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Adolescent mental health problems are a well-recognized and frequently discussed societal problem in Sweden. However, few studies concerning adolescents’ own views on mental health concepts and associated stigma have been conducted. This thesis, including two sub-studies, investigated Swedish adolescents’ views of mental health concepts, mental health problems and perceptions about stigma. A total of 32 adolescents on the Swedish island Gotland were interviewed either in focus groups or individually.

In sub-study I on mental health concepts, adolescents described mental well-being as a condition with emotional well-being and good psychological and social function, which they termed to feel well. Mental health problems were described as a spectrum of conditions, caused by several factors. All kinds of mental health problems were termed to feel unwell or to not feel well. Both the presence of mental well-being and symptoms of mental health problems were suggested to be considered when assessing young peoples’ mental health.

Sub-study II explored adolescents’ perceptions of the prevalence of mental health problems and related stigma among young people. The adolescents perceived mental health problems as a natural part of their lives and explained the increase by current living condition factors, e.g. pressure related to school or social media and improved openness about mental health problems. Stigmatisation of young people with mental health problems were recognised to be caused by prejudice, triggered by lack of knowledge. The adolescents wished for a future without stereotypic gender norms and stigma of mental health problems.

In conclusion, findings of the thesis suggest that adolescents’ descriptions of mental health concepts encompass a broad range of conditions, from normal challenges that can cause distress to severe disabling mental health problems. Furthermore, adolescents acknowledge the simultaneous presence of mental wellbeing and mental health problems, as well as stigma consisting of negative preconceptions, stereotyping and discrimination. The results highlight that adolescents have a complex contextual understanding of mental health problems, but use the terms to feel well or unwell, of which adults need to be aware. Additionally, taking rumour spreading seriously and actively addressing stereotypic gender norms could be important to improve adolescents’ mental health.

Adolescents’ mental health is a current public health issue. However, research, on adolescents’ views on different aspects of mental health, and the prevalence of mental well-being, mental illness and related stigma, among adolescents is limited in Sweden. The overall aim of this thesis was to explore perceptions and status of mental health and stigma related to mental health problems among adolescents in a Swedish context. 

Study I and II were based on qualitative interviews with 32 adolescents on the Swedish island Gotland. Study I indicated that the adolescents had a complex understanding of various mental health concepts but labelled mental well-being as ‘feeling good’ and mental illness as ‘feeling bad’. In Study II, the adolescents described mental health problems as common due to current living conditions, e.g. stress related to school performance and social media and an increased openness about mental health problems. Stigmatisation of people with mental health problems was perceived as problematic, caused by lack of experience and knowledge, but also as related to rumour spreading and stereotypical gender norms. 

Study III and IV were based on the Life and Health Youth survey, conducted in secondary schools located on Gotland. In study III, the results according to the dual-factor model of mental health showed that most adolescents had vulnerable mental health status (47.5%), while 36.2% had complete mental health. A smaller proportion had troubled (13,9%) or symptomatic but content (2,5%) mental health status. Associations were observed between mental health status and gender, grades, truancy, stress level, resilience, and subjective social status in school. 

In study IV, the factor structure and internal consistency was acceptable for the modified Attitudes About Mental Illness and its Treatment scale, but the adolescents perceived it as difficult to answer. Further, negative attitudes towards people with mental health problems were present, and more common among boys and foreign-born adolescents. 

The findings of this thesis suggests the two-factor model of mental health and the three-part description of stigma, including stereotypes, prejudice and discrimination, to be applicable among adolescents. Further, the findings suggest a need for promotion of mental well-being and prevention of mental health problems such as interventions to reduce school-related stress, increase resilience and promote societal knowledge about mental health, stigma and gender stereotypes among adolescents. The findings also motivate support to adolescents with low mental wellbeing and minor mental health problems as well as to adolescents who have friends with mental health problems. 

Ungdomars psykiska hälsa är en aktuell folkhälsofråga. Forskning om ungdomars syn inom området psykisk hälsa och om förekomst av psykiskt välbefinnande, psykisk ohälsa och relaterat stigma är dock begränsad i Sverige. Syftet med avhandlingen var att undersöka uppfattningar om och status för psykisk hälsa och stigma relaterat till psykisk ohälsa bland ungdomar i en svensk kontext.

Studie I och II byggde på kvalitativa intervjuer med 32 ungdomar på Gotland. I studie I framkom att ungdomarna hade en komplex förståelse för begrepp inom området psykisk hälsa, men benämnde psykiskt välbefinnande som att ”må bra” och psykisk ohälsa som att ”må dåligt”. I studie II beskrev ungdomarna psykisk ohälsa som vanligt förekommande utifrån nuvarande levnadstillståndsförhållanden med t.ex. stress relaterat till skolprestationer och sociala medier, samt ökad öppenhet kring psykisk ohälsa. Stigmatisering av personer med psykiska problem uppfattades som negativt och beroende på bristande erfarenhet och kunskap, men också relaterat till ryktesspridning och stereotypa könsnormer.

Studie III och IV byggde på enkäten Liv och Hälsa Ung Gotland som genomfördes i högstadiet och gymnasiet på Gotland. I studie III visade resultaten utifrån två-faktormodellen för psykisk hälsa att 36,2% hade fullständig psykisk hälsa. De flesta ungdomarna hade sårbar psykisk hälsa (47,5%). En mindre andel hade besvärad eller symtomatisk men nöjd psykisk hälsostatus (13,9% respektive 2,5%). Resultaten visade också samband mellan psykisk hälsostatus och kön, betyg, skolk, stressnivå, resiliens och subjektivt upplevd social status i skolan.

I studie IV uppvisade den modifierade versionen av skattningsskalan Attitudes About Mental Illness and its Treatment acceptabel faktorstruktur och intern konsistens. Ungdomarna upplevde den dock som svår att besvara. Vid mätningen med skattningsskalan återfanns viss förekomst av negativa attityder mot personer med psykisk ohälsa, vilket var vanligare bland pojkar och utlandsfödda ungdomar.

Avhandlingens resultat indikerar att två-faktormodellen för psykisk hälsa och den tredelade beskrivningen av stigma som innefattande stereotyper, fördomar och diskriminering är tillämpbar bland ungdomar. Resultaten tyder på behov av åtgärder för främjande av psykiskt välbefinnande och förebyggande av psykisk ohälsa. Exempelvis insatser för att minska skolrelaterad stress och öka resiliens bland ungdomar, samt för att främja kunskap om psykisk hälsa, stigma och stereotypa könsnormer i samhället. Stöd till ungdomar med lågt psykiskt välbefinnande, mildare psykisk ohälsa och med vänner med psykisk ohälsa är också motiverat.