Adolescent mental health problems are a well-recognized and frequently discussed societal problem in Sweden. However, few studies concerning adolescents’ own views on mental health concepts and associated stigma have been conducted. This thesis, including two sub-studies, investigated Swedish adolescents’ views of mental health concepts, mental health problems and perceptions about stigma. A total of 32 adolescents on the Swedish island Gotland were interviewed either in focus groups or individually. In sub-study I on mental health concepts, adolescents described mental well-being as a condition with emotional well-being and good psychological and social function, which they termed to feel well. Mental health problems were described as a spectrum of conditions, caused by several factors. All kinds of mental health problems were termed to feel unwell or to not feel well. Both the presence of mental well-being and symptoms of mental health problems were suggested to be considered when assessing young peoples’ mental health. Sub-study II explored adolescents’ perceptions of the prevalence of mental health problems and related stigma among young people. The adolescents perceived mental health problems as a natural part of their lives and explained the increase by current living condition factors, e.g. pressure related to school or social media and improved openness about mental health problems. Stigmatisation of young people with mental health problems were recognised to be caused by prejudice, triggered by lack of knowledge. The adolescents wished for a future without stereotypic gender norms and stigma of mental health problems. In conclusion, findings of the thesis suggest that adolescents’ descriptions of mental health concepts encompass a broad range of conditions, from normal challenges that can cause distress to severe disabling mental health problems. Furthermore, adolescents acknowledge the simultaneous presence of mental wellbeing and mental health problems, as well as stigma consisting of negative preconceptions, stereotyping and discrimination. The results highlight that adolescents have a complex contextual understanding of mental health problems, but use the terms to feel well or unwell, of which adults need to be aware. Additionally, taking rumour spreading seriously and actively addressing stereotypic gender norms could be important to improve adolescents’ mental health. / <p>Licentiatseminariet kan även följas via Zoom: https://uu-se.zoom.us/j/69890471140 Lösenord: Ungdomar</p><p>Ingen opponent utan tre medlemmar i betygsnämnd: Docent Fredrik Söderqvist, Örebro universitet (Ordförande i betygsnämnden); Professor Christina Dalman, Karolinska Institutet; Professor Karin Enskär, Uppsala universitet.</p><p></p><p></p>

Purpose: Neurodevelopmental difficulties are correlated with lower mental well-being and more mental health problems. Issues in social relations such as bullying are a prominent risk factor in a social setting of high school, have also been associated with the status of disability. This thesis investigated the relation between mental health problems, mental well-being, and bullying in adolescents with self-reported neurodevelopmental difficulties and compared these with adolescents with Other disabilities. Materials and methods: Data from a Swedish longitudinal survey study (LoRDIA) was used. Mental health problems were measured through emotional and conduct problems scales of SDQ, mental well-being was measured with MHC-SF, and a bullying questionnaire was used. Results: Adolescents with NDD experience more bullying victimization and perpetration than adolescents with Other disabilities such as physical disability and autoimmune diseases. Significant association to bullying perpetration was found in NDD adolescents. Adolescents with Other disabilities indicated high mental well-being compared to NDD. While gender predicts high mental well-being, disability and emotional problems have a negative relation with it. Conclusion: Adolescents with NDD report more bullying victimization and perpetration experiences in comparison to adolescents with Other disabilities. Emotional problems have an inverse relation for predicting high mental well-being for adolescents with NDD and Other disabilities.

The diploma thesis is devoted to the area of mental health problems / mental illnesses as a possible topic of general primary prevention in the school environment. It points out, that the mental health and illness is not being systematically solved. In the area of primary prevention is not given the kind of attention it deserves. In the theoretical part, basic notions are defined first, such as mental health and illness, risk behavior, stigma and prevention. The focus is on the period of adolescence and the perspective of possible links between risky behaviors and mental health problems/illnesses. The theoretical part of the work is also centered on the coping strategies of adolescents and the area of general primary prevention of risk behavior in the current concept of the Ministry of Education. That includes ensuring and controlling the quality and effectiveness of primary prevention programs. In brief, follow-up care - supported education and early intervention is discussed. The aim of the work is to map the relation of the needs of young people with mental illnesses and primary prevention. In addition, the findings will be a base for recommendations how to incorporate the topic of mental health and illness into the existing system of primary prevention. The methodology is based on a qualitative research...

Hintergrund: Psychische Auffälligkeiten beginnen häufig im Kindesalter und können in psychische Störungen münden. Vorhandene Präventionsangebote werden trotz Wirksamkeit nur spärlich in Anspruch genommen. Ziel war zu prüfen, inwiefern durch die Etablierung einer Versorgungskette Risikokinder frühzeitig identifiziert und Präventionsmaßnahmen zugewiesen werden können, sowie inwieweit indikative Präventionsprogramme schlussendlich in Anspruch genommen werden. - Methoden: In einer prospektiven Implementationsstudie wurde während der regulären U9- bis U11-Gesundheitsuntersuchungen (Altersbereich: 5–10 Jahre) der „Strengths and Difficulties Questionnaire“ als Screeninginstrument an Familien ausgegeben. Diese erhielten von ihren Kinderärzt*innen unmittelbar eine Ergebnisrückmeldung und im Falle von grenzwertig auffälligen emotionalen oder Verhaltensproblemen eine Empfehlung für ein indikatives Präventionsprogramm. Vor Programmteilnahme fand im Vorgespräch eine Indikationsprüfung statt. - Ergebnisse: Im Raum Dresden beteiligten sich n = 46 (38,7 %) Kinderärzt*innen am Projekt. In n = 28 Kinderarztpraxen nahmen n = 3231 (86,4 %) Familien am Screening teil, n = 864 (26,7 %) Kinder, deren Familien eine Ergebnisrückmeldung erhielten, bekamen eine Präventionsempfehlung. Zur Präventionsprogrammteilnahme meldeten sich n = 118/864 (13,7 %) Familien selbstständig. n = 215/624 (35,5 %) zeigten Interesse nach projektinitiierter Kontaktaufnahme. Über andere Zugangswege kamen n = 139 Teilnahmeanfragen. n = 337 (n = 461; über alle Zugangswege) Vorgespräche wurden geführt. Schließlich nahmen n = 237 (n = 337) Kinder ein indikatives Präventionsprogramm in Anspruch. - Schlussfolgerung: Eine Ausweitung der Vorsorgeuntersuchung auf psychische Auffälligkeiten ist umsetzbar, nützlich und erfährt breite Akzeptanz. Um eine Versorgungskette einzurichten, sollte eine Angebotsstruktur etabliert werden, um damit die Zuweisung zu und Inanspruchnahme von Präventionsmaßnahmen zu ermöglichen. / Background: Mental health problems usually have their onset in childhood. Undiagnosed, they may progress into mental disorders. Despite their effectiveness, existing preventive programs have been rarely used. We aimed to examine to what extent the establishment of a care chain can identify children at high risk at an early stage and assign them to preventive interventions. In addition, prevention program participation was assessed. - Methods: In a prospective implementation study, the Strengths and Difficulties Questionnaire was administered as a screening instrument to families during regular pediatric health examinations (U9–U11, child age 5–10 years). Families received feedback directly from the pediatrician, and in the case of borderline abnormal emotional or behavioral problems, a recommendation for an indicative prevention program. Program indication was additionally determined in an entry examination prior to program participation. - Results: In the area of Dresden (Germany), n = 46 (38.7%) pediatricians participated in the project. In n = 28 pediatric practices, n = 3231 (86.4%) families participated in the screening and n = 864 (26.7%) children received a prevention recommendation. Of the families, n = 118/864 (13.7%) self-registered for the prevention programs, n = 215/624 (35.5%) showed interest after being contacted by the study teamn. Through other pathways, n = 139 families requested participation. Clinical evaluation interviews to assess prevention indication were conducted in n = 337 children (n = 461; via all entry pathways). Finally, n = 237 (n = 337) children participated in an indicated prevention program. - Conclusion: Expanding screening to mental health problems during regular health checkups is feasible, useful, and widely accepted. In order to implement a care chain, a supply structure should be established to enable referral to and uptake of preventive interventions.

<p>Allmänläkare i primärvården är den första vårdgivare som människor i behov av psykisk hjälp möter. Det saknas forskning om behandling av psykiskt sjuka inom primärvården i enskilda länder. I syfte att hitta nya frågeställningar och få djupare förståelse av hur primärvården fungerar med avseende på psykiskt sjuka intervjuades elva allmänläkare i en kroatisk stad. Insamlade data från intervjuerna strukturerades och bearbetades genom en induktiv tematisk analys. Resultaten visar att allmänläkare upplever en hög arbetsbelastning. Deras tid för samtal med psykiskt sjuka är väldigt begränsad. Behandling med psykofarmaka blir ofta det enda vårdalternativet. Psykosociala problem och psykotrauma förekom ofta som konsekvens av krig. Sjukpensionering av krigsveteraner med PTSD-diagnos blev en omdiskuterad fråga. Undersökningen visar att det kan bli ansträngande för allmänläkare att behandla psykisk ohälsa. De behandlar dessutom majoriteten av psykiskt sjuka men deras vård kompletteras inte med några psykosociala tjänster. Behovet av psykiskt stöd blir inte bemött hos många patienter.</p>

Allmänläkare i primärvården är den första vårdgivare som människor i behov av psykisk hjälp möter. Det saknas forskning om behandling av psykiskt sjuka inom primärvården i enskilda länder. I syfte att hitta nya frågeställningar och få djupare förståelse av hur primärvården fungerar med avseende på psykiskt sjuka intervjuades elva allmänläkare i en kroatisk stad. Insamlade data från intervjuerna strukturerades och bearbetades genom en induktiv tematisk analys. Resultaten visar att allmänläkare upplever en hög arbetsbelastning. Deras tid för samtal med psykiskt sjuka är väldigt begränsad. Behandling med psykofarmaka blir ofta det enda vårdalternativet. Psykosociala problem och psykotrauma förekom ofta som konsekvens av krig. Sjukpensionering av krigsveteraner med PTSD-diagnos blev en omdiskuterad fråga. Undersökningen visar att det kan bli ansträngande för allmänläkare att behandla psykisk ohälsa. De behandlar dessutom majoriteten av psykiskt sjuka men deras vård kompletteras inte med några psykosociala tjänster. Behovet av psykiskt stöd blir inte bemött hos många patienter.