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In this cross-sectional study, we aimed to I) investigate the dual-factor model of mental health by forming and describing four participant groups and II) examine associations between mental health status and background factors, school-related factors, stress, and resilience among adolescents in a community population in Sweden. Data were collected through a survey completed by 2,208 students in lower and upper secondary school on the Swedish island of Gotland. After missing data were removed, a total of 1,833 participants were included in the study. The survey included the Mental Health Continuum Short Form (MHC-SF) for the assessment of mental well-being and the Strengths and Difficulties Questionnaire (SDQ) for the assessment of mental health problems. These two measures were combined into a dual-factor model, forming four mental health status subgroups: Vulnerable (47.5%), Complete mental health (36.2%), Troubled (13.9%), and Symptomatic but content (2.5%). Associations between these groups were explored regarding background factors, school-related factors, stress, and resilience through chi-squared tests and logistic regressions. Girls (OR: 1.88) and participants with high stress levels (OR: 2.23) had elevated odds for Vulnerable mental health status, whereas higher resilience (OR: 0.87) and subjective social status in school (OR: 0.76) were factors associated with reduced odds for this mental health status classification. Female gender (OR: 5.02) was also associated with Troubled mental health status. Similarly, a high level of stress (ORs: 4.08 and 11.36) was associated with Symptomatic but content and Troubled mental health status, and participants with higher levels of resilience had decreased odds for being classified into these groups (ORs: 0.88 and 0.81). The findings highlight the importance of interventions to increase resilience, reduce stress, and address stereotypic gender norms as well as social status hierarchies to support adolescents' mental hea, The study was funded by: • Planeringsrådet Gotland at Uppsala University [19-10-28 §5, 2019] (AS) • Länsförsäkringar Gotland [19-12-16 #11 §139, 2019] (AS) • Region Gotland [RS2020/663, 2020] (VH).

Aims To explore Swedish adolescents' conceptual views of mental health and mental health problems. Design A qualitative descriptive study design. Methods Semi-structured focus group interviews and individual interviews were conducted with, in total, 32 Swedish adolescents (15–18 years old) in October–November 2020. Data were analysed using systematic text condensation. Results Three themes were identified through the analysis: Mental health is about how we feel; One's mental health depends on one's situation, thoughts and ways of coping; and Mental health problems should be taken seriously and can get severe. Conclusion The results indicate that adolescents understand the complexity and holistic nature of mental health and mental health problems. According to the participating adolescents, positive mental health and mental health problems should be considered simultaneously to understand a young person's mental health state. Good health was described as having both absence of mental health problems and high levels of well-being: feeling well. Mental health problems were defined as something other than normal difficulties in life, but ranging from minor difficulties to more severe conditions. However, all kinds of mental health problems were termed as feeling unwell. The results suggest that adolescents are in need of support to cope with normal difficulties in life rather than lectures about life sometimes being challenging. In addition, the results highlight the need to prevent school-related stress and offer adolescents support for minor mental health problems. Impact The findings have implications for nurses and other professionals who encounter adolescents in their profession, for example specialist nurses, school nurses and public health professionals. The findings add knowledge that could be useful for communication with adolescents about their mental health and methods to assess their mental health status. Patient or Public Contribution The preliminary result, Title in the list of papers in Veronica Hermann's thesis: ‘Feeling down one evening doesn’t count as having mental health problems’ - A study on adolescents’ conceptual views of mental health

Young people suffering from mental health problems is a public health issue, and it is important to listen to adolescents’ views on the issues that affect their lives. This qualitative study describes adolescents’ perceptions of the prevalence of and public stigma towards mental health problems among young people. A total of 32 Swedish adolescents, aged 15–18 years old, took part in either semi-structured focus groups or individual interviews. The data were analyzed using systematic text condensation, resulting in three themes: Having mental health problems is the new normal; What others think of you affects you; If others lack experience and knowledge, they don’t respond well. The adolescents considered mental health problems to be common in young people and a normal feature of their lives. They displayed an in-depth understanding for reasons of the increase in mental health problems in young people, and factors such as pressure from school, stereotypical gender norms, rumors and prejudice were suggested as possible explanations for the increase, alongside improved openness about mental health problems. The adolescents’ perceptions of the stigmatization of mental health problems were consistent with a trifold definition of stigma, comprising stereotypes, prejudice and discrimination. The adolescents suggested that better education about mental health problems, and more inclusive gender norms, would help reduce stigma and improve young people’s mental health., Title in thesis list of papers: Feeling mentally unwell is the “new normal”. A qualitative studyon adolescents’ views of mental health problems and associated stigma

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, a, Licentiatseminariet kan även följas via Zoom: https://uu-se.zoom.us/j/69890471140 Lösenord: UngdomarIngen opponent utan tre medlemmar i betygsnämnd: Docent Fredrik Söderqvist, Örebro universitet (Ordförande i betygsnämnden); Professor Christina Dalman, Karolinska Institutet; Professor Karin Enskär, Uppsala universitet.

Aims To explore Swedish adolescents' conceptual views of mental health and mental health problems. Design A qualitative descriptive study design. Methods Semi-structured focus group interviews and individual interviews were conducted with, in total, 32 Swedish adolescents (15–18 years old) in October–November 2020. Data were analysed using systematic text condensation. Results Three themes were identified through the analysis: Mental health is about how we feel; One's mental health depends on one's situation, thoughts and ways of coping; and Mental health problems should be taken seriously and can get severe. Conclusion The results indicate that adolescents understand the complexity and holistic nature of mental health and mental health problems. According to the participating adolescents, positive mental health and mental health problems should be considered simultaneously to understand a young person's mental health state. Good health was described as having both absence of mental health problems and high levels of well-being: feeling well. Mental health problems were defined as something other than normal difficulties in life, but ranging from minor difficulties to more severe conditions. However, all kinds of mental health problems were termed as feeling unwell. The results suggest that adolescents are in need of support to cope with normal difficulties in life rather than lectures about life sometimes being challenging. In addition, the results highlight the need to prevent school-related stress and offer adolescents support for minor mental health problems. Impact The findings have implications for nurses and other professionals who encounter adolescents in their profession, for example specialist nurses, school nurses and public health professionals. The findings add knowledge that could be useful for communication with adolescents about their mental health and methods to assess their mental health status. Patient or Public Contribution The preliminary result, Title in the list of papers in Veronica Hermann's thesis: ‘Feeling down one evening doesn’t count as having mental health problems’ - A study on adolescents’ conceptual views of mental health