Speaker
Description
Background: This study aimed to understand the context and needs of adolescents experiencing subclinical anxiety and depression symptoms, who are termed in policy as the missing middle in Wales. It is part of a project to inform the identification and adaptation of a feasible, acceptable and effective targeted secondary school-based intervention to Wales.
Methods: The study drew on two methods. An analysis of 16 documents from policy, research, and reports of stakeholders’ views on adolescent mental health in Wales. Following, focus groups and interviews were conducted with 35 students aged 11-18 years old (M=14.57, SD=1.72); 18 school staff; 23 practitioners involved in managing, delivering or referring to non-clinical and clinical mental health services; and two policy officials. A hybrid approach of deductive and inductive thematic analysis of data was conducted.
Results: Stakeholders discussed four themes. First, perceptions of the missing middle helped to understand the population. Secondly, contextual norms included a more mental health aware and open adolescent population, alongside challenges of understanding normal mood fluctuations, self-diagnosis and social contagion. A third theme highlighted enablers and barriers to implementing targeted provision in Wales, such as a lack of clarity on what services/interventions target. Lastly, potential intervention targets suggested focused on the intrapersonal (cultivating emotional regulation and problem-solving skills) and the interpersonal levels (reducing loneliness and supporting the development of social relationships).
Conclusions: Challenges with targeting and researching populations at the intersection of the mental health and mental wellbeing paradigms arose as follows. Defining such a heterogeneous group can be difficult as some adolescents have subsyndromal symptoms, but others have high levels of distress or functional impairment without elevated symptomology. Screening processes need to accommodate this. Furthermore, documents and participants often flowed between paradigms, making it problematic to understand what related only to this population rather than all adolescents.
| Conflict of interest | There are no conflicts of interest. |
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