Psychology Theses

Intersectionality is concerned with processes of power and oppression emerging at the intersections of social categories such as gender and ethnicity. Given the psychological impact of oppression and inequality, understanding intersectional effects on health outcomes is of relevance to practice and policy. While intersectionality is a growing framework in clinical psychology, its application to adolescent mental health is still under-researched. The present thesis thus sought to examine the effects of social categories, processes, and determinants within intersectionality’s framework, on adolescent mental health outcomes. Firstly, to explore mental health more deeply as experienced through the complex social category of ethnicity, a qualitative systematic review of 17 academic and non-academic studies centralising adolescents’ voices was conducted. The narrative synthesis highlighted contexts, processes, and determinants effecting the mental health of adolescents from ethnically and culturally diverse backgrounds, notably discrimination, social inequalities, and interpersonal connection. However, unique intersectional effects were not explicitly examined in this study. Thus, a quantitative empirical study was conducted in an Irish secondary-school sample of 9,011 adolescents from diverse backgrounds to examine the intersectional effects of gender, sexual orientation, ethnicity, and disability on adolescent mental health. Multilevel Analysis of Individual Heterogeneity and Discriminatory Analysis (MAIHDA) examined the intersectional effects of these social categories on mental health outcomes, and a series of fixed-effects models were also conducted to investigate the individual effects of social categories and risk/protective determinants on adolescents’ mental health. Significant intersectional effects were not observed for the four social categories. Instead, significant effects for determinants such as bullying, discrimination, and connectedness to school emerged, reflecting the systematic review. The present thesis demonstrated that while it is important to remain cognisant of intersectionality, there are salient determinants reflecting oppression and inequality that warrant practice and policy attention in the interest of adolescent health and wellbeing.

When an adolescent experiences a mental health difficulty they rarely seek help on their own and they frequently rely on their parents to access help and support. However, to date, the role of parents in adolescent help-seeking has been neglected. This research investigated parental help-seeking using a multi-method approach. Study one aimed to explore what factors influence parental help-seeking. Participants were 30 parents of adolescents: 23 mothers and seven fathers. The findings suggest seeking help is a complex process in which parents have to overcome a number of challenges (e.g. limited knowledge, systemic issues with the delivery of services, difficulties engaging their adolescent in services) in order to access appropriate help for their child. The results also suggest that theory needs to acknowledge the complexities of parental help seeking. Study two was informed by the results of study one. Study two tested the application of the Common-Sense Model of Illness Representations to explain how parents perceive adolescent distress and how this predicts intentions to seek help. The study employed an experimental design using video vignettes. The sample consisted of 1,176 parents of adolescents aged 10-19 years. Results showed that the model was useful for explaining parental help-seeking intentions. Parents were more likely to report intending to seek help if they believed that treatment could control the problem and if they believed the problem would have negative consequences for the adolescent. If parents believed the problem was in the control of the adolescent, they were less likely to intend to seek help. Study three was a systematic review of the literature of parental help-seeking interventions. Six electronic databases were searched from inception to May 2020 and eighteen studies met the inclusion criteria. The Behavioural Change Taxonomy was used to code behavioural change techniques, and “promising interventions” were identified using pre-established criteria. The most frequently identified Behavioural Change Taxonomies included a credible source delivering the intervention, supporting parents, and providing prompts/cues regarding services/appointments. Four interventions were identified as “promising” because of strong methodology, significant positive outcomes, and strong evidence-base. The findings from this body of research have enhanced our understanding of the parental help-seeking journey. The research also provides valuable insights regarding how parents can be better supported when seeking help for an adolescent mental health difficulty.