Mental health from a Person-centred Perspective: Analyzing mental health problems, risk factors and outcomes in children, adolescents and young adults

The relevance of mental health problems has accumulated over the last few years in light of the potential detrimental effects of the worldwide pandemic. The burden of mental ill-health with its various negative long-term consequences for children, family and the high indirect and direct costs for society raises the essentiality to make mental health promotion a central issue. General scientific research on mental health problems among children and adolescence has largely relied on variable-centred methodology (e.g., multiple regression, factor analysis, cumulative risk index) by focusing mainly on explaining relationships between variables (i.e., linear association and single relationship). However, this method assumes homogeneity of mental health problems and risk factors for mental ill-health within a population, however there is likelihood for diversity of individual patterns for types of problems and exposure to multiple risk factors. The current dissertation uses a person-centred approach, a complementary and promising method to identify subpopulations with heterogenous patterns of mental health problems and to investigate different risk subgroups. The aims of the present work include the exploration and modelling of patterns and transitions of mental health problems with a focus on the importance of parental factors, the examination of multiple risks and the manifestation of mental disorders. In Study I, the central question was: “How do mental health problems differ across individuals and time”. Based on a sample of almost 1,300 children and adolescents (age range 8 – 26), a three-class solution identified a normative class, an emotional problem class, and a multiple problem class. The findings confirm the stability of mental health problems as common rather than atypical. According to Latent transition analysis, the majority of the sample (91.6%) did not change latent class membership over time, while 14.7% of individuals showed a persistent pattern of mental health problems across time. Co-occurring internalizing and externalizing problems (i.e., multiple problem class) were found in 11.3% of the sample and diagnoses of mental disorders were more likely to be reported by individuals in the emotional problem or multiple problem class. Taken together, implications for prevention can be formulated based on the findings including the importance of early, continuous, and gender-sensitive preventive interventions to ameliorate the mental health burden for the young and their family. In Study II, the mediating role of parenting dimensions between parental personality and adolescent mental health problems was investigated with a cross-sectional sample of 4,258 German adolescents (48.7% male, 11–17 years). The results underline and extend previous indications of direct associations between parental personality and their children’s mental health problems by highlighting the adverse role of neuroticism with increased externalizing and internalizing problems. Furthermore, results confirmed a positive effect of parental warmth and behavioural control on externalizing and internalizing problems and a negative effect of psychological control on both problems. An important finding includes the mediating role of parenting. Results showed negative associations between parental neuroticism as well as psychological control and adolescent mental health and highlighted their mutually reinforcing negative effect. To summarise, a good entry point for effective preventive intervention to ameliorate mental health problems during adolescence could include early screening of personality traits that may result in maladaptive parenting practises and therefore could be a guidance towards a better preparation for parenthood. In Study III, a longitudinal survey data of 10,853 German children, adolescents and young adults was used to examine 27 robust risk and protective factors for mental health across multiple domains (i.e. individual, family, social) to identify four subgroups of individuals with different risk profiles: a basic-risk (51.4%), high-risk (23.4%), parental-risk (11.8%) and social-risk class (13.4%). Results confirmed the crucial role of family-specific risk factors across the extracted classes and point towards parents as a key target to develop effective interventions to promote children’s health. Risk classes are associated with negative mental health outcomes (e.g., mental health problems, depression, ADHD). Gender differences were found. In conclusion, results contribute to previous research by stressing the effect of multiple risk factor on youth mental health. Future approaches to ameliorate mental health problems should include a combination of strengthening protective factors, involving parents and targeting schools. The findings of the present dissertation which include the importance of co-occurring mental health problems (Study I) and the examination of multiple risk factors (Study III) as well as the central role of parents (Study II), highlight the necessity to intervene early, continuous and on different levels of society. Implications and future research directions are discussed, focusing on the societies responsibility to guarantee that the most vulnerable and most important members have a chance for a healthy development. While important steps have been taken toward mental health prevention, there is still a lot of potential for research and practise