Adolescents' Reflections on Mental Health: Key Findings From a 13-Country Qualitative Study.

Purpose: Adolescence is a sensitive developmental period for the emergence of mental health challenges, but few multicountry qualitative studies explore how adolescents themselves understand these challenges. Through focus group discussions (FGDs) with adolescents across 13 countries, this study aimed to understand adolescents' perspectives on significant mental health challenges in their age group, key risk and protective factors, and principle coping strategies.

Methods: A total of 71 FGDs were conducted between February and June of 2021. Countries were selected to ensure geographic, economic, and cultural diversity, and included: Belgium, Chile, China, the Democratic Republic of the Congo, Egypt, Indonesia, Jamaica, Jordan, Kenya, Malawi, Sweden, Switzerland, and the United States. Within each country, FGDs were stratified by sex and age. FGDs were recorded, transcribed verbatim, and translated into English for analysis.

Results: Across countries, adolescents generally described and understood mental health challenges in terms of distress (e.g., sadness, loneliness, anger) rather than disorder (e.g., depression, anxiety). They emphasized the many contexts that drive mental health challenges, including family adversity, peer and school environments, pervasive violence, endemic poverty, and restrictive gender norms. They also discussed significant barriers to help-seeking, which frequently resulted in adolescents coping without what they perceived as sufficient support.

Discussion: Adolescents around the world highlighted numerous social and environmental factors that contribute to mental health challenges, as well as a pressing need for greater formal and informal supports. The nonclinical terminology favored by adolescents suggests that taking a purely diagnostic approach may exclude many adolescents in need of assistance.