Aspects of positive and negative mental health in young people, aged 16-29 years : measurements, determinants, and interventions

Background: Mental health problems in young people, i.e. those self-reported as well as registered diagnoses, have been of concern for decades. For Western societies, most studies indicate a rise in symptoms, but also in diagnoses of depression, anxiety and stress in younger age groups since the 1990s. The increase follows a pattern of societal changes, namely a prolongation of young people’s years in education, later entry into the labour market with frequently insecure conditions, longerstanding time without own housing and postponed building of partnership and family. A large number of studies focusing on young people’s mental ill health have been carried out, but less attention has been paid to positive mental health (PMH) in the age group of 16-29 years. PMH allows a view where building on strengths, capacity and health promotion is accentuated rather than leaning on deficit models and prevention of mental ill health. A balanced consideration of both aspects of mental health should give a more complete picture of the mental health characteristics in young people. Aim: The overall aim was to identify which potential determinants are associated with or may predict positive and negative mental health (NMH) in the age group of 16-29 years by self-reporting measurements, and to investigate the effectiveness of mental health interventions. Methods: The thesis is built on analyses of two population surveys (Study I and Study II), along with merged data from intervened secondary schools (Study III), and lastly on a systematic review and meta-analysis of mental health interventions for students in tertiary education (Study IV). Specifically, the data-sources and study populations for the specific research questions were as follows. First, we investigated if the 12-item General Health Questionnaire (GHQ-12) had the capacity to measure PMH in addition to NMH. We employed data from the cross-sectional Swedish National Public Health Survey 2004-2009, including 41,668 individuals aged 16-29 years. Additionally, we investigated if the survey’s health and background factors, i.e. potential determinants of mental health, could be related to either PMH or NMH factors (Study I). Second, we examined which potential determinants predict stable mental health, specifically reporting < 3 GHQ-points at all four measurement waves in the population aged 18-29 years compared to older age groups. We utilised longitudinal data from the Stockholm Public Health Cohort 2002, 2007, 2010, and 2014 including 3,373 individuals in the younger group, and 16,614 individuals aged 30-84 years (Study II). Third, we explored whether subjective well-being (SWB), i.e. emotional well-being and life satisfaction, is associated with personality traits at baseline and at 15-18 months of follow-up and whether personality traits may prospectively predict subjective well-being and vice versa. We employed our earlier data-collection from four secondary schools, two intervention- and two control schools, including 446 pupils (Study III). Finally, we investigated sustainable promotive and preventive mental health intervention effects for students in higher education. A systematic review and meta-analyses based on 26 included studies and a study population of 8,136 individuals were conducted (Study IV). Results: Study I. The General Health Questionnaire 12 (GHQ-12) in the National Health Survey revealed a capacity to measure PMH as well as NMH. However, when we examined the association between the GHQ-12 scores and 22 potential determinants of health, we found that most determinants showed significant and opposing effects on both PMH and NMH. Nonetheless, female sex, economic strain, risky gambling, and, above all, suicide ideation and perceived humiliation increased NMH more than they decreased PMH, and could qualify as risk factors. Participating in societal events and moderate gambling elevated PMH more than they reduced NMH and could subsequently be ascribed as promotive factors. Being a student was associated with lower PMH and higher NMH compared to being employed. Lastly, PMH decreased as age increased in the group of 16-29 years, whereas no age-related changes were found for NMH. Study II. In the Stockholm Public Health Cohort, 46% for males and 36% for females reported stable mental health among young people aged 18-29 years, compared to 66% and 55% respectively, in the age group 30 years and above. Out of 17 possible determinants of health, six predicted stable mental health in the younger group: occupational status, especially employment, emotional support, being male, being born in Sweden, absence of financial strain, and consumption of fruit and berries. In the older age group, the pattern was similar, with 11 significant determinants of health. However, more determinants were related to social capital and health behaviour compared to the younger group, and a significant group difference was evident for physical activity and absence of financial strain with higher importance in the older group. Study III. Among secondary school pupils aged 16 years, SWB at baseline and follow-up was associated with low levels of Neuroticism, and high levels of Conscientiousness, Extraversion and Agreeableness. In particular, the correlation between SWB and Neuroticism was strong. Compared to boys, trait stability was significantly higher in girls. However, one exception was Neuroticism, the only trait with stability in boys. SWB showed one prospective effect, namely on Agreeableness and only in girls. For personality traits, no prospective effects on SWB were found. Study IV. According to our systematic review and meta-analysis combined effects for interventions designed to prevent mental ill health in students in higher education showed that the symptom reduction sustained up to 7-12 months postintervention, although the effect size was small, ES of -0.28 (95% CI -0.49, -0.08). Specifically, for depression the sustainability was up to 13-18 months, for anxiety up to 7-12 months, and for stress up to 3-6 months. The sustainability for interventions designed to increase positive mental health was up to 3-6 months for all effects combined, and the effect size was small, ES of 0.32 (95% CI 0.05, 0.59). Specifically, active coping sustained 3-6 months with a medium effect size, ES of 0.75 (95% CI 0.19, 1.30). Conclusions: In our national sample, the GHQ-12 did not systematically discriminate potential determinants associated to positive and negative mental health, respectively, and therefore should be reserved for its purpose of origin, namely to measure symptoms of mental ill health in the population. Our results which show that young females seem to perceive less stable mental health and higher levels of Neuroticism compared to their male peers confirm the results from earlier studies. This is also true regarding young people’s less stable mental health and higher levels of mental ill health symptoms compared to older age groups. As occupational status, especially employment, and emotional support may serve as determinants predicting mental health stability among young people, promoting them should be a matter of urgency. Interventions in higher education showed sustainable effects, and it may be of importance to endorse those interventions. As other interventions enhancing positive mental health, and those with a whole-system approach in schools, higher education, and working-life are less well explored, further research should shed a light on these important topic

Social innovation supports inclusive and accelerated energy transitions with appropriate governance

Accelerating energy transitions that are both sustainable and just remains an important challenge, and social innovation can have a key role in this transition. Here, we examine the diversity and potential of social innovation in energy systems transformation, synthesizing original mixed methods data from expert interviews, document analysis, social innovation experiments, a representative survey, and an expert survey. Based on a thematic analysis of these data, we advance four key findings: (1) the diversity of social innovation in energy is best understood when recognizing core social practices (thinking, doing, and organizing) and accounting for changes in social relations (cooperation, exchange, competition, and conflict); (2) governance, policy networks, and national context strongly shape social innovation dynamics; (3) processes of social innovation are implicated by multidimensional power relations that can result in transformative changes; and (4) social innovation in energy generally has strong social acceptance among citizens, benefits local communities and is legitimized in key community and city organizations. We discuss an agenda for 9 future research directions on social innovation in energy, and conclude with insights related to national context, governance, and acceleration

Does a short-term intervention promote mental and general health among young adults? – An evaluation of counselling

<p>Abstract</p> <p>Background</p> <p>Since 1988, self-reported mental health problems in Sweden have increased more among young people than in any other age group. Young adults aged 18 – 29 with minor mental health problems were welcomed to four (at most) counselling sessions led by psychotherapists. The present study aimed to evaluate the method's appropriateness and usefulness.</p> <p>Methods</p> <p>The study population was recruited consecutively during six months (N = 74) and consisted of 59 women and 15 men. Fifty-one, 46 women and five men, met the criterion for a <it>personal semi-structured interview </it>three months post intervention. Self-assessed health data were collected on three occasions using the General Health Questionnaire (GHQ-12), Pearlin's Personal Mastery Scale and two items from the Swedish Living Conditions Surveys. Thirteen women and six men were not statistically assessed due to incomplete data, but were <it>interviewed by telephone</it>. Four men refused to be interviewed and became <it>dropouts</it>.</p> <p>Results</p> <p>The largest group of the study population had long been troubled by their problem(s): 43 percent for over three years and 28 percent for over one year. Among those <it>personally interviewed</it>, 76 percent reported psychological distress (> 3 GHQ points) before the counselling. After the counselling, GHQ-12 distress decreased by 50 percent while mastery and perceived health status increased significantly. A majority experienced an improved life situation, found out something new about themselves and could make use of the sessions afterwards. Personal participant session contentment was about 70 percent and all counsellees would recommend the intervention to a friend. Those <it>interviewed by telephone </it>were not statistically assessed due to incomplete health data. Their personal contentment was just under 50 percent, though all except one would recommend the counselling to a friend. Their expectations of the intervention were more result-orientated compared to the more process-directed personally-interviewed group.</p> <p>Conclusion</p> <p>This evaluation shows a clear improvement in self-rated mental and general health, mastery and control in the group completing the study agreement. The intervention seems to be effective for young adults with minor mental health problems, but due to the skewed gender-distribution it is unclear if the method is appropriate for men. After the proposed internal quality improvements, this short-term counselling could enhance mental and general health among young people.</p

Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy

Background: Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods: ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings: Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86–1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91–1·32; p=0·21). Interpretation: Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable. Funding: UK Medical Research Council and Health Technology Assessment Programme

Social innovation in energy transition : evaluation challenges and innovative solutions

The climate crisis needs urgent solutions and potential agents of change are cooperatives, citizen initiatives, start-ups etc., which form social innovation initiatives. Social innovations in energy transition (SIEs) are defined as “(combinations of) ideas, objects and/or actions that change social relations and involve new ways of doing, thinking and/or organising energy. ” (Wittmayer et al. 2020, iv). This is how the H2020 project SONNET defines SIEs, on which this paper is based on. The aim of the paper is to illustrate how challenging the evaluation of the success of those diverse types of SIEs is and what approaches were and can be applied. Evaluating whether SIEs are successful means to understand whether SIE-initiatives have been successful in achieving goals and which types of SIEs are more successful in achieving certain goals than others. We differentiated between the aims held by SIE-initiatives themselves (SIE-aims), aims which are shared by the EU and SIEs (shared-aims), and aims of the European Energy Union which are not shared by SIE’s (EU-aims). The aims of the SIE-initiatives were based on literature review and a survey among the empirically studied SIEs in SONNET. We find that many of the studied SIE-initiatives do not monitor their impacts as resources are scarce. Some of the impacts occur in people’s mind (such as impacts on “thinking”), and even the impacts which can and have been monitored are hard to compare across different initiatives, due to their diversity. Therefore, our surveys only capture the perceived contributions of SIEs to the different goals. Based on the surveys we find that SIE-initiatives achieved significantly higher contributions towards SIE-aims than towards EU-aims or shared-aims and that the perceived contribution is stronger for those aims with higher importance. The SIE-aims with the highest contributions were “improve social acceptance of renewable energy production” and “strengthen local community”. The shared-aims with the highest contributions were “increased renewables production” and “reduced greenhouse gas emissions”. The perceived contribution towards other EU-aims or shared-aims was rather low. Looking at the different SIE-types, in general SIE-initiatives focusing on “Thinking”-type of activities seem to achieve slightly lower contributions for many of the aims we assessed than the other types of activities (“Doing”, “Organizing”). Regarding the social relation, contributions towards shared aims were significantly higher in case of SIE-initiatives working on a “Competition” setting, and significantly lower in case of SIE-initiatives that were in “Conflict” than for the other types of social relations (i.e. “Cooperation” and “Exchange”). Our conclusion was that not one evaluation method fits all SIEs and we explored in a workshop how innovative approaches such as media analysis (news databases, websites, social media) and web tracking (google analytics/facebook) might be used for future evaluations of SIEs

Der schweizerische Strommarkt zwischen Liberalisierung und Regulierung : eine ökonomische Auslegeordnung

Die Energiestrategie 2050 des Bundes verfolgt einen weitgehenden Umbau des Energiesystems in der Schweiz. In diesem System wird der Strommarkt eine wichtige Rolle spielen. Die zentralen Fragen dabei sind, wie viel Liberalisierung möglich und wie viel Regulierung nötig ist, um einen effizienten Markt zu schaffen und gleichzeitig die politisch angestrebten Ziele zu erreichen. Das vorliegende Handbuch setzt an dieser Stelle an. Es erarbeitet eine Auslegeordnung in einem ökonomischen Analyserahmen, welche diese Fragen zwar nicht abschliessend beantwortet, aber dazu beiträgt, die aktuelle und künftige Strommarktpolitik der Schweiz zu verstehen, einzuordnen und sachlich zu beurteilen

What Predicts Stable Mental Health in the 18–29 Age Group Compared to Older Age Groups? Results from the Stockholm Public Health Cohort 2002–2014

Mental health has decreased in young people since the 1990s, and mental health promotion is an urgent matter. A first step is to identify which social determinants could be of importance for intervention. We used the Stockholm Public Health Cohort, a longitudinal population-based health survey, completed by 31,000 inhabitants in the Stockholm County. We focused on the 18&#8315;29 age group, n = 3373 (60% females, 40% males) and aimed at assessing which social determinants predict stable mental health, measured as scoring &lt;3 points on the General Health Questionnaire 12 at all time points: 2002, 2007, 2010, and 2014. Forty-six percent of males and 36% of females reported stable mental health. Among the 17 predictors on sociodemographics, socioeconomics, social capital, health behavior, and victimization, six predicted stable mental health in the following order: occupation and especially employment, emotional support, male gender, being born in Sweden, absence of financial strain, and consumption of fruit and berries. In the 30&#8315;84 age group, 66% males and 55% females reported stable mental health. Nine determinants in the following rank predicted stable mental health: absence of financial strain, occupation and especially being self-employed, emotional support, male gender, physical activity, instrumental support, interpersonal trust, community trust, and absence of hazardous alcohol consumption. Interaction analysis showed significant difference between the younger and older group regarding physical activity and absence of financial strain with importance being higher for the older group. Our findings indicate that the determinants of health differ across the life-course with fewer predictors related to social capital and health behavior in the younger group compared to the older. We conclude that health-promoting interventions should be lifespan-sensitive

Effects of mental health interventions for students in higher education are sustainable over time: a systematic review and meta-analysis of randomized controlled trials

Background Symptoms of depression, anxiety, and distress are more common in undergraduates compared to age-matched peers. Mental ill health among students is associated with impaired academic achievement, worse occupational preparedness, and lower future occupational performance. Research on mental health promoting and mental ill health preventing interventions has shown promising short-term effects, though the sustainability of intervention benefits deserve closer attention. We aimed to identify, appraise and summarize existing data from randomized control trials (RCTs) reporting on whether the effects of mental health promoting and mental ill health preventing interventions were sustained at least three months post-intervention, and to analyze how the effects vary for different outcomes in relation to follow-up length. Further, we aimed to assess whether the effect sustainability varied by intervention type, study-level determinants and of participant characteristics. Material and Methods A systematic search in MEDLINE, PsycInfo, ERIC, and Scopus was performed for RCTs published in 1995–2015 reporting an assessment of mental ill health and positive mental health outcomes for, at least, three months of post-intervention follow-up. Random-effect modeling was utilized for quantitative synthesis of the existing evidence with standardized mean difference (Hedges’ g) used to estimate an aggregated effect size. Sustainability of the effects of interventions was analyzed separately for 3–6 months, 7–12 months, and 13–18 months of post-intervention follow-up. Results About 26 studies were eligible after reviewing 6,571 citations. The pooled effects were mainly small, but significant for several categories of outcomes. Thus, for the combined mental ill health outcomes, symptom-reduction sustained up to 7–12 months post-intervention (standardized mean difference (Hedges’ g) effect size (ES) = −0.28 (95% CI [−0.49, −0.08])). Further, sustainability of symptom-reductions were evident for depression with intervention effect lasting up to 13–18 months (ES = −0.30 (95% CI [−0.51, −0.08])), for anxiety up to 7–12 months (ES = −0.27 (95% CI [−0.54, −0.01])), and for stress up to 3–6 months (ES = −0.30 (95% CI [−0.58, −0.03])). The effects of interventions to enhance positive mental health were sustained up to 3–6 months for the combined positive mental health outcomes (ES = 0.32 (95% CI [0.05, 0.59])). For enhanced active coping, sustainability up to 3–6 months was observed with a medium and significant effect (ES = 0.75 (95% CI [0.19, 1.30])). Discussion The evidence suggests long-term effect sustainability for mental ill health preventive interventions, especially for interventions to reduce the symptoms of depression and symptoms of anxiety. Interventions to promote positive mental health offer promising, but shorter-lasting effects. Future research should focus on mental health organizational interventions to examine their potential for students in tertiary education

Positive versus negative mental health in emerging adulthood : a national cross-sectional survey

Background: The dual continuum model suggests that positive mental health not only implies the absence of mental illness, but also constitutes an entity of its own. Measures that encompass both positive and negative mental health in young adults are rare. Thus, we assessed whether dimensions corresponding to positive and negative mental health could be identified in a sample of young individuals. Additionally, we explored how such dimensions were associated with potential health-related factors. Methods: We obtained data from the Swedish National Public Health Survey 2004-2009 (23,394 women, 18,274 men, aged 16-29 years). We used exploratory factor analysis (EFA) to identify relevant factors revealed by the 12-item General Health Questionnaire (GHQ-12) and confirmatory factor analysis (CFA) to verify the factor structure. We tested the significance of the difference between effects of potential health-related factors on positive mental health (PMH) and negative mental health (NMH). Results: The EFA for the GHQ-12 revealed a two factor model with negative items that had high positive loadings on one factor and lower negative loadings on the other factor. The positive items had loading trends that were opposite those of the negative items. The fit of this model was supported by the CFA, which yielded a significantly better match than a unidimensional model. When we investigated the associations between GHQ-scores and potential predictors of health, we found that most potential predictors had significant and opposing effects on both PMH and NMH; with the strongest effects from suicidal ideation and perceived humiliation. Conclusions: Our results could be seen to indicate that positive and negative mental health are distinct and complementary constructs. Still, the results of our factor analysis may specifically reflect the wording of the items. We conclude that the GHQ-12 is an appropriate tool for its original purpose, to detect "psychiatric morbidity". More refined measures, including predictors of health, are needed to assess PMH and validate the bidimensionality hypothesis