Using data gathered during in-depth interviews as the primary method of analysis, the current study explored the transition planning process and the factors that helped youth with internalizing disorders decide to pursue and enroll in college. More specifically, the purposes of the current study were to: (1) explore the resources and supports available to students with internalizing disorders both within and outside of the high school setting as they prepare for the transition to postsecondary education and (2) explore student perceptions of the impact of the transition planning process. Eight college students from the Midwestern United States who received special education services and had a diagnosed internalizing disorder in high school participated in the study. An analysis of the interviews was conducted using the constant comparative method as a guide. The data analysis process involved creating codes, developing broader categories for codes, comparing newer interview data to prior interview data, and continuing to revise findings until a point was reached where additional coding no longer led to new conclusions. Results of the current study suggest that participants received many of the transition planning components considered to be best practice within the transition planning literature; however, their experiences highlight the need for plans to be tailored in order to address concerns related to the daily impact of their symptoms of anxiety and/or depression. Although no participants reported a seamless transition to college, they did identify several school-based services and outside supports that helped facilitate the process. These services included individualized transition plans, access to mental health services in and out of school, access to informal emotional support from school staff, and sometimes relying on family members as an additional resource throughout the process. Even when they were able to access these components during transition planning, participants noted that their internalizing symptoms continued to negatively affect their functioning as young adults. In addition, lack of access to quality mental health care in young adulthood emerged as a salient concern for participants.

ABSTRACT When depressive illness has its onset during adolescence it can exert a profound negative influence upon the individual and their daily functioning. Early identification of young people at risk of, or already experiencing, depressive symptoms is critical to enabling targeted intervention from clinicians, including occupational therapists. Early identification, however, is hampered by an incomplete understanding of how the disorder manifests in the daily lives of adolescents. The mental health determinants and sequelae of engagement in everyday activities represent core concerns of occupational therapists. As part of therapy with adolescents in Child and Youth Mental Health Services (CYMHS), occupational therapists endeavour to improve health by assessing time use, and engaging in interventions which explicitly target involvement in daily activity. Notwithstanding current practice, evidence for a link between actual time use and depressive symptom severity is scant. Background and Research Aims In this thesis the time use of adolescents is explored and related to depressive symptom severity in a series of three cross sectional studies. In keeping with ecologically- and occupation-focussed theoretical models of health and adolescent development (Bronfenbrenner & Morris, 2006; Poulsen & Ziviani, 2004; World Health Organization, 2002), a novel approach to the study of time use has been taken. The studies quantify the amount of time that adolescents are exposed to the various conditions inherent in activities and their ecological settings. In conceptualising time use as ‘exposure’, attention is drawn specifically to common affordances of activities. In this thesis these are described as ‘underlying dimensions’ of time use. Key underlying dimensions of interest include (a) ‘physical exertion’ in daily time use, (b) time spent with different social partners, and (c) time engaged in structured activities. The studies make use of cumulative estimates of time use by summing each episode of exposure to the underlying dimensions of time use, across the out-of-school hours. This research was conducted with the aims of (a) aiding early identification of adolescents who are vulnerable to depressive illness, (b) examining the evidence for the assessment of time use in CYMHS, (c) identifying aspects of adolescent time use which are appropriate targets for occupational therapists’ intervention, and (d) directing future research into the effectiveness of time use-focussed interventions offered by occupational therapists to adolescents who are vulnerable to depressive illness. Methodology and Study Findings All the studies involve secondary analysis of interview and time diary data collected from a nationally representative sample of approximately 730 adolescents (13-18 years) participating in the Panel Study of Income Dynamics Child Development Supplement II. Data were gathered in 2002/2003 by the Institute of Social Research at the University of Michigan in America. Studies 1 and 2 employ ordinal logistic regression analyses to separately explore two of the underlying dimensions of time use, namely the physical exertion in daily activity, and the time spent engaged in activity alone or with key social partners (including parents, siblings and friends). These studies indicate that time devoted to physical activity of moderate to vigorous intensity does not predict depressive symptom severity, breadth of participation in sporting extracurricular activity may be protective against depressive illness for males. For both genders, factors related to the positive or negative aspects of social relationships (such as adolescents’ ratings of how close they felt to parents, and the extent of risky behaviour among friends) appear to be stronger predictors of depressive symptomatology than the actual amount of time engaged in activity with others. Study 3 is informed conceptually and methodologically by the findings of Studies 1 and 2, and uses structural equation modeling, to examine a complex multivariate model of time use and depressive symptoms. This model incorporates a large range of factors which are theorized to influence the qualitative experience of spending time in a given context (e.g., adolescents’ perceptions of friend acceptance, which may influence the psychological impact of a prolonged encounter with friends). Study 3 reveals that the quantity of time over the course of a weekday or weekend day that adolescents are exposed to different types of activity (e.g., structured extracurricular activity, shared activity with parents) has no direct association with depressive symptom severity. However, an indirect path is identified, whereby the amount of time devoted to joint activity with parents is linked with depressive symptom severity via adolescent perceptions of parent acceptance. Conclusions and Recommendations The studies of this thesis have shown that the conceptualisation and quantification of time use as cumulative exposure to some specific underlying dimensions of engagement, are of little direct assistance in identifying young people who are vulnerable to depressive illness, however, this information may inform a range of clinical practices for occupational therapists working in CYMHS. Information on time use is therefore worth gathering in such services, particularly when it provides insights into social contact. It has been clearly and consistently identified that time use and its links with depression cannot be fully appreciated without considering the nature of adolescents’ relationships with their social partners in time use. Findings indicate that when time spent engaged in joint activity with parents is scant, or when poor relationships with parents are reported, adolescents at risk of depression are likely to benefit from therapy which is directed towards enhancing the quantity and quality of parent-adolescent interactions. The significance of this research lies in the generation of evidence to support further research into time use and its implications for mental health. Greater support for the specialist role of occupational therapists in addressing time use concerns will be gained through future studies which explore the immediate affective experience of spending time in activity, the personal and environmental contextual factors which mediate these experiences, and the implications of such experiences for mental health. Further to the insights gained regarding time use and depressive illness, the thesis presents an approach to research (i.e., a secondary analysis) and research methodologies which may be used by occupational therapists to answer complex questions regarding occupational engagement across the lifespan. Keywords: Adolescence, Depression, Internalizing Disorder, Time Use, Time Diary, Physical Activity, Social Contexts, Structured Extracurricular Activity, Organised Activity, Structural Equation Modeling. Australian and New Zealand Standard Research Classifications (ANZSRC): 111714 Mental Health 100%.