Children's Understanding of Mental Health - A Qualitative Study to Inform Mental Health Prevention

Introduction: To counteract child and adolescent mental health issues, EU health priorities emphasize the importance of low-threshold, prevention programs on a population level. Increasing mental health literacy (MHL), i.e. the knowledge and attitudes of mental health, has been suggested as a promising prevention approach from the age of eight onwards. To develop an age-appropriate MHL program for primary schools, a comprehensive understanding of children’s concepts of mental health and wellbeing is needed.

Methods: A participatory development approach was adopted, with a focus on exploring children’s awareness and experiences concerning emotions, wellbeing, and mental health. Over the course of one academic year, iterative qualitative research workshops were conducted in six primary schools in Austria. Children aged nine to eleven participated in brainstorming, story-creation, and focus-group tasks, which were analyzed using thematic analysis.

Results: Children differentiated between small and big feelings. For this age group, big feelings could equally concern major challenges and events (death of a relative, school transition) and everyday situations that are momentarily overwhelming (sibling fights). Their understanding of wellbeing incorporated many momentary feelings and challenges, as this age groups’ awareness of persistence over time and interference with everyday activities was still limited. Initially, only few children had a concept of mental health at this age. However, through their participation in repeated workshops, children gained a more nuanced understanding of the components of MHL as indicated in the child MHL model.

Discussion: Assessing children’s baseline understanding of mental health is crucial to adapt mental health education to their knowledge levels, create examples relevant to their everyday experiences and develop age-appropriate ways to explain the components of MHL. Cultural differences and societal discourse are likely to shape children’s baseline knowledge. Thus, combining participatory approaches and evidence-based intervention development is crucial to achieving effective mental health prevention.