Conceptualisations of positive mental health and wellbeing among children and adolescents in low‐ and middle‐income countries: A systematic review and narrative synthesis

Upper middle-income countries

Suttharangsee (1997)

Thailand

Qualitative—ethnonursing 23; 13 (56%) 17 [N/R, N/R]a To assess views about what constitutes mental health and beliefs about factors for achieving and maintaining positive mental wellbeing

Mental health

good mood (smiling, being cheerful and polite and being worry-free),

positive thinking (good attitude towards one's self, focussing on the positive aspects of others and of situations) and

good social relationships (being friends with others and ability to manage problems).

Consistent with Thai cultural belief and Buddhism

Yu et al. (2019)

China

Qualitative—multimethod comprising

photovoice, community mapping and focus group discussions

90; 44 (48.8%) 17.4 [1.3; 15–19] To understand the factors that facilitate and hinder disadvantaged adolescents from obtaining the health information and services they need to secure good health Mental health perceived mainly in negative terms

frustration,

low self-esteem,

mood swings

Zeng et al. (2019)

China

Survey design—longitudinal 17,854; 8306 (46.5%) N/R [N/R; 6–18] To analyse the network structure of adolescent well-being and identify the central well-being traits utilizing data from 11 samples of adolescents from primary and secondary schools in rural and urban areas of Southern, Northern and middle parts of China Perceptions of wellbeing Engagement relates to the high value placed on achievement in Chinese culture

Davids et al. (2017)

South Africa

Survey design—cross-sectional 243; 131 (53.8%) 16.31 [0.4, N/R] To examine the relationship between psychological wellbeing and mental health self-help behaviour Mental health behaviours for wellbeing (most to least used among children and adolescents)

spiritual growth,

interpersonal relations,

stress management

Having intrinsic and extrinsic goals were correlated with positive affect (PA) while mental health behaviour did not significantly predict PA in regression analysis No gender differences in goals, affect or mental health behaviours

Morais et al. (2012)

Brazil In Portuguese

Survey design 1168; 619 (53%) 15.80 [1.68, 10–21] To explore the concepts of mental health and wellbeing and understand self-help strategies to improve wellbeing Psychological wellbeing manifest in children and adolescents

Positive attributes and behaviours (good relationships, happiness, positive thoughts, energy, equilibrium)

Control (clear thoughts, life under control)

Absence of illness (absence of maladaptive coping, no personal problems or illness, not seeing a therapist)

Children and adolescents agreed on the importance of wellbeing and mind-body connection

Nastasi and Borja (2015)b Chapter 8—Perkins et al.

Mexico

Mixed methods (some quantitative and some qualitative analysis—focus groups and ecomap activities)

68; 37 (54%) Focus group study

68; 52 (59%) Ecomap Study

N/R [N/R, 6–15] Focus group study

12 [N/R, 6–16]

Ecomap Study

To explore stressors and sources of support for psychological wellbeing Family most frequently occurring source of support, children and adolescents reported several sources of stress/negative influences on wellbeing:

academics/school

family,

peers

community

Identified a range of positive self-help strategies and females had a higher number of supportive relationships than males

Jenkins et al. (2019)

Mexico In Spanish

Mixed-methods comprising quantitative (sociodemographic questionnaire and standardized symptom scales) and qualitative (in-depth ethnographic interviews, observation) components 35; 20 (57.1%) 15.9 [0.7, 15–17] To generate an ethnographically informed understanding of contexts and processes that shape the emotional wellbeing and mental health of adolescents Deficiencies in familial and close interpersonal relationships significant contributors to loneliness that lead to poor mental health A range of self-help strategies identified, including music, exercise and sport, going online and spending time alone to process difficult emotions

Gonzalez-Fuentez Palos (2016)

Mexico In Spanish

Mixed methods comprising quantitative survey derived from qualitative analysis 1635; 856 (52.35) N/R [N/R, 14–20] To qualitatively evaluate the meaning of psychological wellbeing for adolescents and design and validate a scale to measure this construct Factorial analysis of wellbeing components included seven factors:

Nastasi and Borja (2015)b Chapter 3—Lizardi and Carregari Brazil

Qualitative—multimethod comprising focus groups and ecomaps 55; 27 (49%) N/R [N/R, 6–17] To identify understandings of psychological wellbeing Important sources of support identified included:

parents,

family relations,

siblings,

teachers

Younger children were identified as having fewer self-help strategies while older children were more likely to describe aggressive physical and verbal reactions as effective ways of coping with stress Lower middle-income countries

Adelson et al. (2016)c

India

Qualitative—multimethod comprising focus groups, ecomap drawings and ecomap stories 37; 37 (100%) N/R[12–20] To explore perspectives of psychological wellbeing Risk factors for poor psychological wellbeing occurred in the following domains: Self-help strategies listed a number of activities and leveraging the support of others for advice and counsel

Nastasi and Borja (2015)c,b

Chapter 6—Adelson et al.

India

Qualitative—multimethod comprising focus groups and ecomaps 37; 37 (100%) N/R, [N/R, 12–20] To explore stressors and protective factors for psychological wellbeing Risk factors affecting wellbeing differed between females and males, the former reporting being less valued – maternal relationships were protective

Sharma et al. (2017)

India

Survey design—cross-sectional 354; 168 (47.5%) N/R [N/R, 13–17] To evaluate depression recognition, help-seeking intentions and beliefs about interventions, causes, risk factors, outcomes and stigmatizing attitudes Important sources of support identified included:

exercise and sport,

meditation

Parikh, Michelson et al. (2019)

India

Qualitative—multimethod comprising stakeholder interviews and focus group discussions 191; 112 (58.7%) N/R [N/R, 11–17] To elicit the views of diverse stakeholders, including adolescents in two urban settings in India about their priorities and preferences for school-based mental health services Risk factors identified as targets for positive mental health strategies include:

pressure to perform in exams,

anxiety about securing a job after education,

one-sided romantic attractions,

rejections and break-ups in romantic relationships,

Shadowen et al. (2019)

India

Mixed methods—quasi-experimental design with qualitative inquiry 15; N/R (N/R) N/R; [N/R, 12–14] To measure the impact of an after-school resilience-building programme for a group of marginalized Indian school children in rural farming villages of Tamil Nadu, India Risk factors identified females feeling less valued due to their gender status and children and adolescents repeatedly reported the value of meditation as a coping strategy

Nguyen et al. (2013)

Vietnam

Qualitative—multimethod comprising stakeholder interviews, key informant interviews, focus groups 138; 83 (60%) N/R [N/R, 15–18] To explore perceptions of mental health and views about what are the risks for mental health problems alongside identifying stakeholder strategies to improve mental health Risk factors for poor mental health arose under the following themes:

problems related to pleasure-seeking,

problems with love and sex

Willenberg et al. (2020)

Indonesia

Qualitative—focus group discussions 86; 41 (47.7%) 17 [N/R; 16–18]d To understand conceptualisations and perceived determinants of mental health from the perspective of Indonesian adolescents Positive mental health characteristics include:

happiness,

personal control (of problems, emotions, stress and personal limits),

ability to socialize and interact with others,

spirituality

Signs of poor mental health include:

inability to cope with contemporary pressures,

poor social skills,

fractured relationships,

males associated poor mental health with interpersonal violence,

females associated it with self-harm

A range of social, parental, peer, media and community factors were identified as risks for poor mental health Protective factors comprised positive emotions (optimism, hopefulness), positive relationships with family and friends, balanced lifestyle, civic participation, prayer and worship

Estrada, Nonaka et al. (2019)

Phillipines

Mixed methods comprising quantitative (cross-sectional survey) and qualitative (in-depth interviews) components

183; 58 (33.9%)

Study 1: 171, Study 2: 12

N/R [N/R, N/R] To describe the prevalence of suicidal ideation and behaviours, attitudes towards suicide among adolescent learners in alternative education. Additionally, relationships between suicidal ideation, behaviours, participant characteristics, attitudes and alternative learning environment were evaluated Children and adolescents identified leveraging support from church ministries and being involved in pastoral activities as a specific self-help strategy to enhance mental health

Secor-Turner et al. (2016)

Kenya

Qualitative 64; 32 (50%) 16.2 [N/R, 12–26] To evaluate perceived barriers and facilitators of health in a cultural context Maintaining health is strongly linked with education from peers, socializing and having positive peers and supportive relationships with family, particularly parents. Protective factors included:

self-esteem,

empowerment,

spirituality

Barriers to emotional health include feelings of:

increased stress,

hopelessness,

isolation,

rejection,

anger,

aggression

Risks include

Tamburrino et al. (2020)

Kenya

Qualitative 7; N/R N/R [N/R, 14–17] To explore how youth stakeholders conceptualize mental illness, contributing factors and required supports for disadvantaged young people in Kenya Positive mental health conceptualized as:

balanced state of mind,

positive state of mind/absence of stress,

being free from obstacles that can affect a person physically, emotionally or cognitively (irrespective of having a mental illness),

being able to make good judgements,

able to manage problems,

sense of wellbeing,

adopt resilient and positive behaviours,

Risk factors for negative wellbeing states

distorted sense of self during the developmental stage of adolescence,

general increase in negative emotions experienced by young people,

lack of parental support

Glozah (2015)

Ghana

Qualitative study using semi-structured interview 11; 6 (54.5%) 16.86 [N/R, N/R] To explore perspectives of interpersonal support for personal wellbeing Wellbeing conceptualized as:

ability to perform daily functions,

mental strength,

sense of vitality,

ability to make critical decisions

Risk factors for poor health and wellbeing:

inadequate sleep,

strictness, teasing, arguments and quarrelling with family, friends and teachers

Protective factors

advice and encouragement from others,

maternal advice to deal with interpersonal conflict,

paternal advice on health-promoting behaviours,

religiosity and spirituality

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