Building mental health in young Australians: a positive psychological approach.

Abstract

In the last decade positive psychology has contributed significantly to the conceptualisation of mental health and shown that increases in positive virtues or strengths are associated with better physical, psychosocial, and psychological functioning, and fewer symptoms of mental illness (Seligman & Csikszentmihalyi, 2000; Seligman, Steen, Park, & Petersen, 2005; Seligman, 2005). It is suggested that if such a positive focus is adopted early in life it can then help develop a young person’s psychological strengths, such as resilience, optimism, and hope, and lay the foundations of a sustained healthy life in adulthood (Licence, 2004). However, despite this knowledge, the focus of mental health in Australia appears to remain on the prevention or alleviation of mental illness. This thesis represents one of the first attempts to redirect the focus of mental health in Australia away from mental illness and towards building positive resources that will enable young Australians to flourish in life. The results of five independent but related studies are presented in three published and two submitted papers that contribute to the conceptualisation and promotion of mental health in young Australians. Paper one (study one) reports the results of a meta-analysis and indicates that when compared to Cognitive Behavioural Therapy (CBT) that contains zero hopeful elements, CBT that contains multiple hopeful elements significantly reduces a young person’s level of depression compared to a control, no treatment, or usual care group. Although evidence was limited by the number of studies available, the results suggest that the inclusion of a specific hope-focus may increase the effectiveness of CBT to prevent depression in young people. Paper two (study two) reports the results of a meta-synthesis and indicates that when promoting mental health in young people with chronic illness, young people require a positive approach in order to bolster their sense of self, normalise the experience, help them accept the situation, and help them develop the cognitive and future-orientated strategies they need to facilitate a sense of hope at this time. Papers three, four, and five report the results of three quantitative studies that used data obtained in the South Australian Youth Mental Health Survey (SAYMHS). The SAYMHS (N = 3913; 13-17 years) collected cross-sectional information from a large sample of young South Australians from both regional and metropolitan areas. The SAYMHS was undertaken specifically for this thesis. Paper three (study three) reports the prevalence of the four key states outlined by the Complete State Model (CSM) of mental health (Keyes & Lopez, 2002), along with the association of each of these states to health-risk and health-promoting behaviour. It was shown that less than 50 percent of young Australians were flourishing in life, that flourishing in life was associated with increased health promoting behaviour and floundering was associated with more health-risk behaviour, and that the propensity to engage in health behaviour (positive or negative) varied by gender and region. Paper four (study four) reports the results of a Confirmatory Factor Analysis (CFA) and indicates that hope, used as an exemplar of a psychological strength, is a stronger predictor of mental health than is mental illness, and that differences existed in the individual predictive value of hope’s components (Agency and Pathways scores). Paper five (study five) provides Australian normative scores for the Adult Hope Scale (AHS) (Snyder et al., 1991) and indicates that differences in total Hope scores exist across age and region, and in its component scores across age, region, and gender. The current results have several implications for the development of strategies to promote mental health in Australian youth. First, an explicit focus on hopeful strategies may be a useful way to ensure that strategies employed to prevent the symptoms of mental illness are effective, as successful hopeful thinking then also builds the resources needed to reach and sustain a state of flourishing in life. Second, a positive focus on hopeful strategies may facilitate the development and maintenance of a young person’s mental health when they are diagnosed with chronic illness. Third, the prevalence of mental health in young Australians has previously been overestimated, with this project demonstrating that the majority are not flourishing in life and, when compared to those who are flourishing, young Australians who are languishing, struggling, or floundering in life are more likely to engage in health-risk behaviour. Fourth, hope may be a better focus of efforts to promote mental health and build the resources needed to reach and sustain a state of flourishing in life than the prevention or alleviation of mental illness. Fifth, Australian clinical psychologists and other health practitioners now have a way to identify young Australians who differ from the developmental norm in terms of the hopeful thinking to then help guide strategies to promote mental health.