by Chui Shu-fai, Fred. / Includes questionaire in Chinese. / Thesis (M.S.W.)--Chinese University of Hong Kong, 1995. / Includes bibliographical references (leaves [45-68] (3rd gp.)). / Chapter ONE --- INTRODUCTION --- p.1 / Chapter TWO --- THE IMPACT OF PARENTAL MENTAL ILLNESS ON CHILDREN --- p.8 / Chapter 2.1 --- Impact of parental mental illness on children --- p.8 / Chapter 2.2 --- Studies about the impact of parental affective disorder on children --- p.9 / Chapter 2.3 --- Children of schizophrenic patients --- p.12 / Chapter 2.3.1 --- Effect of psychiatric symptoms and behavioral change --- p.14 / Chapter 2.3.2 --- Impairment of interaction --- p.15 / Chapter 2.4 --- Parents with depression versus parents with schizophrenia: their differential impacts on children --- p.16 / Chapter 2.4.1 --- Parenting --- p.16 / Chapter 2.4.2 --- Children at risk --- p.18 / Chapter 2.4.3 --- Problems faced by the children --- p.20 / Chapter 2.5 --- Discussion on the above findings --- p.22 / Chapter 2.6 --- Resilience in Children / Adolescents --- p.25 / Chapter 2.7 --- Limitations of some empirical studies about children of mentally ill --- p.27 / Chapter THREE --- "STRESS, COPING RESOURCES AND MENTAL HEALTH" --- p.30 / Chapter 3.1 --- Concept of Stress --- p.30 / Chapter 3.2 --- "Life events, daily hassles and life strains" --- p.36 / Chapter 3.3 --- Objective burdens and subjective burdens arising from the mentally ill in the family --- p.37 / Chapter 3.4 --- "Stressors as management problems, psychological problems and social / economic costs faced by the children" --- p.39 / Chapter 3.4.1 --- Management problems --- p.39 / Chapter 3.4.2 --- Psychological problems --- p.41 / Chapter (a) --- Self-blame and Guilt / Chapter (b) --- Anger / Chapter (c) --- Feeling of Embarrassment and shame / Chapter (d) --- Anxieties caused by parent's hospitalization / Chapter (e) --- Sense of inferiority caused by the prejudice and rejection of community / Chapter 3.4.3 --- Social / economic costs --- p.47 / Chapter (a) --- Disruption of family functioning / Chapter (b) --- Conflict in the family / Chapter (c) --- Financial difficulties / Chapter (d) --- Reduction in social life / Chapter 3.5 --- Perceived Stress --- p.50 / Chapter 3.5.1 --- Measurement of perceived stress --- p.52 / Chapter 3.6 --- Stress and Coping in Children/Adolescents --- p.53 / Chapter 3.7 --- Coping Resources --- p.56 / Chapter 3.7.1 --- Health and energy --- p.58 / Chapter 3.7.2 --- Positive beliefs --- p.58 / Chapter 3.7.3 --- Social skills --- p.61 / Chapter 3.8 --- Coping resources being examined in this study --- p.62 / Chapter 3.8.1 --- Self-efficacy --- p.63 / Chapter (a) --- Self-efficacy as a coping resource / Chapter (b) --- Social self-efficacy / Chapter (c) --- Measurement of self-efficacy / Chapter 3.8.2 --- Self-esteem --- p.71 / Chapter (a) --- Measurement of Self-esteem / Chapter 3.8.3 --- knowledge / Information --- p.73 / Chapter (a) --- Knowledge about schizophrenia / Chapter (b) --- Measurement about mental health knowledge / Chapter 3.8.4 --- Attitude toward the ex-mental patient --- p.76 / Chapter (a) --- Mental health knowledge and attitude toward mental patient / Chapter (b) --- Adolescent's attitude toward the mentally-ill / Chapter (c) --- Measurement of attitude toward mental illness and mental patients / Chapter 3.9 --- Mental Health --- p.81 / Chapter 3.9.1 --- Concept of “Mental´ح --- p.81 / Chapter 3.9.2 --- Concept of “Health´ح --- p.81 / Chapter 3.9.3 --- Mental health as a concept --- p.82 / Chapter 3.9.4 --- Measurement of mental health --- p.84 / Chapter FOUR --- LITERATURE REVIEW ON THE RELATIONSHIPS AMONG VARIABLES UNDER STUDY --- p.85 / Chapter 4.1 --- Stress and mental health --- p.85 / Chapter 4.2 --- Coping resources and perceived stress --- p.87 / Chapter 4.2.1 --- Self-efficacy and perceived stress --- p.87 / Chapter 4.2.2 --- Self-esteem and perceived stress --- p.88 / Chapter 4.2.3 --- Knowledge and perceived stress --- p.89 / Chapter 4.2.4 --- Attitude and perceived stress --- p.89 / Chapter 4.3 --- Coping resources and mental health --- p.90 / Chapter 4.3.1 --- Self-efficacy and mental health --- p.90 / Chapter 4.3.2 --- Self-esteem and mental health --- p.92 / Chapter 4.3.3 --- Knowledge and mental health --- p.93 / Chapter 4.3.4 --- Attitude and mental health --- p.94 / Chapter 4.4 --- Conceptual framework --- p.94 / Chapter 4.5 --- Research questions and hypotheses --- p.99 / Chapter 4.6 --- Definition of concepts --- p.103 / Chapter 4.6.1 --- Definition of stressors --- p.103 / Chapter 4.6.2 --- Definition of perceived stress --- p.103 / Chapter 4.6.3 --- Definition of social self-efficacy --- p.103 / Chapter 4.6.4 --- Definition of self-esteem --- p.104 / Chapter 4.6.5 --- Definition of knowledge about schizophrenia --- p.104 / Chapter 4.6.6 --- Definition of behavioral intentions / attitude --- p.104 / Chapter 4.6.7 --- Definition of mental health --- p.105 / Chapter FIVE --- RESEARCH METHODOLOGY --- p.106 / Chapter 5.1 --- Sample Design --- p.106 / Chapter 5.2 --- Instruments for Measurement --- p.107 / Chapter 5.2.1 --- Scale measuring the stressors (ST-ALL) and Perceived Stress (PS-ALL) --- p.107 / Chapter 5.2.2 --- Rosenberg Self-esteem Scale (RSES) --- p.108 / Chapter 5.2.3 --- Adolescent Social Self-efficacy Scale (SEFF) --- p.108 / Chapter 5.2.4 --- Knowledge about Schizophrenia Scale (SKS) --- p.109 / Chapter 5.2.5 --- Behavioral Intention toward Ex-mental Patients Scale (BIEMPS) --- p.109 / Chapter 5.2.6 --- General Health Questionnaire (GHQ-30) --- p.110 / Chapter 5.2.7 --- Chinese Version of Hopelessness Scale (C-Hope) --- p.111 / Chapter 5.2.8 --- Demographic /personal data --- p.111 / Chapter SIX --- RESULTS --- p.112 / Chapter 6.1 --- Psychometric properties of the measuring instruments --- p.112 / Chapter 6.1.1 --- Measurement of stress / Chapter (a) --- Stressor Scale (ST-ALL) / Chapter (b) --- Perceived Stress Scale (PS-ALL) / Chapter 6.1.2 --- Measurement of coping resources --- p.113 / Chapter (a) --- Adolescent Social Self-efficacy Scale (SEFF) / Chapter (b) --- Rosenberg Self-esteem Scale (RSES) / Chapter (c) --- Knowledge about Schizophrenia Scale (SKS) / Chapter (d) --- Behavioral intention towards Ex-mental Patients Scale (BIEMPS) / Chapter 6.1.3 --- Measurement of mental health --- p.115 / Chapter (a) --- General health questionnaire - 30 (GHQ-30) / Chapter (b) --- Chinese-Hopelessness Scale (C-Hope) / Chapter 6.2 --- Demographic characteristics of the respondents --- p.133 / Chapter 6.2.1 --- Sex and Age of Respondents --- p.133 / Chapter 6.2.2 --- Relationship of Respondents to Their Schizophrenic Parents --- p.133 / Chapter 6.2.3 --- Education Level of Respondents --- p.133 / Chapter 6.2.4 --- No. of Siblings of the Respondents and Their Rank among siblings --- p.134 / Chapter 6.2.5 --- Religion of respondents --- p.134 / Chapter 6.2.6 --- Out-patient or in-patient status of respondents' schizophrenic parents and number of years of treatment --- p.134 / Chapter 6.2.7 --- Education Level of the Parents --- p.135 / Chapter 6.2.8 --- "Occupation of the respondents' parents, the family's income and its source" --- p.135 / Chapter 6.2.9 --- Type of accommodation and family size within the same household --- p.136 / Chapter 6.2.10 --- Marital status of respondents' parents --- p.136 / Chapter 6.2.11 --- Principal caregivers of the respondents' schizophrenic parents --- p.136 / Chapter 6.3 --- Respondents' perception of the existing services and expressed needs --- p.140 / Chapter 6.3.1 --- Number of respondents who had visited social workers in the past 6 months and their satisfaction with the service of social workers --- p.140 / Chapter 6.3.2 --- The social services which were considered by the respondents as important for their schizophrenic parents --- p.140 / Chapter 6.3.3 --- The social services which were needed by respondents --- p.141 / Chapter 6.4 --- "Findings of stress, coping and mental health of respondents" --- p.144 / Chapter 6.4.1 --- Stress --- p.144 / Chapter (a) --- Stressors faced by respondents / Chapter (b) --- Perceived stress experienced by respondents / Chapter 6.4.2 --- Coping resources --- p.148 / Chapter (a) --- Distribution of responses to the items in the Social Self-efficacy Scale / Chapter (b) --- Distribution of responses to the items in the Rosenberg Self-esteem Scale / Chapter (c) --- Distribution of responses to the items in the Knowledge about Schizophrenia Scale / Chapter (d) --- Distribution of responses to the items in the Behavioral Intention toward Ex-mental Patient Scale / Chapter 6.4.3 --- Mental health --- p.152 / Chapter (a) --- Distribution of responses to the items in the General Health Questionnaire-30 (GHQ-30) / Chapter (b) --- Distribution of responses to the items in the Chinese version of Hopelessness Scale (C-Hope) / Chapter 6.5 --- "Interrelationships amongst stress, coping and mental health of the respondents" --- p.166 / Chapter 6.5.1 --- Relationship between perceived stress and psychological well being --- p.166 / Chapter (a) --- Relationship between perceived stress and GHQ-30 / Chapter (b) --- Relationship between perceived stress and hopelessness / Chapter 6.5.2 --- Relationships between perceived stress and coping resources --- p.167 / Chapter (a) --- Relationship between perceived stress and social self-efficacy / Chapter (b) --- Relationship between perceived stress and self-esteem / Chapter (c) --- Relationship between perceived stress and knowledge about schizophrenia / Chapter (d) --- Relationship between perceived stress and behavioral intentions towards ex-mental patients / Chapter (e) --- Differential effects of coping resources on perceived stress / Chapter 6.5.3 --- Relationships amongst the various measures of coping resources and psychological well-being --- p.169 / Chapter (a) --- Relationship between social self-efficacy and psychological well-being / Chapter (b) --- Relationship between self-esteem and mental health / Chapter (c) --- Relationship between knowledge about schizophrenia and psychological well-being / Chapter (d) --- Relationship between attitude toward ex-mental patient and psychological well-being (C-Hope) / Chapter (e) --- Differential effects of coping resources on psychological well-being / Chapter SEVEN --- DISCUSSION --- p.175 / Chapter 7.1 --- Psychometric properties of the tools --- p.175 / Chapter 7.1.1 --- Measurement of stress --- p.175 / Chapter (a) --- Stressor Scale (ST-ALL) / Chapter (b) --- Perceived Stress Scale (PS-ALL) / Chapter 7.1.2 --- Measurement of coping resources --- p.178 / Chapter (a) --- Social Self-efficacy Scale (SEFF) / Chapter (b) --- Rosenberg Self-esteem Scale (RSES) / Chapter (c) --- The Knowledge about Schizophrenia Scale (SKS) / Chapter (d) --- Behavioural Intentions Toward Ex-mental Patients (C-BIEMP) / Chapter 7.1.3 --- Measurement of psychological well-being --- p.181 / Chapter (a) --- GHQ / Chapter (b) --- Chinese version of Hopelessness Scale / Chapter 7.2 --- Characteristics of respondents --- p.183 / Chapter 7.2.1 --- "Sex, age and education" --- p.183 / Chapter 7.2.2 --- "Housing condition, family size and family income" --- p.183 / Chapter 7.2.3 --- Religion --- p.184 / Chapter 7.2.4 --- Caregivng role --- p.185 / Chapter 7.3 --- Respondents' perception of the existing service and expressed concern --- p.185 / Chapter 7.3.1 --- Number of respondents who had visited social worker in the past 6 months and their satisfaction with the service of social workers --- p.185 / Chapter 7.3.2 --- The social services which were considered by respondents as important for their schizophrenic parents --- p.185 / Chapter 7.3.3 --- Social services most needed by respondents --- p.189 / Chapter 7.4 --- "Stress, coping resources and mental health of respondents" --- p.192 / Chapter 7.4.1 --- Stress --- p.192 / Chapter (a) --- Stressors faced by respondents / Chapter (b) --- Perceived Stress / Chapter 7.4.2 --- Coping Resources --- p.201 / Chapter (a) --- Social Self-efficacy / Chapter (b) --- Self-esteem / Chapter (c) --- Knowledge about schizophrenia / Chapter (d) --- Behavioral intentions toward ex-mental patients / Chapter 7.4.3 --- Mental health of respondents --- p.210 / Chapter (a) --- General Health Questionnaire / Chapter (b) --- Hopelessness Scale / Chapter 7.5 --- Findings on relationships among major variables --- p.211 / Chapter 7.5.1 --- Relationship between perceived stress and psychological well-being --- p.211 / Chapter 7.5.2 --- Relationships between perceived stress and coping resources --- p.212 / Chapter 7.5.3 --- Relationship between coping resources and mental health --- p.215 / Chapter 7.6 --- Limitations --- p.216 / Chapter 7.6.1 --- Use of variables --- p.216 / Chapter 7.6.2 --- Sampling --- p.217 / Chapter 7.6.3 --- Data Collection --- p.219 / Chapter 7.6.4 --- Measuring Instruments --- p.219 / Chapter EIGHT --- CONCLUSIONS AND RECOMMENDATIONS --- p.220 / Chapter 8.1 --- Conclusions --- p.220 / Chapter 8.2 --- Recommendations --- p.225 / Chapter 8.2.1 --- Education on management of problems arising from mental patients --- p.225 / Chapter 8.2.2 --- Training on stress management --- p.226 / Chapter 8.2.3 --- Social skills training --- p.226 / Chapter 8.2.4 --- Special counselling service --- p.227 / Chapter 8.2.5 --- Mental health education for the patients and their family members as well --- p.228 / Chapter 8.2.6 --- Public education --- p.230 / Chapter 8.2.7 --- Promotion of teamwork approach among different professionals --- p.231 / Chapter 8.2.8 --- Cooperation among different professionals and special training for them --- p.231 / Chapter 8.2.9 --- Community support service and utilitarian support --- p.233 / Chapter (a) --- Financial assistance / Chapter (b) --- Special home help /family aid service / Chapter (c) --- Outreaching psychiatric service / Community nursing service / Chapter (d) --- Volunteer service / Chapter (e) --- Aftercare service team / Chapter (f) --- Social club for ex-mental patients / Chapter (g) --- Respite service / Chapter 8.2.10 --- Concluding remarks --- p.236 / APPENDIX A QUESTIONNAIRE (English Version) / APPENDIX B QUESTIONNAIRE (Chinese Version) / APPENDIX C TABLE31 / REFERENCES

Thesis (PhD)--Macquarie University, Faculty of Human Sciences, Department of Psychology, Centre for Emotional Health, 2009. / Includes bibliographical references. / Introduction -- Parenting in adolescent depression: the mediating role of self-worth in a prospective test -- Neuroticism, life events and negative thoughts in the development of depression in adolescent girls -- A cognitive diathesis-stress generation model of early adolescent depression -- General discussion. / This research examined the longitudinal development of depressive symptoms among young adolescents (mean age 12 years). The first model examined depressive symptoms across 6 months in 315 young adolescents and their mothers, considering the mediation of perceived parenting and its influence on adolescent self-worth. Although parent-reported parental depression was not linked with child-reported perceived parenting, the child's perception of his or her mother as rejecting or less caring was associated with a lower sense of self-worth, which in turn predicted depressive symptoms 6 months later, controlling for initial depression. In the second model, tested across 12 months with 896 young adolescent girls, neuroticism served as a distal vulnerability for depression, conferring a risk of experiencing dependent stressors and negative automatic thoughts which fully mediated the effect of neuroticism on later depression. Initial depressive symptoms also followed this meditational pathway, in a possible maintenance and risk pathway for adolescent depression. Unexpectedly, independent stressors were also predicted by initial depressive symptoms, suggesting possible shared method or genuine environmental factors. Finally, it was proposed that young adolescents at risk of depression will not only display cognitive vulnerabilities contributing to increased depressive symptoms following stressors (cognitive diathesis-stress theory), but also be more likely to experience stressors at least partly dependent on their own behaviour (stress-generation theory). This model was supported with a large (N=756) sample of young adolescents across 6 months, controlling for initial depression. Taken together, this thesis extends previous theories about the aetiology of depression, providing evidence from family, personality and cognitive risk factors to better explain the development of depressive symptoms in early adolescence, with significant implications for intervention and treatment. / Mode of access: World Wide Web. / viii, 140 leaves ill

xv, 238 p. : ill. / This dissertation study is an examination of childhood contextual factors that contributed to adolescent resilient outcomes among children who experienced interparental violence (IPV). More specifically, the study examined the degree to which verbal ability, temperament, behavior problems, parenting quality, parent-child conflict, IPV, and parent's perceived support in childhood account for variance in behavioral problems, self-efficacy, and parenting received in adolescence. The present study addresses gaps in IPV and resilience literature in the following ways: (a) Few studies have focused on adaptive outcomes of children who experienced IPV; (b) little is known about which contextual factors are most important in facilitating resilient outcomes for this population; (c) factors beyond the microsystem were included as predictors; and (d) little is known about the early predictors of general self-efficacy (a defining attribute of resilience) and parenting (a protective factor that facilitates resilience) for the present population. The sample was derived from an existing data set from the Project on Human Development in Chicago Neighborhoods. This is a longitudinal data set using a nonclinical, randomly selected sample. Using regression models to test whether childhood ecological factors could predict adolescent outcomes, the study had four primary findings. First, childhood (Wave 1) emotionality temperament predicted childhood internalizing problems, which predicted adolescent (Wave 3) internalizing problems. Second, childhood emotionality and parenting quality predicted childhood externalizing problems, which predicted adolescent externalizing problems. Third, none of the childhood variables were strong predictors of adolescent general self-efficacy. Lastly, parenting quality in childhood predicted parental monitoring in adolescence; however, none of the study variables were strong predictors of parenting quality in childhood. Results are discussed in the context of varying adolescent outcomes and the larger literature on IPV. The study highlights directions for future research, including the need to further examine protective processes among children survivors of IPV. / Committee in charge: Dr. Krista M. Chronister, Chair; Dr. Ellen H. McWhirter, Member; Dr. Jeffrey L. Todahl, Member; Dr. Philip A. Fisher, Outside Member

D.Cur. / South Africa, like many other countries, is charged with ensuring that her adolescents are mobilised to believe in the power of their own dignity in order for their life-world to change. Hundreds of thousands of adolescents were forced to experience political upheavals, violence, neglect, incarceration and family disorganisation. Many of these adolescents were forced onto the margins of society in their strive for understanding and survival. Many dropped out of school, are unskilled and therefore unemployed. They feel hopeless as they struggle for a place in society, because society has no faith in them - "they are lost to society". The purpose of this study was to generate a psychiatric nursing model to facilitate the reintegration of marginalised adolescents into the community. This study therefore has profound social, political and economic implications for the South African community. Through this model, which is a theoretical framework to be utilized by the advanced practitioner in psychiatric nursing, adolescents will be empowered to believe in themselves, to engage in meaningful relationships and activities with their families, peer groups and the broader community. The model provides a theoretical framework that attempts to rekindle and inspire the adolescents from a state of hopelessness and disillusionment, to integrated individuals who are respected, valued and accepted as integral members of their families, peer groups and communities. The model will assume a problem solving and preventative approach. Based on this discussion, the following questions were addressed in this research: What obstacles exist that hamper marginalised adolescents' reintegration into the community? What could be done to assist marginalised adolescents' reintegration into the community? A theory generative, qualitative, contextual, exploratory and descriptive design was followed. The research was conducted in four steps with a pilot-study that preceded step one of the research. In step one, focus group discussions were conducted with five groups of respondents to explore and describe obstacles that hamper the reintegration of marginalised adolescents into the community, as well as their views on how marginalised adolescents can be assisted to be reintegrated into the community. Data was analysed using Tesch's method. Based on the results of analyzed data, disempowerment, characterized by hopelessness, alienation/isolation, anger, frustration and worthlessness - related to poor socialisation, lack of support and services, family disorganisation, peer pressure and fragmented services - was identified as a main theme among stumbling blocks. Empowerment, characterized by improved self-image, feelings of worth, belief in own dignity - related to a sense of wellbeing, belonging and respect - resulting in personal growth and societal change with ultimate reintegration, was identified as major strategy to address marginalisation. In step two, the defined concepts were related to each other to show interrelationships. Classification of central and relational concepts followed to formulate relationship-statements, the result being to depict related concepts in structural form. In step three, a visual model to be utilized as a theoretical framework by the advanced psychiatric nurse practitioner to facilitate the marginalised adolescents as recipients and the advanced psychiatric nurse as agent, was designed to facilitate reintegration into the community. The model was evaluated by a panel of experts. Step four dealt with guidelines to operationalise the model in practice, education and research. Recommendations and limitations of the research were also discussed.

The difficulty of distinguishing between genuine disorder and characteristics that can be attributed to high IQ increases the likelihood of diagnostic error by mental health practitioners. This mixed methods study explores the possibility of misdiagnosis of high IQ youth by mental health professionals. Participants were private practice mental health professionals who read case study vignettes illustrating high IQ youth exhibiting characteristics associated with their population. Participants then completed a survey and provided an assessment of the hypothetical client. In the study, 59% of participants were unable to recognize behavioral characteristics associated with high IQ youth unless suggested to them, and 95% of participants were unable to recognize emotional characteristics associated with high IQ youth unless suggested. The results of this study provide much-needed empirical exploration of the concern for misdiagnosis of high IQ youth and inform clinical practice and education.

This qualitative, explorative, descriptive and contextual study was aimed at exploring and describing secondary teachers’ experiences in dealing with adolescent learners displaying mental distress in Gaborone. Moreover, recommendations were proposed for the support needed by secondary teachers who interact with adolescents learners in order to curb mental distress in schools. The sampling method that was used to identify 21 secondary school teachers who participated in this study was purposive. Focus group discussions, as well as field notes, were used to collect data, which were analysed using a thematic analysis. An array of factors that could lead to delays in identifying adolescent learners with mental distress, such as large student numbers and insufficient resources to meet their needs, learners showing signs of mental distress not being taken seriously, lack of parental involvement, relegating parental duties and lack of trust were revealed by the findings. The researcher observed that approaches to support, such as policy guides, parental involvement, peer education and life skills training were best suited to address mental distress in schools as noted by participants. The participants shared the various ways they employed to deal with mental distress in adolescent learners, and suggested strategies that they, together with parents and other stakeholders, could engage in to address these factors. The identified strategies provided a contextual way of establishing recommendations to overcome adolescent mental distress. These included, but were not limitted to, the engagement by parents in mental health problems in schools, as well as policy reviews, and restructuring the referral system. / Health Studies / M. P. H.

Bibliography: pages 108-115. / The aim of the proposed study is to evaluate demographic factors and treatment characteristics contained in the historical records of those treated as in-patients at the Sonstraal Adolescent unit of Lentegeur Hospital, during the period 1986 to 1990. This demographic study details the following aspects of the adolescent in-patients: size, that is, numbers of those admitted to the unit; composition, including age, sex and area. Treatment characteristics such as reasons for admission, diagnosis of psychopathology, referral agent on admission and discharge and length of stay in the unit are considered. The data for the study have been extracted from the clinical records contained at Sonstraal, namely , the 'Clinical Summary on Discharge' form. This form is completed by the therapist of each adolescent attending the unit. The EpiInfo computer programmes have been utilised to create a database and to select the appropriate procedures and statistics which form the basis for data analysis and interpretation. Data interpretation includes an analysis of the emerging trends and details the implications for policy issues, unit staffing and treatment options. Analysis of the trends and comparisons with literature findings have facilitated the generation of hypotheses which could be tested in future studies. This study therefore provides a working document for future prioritising and planning of in-patient, out-patient and community mental health services to adolescents, their families and communities. This involves recommendations for intervention and community involvement. In addition, the study provides a basis for future research into adolescent mental health care.

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.

The goal of this study was to discover the contributing factors to depression in adolescents leading to hospitalisation to a psychiatric hospital. The study was conducted in a Federal Neuropsychiatric Hospital Enugu, Nigeria. The study population was adolescents (between 11-19years of age) both males and females who were diagnosed of depression admitted between the year of 2017-2018 at Federal Neuropsychiatric Hospital Enugu, Nigeria. A qualitative descriptive research was done. Participants were chosen by purposive (non-probability) sampling methods. Data was collected through face-to face individual interviews method. The study’s findings showed that factors contributing to depression in adolescents are related to biological, psychological and social causes. It would further be useful to help the health professionals in their care of adolescents’ psychiatric patients with depression having known the contributing factors. The study recommended early detection and treatment that could reduce incidence of depression and hospitalisation in the psychiatric units. / Health Studies / M. P. H. (Public Health)

Risk taking (RT) and self-harm (SH) are clinically, conceptually, and empiricallyrelated, yet separate constructs, which occur most frequently during adolescence. The current study utilized retrospective reports of college students to determine reported ages of engagement in RT and SH behaviors. Reported ages were compared with predictions for ages of high frequency engagement in RT based on the Dual Systems Model of Adolescent Risk Taking (DSMART; Steinberg, 2010). The sample consisted of 228 college students, ranging in age from 18 to 48 years (mean 22.8), who completed a survey of commonly investigated RT (12 items) and SH (18 items) behaviors. A positive correlation between the RT and SH scales supported a relationship between RT and SH, as predicted. The mean ages of engagement reported for both RT and SH behaviors were significantly higher than the ages predicted by the DSMART. However, the mean ages of engagement varied significantly by behavior grouping (RT, SH), and by subgroups within each behavior group. The NSSI subgroup of SH and the Situational subgroup of RT were noted to have the lowest mean age of high frequency engagement at the subgroup and behavior item level. A relationship between RT and SH was supported and information regarding ages of engagement in RT relative to ages of engagement in SH in the sample provided a further basis for understanding the emergence of these behaviors. The findings are discussed with regard to the DSMART and the relationship between RT and SH behaviors