Millennial mental health: examining current approaches and exploring challenges to the measurement and promotion of mental health in young Australians

Abstract

Millennials, the current generation of young people (born 1982-2004), now comprise more than a quarter of the world’s population – the largest proportion in history. Mental disorders are a key cause of disease burden among young people (aged 12-24 years) who face unique challenges to building and maintaining mental health. Good mental health in adolescence decreases the likelihood of developing mental health problems across the lifespan, but young people are the least likely group to seek help and receive treatment for mental disorders compared to older populations. With this in mind, and knowing that lack of mental disorders does not necessarily equate to good mental health, the present thesis sought to investigate current approaches and explore new challenges to the measurement and promotion of mental health in young people, encompassing children, adolescents and young adults. Paper One reports a preliminary exploration into the differences between three measurement approaches to mental health and illness in an Australian sample of emerging adults (aged 23-27 years; N=117): an exclusive mental illness approach, an exclusive mental wellbeing approach and a dual continua approach. The results illustrated discrepancies between the three approaches, which resulted in vastly different depictions of the collective mental health of a group of young people. A significant proportion of cases fell outside of a single dimension model, and moderate mental health categories were identified as a challenge to gaining a comprehensive and informative picture of groups of emerging adults when using single dimension measures, suggesting that adopting a dual continua approach to measurement can provide a more comprehensive picture of mental health. Paper Two reports the results of a cross-sectional, qualitative study aimed to explore how a non-clinical sample of adolescents (aged 12-18 years; N=16) speak about mental health and illness and to gain insight into their perceptions and experiences. When discussing mental health concepts and appropriate behaviours towards sufferers of mental illness, adolescents conveyed a sense of acceptance and understanding of the potential complexity and severity of mental illness. In contrast, when discussing mental health in the context of their own lives, a stronger sense of scepticism was conveyed. Students expressed difficulty with the lack of visible markers of mental health and confusion determining authenticity in the mental health states conveyed by their peers. Interestingly, adolescents commonly expressed the notion that young people may exaggerate or ‘fake’ a mental illness for personal gain. Paper Three involved further analysis of the same sample to explore the topic of help-seeking for mental health specifically from the perspectives of young people. Findings highlighted that even among a non-clinical sample of adolescents who had participated in a school mental health promotion program, there was a strong reluctance to seek help due to complex and interrelated personal, social and institutional influences. Students conveyed that they would strongly avoid seeking help for their mental health, referencing themes including self-reliance, positive thinking, doubt about significance of problems, peer acceptance, burdening others, informal help-seeking, concerns about confidentiality and negative perceptions of mental health services and professionals. Students spoke about the concept of “first world problems”, and described their personal problems as minor or trivial in comparison to large-scale or global issues. Paper Four reports the results of a cross-sectional quantitative study utilising survey methodology to test the traditional assumption that knowledge influences behaviour by exploring whether knowledge about mental illness was related to stigmatising attitudes towards mental illness and intentions to seek help, within a sample (aged 13-17 years; N=327) of adolescent girls. Results indicated that a weak negative relationship existed between knowledge about mental health and stigmatising attitudes about mental illness, but no relationship between knowledge about mental health and intentions to seek help for mental health problems was found. When mental health was categorised (e.g., optimal vs. poorer mental health), a significant relationship between knowledge about, and attitudes toward, mental health was shown in those with poor mental health, but not for adolescents categorised as having moderate or good mental health. The series of studies presented in this thesis add to understandings of youth mental health knowledge, attitudes and behaviour in Australia. Practical implications include the usefulness of conceptualisation that includes both positive and negative aspects of mental health, the need to consider adolescent mental health within the broader sociocultural context, the potential for a knowledge-behaviour gap related to mental health among young people and insights about mental health in the context of Millennials (and subsequent generations) as “digital natives”. The results draw attention to several key areas of focus for future research, policy and practice to explore, including the predictive power of mental health states according to a dual continua model, further consideration of current practice (including universal programs and individual approaches applied to populations), reshaping the role of education in mental health promotion and broadening focus to include a socioecological model of mental health emphasising community and interconnectedness, while prioritising youth participatory approaches. Taken together, the four journal articles (1 published, 1 accepted with minor revisions, 2 submitted) that make up this PhD thesis draw attention to the complexity of youth mental health, including aspects that are salient to young people, within a developmental and social context.