- Title
- Preventing mental health problems in children and adolescents: strengthening resilience as a potential approach
- Creator
- Dray, Julia
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2018
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Mental health problems are estimated to affect 10-20% of children and adolescents worldwide, often continue into adult years, and contribute to considerable economic, social, and community burden. Prevention of mental health problems in children and adolescents has been identified as an international public health priority. Comprehensive, population level prevalence data and effective interventions are necessary for the prevention of mental health problems in children and adolescents. This thesis addressed three related aims. Population level data regarding the general mental health status and the socio-demographic factors associated with the mental health status of adolescents in Australia aged 12–16 years was limited at the time the studies were being planned. Aim one was to examine prevalence of four mental health problems and association with five socio-demographic characteristics in a regional sample of Australian adolescents (Chapter 2). Data on mental health outcomes measured by the Strengths and Difficulties Questionnaire (SDQ) was obtained from a survey of almost 7,000 Australian adolescents aged 12-16 years conducted in 2011 as baseline data collection for a cluster randomised controlled trial. The study region was characterised by a low index of socio-economic status and a high proportion of Aboriginal students relative to the state of New South Wales (NSW) and Australia overall. Key findings included: 19% of students with a Total SDQ score in the ‘very high’ range; a significant association of gender with all outcomes (total difficulties and internalising problems higher for girls and a significant interaction with age resulting in greatest mean difference between females and males at age 15, and externalising problems and prosocial behaviour problems higher for boys), and; no significant associations of either socio-economic status or geographic location of residence with any outcomes. Aboriginal students, who composed 11% of the sample, scored higher for mental health problems across all four outcomes as compared to non-Aboriginal students. Resilience - often referred to as the ability to maintain or return to a positive state of mental health by employing multiple internal or external protective factors - has been proposed as a potential approach for interventions to prevent or reduce mental health problems in children and adolescents. Universal interventions represent one approach to doing so that aligns with international objectives supporting mental health across all people and are commonly adopted within community-based settings (e.g. schools). Universal, school-based interventions that target the strengthening of protective factors central to the concept of resilience have been evaluated within many studies internationally. However, the evidence relating to such an approach had not been comprehensively quantitatively synthesised. Aim two was to quantitatively synthesise the international evidence-base for the effectiveness of universal, school-based, resilience-focussed interventions on mental health problems in children and adolescents (Chapters 3 and 4). A systematic review with meta-analysis was conducted, and included 57 trials of participants aged 5-18 years. Key findings, based on child and adolescent trials combined, indicated resilience-focussed interventions to be effective relative to a control in reducing four of seven mental health problem outcomes: depressive symptoms, internalising problems, externalising problems, and general psychological distress (but not anxiety symptoms, hyperactivity and conduct problems). Effects of intervention were found to vary by age, length of follow-up, and therapeutic basis (cognitive behavioural therapy [CBT]-based vs. non-CBT-based). Some methodological limitations of the included trials were noted. The large majority of trials that have assessed the effect of universal, school-based, resilience-focussed interventions on mental health outcomes in children and adolescents have measured intervention effect on internalising problems including anxiety and depression, with fewer trials measuring effect on externalising problems and total difficulties. Additionally, past trials have most commonly tested the effect of a manualised program delivered within the school curriculum, without the utilisation of broader capacity building opportunities provided by the school environment and in keeping with a Health Promoting Schools approach. Relatively few trials have adopted a pragmatic approach, providing flexibility for participants to select programs to implement which best meet their needs and arguably representing a test of an intervention under somewhat ‘real world conditions’. Aim three was to develop and evaluate the effect of a pragmatic, universal, resilience-focussed intervention in secondary schools on total difficulties, internalising problems, externalising problems, and prosocial behaviour problems, and student internal and external protective factors (Chapters 5 and 6). A cluster randomised controlled trial was conducted in 32 secondary schools (20 intervention, 12 control), with data collected from students in Grade 7 at baseline (2011; n=3115), and Grade 10 at immediate post-intervention follow-up (2014, n=2149; enrolments in Grades 7 to 10 typically aged 12-16 years; 50% male; 69.0% retention). The intervention was implemented during Grades 8 to 10 (2012-2014) and consisted of a framework of sixteen broad intervention strategies targeting internal and external resilience protective factors across the three Health Promoting Schools domains. Schools were asked to implement sixteen broad intervention strategies however, in line with a pragmatic approach, schools were given the flexibility to select the specific programs or resources to do so, and the order and manner in which these were implemented within each intervention school varied. To assist schools to achieve this, a list of programs and curriculum resources targeting resilience protective factors and recommended to promote mental health in children and adolescents was provided. Key findings included no significant intervention effect for four mental health outcomes measured utilising the SDQ (total difficulties, internalising problems, externalising problems, and prosocial behaviour problems), nor for internal and external protective factors measured utilising the Resilience and Youth Development Module of the California Healthy Kids Survey. A number of possible explanatory factors pertaining to the null results of the trial were considered, including: that the pragmatic approach may have resulted in inconsistent strategy implementation across intervention schools, and; process data suggesting that strategies for supporting positive mental health and resilience may similarly have been a focus in control schools due to contextual changes in policy and practice across the broader school system of NSW, Australia, during the time of the trial. Supported by the research reported in this thesis, a number of needs for ongoing research were identified relating to: measurement and monitoring prevalence of mental health problems in children and adolescents; enhancing understanding of how resilience protective factors relate to mental health problems in children and adolescents, and; considerations for the conduct of future intervention trials.
- Subject
- adolescent mental health; resilience; children; adolescence; child mental health; thesis by publication; protective factors; universal intervention; psychology; health behaviours; school; SDQ; socio-demographic factors; prevention
- Identifier
- http://hdl.handle.net/1959.13/1389016
- Identifier
- uon:32840
- Rights
- Copyright 2018 Julia Dray
- Language
- eng
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| View Details Download | ATTACHMENT01 | Thesis | 15 MB | Adobe Acrobat PDF | View Details Download | ||
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