic but content and Troubled mental health status, and participants with higher levels of resilience had decreased odds for being classified into these groups (ORs: 0.88 and 0.81). The findings highlight the importance of interventions to increase resilience, reduce stress, and address stereotypic gender norms as well as social status hierarchies to support adolescents' mental health.

The latest World mental health report states that mental health is an integral component of health and well-being and is more than the absence of pathology. Indeed, the view of mental health is slowly shifting to an emphasis on positive health indicators as national authorities around the world are increasingly adopting the two continua model of mental health (TCM). Adopting the TCM has several important implications for public health practice. One is that the epidemiological surveillance will have to include measures of both mental illness and mental well-being. The purpose of this presentation is to illuminate the conceptual and practical use of the TCM in the analysis of adolescent mental health. The presentation will be limited to a focus on the theoretical underpinnings and methodological considerations made to operationalize and categorize mental health according to the TCM. It will consider the added value of the TCM to epidemiological surveillance as well as its implications for public health practice when it comes to meeting population needs with appropriate interventions. To construct the model, data from population-based regional public health surveys among adolescents including validated measures of both mental ill health and mental well-being was used. The Kessler 6 scale was used to estimate the proportion of adolescents with or without probable serious mental illness (SMI, >13) and the Mental Health Continuum - Short Form was used to estimate the proportion of adolescents with flourishing (FMH), moderate (MMH) or languishing (LMH) mental health according to the original categorization developed by Keyes. Combining these two dimensions of mental health and their respective categories will yield six mental health status groups: Complete mental health = FMH without SMI, Vulnerable = MMH without SMI, Most vulnerable = LMH without SMI, Symptomatic but content = SMI with FMH, Troubled = SMI with MMH, and Most troubled = SMI with LMH.

Viewing mental health from a two continua perspective, this presentation focuses on results of pooled data from a recurrent cross-sectional survey, carried out in ninth and eleventh grade in lower and upper secondary school of Västmanland county, Sweden, 2020 - weeks prior to the Covid-19 outbreak - and 2023. In total, 7908 students participated of which 50% were girls (2020 N = 3880; 2023 N = 4028; response rate≈72%). A compilation of the results according to the two continua model and the six mental health status groups described in the previous presentation shows that 39.0% are categorized as having Complete Mental Health (CMH), 1.6% as Symptomatic But Content (SBC), 36.7% as Vulnerable (V), and 2.9% as being the Most Vulnerable (MV). Further, 12.8% are categorized as being Troubled (T) and 6.9% as Most Troubled (MT). Statistically significant differences are seen between boys and girls in the categories CMH (boys=47.4%, girls=30.8%), SBC (boys 1.0%, girls 2.1%), T (boys 7.2%, girls 18.3%) and MT (boys 3.7%, girls 10.1%). Significant changes over time, between 2020 and 2023, are seen in SBC (0.9% statistically significant increase) and MV (1.9% statistically significant increase). When divided by sex, significant changes over time are only seen among girls: in CMH (5.3% statistically significant decrease), MV (1.9% statistically significant increase) and SBC (1.3% statistically significant increase). No statistically significant changes are seen over time for boys. The result indicates that only four out of ten adolescents have a CMH. The differences between boys and girls are substantial; almost five out of ten boys and three out of ten girls has CMH. This emphasizes the importance of promoting mental well-being, especially among girls. The result also implies the importance of strengthening well-being in the large group without flourishing mental health since the latter can also provide a buffer against mental illness.

The Mental Health Continuum - Short form (MHC-SF) is a self-report measure that has been increasingly used to monitor mental well-being at the population level. The aim of this study was to evaluate, for the first time, the psychometric properties of the MHC-SF in a population of Swedish adolescents. First, the evaluation was performed by examining face validity and test-retest reliability obtained in a pre-study. Then using data from the Survey of Adolescent Life in Vestmanland 2020 (n = 3880) we performed confirmatory factor analysis on different factor structures based on theory and previous research. Model-based estimates were calculated for assessing the internal reliability of the factor structure with the best fit. Convergent validity was assessed by bivariate as well as model-based correlations, and test-retest reliability was evaluated by intra-class correlation coefficients. The results show that the MHC-SF is best described with a bifactor model consisting of a dominant general well-being factor and three specific group factors of emotional, social and psychological well-being. Its overall reliability was high to very high, while the reliability of its subscales was low. A practical implication of the latter is that the subcales should not be used on their own because they are more likely to reliably measure the general well-being factor than the specific group factors. Test-retest reliability of the total scale was acceptable, and convergent validity was supported. In conclusion, we consider the Swedish MHC-SF to be a psychometrically sound instrument for monitoring overall mental well-being in Swedish adolescents.

With its compensatory mandate, the school is essential for health-promoting interventions. There are evaluated programs available that prevent mental problems, mental illnesses and various risk behaviours. However, there is a dearth of evaluated interventions designed to promote mental well-being in adolescents, which are adapted for upper secondary school. It was against this background that the development and evaluation of the Solution-focused Intervention for Mental health (SIM) began in 2018. This presentation will briefly overview the intervention, its components, design and results from feasibility studies. As an intervention programme, SIM consists of group-based coaching that starts from the core components and indicators of mental well-being and enjoying school. Thus, the intervention is based on a normative model of mental well-being; however, the dialogue conducted during the nine two-hour weekly group sessions is based on the solution-focused approach and its techniques. Specially trained teachers facilitating the content and process during group sessions lead SIM. The SIM programme is manual-based and designed to help students discover, explore, practice and develop existing personal resources in order to strengthen hedonic and eudemonic well-being. The teacher uses solution-focused coaching techniques to encourage the students to practise and discover how to utilise their existing resources. By focusing on what works small steps can be taken towards a desired future using indicators of well-being and solution-focused techniques. SIM has so far been tested in feasibility studies in 2019 (n∼140), 2021 (n∼200) and 2023 (n∼50). Results from focus group interviews, session scales ratings and pairwise testing of changes in well-being after compared to before interventions show promising results with increased well-being and total effect sizes ranging from Coheńs d of 0.19 to 0.59. SIM is now ready to be properly evaluated in a randomised controlled trial.

The purpose of this paper is to describe how Chinese national adolescent mental health policy is translated into local plans and practice by means of the theoretical perspective of the policy triangle. Document analysis of national, provincial and local policy documents and semi-structured interviews with local policy actors were performed. National policies were implemented by a top-down process. The ministries were strong policy-makers on the national level, while the policy actors at the local level were mainly found in the educational sector. The content of the policy actions was moral education, knowledge dissemination and learning, rather than counselling and treatment.

Background: Studies investigating the prevalence of positive mental health and its correlates are still scarce compared to the studies on mental disorders, although there is growing interest of assessing positive mental health in adolescents. So far, no other study examining the prevalence and determinants of positive mental health in Chinese adolescents has been found. The purpose of this study was to assess the prevalence and correlates of positive mental health in Chinese adolescents.

Methods: This cross-sectional study used a questionnaire including Mental Health Continuum-Short Form (MHC-SF) and items regarding multiple aspects of adolescent life. The sample involved a total of 5399 students from grade 8 and 10 in Weifang, China. Multivariate Logistic regression analyses were performed to evaluate the associations between potential indicators regarding socio-economic situations, life style, social support and school life and positive mental health and calculate odds ratios and 95% confidence intervals.

Results: More than half (57.4%) of the participants were diagnosed as flourishing. The correlated factors of positive mental health in regression models included gender, perceived family economy, the occurrence of sibling(s), satisfaction of self-appearance, physical activity, sleep quality, stress, social trust, desire to learn, support from teachers and parents as well as whether being bullied at school (OR ranging from 1.23 to 2.75). The Hosmer-Lemeshow p-value for the final regression model (0.45) indicated adequate model fit.

Conclusion: This study gives the first overview on prevalence and correlates of positive mental health in Chinese adolescents. The prevalence of positive mental health in Chinese adolescents is higher than reported in most of the previous studies also using MHC-SF. Our findings suggest that adolescents with advantageous socio-economic situations, life style, social support and school life are experiencing better positive mental health than others.

Folkhälsan i Sverige är generellt sett god men inte jämlikt fördelad. Medan detfinns en del kunskap om skillnader i psykiska besvär och psykisk sjukdom mellan grupper är underlaget betydligt tunnare när det gäller skillnader i förekomst av (positiv) psykisk hälsa, som har ett värde i sig. Den nationella kommissionen för jämlik hälsa lyfter fram åtta områden som är viktiga i arbetet med att utjämna de påverkbara hälsoskillnaderna. Ett av dessa är likvärdiga villkor och möjligheter under det tidiga livet och i skolan. Av detta följer att barn och ungdomar blir särskilt viktiga att studera för att förstå skillnader i psykisk hälsa så att verknings-fulla insatser kan utformas. Syftet med den här studien är att undersöka skillnader ipsykisk hälsa bland ungdomar. Rapporten baseras på den återkommande tvärsnittsstudien Liv och hälsa ung Västmanland, undersökningsåren 2014 och 2017. Datainsamling genomfördes på skoltid och under skrivningslikna nde förhållanden. Studiepopulationen bestod av ungdomar i årskurs 9 i grundskolan och årskurs 2 i gymnasiet. Skillnaderna i psykisk hälsa studerades utifrån: socioekonomisk status (SES), kön, ålder, sexuell läggning, födelseland och fem typer av funktionsnedsättningar. Psykisk hälsa mättes med instrumentet Mental Health Continuum – Short Form. Deltagandet i berörda årkurser var 78 procent 2014 och 76 procent 2017, vilket motsvarar totalt 7 637 ungdomar varav 52 procent var tjejer.Studien visar att det finns statistiskt signifikanta skillnader i psykisk hälsa inomfyra av sex studerade indelningsgrunder. Av dessa är det skillnader mellan grupper med olika SES som är av sådan storlek att de kan anses ha praktisk betydelse. Skillnader inom övriga indelningsgrunder – justerade bland annat för SES – är små eller mycket små men kan tillsammans få praktisk betydelse. Det gäller t.ex. de samlade skillnaderna inom kön, sexuell läggning och funktionsnedsättningar såsom add, adhd och Tourettes. Studien visar också signifikanta skillnader i psykisk hälsa mellan de två mättillfällena. Totalt sett är dessa skillnader att betrakta som mycket små. Ändå är de bekymrande eftersom de kan kopplas till fyra funktionsnedsättningar inom vilka ojämlikheten i psykisk hälsa ser ut att ha ökat mellan 2014 och 2017. Visserligen finns det metodologiska skillnader mellan de två undersökningsåren men det är inte troligt att ökningarna beror på dem. Åtgärder för att reducera skillnader i psykisk hälsa bör anpassas så att de i omfattning och utformning tar särskild hänsyn till grupper med låg SES eller dem med låg SES i kombination med kön (tjej), sexuell läggning ( icke-heterosexuell) och funktionsnedsättningar i form av add, adhd, Tourettes eller liknande.