Over the last 20 years, Iceland has made major progress in reducing substance use among its youth. Many credit this impressive reduction to implementation of the Youth in Iceland (YiI) Model. YiI programming aims to prevent substance use by increasing youth social support through strengthening family relationships, peer relationships, community connection, and community engagement. It involves a wide variety of relevant stakeholders, including policymakers, teachers, parents, and youth workers. Specific programming ranges from recreational sports teams to parental neighborhood watches. While studies have indicated that YiI programming has greatly reduced substance use among youth, new data have suggested that mental health problems are rising among Icelandic adolescents. Despite an increase in the prevalence of mental health problems, no studies have explored the impact of YiI programming on Icelandic youth mental health. This mixed-methods project consisted of three studies that evaluated the effect of YiI Model programming on Icelandic adolescent mental health. In the first study, a secondary data analysis of cross-sectional YiI Survey data of all 8th to 10th grade students enrolled in Icelandic public schools was performed to explore the relationship between the YiI Model components and self-reported mental illness symptoms. The annual transnational YiI Survey collects data on demographics, behavior, and other social variables. In the second and third studies, focus groups and interviews were conducted with adolescents and key stakeholders to collect feedback on the YiI Model programming and identify barriers and resources for adolescent mental health. For the secondary data analysis of the YiI Survey data, a multivariate logistic regression model was constructed to relate YiI and mental health scores, including terms for covariates that may confound or bias. To supplement the quantitative component, a content analysis of the transcribed focus groups and interviews was performed to elucidate key themes and patterns surrounding Icelandic adolescent mental health and the YiI model. Study results suggest that more engagement in the YiI programming may be associated with fewer symptoms of anxiety and depression. Focus group and interview results pointed to a possible fifth YiI Model domain, and highlighted barriers to adolescent mental healthcare.

published_or_final_version / Public Health / Master / Master of Public Health

This study focused on youths’ experience of receiving school-based mental health services and community-based mental health services. This qualitative study utilized a sample of eight girls and boys, ages 15-17 years old, who attended school within the district of Timmins. Data was collected using individual interviews and analyzed using thematic analysis. Results of the study revealed benefits to services, limitations to services, and some recommendations for changes to services. This research helped to explain what the participants, who have had experiences with mental health services, thought about the services they have had; it also provided some recommendations the participants made for changes to the mental health services based on their experiences. The conclusion of this study involved a connection between this study and social work practice, and offered suggestions for future research in the field of children’s mental health services.

xvii, 93 p. : ill. (some col.) / Since Rosenzweig's "Dodo Bird Verdict" in 1936, the "common" versus "specific" factors debate has continued to polarize the field of psychotherapy. Treatment expectancy is an important but often overlooked common factor. The current study investigated the role of treatment expectancy in the Treatment of Adolescents with Depression Study (TADS). Four-hundred three adolescents ( M age =14.62, SD =1.56) filled out the Treatment Expectancy for Adolescents (TEA) measure prior to treatment randomization to one of four treatments: fluoxetine (FLX), cognitive behavior therapy (CBT), their combination (COMB), and placebo (PBO). Adolescents randomized to CBT or COMB also filled out the CBT Rationale Acceptance and Expectation for Improvement (C-RAEI) form during their second session of CBT. Before finding out their treatment assignments, adolescents endorsed higher treatment expectancies for COMB than CBT and medication only. Family income levels below $75,000 and higher levels of depression severity, hopelessness, and suicidality were associated with lower expectations for improvement with CBT. The presence of a comorbid anxiety disorder diagnosis was associated with lower expectations for medication without CBT. Separate random coefficients and logistic regression models identified treatment expectancy as a predictor of outcome for three primary outcome measures in TADS, irrespective of treatment assignment. Severity of depression moderated this relationship; mild to moderately depressed adolescents appeared to be more sensitive to the effects of treatment expectancy than marked to severely depressed adolescents. The opposite results were found for the self-rated outcome measure in TADS based on the C-RAIE. For marked to severely depressed adolescents assigned to CBT or COMB, acceptance of treatment rationale and expectancy for improvement were associated with treatment response. These results suggest that treatment expectancy is an important common factor of treatment for mild to moderately depressed adolescents prior to treatment initiation, although it may be especially important for initially skeptical, marked to severely depressed adolescents to "buy in" to treatment after treatment initiation. Treatment effects were still found after controlling for the effects of treatment expectancy on outcome. It seems that both the "common" factor of treatment expectancy and the "specific" factor of treatment assignment contributed to outcome in TADS. / Committee in charge: Anne D. Simons, Chair; Gordon Nagayama Hall, Member; Holly Arrow, Member; Jeffrey Todahl, Outside member

Child and adolescent mental health represents a key area of concern and public health relevance. Mental health disorders are one of the most prevalent illnesses affecting young people and contribute significantly to the global burden of disease. Childhood and adolescent mental health problems often persist into adulthood and as such frequently result in lifelong negative consequences. Yet despite the growing concern with regards to the mental health needs of children and adolescents, not much research, both internationally and particularly locally, has focused on the provision of mental health services to children and adolescents. Additionally, little has been published on the changes and trends in diagnostic rates and assessment procedures over time. Only a few international studies have investigated mental health trends in children and adolescents; hence, there is a crucial need for South African data to inform preventative and curative services for children in South Africa. This present study therefore investigated the trends and patterns relating to diagnostic rates and assessment practices in children and adolescents over time at a local South African psychological community service centre in Pietermaritzburg. The study was a retrospective chart review and the sample consisted of 679 case files from children and adolescents between 3-17 years of age, who had been seen at a local psychological service centre between 1987-1989, 1997-1999 and 2007-2009. The case files were systematically analysed with regards to diagnosis and assessment practices. It was hypothesised that the years of continuous social and political conflict in the Pietermaritzburg area, namely 1987-1989, had a direct impact on the psychological development and well-being of children and adolescents from this area, and that this would be reflected in the case files from the corresponding years. The research findings with regard to the assessment practices were comparable to the internationally observed trends relating to choice of tests and procedures. In addition, the findings of the current study also showed similar trends with regard to the increasing diagnostic rates for ADD/ADHD, Mood Disorder, and Autism Spectrum Disorders as were observed internationally. Additionally, the reported decreasing diagnostic rates for Mental Retardation and behaviour disorders were also found in this local study. However, the internationally observed increases in Anxiety Disorder diagnoses contrast with the findings of this study, where the results revealed that the rates for Anxiety Disorder and PTSD were considerably higher in the late 1980s and 1990s. This finding supports the initial hypothesis that the violence and social unrest had an effect on children’s psychological well-being. / Thesis (M.A.)-University of KwaZulu-Natal, Pietermaritzburg, 2012.

M.Cur. / An exploratory descriptive study was undertaken, focusing on sexually transmitted diseases among teenagers. The aim of the study was to explore and describe the possible reasons for the high rate of sexually transmitted diseases in teenagers. The knowledge, attitudes and opinions of teenagers and community nurses involved in the teenage clinic in a specific predominantly black area were assessed. Twenty teenagers and five community nurses in a specific predominantly black area, were participants in the study. Focus group interviews are used. The study is conducted in two phases: teenagers representing phase one (1) and community nurses as phase two (2). It can be concluded that the attitudes of community nurses may have an influence on the high rate of sexually transmitted diseases, and the knowledge of the teenagers about sexually transmitted diseases is based on myths and misconceptions. The recommendations made are that the training standards for all community nurses should be reviewed and adapted to meet the needs of teenagers attending the teenage services. The policy on in-service training must be reviewed and monitored. Community nurses' intensive training on teenage service delivery and sexually transmitted diseases services should be in correlation with the principles of Primary Health Care. Community nurses need to attend intensive courses on interpersonal skills specifically related to teenagers. Selection procedures for recruiting community nurses to attend specifically to teenagers should be researched. The attitude of community nurses and teenagers should be the core of the service delivery. Teenagers should be involved in planning programmes and the teenage clinic should be evaluated frequently to improve the standards. The availability of teenage services should result in a decrease in sexually transmitted diseases among teenagers.

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.

xiv, 105 p. ill. (some col.) / Depression during adolescence is highly prevalent with as many as 20% experiencing a major depressive episode by the age of 18. Adolescent depression causes significant impairment across life areas including school functioning, such as poor academic performance and decreased academic achievement. Despite the existence of many evidence-based treatment options, merely 25% of depressed adolescents receive treatment. For this reason, it is essential that easily accessible preventive interventions for adolescent depression be developed and made available. Computerized interventions could broaden the reach of prevention efforts and preliminary results indicate that they have the potential to successfully prevent adolescent depression. The Coping with Depression course is an empirically validated cognitive-behavioral depression treatment and prevention program that is well-suited for computerized delivery. This dissertation reports on the development and evaluation of a web-based interactive multimedia version of the adolescent Coping with Depression course with students experiencing subclinical levels of depression. The Blues Blaster program includes the following six modules, with five mini-sessions in each: (a) defining depression, (b) mood monitoring, (c) increasing fun activities, (d) increasing positive thinking, (e) recognizing negative thinking, and (f) decreasing negative thinking. Key concepts are presented and reinforced in a variety of engaging ways within each session, including video, animation, comic strips, graphics, interactive exercises, and games. The Blues Blaster program was evaluated in a randomized controlled trial with 161 adolescents who were randomly assigned to either the Blues Blaster or informationonly control conditions. Participants were assessed at baseline, post-treatment (six weeks after baseline), and six-month follow-up. Results demonstrated greater improvement for the Blues Blaster condition in depression levels, negative thoughts, behavioral activation, knowledge, self-efficacy, and school functioning compared to the information-only control condition. These findings suggest that this targeted prevention program is appropriate for use with middle school students to decrease depression levels and therefore the risk that they will develop major depression in the future. / Committee in charge: Christopher Murray， Chairperson； Deanne Unruh， Member； Jeffrey Sprague， Member； John R. Seeley， Member； Sara Hodges， Outside Member

This study was undertaken as a qualitative needs assessment of emotional support to the adolescent with a terminally ill parent. Five participants in their adolescent life phase (14 to 18 years) with a terminally ill parent, participated in the study. Individual unstructured interviews were conducted with each participant, in order to assess their need for emotional support. With the consent of the parents and adolescents, the interviews were video-recorded and transcribed. Eight recurring themes were selected from the case studies and verified with the existing literature. The result of the study is the assessment of the need for emotional support to the adolescent with a terminally ill parent. / Social Work / M. Diac (Play Therapy)(Social Work)

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)