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Mental health problems among adolescents: Public health nurses' work and interprofessional collaboration within the school health service
Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013). Inland Norway University of Applied Sciences, Norway.ORCID iD: 0000-0002-9105-2791
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim with this thesis was to study adolescents with mental health problems, factors that are associated with mental health problems, visits to the public health nurse (PHN), and how PHNs and other professionals experience the collaboration in school and school health services related to mental health problems.

 

Methods: Qualitative and quantitative methods were used. Study I included cross-sectional data from Ungdata, with 8052 adolescents. Descriptive statistics and hierarchical regression were used to analyse the data. Study II included individual interviews with 12 boys and qualitative content analysis was used. In study III, four focus group interviews were conducted and analysed with qualitative content analysis. In study IV, 18 PHNs were individually interviewed and a phenomenographic approach was used to analyse the interviews.

Results: Gender differences were seen in the symptoms of depression, family conflicts and economics, lifestyle habits, school satisfaction and use of school health services with girls reporting in a higher proportion than boys. Boys described barriers such as finding the PHN inaccessible, difficulty talking about mental health problems and uncertainty about confidentiality when visiting the PHN. Interprofessional collaboration (IPC) is important for identifying adolescents with mental health problems. Accessibility, having different obligations, lack of criteria and goals and being dependent on others were described as affecting IPC.

Conclusion: There are differences in boys and girls with girls reporting more mental health problems and visiting the school health service more often than boys. Boys described several barriers to visiting the PHN, but, when these barriers were crossed, the boys experienced the visit as positive. Several factors affected IPC in schools and the school health services. There were variations in the collaboration experienced, but when it worked it was experienced as positive.

Abstract [en]

Mental health problems among adolescents are increasing and are a major public health issue worldwide. The aim of this thesis was to study adolescents with mental health problems, factors that are associated with mental health problems, the visit to the public health nurse (PHN), and how PHNs and other professionals experience interprofessional collaboration (IPC) in school and school health services related to mental health problems. Gender differences in mental health problems, as well as in help-seeking behavior, were identified. Boys visit the PHN to a smaller extent than girls and they experienced barriers such as finding the PHN inaccessible, difficulty talking about their problems with the PHN and uncertainty about confidentiality. When the PHN was trustworthy, confident and supportive, the visit was described as positive.

The PHN in the school health service is in a position to identify mental health problems among adolescents In this setting IPC is essential. Factors such as lack of criteria and goals, different obligations, accessibility and being dependent on others were affecting collaboration. When the professionals and the PHN were included in the IPC, it was experienced as positive.

Place, publisher, year, edition, pages
Karlstad: Karlstads universitet, 2019. , p. 81
Series
Karlstad University Studies, ISSN 1403-8099 ; 2019:24
Keywords [en]
adolescents, interprofessional collaboration, mental health problems, public health nurse, secondary school
National Category
Nursing
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:kau:diva-74366ISBN: 978-91-7867-043-7 (print)ISBN: 978-91-7867-048-2 (electronic)OAI: oai:DiVA.org:kau-74366DiVA, id: diva2:1343434
Public defence
2019-10-04, 1A 305, Lagerlöfsalen, Karlstad, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2019-09-11 Created: 2019-08-16 Last updated: 2019-09-11Bibliographically approved
List of papers
1. Gender differences in symptoms of depression among adolescents in Eastern Norway: Results from a cross-sectional study
Open this publication in new window or tab >>Gender differences in symptoms of depression among adolescents in Eastern Norway: Results from a cross-sectional study
2019 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 47, no 2, p. 157-165Article in journal (Refereed) Published
Abstract [en]

Aim: The aim of this study was to compare and describe gender differences and the associations between symptoms of depression and family conflict and economics, lifestyle habits, school satisfaction and the use of health-care services among adolescents. Methods: Data were retrieved from Ungdata which is a cross-sectional study. Adolescents (n=8052) from secondary school grades 8, 9 and 10 (age 13–16 years) participated in the study from 41 municipal schools in four counties. Results: Girls reported a higher prevalence of symptoms of depression than boys. Gender differences were seen on all items related to symptoms of depression, family conflict and economics, lifestyle habits, school satisfaction and health-care services. Multiple regressions showed that family conflicts and economics contributed to 19.2% of the variance in symptoms of depression in girls and 12.4% in boys. School satisfaction made a strong contribution: 21.5% in girls and 15.4% in boys. The total model explained 49% of the total variance in symptoms of depression in girls and 32.5% in boys. Conclusions: Gender demonstrated a pattern through a higher proportion of girls reporting symptoms of depression, family conflict and economics, lifestyle habits, school satisfaction and use of health-care services. Even though the adolescents reported symptoms of depression, few used the school health-care services and public health nurses. This indicates that they need a person-centered approach for symptoms of depression. The findings may have important implications for planning for adolescents in school health services.

Place, publisher, year, edition, pages
SAGE Publications Ltd, 2019
Keywords
Adolescent, depression, gender, lifestyle habits, school health-care, school satisfaction, socioeconomics
National Category
Nursing
Identifiers
urn:nbn:se:kau:diva-66553 (URN)10.1177/1403494817715379 (DOI)000462758700010 ()2-s2.0-85042186768 (Scopus ID)
Available from: 2018-03-02 Created: 2018-03-02 Last updated: 2019-08-16Bibliographically approved
2. Overcoming barriers to reach for a helping hand: Adolescent boys' experience of visiting the public health nurse for mental health problems
Open this publication in new window or tab >>Overcoming barriers to reach for a helping hand: Adolescent boys' experience of visiting the public health nurse for mental health problems
(English)Manuscript (preprint) (Other (popular science, discussion, etc.))
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-74369 (URN)
Available from: 2019-08-16 Created: 2019-08-16 Last updated: 2019-08-27Bibliographically approved
3. Experiences of interprofessional collaboration in a special school programme for adolescents who struggle with school life: an explorative study
Open this publication in new window or tab >>Experiences of interprofessional collaboration in a special school programme for adolescents who struggle with school life: an explorative study
2019 (English)In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567Article in journal (Refereed) Epub ahead of print
Abstract [en]

A growing proportion of adolescents struggle with school life and could benefit from special school programmes. School could be an arena for supporting such adolescents and, to meet these challenges, interprofessional collaboration (IPC) has been recommended for better health. The aim of the present study was to explore the experience of IPC in a special school programme offered to adolescents who struggle with school life–from the perspective of the professionals involved. Focus group interviews were carried out with four groups and fourteen participants, and the focus groups included two to five participants each. The focus group interviews were analysed using qualitative content analysis. The analyses from this study resulted in a main theme: IPC in the special school programme is unpredictable. Five categories emerged from the data, including: variations in initiative, significance of individual characteristics, informal and formal contact, lack of criteria and goals, and different obligations. The participants described IPC as differing from case to case, with a lack of criteria and goals for adolescents in the special school programme. They experienced the random nature of whoever took the initiative to collaborate, and that confidentiality and the different documentation requirements could affect IPC.

Place, publisher, year, edition, pages
Taylor and Francis Ltd, 2019
Keywords
Adolescent, interprofessional collaboration, qualitative content analysis, school absence, school programme, secondary school, article, clinical article, confidentiality, content analysis, documentation, female, high school, human, human experiment, interview, male
National Category
Pedagogy Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Education; Public Health Science
Identifiers
urn:nbn:se:kau:diva-71276 (URN)10.1080/13561820.2019.1565755 (DOI)2-s2.0-85060213212 (Scopus ID)
Note

In press 21 feb 2019

Available from: 2019-02-21 Created: 2019-02-21 Last updated: 2019-08-16Bibliographically approved
4. Public health nurses' perceptions of interprofessional collaboration related to adolescents' mental health problems in secondary schools: A phenomenographic study
Open this publication in new window or tab >>Public health nurses' perceptions of interprofessional collaboration related to adolescents' mental health problems in secondary schools: A phenomenographic study
2019 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 28, no 15-16, p. 2899-2910Article in journal (Refereed) Published
Abstract [en]

Aims and objectives: To describe the variation in public health nurses' perceptions of interprofessional collaboration related to adolescents' mental health problems in secondary schools in Norway. Background: Mental health problems among adolescents account for a large portion of the global burden of disease and affect 10%–20% of adolescents worldwide. Public health nurses in school health services play an important role in disease prevention and promotion of physical and mental health. In order to serve adolescents with regard to mental health problems, public health nurses are dependent on collaboration with other professionals in schools. Design: Qualitative interviews were conducted with 18 public health nurses working in the school health services. Method: A phenomenographic approach was used for interviewing and for analysing the qualitative interviews. This study is presented in line with COREQ's checklist. Result: The analysis resulted in three descriptive categories based on eight identified conceptions. The categories are as follows: “The formal structure has an impact on interprofessional collaboration”; “The public health nurse is an important, but not always self-evident, partner in interprofessional collaboration”; and “The primary players are the teachers in collaboration.”. Conclusion: The public health nurses describe that they had limited impact on collaboration and were dependent on both the school principal and the teachers for achieving good collaboration. Teachers have the power to decide whether to collaborate with the public health nurse, and public health nurses regard teachers as the most important collaborative partners. The public health nurses need to make themselves and their competence visible. Relevance to clinical practice: The findings demonstrated that public health nurses are important collaborators, but are not always included in interprofessional collaboration. This knowledge is essential to strengthen public health nurses' roles and presence in schools, which could most certainly benefit adolescents with mental health problems in secondary school.

Place, publisher, year, edition, pages
Blackwell Publishing, 2019
Keywords
adolescents, interprofessional collaboration, mental health problems, phenomenography, public health nurse, secondary school
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-72498 (URN)10.1111/jocn.14881 (DOI)000476595300018 ()2-s2.0-85065186850 (Scopus ID)
Available from: 2019-06-13 Created: 2019-06-13 Last updated: 2019-08-16Bibliographically approved

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Granrud, Marie Dahlen

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