Adolescent positive mental health : policy, measurements, prevalence and correlates in a Chinese setting

Introduction: Adolescence is a period of one’s life that harbors many risks, but it also presents us with a number of fantastic opportunities for sustained health and wellbeing, through education and preventive efforts, for example. Mental health issues in adolescents have attracted the attention of the public and of academia. This is the case because mental health problems affect 10% – 20% of children and adolescents worldwide, accounting for a large portion of the global burden of disease which may develop into psychiatric disorders in later life. Positive mental health, as a syndrome of symptoms including positive feelings and life functioning, is an essential part of understanding mental health in general. The promotion of mental health and the identification of adolescents who are at risk (in terms of mental health problems) by using appropriate instruments is essential to the reduction of mental illness worldwide. Thus far, there has been no previous study of positive mental health in adolescents in China. This thesis explores and examines the policy context, measurement, prevalence, and a number of relevant correlates of positive mental health in Chinese adolescents from the city of Weifang. Method: In Study I, a policy translation with respect to adolescent mental health was analyzed using the Policy Triangle Framework. Data was collected by means of interviews with local policy actors and via an analysis of a number of official documents at the national, provincial, and local levels. Study II and Study III include a quantitative survey study, using a comprehensive questionnaire including Mental Health Continuum-Short Form (MHC-SF) and other scales and items and was distributed in the urban area of Weifang, Shandong Province in 2014. Approximately 5,400 students from Grade 8 and Grade 10 responded to the questionnaire. In Study II, the reliability and validity of the MHC-SF was tested by (i) calculating Cronbach’s alpha coefficient, (ii) performing a confirmatory factor analysis and (iii) by comparing the strength of the correlation between a number of different measurements of positive mental health and mental illness. In Study III, the prevalence of positive mental health was presented in terms of proportions of categories of interest. Multivariate logistic regressions were employed in calculating odds ratios (OR), and 95% confidence intervals (CI) were used in analyzing a number of variables associated with ‘flourishing mental health’ (as the dependent variable). In an additional analysis, a twocontinua model of positive mental health and mental disorders was tested by using exploratory factor analysis and confirmatory factor analysis. Results: Chinese national policies are implemented via a top-down process; the Ministries of Health and Education instruct provincial- and local levels, in some detail, on how they should provide education about mental health to school students (Study I). MHC-SF showed excellent internal reliability (Cronbach’s α=0.92), structural validity and external validity (Study II). In the sampled Chinese adolescents, 57.4% of the participants were diagnosed as ‘mentally healthy’ or ‘flourishing’ (Study III). ‘Gender’, ‘perceived family economy’, ‘the occurrence of sibling(s)’, ‘satisfaction of self-appearance’, ‘physical activity’, ‘sleep quality’, ‘stress’, ‘social trust’, ‘desire to learn’, ‘support from teachers and parents’, as well as ‘not being bullied at school’ were significant indicators of positive mental health (OR ranging from 1.23 to 2.75) (Study III). Mental disorders and mental wellbeing were confirmed to be related, but also distinct factors (see additional analysis). Conclusion: This is the first time that the positive mental health of adolescents has been assessed in Chinses adolescents. This thesis presents an analysis of a number of different aspects relevant to the positive mental health of adolescents in Weifang, China. In particular, the prevalence of and associated indicators of positive mental health in the sampled adolescents were investigated. The main findings in this study are in agreement with many previous studies in this area