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Poor mental health among children and teenagers in Sweden has been recognized and been described as increasing (Folkhälsomyndigheten, 2018). Folkhälsomyndigheten (2018) suggests that there has been a twofold increase of psychosomatic symptoms within the age group of 13-to 15-year-olds in Sweden. This study enlightens the importance of the health promotions within the school system where all the professions within the school should work together to improve the mental health of the students. The purpose with this study is to produce a qualitative study where our intention is to increase the knowledge regarding lesson structures as a success factor from the perspective of the student where the sense coherence-component’s comprehensibility, management and meaningfulness describe the psychological health of the students. Our study has a qualitative approach as we wish to understand how students perceive distinct lesson structures as opposed to vague lesson structures. The collection of data used for this study consists of semi-structured interviews conducted with six informants from two separate junior high schools, that have been analyzed using both a deductive as well as an inductive hypothesis. The inductive coding gave us the subcategories: stress, security, interests, and boredom. The sense coherence-theory has helped us analyze our collection of data, the results of which indicate that of previous research; lesson structure, clarified pedagogy, and participation are the success factors when it comes to the students' sense of coherence. The study also indicates that the informant’s psychological health is affected negatively by vague lessons. The study recognizes the important work being done regarding a Special education methodology and technology approach and the preventively and health promotion within our schools which only benefit from a salutarily perspective. Keywords: clarification pedagogy, lesson structure, poor mental health and sense of coherence.

Objective: Although factors that promote initial and recurring homelessness among inner city women have been long explored, impoverished women continue enter and re-enter shelters at troubling rates. This trend is projected to increase over time. This longitudinal study uses Sydemics as a framework to advance our understanding of the relationship between depression, PTSD, trauma and intimate partner violence and the loss of housing among impoverished women using inner city Emergency Departments. We hypothesized that depression, PTSD, childhood trauma and IPV are positively associated with homelessness at baseline and that women with higher rates of a combination of these variables (e.g. PTSD and IPV) in wave 1 will have higher odds of experiencing both an initial and repeat bout of homelessness in the second and/or third waves, controlling for all other variables in the study. Method: Multivariate analyses and logistic regression, at baseline and longitudinally, were conducted to test study hypotheses with homelessness as the dependent variable. Six multivariate logistic regression models were used. Odds ratios (OR) with their 95% confidence intervals are reported. Results: Depression and childhood trauma were individually associated with homelessness at the .05 level in this sample of low income women. IPV was marginally related to homelessness (p=0.0917). PTSD however was not. Importantly, although IPV and PSTD were not individually associated with homelessness in bivariate analyses, housed, never homeless women, and women who had previously experienced homelessness had a greater odd of becoming homeless than those who experienced only one of these risk variables. Specifically, housed, never homeless women who had PTSD and IPV had a 2.2 odd of becoming homeless for the first time in waves 2 and 3, whereas those who experienced PTSD only had a 1.3 odds of becoming homeless for the first time; never homeless participants who experienced IPV only a 1.7 greater odds of becoming homeless (CI.0.348, 14.84; p=0.385), adjusting for all other variables. Similarly, the odd of becoming homeless again among participants who had PTSD and experienced IPV was 1.7 whereas the odds of recurrent homelessness was 1.2 among those who experienced PTSD only and 1.1 among those who experienced IPV only (CI.0.397, 7.46; p=0.463), controlling for all other variables in the study. Conclusion: Our findings confirm our hypotheses that low-income women who have PTSD, depression, histories of childhood trauma, and/or IPV have a higher odds of initial and recurrent homelessness when compared with women who do not have these risk variables. Our findings further confirm that women who have combinations of risk variables have even higher odds of future homelessness. Due to the low sample size of women with histories of homelessness in the study, there was lack of power. Despite this challenge, the results of these explorations (in determining heretofore unidentified effect sizes) utilizing Syndemics as a conceptual framework are promising. Future research with larger sample sizes (and sufficient power) are important to further the initial findings from this study.

Objective: To study the psychometric properties and construct validity of a multidimensional instrument to measure employment precariousness; to assess the association between employment precariousness and poor mental health; to estimate the prevalence and distribution of employment precariousness in the Spanish workforce; and to estimate the population attributable fraction of poor mental health due to employment precariousness. Methods: Cross-sectional study using data from the Psychosocial Work Environment Survey conducted in 2004-2005 in Spain. Representative sample of 6968 temporary and permanent workers with a formal work contract. Main results: The Employment Precariousness Scale (EPRES) proved to be an acceptable and psychometrically sound measurement instrument. A high score of employment precariousness was associated with more than double the prevalence of poor mental health than a low score, both in women and men and after adjustments for relevant indicators of social position. More than 45% of the sample was exposed to some degree of precariousness, over 6.5% to high precariousness, with a highly unequal distribution across groups of workers. With due caution, it was estimated that if the observed association were causal, between 11% and 23% of poor mental health in the working population in Spain could be attributable to employment precariousness. Conclusions: Results highlight the relevance of employment precariousness for the mental health of the Spanish workforce. The EPRES is a promising tool for future research. / Objetivo: Estudiar las propiedades psicométricas y la validez de constructor de un instrumento multidimensional para medir la precariedad laboral; estudiar la asociación entre precariedad laboral y mala salud mental; estimar la prevalencia y distribución de la precariedad laboral en la fuerza de trabajo Española; y calcular la fracción atribuible poblacional de mala salud mental debida a la precariedad laboral. Métodos: Estudio transversal con datos de la Encuesta de Factores de Riesgo Psicosociales realizada entre 2004 y 2005 en España. Muestra representativa de 6.968 trabajadores temporales y permanentes con contrato formal de trabajo. Resultados principales: La Escala de Precariedad Laboral (EPRES) demostró tener buenas propiedades psicométricas. Una puntuación alta en la escala se asoció con una prevalencia dos veces más elevada de mala salud mental que una puntuación baja, tanto en mujeres como en hombres y aun después de varios ajustes por indicadores de posición social. Más del 45% de la muestra estaba expuesta a algún grado de precariedad laboral, más del 6,5% a precariedad laboral alta, con una distribución muy desigual entre distintos grupos de trabajadores. Con la debida precaución, se estimó que si la asociación observada es causal, entre el 11% y 23% de la mala salud mental de la población trabajadora española podría ser atribuible a la precariedad laboral. Conclusiones: Los resultados destacan la importancia que la precariedad laboral puede tener para la salud mental de la población trabajadora Española. La EPRES es un instrumento útil para investigaciones futuras

Introduction: There is growing evidence for increased prevalence of poor adolescent mental health, including depression, in the United States. Increases in adolescent depression beginning around 2008-2010 coincided with the timing of the Great Recession and there are plausible mechanisms through which economic recessions may influence adolescent depression (e.g., caregiver job loss, household economic hardship). More research is needed to understand the potential relationship between the 2007-2009 Great Recession and long-term impacts on mental health by household poverty, as many mechanisms (e.g., cumulative familial stress) can impact adolescent mental health after the peak of a recession passes. The objective of this dissertation is to examine the associations between economic recessions and adolescent depression. This dissertation includes five chapters: first, an introduction; second, a literature review to examine evidence of time trends and birth cohort effects in depressive disorders and symptoms among adolescents in recent years; third, an empirical study to assess changes in adolescent depression and depression treatment, including differences by household poverty occurring at the beginning of the Great Recession; fourth, an empirical study to estimate potential longer-term impacts of the Great Recession by examining whether young adults from birth cohorts who were adolescents at the time of the Great Recession had higher risk of MDE and mental health treatment use as young adults compared with birth cohorts who were adolescents and surveyed prior to the Great Recession with potential differences by household poverty; and fifth, a conclusion to summarize results and discuss implications for future research. Methods: The integrative systematic literature review included 10 studies related to the United States, adolescent populations, birth year and time trends, and depressive symptoms or disorders. The two empirical aims utilized data from the National Survey on Drug Use and Health (NSDUH), a national survey assessing behavioral health among participants aged 12 and older. For the first empirical aim, I analyzed data for adolescents ages 12-17 participating in the 2004-2019 NSDUH (N = 256,572). For the second empirical aim, I included young adults ages 18-29 from the 2005-2019 NSDUH (N = 135,158). For this aim, the main exposure measure was belonging to birth cohorts (1990-1994) who were adolescents during the Great Recession and surveyed in 2008-2019 versus those from birth cohorts (1976-1989) that did not experience the Great Recession and were surveyed prior to the Great Recession in 2005-2007. For both empirical aims, I measured past year DSM-IV and DSM-5 major depressive episodes (MDE) from self-reported symptoms. MDE treatment was assessed among those with past year MDE, excluding those who were already successfully treated for MDE. For the first empirical aim, I tested how MDE and MDE treatment conditioned on MDE changed from pre-Great Recession (2004 to Fall 2007) to post-Great Recession (Winter 2007 to 2019) using interrupted time-series (ITS) segmented regression models accounting for seasonality (January-March, April-June, July-September, October-December) and autocorrelation. For the second empirical aim, regression models assessed the relationships between the birth cohort exposure measure and MDE and mental health treatment utilization adjusting for age, gender, race/ethnicity, educational attainment, and insurance status. Both empirical aims tested effect modification by household poverty. Results: The review of 10 studies found increases in depressive symptoms and disorders in adolescents across recent survey years with increases observed between 1991 and 2020. Of the 3 articles that assessed birth cohort trends, birth cohort trends were less prominent than time period trends. Proposed explanations for increases included social media, economic-related reasons, changes in mental health screening and diagnosis, changes to mental health stigma and treatment and, in more recent years, the COVID-19 pandemic. In the first empirical study, I illustrated that the Great Recession was not associated with an immediate change in MDE prevalence (β: -0.77, 95% CI: -2.23, 0.69). However, following the Great Recession, the increase in MDE prevalence accelerated (β: 0.29, 95% CI: 0.13, 0.44). The Great Recession was not associated with acute changes in adolescent MDE treatment (β: -2.87, 95% CI: -7.79, 2.04) nor longer-term slope effects (β: 0.03, 95% CI: -0.46, 0.51). Evidence of interaction by household poverty was not observed for either the MDE or MDE treatment outcome. In the second empirical aim, interaction between the birth cohort exposure and household poverty was observed for MDE (F=10.17, df=2, p=<0.0001), but not for mental health treatment use. Great Recession exposure effects were stronger among those at higher levels of household income. For example, among young adults who were living in households at two times the poverty threshold, those from birth cohorts who were exposed during adolescence to the Great Recession had higher odds of MDE compared with young adults from birth cohorts who were unexposed during adolescence to the Great Recession (adjusted odds ratio= 1.16, 95% CI= 1.04, 1.29). Conclusions: Multiple cross-sectional surveys and cohort studies documented rising prevalence of depressive symptoms and disorder among adolescents from 1991-2020. The Great Recession coincided with accelerated trends of increasing MDE, but not MDE treatment of these adolescents. Contrary to my hypothesis, the strength of changes in the rate of increase in MDE did not differ by household poverty and adolescents from households living in poverty, who likely experienced a greater financial burden during the recession, did not experience an increase in the rate of MDE. Birth cohort effects by household poverty were observed and exposure to the Great Recession during adolescence was associated with long-term effects on MDE, but not mental health treatment utilization, during young adulthood compared with those not exposed to the Great Recession. Young adults from higher income households who were exposed to the Great Recession had heightened likelihood of MDE. Future research should explore alternative drivers of MDE during the 2010s, as poverty-specific cohort analyses did not show that those living in poverty who likely experienced the greatest burden of a recession financially had increased risk of MDE.