Improvement of the mental wellbeing of Hong Kong Chinese adolescents

Abstract

Adolescent mental health conditions account for 16% of the global burden of disease and injury in people aged 10–19 years. Depression and anxiety are the most common disorders that emerge during adolescence, with approximately one in every five adolescents affected by either condition. The incidence of depression and anxiety in adolescents has increased in Hong Kong, particularly after the large-scale social movement in 2019 and the coronavirus disease 2019 pandemic that began in 2020. Hence, there is an urgent need to identify effective strategies and early interventions that can improve the mental health of adolescents in Hong Kong. In view of the high prevalence rates of adolescent mental health issues in Hong Kong, this thesis aims to: (1) evaluate and summarise the current evidence on adolescent mental health issues, i.e., depression and anxiety, both worldwide and in Hong Kong; (2) explore and identify effective universal interventions that can improve mental health and reduce depression symptoms; and (3) implement and examine the effectiveness of an outward bound training program that aims to reduce depression in adolescents by building resilience and self-esteem. A comprehensive integrative literature review on the mental health issues faced by adolescents in Hong Kong summarized that universal resilience-focused interventions hold the promise, at least in the short term, for reducing the severity of depressive symptoms in adolescents. A systematic review was thereafter conducted to synthesis current evidences on the effectiveness of universal resilience-focused intervention in improving adolescent mental health. It revealed that although interventions are mostly conducted in school settings, outward bound training can also effectively improve adolescent mental health. However, a rigorous empirical investigation of the effectiveness of outward bound training as a feasible approach for increasing resilience has not yet been performed. A randomised controlled trial to implement and examine the effectiveness of outward bound training in increasing resilience and self-esteem and reducing depressive symptoms in adolescents was conducted in 2018. Secondary school students aged 12–16 years who visited the Integrated Children and Youth Services Centre in a large public housing estate in Hong Kong were invited to participate in this study. Two hundred and twenty-eight eligible adolescents were randomly assigned to an experimental group (n = 115) that participated in a 2-day/1-night outward bound training programme or to a control group (n=113) that participated in 2 days of leisure activities organised by the Integrated Children and Youth Services Centre. Data were collected at baseline and at 3 and 6 months after the corresponding interventions. Upon comparing the experimental and control groups, the experimental group was found to have significantly higher resilience (p = 0.001) and fewer depressive symptoms (p = 0.02) at 6 months and significantly higher self-esteem at 3 months (p = 0.04), but not at 6 months (p = 0.12). This suggests that outward bound training has a larger effect on resilience than on depressive symptoms and self-esteem. A potential explanation for this distinction might be that the training included a variety of activities that helped the participants figure out how to overcome challenges that they might not have recently experienced.