Abstract
Internationally, the mental health of children and adolescents is undoubtedly an important construct of theoretical, clinical, and policy level concern. Worldwide, five mental disorders (depression, alcohol misuse, bipolar affective disorder, schizophrenia, and obsessive-compulsive disorder) represent half of the 10 leading causes of disability and premature death; with mental disorders accounting for 15–30% of disability adjusted life years in the first three decades of life. This provides a solid rational founded in implications for population health as to why reducing and preventing mental health problems in children and adolescents deserves attention. Past research has indicated interventions focussed on building resilience through strengthening protective factors may offer the potential to address mental health problems in children and adolescents, and in particular aid in reducing such problems during times of increased risk or adversity. With childhood and adolescence being critical periods of development, there is a need to reflect on the strengths and limitations of resilience-focussed interventions and anticipated future needs of the world’s youth. This conceptual analysis identifies a number of future research directions that may meaningfully add to the evidence base and improve implementation, evaluation, and impact of resilience-focussed interventions. These largely relate to refining the understanding of how resilience protective factors relate to mental health problems in children and adolescents. Important issues and potential opportunities to improve the related research field include improved reporting of intervention content; improved measurement of resilience protective factors in intervention trials; continued reporting and review of evidence of association between protective factors and mental health outcomes; and incorporation of mediation analysis within intervention trials. There is a need for further intervention studies in this space to be conducted as rigorous trials of resilience-focussed approaches based on such evidence of association, with clearly posited mechanisms of change, and inclusive of analysis of differential intervention effects. The suggested implications for research made in this conceptual analysis will aid in improving the quality of the evidence base relevant to the fostering of resilience and prevention of mental health problems in children and adolescents.
Highlights
IntroductionDray et al, 2017 [27], in undertaking a recent relevant systematic review of the related international evidence base, compiled a list of 31 internal and external protective factors from research published by eminent resilience and mental health researchers conducting eligible studies across 16 countries including: Australia, United States, Canada, Ireland, Germany, Italy, Netherlands, Scotland, Norway, China, Switzerland, England, Chile, India, Mauritius, and New Zealand [17,19,22,37,38,39,40,41,42,43,44,45,46,48,54,55] (Table 1)
Licensee MDPI, Basel, Switzerland.Internationally, the mental health of children and adolescents is undoubtedly an important construct of theoretical, clinical, and policy level concern [1]
International sources of evidence were examined in this conceptual analysis, including a sample of recent peer review publications demonstrating the large variability in factors identified as relating to resilience and systematic reviews that had attempted to consolidate evidence on associations between protective factors and mental health outcomes in children and adolescents in the past 10 years
Summary
Dray et al, 2017 [27], in undertaking a recent relevant systematic review of the related international evidence base, compiled a list of 31 internal and external protective factors from research published by eminent resilience and mental health researchers conducting eligible studies across 16 countries including: Australia, United States, Canada, Ireland, Germany, Italy, Netherlands, Scotland, Norway, China, Switzerland, England, Chile, India, Mauritius, and New Zealand [17,19,22,37,38,39,40,41,42,43,44,45,46,48,54,55] (Table 1) This list is not assumed to be complete or a ‘gold standard’, but does serve as a tool for classifying the multitude of factors targeted by resilience-focussed interventions. Meaningful relationships with ≥1 significant supportive adult who the child can talk to (e.g., family member, teacher, community mentor)
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