Finding Meaningful Support: Young People's Experiences of “Risky” Environments

This paper reports on the qualitative phase of a New Zealand study of young people who had been exposed to “risky” environments from a young age. These young people had experienced traumatic events such as abuse, violence, addictions, mental health issues, and many had been excluded from school. The young people (aged between 13 and 17) were users of multiple services (statutory and nongovernmental services including: child welfare, juvenile justice, remedial education, and mental health services). Qualitative interviews (n?=?109) explored young people's experiences in their families, communities, education, and their perspectives on support provided by services and their own support networks. Three thematic clusters emerged as central motifs in young people's experiences and are the focus of this article: navigating “risky” environments; services and support; and, working to find different pathways.     

Effects of Testosterone Treatment and Chest Reconstruction Surgery on Mental Health and Sexuality in Female-To-Male Transgender People

ABSTRACT. Objectives: This study examined the effects of testosterone treatment with or without chest reconstruction surgery (CRS) on mental health in female-to-male transgender people (FTMs). Methods: More than 200 FTMs completed a written survey including quantitative scales to measure symptoms of anxiety and depression, feelings of anger, and body dissatisfaction, as well as qualitative questions assessing shifts in sexuality after the initiation of testosterone. Fifty-seven percent of participants were taking testosterone and 40% had undergone CRS. Results: Cross-sectional analysis using a between-subjects multivariate analysis of variance showed that participants who were receiving testosterone endorsed fewer symptoms of anxiety and depression as well as less anger than the untreated group. Participants who had CRS in addition to testosterone reported less body dissatisfaction than both the testosterone-only or the untreated groups. Furthermore, participants who were injecting testosterone on a weekly basis showed significantly less anger compared with those injecting every other week. In qualitative reports, more than 50% of participants described increased sexual attraction to nontransgender men after taking testosterone. Conclusions: Results indicate that testosterone treatment in FTMs is associated with a positive effect on mental health on measures of depression, anxiety, and anger, while CRS appears to be more important for the alleviation of body dissatisfaction. The findings have particular relevance for counselors and health care providers serving FTM and gender-variant people considering medical gender transition.     

Promoting young people’s musical identities to facilitate recovery from mental illness

The new ‘youth mental health paradigm’ (IAYMH. 2015. “International Association for Youth Mental Health.” Accessed February 15, http://www.iaymh.org/) promotes the need for youth-friendly mental health options. Music therapy initiatives offer innovative modes of working towards young people’s recovery in ways that align with the ethos of these services (McCaffrey, Edwards, and Fannon. 2011. “Is There a Role for Music Therapy in the Recovery Approach in Mental Health?” The Arts in Psychotherapy 38 (3): 185–189). This paper details a participatory research project investigating how and why promoting young people’s musical identities can facilitate their recovery from mental illness. Young people accessing a music therapy programme in a youth mental health service in Australia participated in collaborative qualitative interviews that were analysed using constructivist grounded theory techniques. Cycles of action and reflection resulted in a grounded theory explaining the recovery of musical identity, and mapping young people’s community-based music needs for wellbeing. We propose that promoting young people’s musical identities facilitates recovery through: the construction of a health-based identity; facilitating meaning-making; and supporting social participation. Findings are discussed in relation to recovery literature and social justice issues that arise in response to findings about young people’s needs for appropriate music access.     

Smartphone and social media addiction: Exploring the perceptions and experiences of Canadian teenagers

“Addiction” to internet‐connected technology continues to dominate media discourses of young people. Researchers have identified negative outcomes, including decreased mental health, resulting from anxieties related to technology, e.g., a fear of missing out and social connectivity related to online technologies. Not enough is known, however, regarding young people's own responses to these ideas. This paper highlights discussions with teenagers around the idea of internet addiction, exploring their experiences and perceptions regarding the idea that “kids today” are addicted to their devices, especially smartphones and the social network sites they often access from them. Thirty‐five focus group discussions with 115 Canadian teenagers (aged 13–19 years old) center on their use of information communication technologies, especially contemporary social network sites such as Snapchat, Instagram and Facebook. Our discussions reveal (1) that teens are actively embracing the label of addiction; (2) their ironic positioning occurs despite a felt sense of debased agency in relation to the power of the algorithms and affordances of the technologies mediating their use; and (3) rather than a stark divide between adults as “digital immigrants” versus young people as “digital natives,” our teens positioned themselves in contrast to both their parents and younger siblings, both of whom are criticized as addicted themselves. A consistent theme is the influence of peer groups who socially compel addictive behaviours, including the fear of missing out, rather than the technologies per se. Wider implications for thinking beyond solely young people as suffering from online addiction are considered.     

Emotions into Disorder: Anxiety Disorders and the Social Meaning of Fear

This article explores what we refer to as norm-stimuli-state discrepancies, which are disparities between people's physical-emotional responses to emotional cues and the normative meanings of those cues. Drawing on forty qualitative interviews and participant observation research at support groups, we show that people with anxiety disorders describe two forms of norm-stimuli-state discrepancies. The first form involves discrepancies of type, in which people label fearful emotional states as deviant for being caused by the “wrong” stimuli. The second involves discrepancies of intensity, in which people label fearful states as deviant for involving feelings or displays of “too much” anxiety in response to an “appropriate” stimuli. The article further addresses the role of stimuli in prompting treatment seeking. Unexpected and intense emotional distress in combination with the falling away of external cues—which we refer to as “stimuli-less fear”—serve as a critical juncture on the path to an anxiety disorder diagnosis.     

A Review of Lesbian Depression and Anxiety

SUMMARY

The Surgeon General's first report on mental health identified depression and anxiety as significant mental health issues that disproportionately affect women. Research indicates that lesbians experience depression at rates that parallel those of the general female population, suggesting that depression is an important mental health issue for lesbians. Given the high rate of comorbidity between depression and anxiety disorders, it is likely that many depressed lesbians have struggled with problems related to anxiety as well. This paper reviews literature pertaining to lesbians and depression including incidence rates, risk factors, suicidality and treatment approaches, and stress and anxiety that may also contribute to the experience of depression among lesbians.     

Talking or Keeping Silent About Parental Mental Health Problems—A Grounded Theory of Parents' Decision Making and Experiences with Their Children

This grounded theory study explored parents' experiences of responding to their children's need for understanding parental mental health concerns. Fifteen parents with severe and enduring mental health difficulties participated in the study. The findings suggest four main social processes that influence parents' talk with their children about parental mental health issues, namely “Protecting and being protected,” “Responding to children's search for understanding,” “Prioritizing family life,” and “Relating to others.” Implications of the findings for clinical practice and future research are considered. In particular, the need for more family‐orientated services where parents experience parental mental health problems is highlighted.     

Adolescents’ Subjective Social Status Predicts Day‐to‐Day Mental Health and Future Substance Use

Adolescents’ subjective social status (SSS) is associated with mental and behavioral health outcomes, independent of socioeconomic status (SES). Many previous findings, however, come from cross‐sectional studies. We report results from a longitudinal study with 151 adolescents identified as at risk for early substance use and behavioral problems sampled from low‐SES neighborhoods. We examined whether adolescent's SSS predicted mental health (depression, anxiety, and inattention/impulsivity) measured over 30 days via ecological momentary assessment and risk for substance use at an 18‐month follow‐up. Results showed that with each perceived step “up” the SSS ladder, adolescents experienced fewer mental health symptoms in daily life and lower future substance use risk after adjusting for objective SES and previous psychopathology. Implications of these findings are discussed.     

Cognitive behavioral interventions for depression among Hispanic people: promising meta-analytic evidence for deep cultural adaptations

ABSTRACT

Depressive disorders are common among Hispanic people. Evidence-informed guidelines indicate cognitive behavioral interventions (CBI), but they were developed primarily with non-Hispanic White people. Narrative studies of clients and workers along systematic review evidence suggested that well-defines cultural adaptations of CBIs would likely improve outcomes among Hispanics people with diverse mental health problems. We advanced the meta-analytic hypothesis that CBIs incorporating so-called “deep structure” cultural adaptations will be more effective than otherwise similar, but more superficially, “surface structure” or non-adapted interventions with depressed Hispanic people. This meta-analysis synthesized evidence from nine typically randomized trials in the United States with one subsample from the Commonwealth of Puerto Rico. Most clients were young women, living in poverty and suffering a reactive depressive episode. We found statistical and practical support for our hypothesis. In most practice contexts, CBI success rates were between 15% and 30% better than those typically observed with other usual practices. Moreover, these effects were maintained at 6- to 12-month follow-up. Given the size and growth of the Hispanic American population, their prevalent experience of depression, and the size of the intervention effects, these synthesized findings seem of potentially great human, clinical, and policy significance.     

Bullying victimization in non-heterosexual university students

In this study the prevalence, impact on mental health, and coping of bullying victimization in university students identifying as non-heterosexual was compared with their heterosexual peers. University students were surveyed on bullying experiences within the past 12 months, their mental health, and use of coping strategies. Demographic information identified gender, age, and sexual orientation. Results indicated that 14.3% of students reported victimization, and that students ages 24 to 35, and those who identified as non-heterosexual, reported higher rates of victimization. No gender differences were found. Bullied students scored significantly higher on depression, anxiety, and stress scores than non-bullied students. Comparisons of mental health scores and coping strategies of non-heterosexual and heterosexual bullied students found no significant differences, indicating both groups are equally impacted, and equally utilize adaptive and maladaptive strategies to manage the victimization. Implications for tertiary institutions include identification of effective coping resources for diverse university student populations. Limitations and recommendations for future research are considered.     

Concept mapping as an approach for expert-guided model building: The example of health literacy

Concept mapping served as the starting point for the aim of capturing the comprehensive structure of the construct of ‘health literacy.’ Ideas about health literacy were generated by 99 experts and resulted in 105 statements that were subsequently organized by 27 experts in an unstructured card sorting. Multidimensional scaling was applied to the sorting data and a two and three-dimensional solution was computed. The three dimensional solution was used in subsequent cluster analysis and resulted in a concept map of nine “clusters”: (1) self-regulation, (2) self-perception, (3) proactive approach to health, (4) basic literacy and numeracy skills, (5) information appraisal, (6) information search, (7) health care system knowledge and acting, (8) communication and cooperation, and (9) beneficial personality traits. Subsequently, this concept map served as a starting point for developing a “qualitative” structural model of health literacy and a questionnaire for the measurement of health literacy. On the basis of questionnaire data, a “quantitative” structural model was created by first applying exploratory factor analyses (EFA) and then cross-validating the model with confirmatory factor analyses (CFA). Concept mapping proved to be a highly valuable tool for the process of model building up to translational research in the “real world”.     

Demands and Devotion: Cultural Meanings of Work and Overload Among Women Researchers and Professionals in Science and Technology Industries

How do cultural meanings influence how people experience work‐life demands? Much research, especially quantitative research, on the effects of structural work and family conditions does not account for employees’ cultural beliefs about the meaning of work in their lives. This article uses unique survey data to investigate the effects of employee embrace of elements of the “work devotion schema”—a cultural model that valorizes intense career commitment and organizational dedication—on their sense of “overload,” an experience that includes feeling exhausted and overloaded by all one's roles, net of actual hours on the paid job and family responsibilities. We argue that by cognitively, morally, and emotionally framing work as a valued end, the work devotion schema reduces feelings of overload. Using a case of senior women researchers and professional service providers in science and technology industries, we find that those who embrace work devotion feel less overloaded than those who reject it, net of work and family conditions. However, this effect is curtailed for mothers of young and school‐aged children. We end by discussing implications for flexibility stigma and gender inequality.     

Displaying Gender: Transgender People's Strategies in Everyday Life

Drawing upon data from in‐depth interviews with transgender people in Portugal and in the United Kingdom, this article critically reflects upon different ways through which transgender people recreate their gender displays, particularly in terms of gender embodiment and aesthetics, in order to navigate their everyday lives. I focus on four strategies of articulating gender displays with one's own gender subjectivities: “blending in,” “masking,” “naturalizing,” and “subverting.” These strategies are not exclusive of one another. They are used differently throughout the participants' own lives in accordance to the social contexts they were in.     

Gender roles and social control

Drawing upon social control theory in criminology, this paper examines the relationship between gender roles and the inhibitors of deviance. We develop and test hypotheses that “traditional” females, defined in terms of either position in the social structure or gender‐role attitudes, perceive higher levels of three types of sanctions assocíated with crime than do males; while “nontraditional” females are similar to males in their perceptions of sanctions. Results indicate that while changing gender roles and gender‐role attitudes affect perceived threats of guilt‐feelings and social stigma, they do not appear to influence women's perceptions of legal sanctions.     

Photography as a pedagogical tool for shedding light on ‘bodies-at-risk’ in physical culture

In Western countries, given current global public health imperatives around obesity, the lack of engagement with and compliance to normative health-related physical cultures is a concern for young people of ethnic minority backgrounds (particularly females) and low socio-economic class. These groups represent cohorts of young people more likely to be physically inactive and unhealthy compared to other groups, and thus are framed as ‘bodies-at-risk’ or portrayed as a ‘problem’ by neoliberal projects of the body in public health. What remains hidden in the enterprise of the fit body produced by a Western physical culture of healthism, however, is how sport and physical and health education in schools continue to reproduce inequalities of gender and race/ethnicity that heavily bear upon some young people's bodies in local sites. To problematise the body-at-risk discourse, this visual participatory ethnographic research conducted in inner-city, state-funded schools in the Midlands region of the UK, aimed to reveal the visual dimensions of embodiment as expressed by young people of different ethnic backgrounds in the local contexts of their lives. Student-researchers used digital cameras to create visual diaries entitled Moving in My World to express their thoughts, feelings and ideas, and to ‘speak for themselves’ about their knowledge of their own bodies, sharing their embodiments. What moving in their worlds meant to young people varied significantly based on differences of cultural background, gender negotiations and opportunities for, and choices in, their engagement with physical activity. The student-researchers’ visual diaries captured a heterogeneity of meanings about the moving body that young people construct and represent in their creation of the hybrid physical cultures of their daily lives.     

Symptoms of Mental Health Problems: Children’s and Adolescents’ Understandings and Implications for Gender Differences in Help Seeking

Amidst concerns that young people’s mental health is deteriorating, it is important to explore their understandings of symptoms of mental health problems and beliefs around help seeking. Drawing on focus group data from Scottish school pupils, we demonstrate how they understood symptoms of mental health problems and how their characterisations of these symptoms as ‘rare’ and ‘weird’ informed participants’ perceptions that peers, teachers and parents would respond to disclosure in stigmatising ways. Consequently, participants suggested that they would delay or avoid disclosing symptoms of mental health problems. We highlight subtle gender and age differences and outline implications for policy and practice.     

Policy, Practice and People: Current Issues Affecting Clinical Practice

This commentary highlights current policy issues affecting lesbian, gay, bisexual, transgender, and queer (LGBTQ) people in the US with implications for mental and behavioral health care and social work services. These issues include conversion or reparative therapies, especially for young people, and conscience clauses that may exempt some students and practitioners from serving LGBTQ people and their families. While not a “policy” per se, emerging knowledge about health disparities that affect LGBTQ people will also be summarized because of its relevance to practice; many of these concern mental health and behavioral health. Finally, some resources for making health care organizations more responsive to the needs of LGBT people are identified.     

Health Care “As Usual”: The Insertion of Positive Psychology in Canadian Mental Health Discourse

The recent shift to a “positive psychological” approach that emphasizes a “health model,” rather than a “disease model,” in mental health discourses is intended both to reduce the stigma around mental health issues and to enable people to play a role in monitoring their own mental health. As a component of a larger study on access to and utilization of mental health services by immigrant women, and a partial reflection of the current ideological context of mental health policy and practice in Canada, this shift was examined by analyzing the Canadian Mental Health Association's mental health discourse as posted in Web-based text using features of critical discourse analysis. Although considered an improvement over previous approaches by some, the current mental health discourse continues to reflect ideologies that assume a universal psychology of individual mental health. Framing this research with aspects of sociocultural and postcolonial theories, this article seeks to identify the possibilities of this new discourse and expose its limitations in relation to immigrants to Canada.     

Parental Depression and Anxiety and Early Childhood Behavior Problems Across Family Types

Using the Fragile Families and Child Wellbeing Study, we examine the association between parental major depressive and generalized anxiety disorders and child behavior problems across family types: married, cohabiting, involved nonresident father, and noninvolved nonresident father. Among 3‐year‐olds in all families, maternal anxiety/depression is associated with increased odds of anxious/depressed, attention deficit, and oppositional defiant disorders (N = 2,120). Paternal anxiety/depression has no significant association with these problem behaviors; father’s illness, however, exacerbates anxious/depressed behaviors in young children if both parents are ill and he is coresident. The findings underscore the importance of maternal mental health for child well‐being and suggest that a negative interaction between parent illnesses is most likely when parents and children share the same disorder.     

Tell Me a Story: A Review of Narrative Assessments for Preschoolers

The use of narrative assessments in mental health research with young children has increased significantly over the last 15 years. This article reviews 13 empirically validated narrative assessments for preschool populations. The reviewed instruments assess children’s attachment relationships, moral values, separation anxiety, pro-social behavior, object relations and depression, among other constructs. The authors present an analysis of each instrument including a discussion of its methodological rigor, and point to needed directions in the field. These narrative assessment instruments provide researchers and clinicians with insight into the internal worlds of young children, offering windows into a difficult-to-assess population.