Table 2 Summary of included studies studying child and youth’s perceptions of mental health

Armstrong, C. et al., (2000). Young People's Perceptions of Mental Health. [28]

Country: UK

Semi-structured individual and focus group interviews

n = 145, ages 12–14. Focus groups (n = 120, 17 groups) and individual interviews (n = 18), participants recruited from 4 schools

SES: schools with rural (higher unemployment rates) or urban (more affluent) and mixed SES environments

To explore the attitudes and perceptions of a broad range of young people aged 12–14 towards positive mental health and mental illness

Concepts used: mentally healthy and unhealthy, positive mental health

• The term mental health was not salient and understandings of it were often uncertain

• Those who focused on the word "mentally" usually associated this with mental illness even though the question had been about mental health

• Socioeconomic difference in how to understand mental health: Mainly young people from schools in the most deprived area and the rural area who experienced these difficulties with the term mentally healthy

• For some young people, the notion of mental health was closely linked with the idea of normality, although no consensus about what normality meant

Roose, G.A. & John, M.A. (2003). A focus group investigation into young children’s understanding of mental health and their views on appropriate services for their age group. [38] Country: UK

Semi-structured focus group interviews

Data collected: reported

n = 16, ages 10–11, 2 focus groups with 8 participants each were recruited from two local primary schools, chosen because of their different locations and willingness to take part in the study

SES: not reported

To explore 10- and 11-year-old children’s understanding of the concept of mental health and their opinions regarding an appropriate service for their age group

Concepts used: mental health

• Mental health was understood to be complex

• Children’s understanding of mental health was considered by the authors as sophisticated and many behaviors were considered to be indications of a serious problem. For example, not being able to put unhappiness aside, inability to concentrate on schoolwork, unusual behavior such as a lot of crying from someone who doesn’t usually cry and lying to cover up the sadness. As was the failure of normal strategies, ‘cos if you try, like you do normally to make it go away and it doesn't

• Mental health was considered to have different aspects, emotions, thoughts and behavior, for example, ‘mental health is really peace of mind and not your emotions overbalancing’

Johansson, A., et al., (2007). Adolescent Girls’ and Boys’ Perceptions of Mental Health. [39]

Country: Sweden

Semi-structured interviews, individual or focus groups

n = 48, ages 13 and 16, participants recruited from 2 schools

SES: Participants were from different cultural backgrounds (but no closer description of this was done by the authors)

Concepts used: mental health

To analyze the concept of mental health from the perspective of adolescent girls and boys and to describe what they regard as being important determinants of mental health

• The adolescents perceived mental health as an emotional experience (how you feel and what you think), where positive as well as negative health is part of the concept

• Age differences seemed to be more important than gender in the perception of mental health by children

• Younger girls and boys described their feelings more in relation to other people, friends and parents

• The older girls expressed deeper negative emotions than the older boys and the younger children and could relate more easily to negative emotions than to positive emotions. Positive as well as negative emotions were divided between internal and relational emotions. The internal positive emotions were feeling of being happy, harmony, of being a good person and of having good self-confidence. The internal negative emotions were a feeling of being unhappy, of lack of meaning and hope, of being stressed and of having negative self-confidence

• Older participants related mental health mostly to themselves

Landstedt E., et al., 2009). Understanding adolescent mental health: The influence of social processes, doing gender and gendered power relations [40]

Country: Sweden

Semi-structured focus group interviews

n =  29 focus groups with 3–8 participants each age 16–19. Participants were recruited from schools in six towns of various sizes in rural and urban areas. The total sample varied in terms of age,

socioeconomic and demographic characteristics with the goal of obtaining maximum variation

SES: schools in six towns of various sizes in rural and urban areas, representing educational programmes, is.theoretical and vocational

To explore what 16- to 19-year-old students perceive as significant for adolescent mental health and, apply a gender analysis to the findings

Concepts used: mental health

• Mental health was understood as an emotional experience and described as ‘how you feel’ in terms of self-esteem, stress, confidence and experiences of humiliation

• Mental health was mainly associated with negative aspects, distress or illness

• The participants emphasized that mental well-being, to a large extent, depends on trust, perceived respect, and appreciation for who one is—it’s important to be well treated, to be seen by others and to have somebody to trust

• Joking represents both acts of bonding and assault (humiliation) and was expressed as sometimes contradictory and restraining

• According to the participants, assault was associated with mental health in terms of humiliation, worry, anxiety, fear, stress, and insecurity

• The adolescents considered a low degree of responsibility-taking as being positive for mental health which they exemplified as confidence, independence and feeling relaxed. A low degree of responsibility-taking was exemplified as ignoring or not responding to demands and things for which one is expected to take responsibility

Svirydzenka, N., et al., 2014). Schoolchildren's perspectives on the meaning of mental health. [41]

Country: UK

Workshops with smaller groups. Some groups were asked to write on posters: What does the term mental health means? They concluded the workshops by asking the students to compare their results with the ‘bright futures’ definition of mental health

n =  218, age 13, participants recruited from 5 local schools and community colleges

SES: not reported

To identify how schoolchildren defined mental health

and how they thought they could keep themselves mentally healthy

Concepts used: mental health, mental illness

• Four themes emerged: Personal attributes, disorder, personal management, and relationships

• The “personal attributes” theme encompassed all the answers the students gave regarding themselves and their qualities that would play a part in defining mental health: “good” brain, emotional and physical functioning and development, high self-esteem, and a clear idea of who they are qualified as being “mentally healthy”

• The “disorder” category included naming a mental health disorder

• The “personal management” category included lifestyle choices (most common), being able to learn well, managing emotions, problem-solving and perceived or aspired control of the environment

• The “relationships” category included being able to fit in with the world socially and having positive peer relationships were considered signifiers of good mental health

Chisholm, K., et al. 2016). Adolescent construction of mental illness: implication for engagement and treatment. [42]

Country: UK

Participants were left to themselves in groups to discuss and define what they felt that 'mental health' might mean

n =  46, ages 11–18, participants recruited from 6 schools

SES: Schools were selected to be broadly representative of Birmingham, UK

To develop a preliminary model of how adolescents perceive mental illness and construct their understanding of mental health

Concepts used: mental health and mental illness

• Conflicting experiences and perceptions of mental illness. Participants discussed Stereotypes and Extreme symptoms of mental illness, but also displayed an insightful and empathetic understanding of the negative impact of stress, based on their own reality and experiences

• Emotions of fear and anxiety were associated with both perceptions

• Conflicting picture of mental illness. Distinctions were drawn; between ‘them’ and ‘us’, between ‘born with it’ and ‘developed’, and between ‘crazy’ and ‘diagnosed’

• Those with mental disorders were considered somehow ‘not normal’ or ‘different’ by participants

• Participants in the older age groups interpreted mental health and illness as a continuum, rather than just focusing on the extreme examples. Older participants also talked about mental health in terms of positive emotions

• Participants drew strong links between the term mental illness and derogatory terms such as “crazy”, but were less stigmatizing regarding individual diagnoses

Perre et al., (2016). Australian University Students’ Perceptions of Mental Illness: A Qualitative Study. [37] Country: Australia

Semi-structured interviews

n =  10, ages 19—24, participants recruited from one university. 9 out of 10 participants were girls

SES: A mix of Australian-born and non- Australian born participants

Concepts used: mentally healthy, mental health, mental illness

To explore young people’s perceptions of common mental health issues, predominantly depression and anxiety, alongside possible experiences of stigma

• Personal attributes in relation to the term ‘mentally healthy’, as ‘energy’ ‘confidence’ ‘happiness’, balance’, thinking logically, in-tuned with oneself

• Mental health was linked with rationality

• Participants expressed a sense of confusion surrounding diagnostic labeling of mental health issues and mental illness and held mixed opinions on the purpose of clinical diagnoses

• Perceptions of depression varied amongst the participants, from those who aligned it with psychosis, to those who related it to simply ‘feeling down’. Most participants commented on depression as being a concern when it occurred frequently as opposed to transient feelings of sadness. Length of time that individuals had felt depressed and particularly loss of interest in socializing, were both seen as adequate measures for determining the difference between ‘feeling down’ and ‘clinical depression’

• Since young people have generally experienced the sensation of being anxious, nervous and apprehensive in their everyday lives, anxiety was harder to define in terms of it being an illness

Laidlaw, A., et al., (2016). Understanding undergraduate student perceptions of mental health, mental well-being and help-seeking behavior. [43]

Country: UK

Semi-structured individual interviews

n =  20, ages 18–22, participants recruited from one university, and 5 different subject areas (psychology, biology, physics or English)

SES: not reported

To improve their understanding of student perceptions of mental health, mental well-being and help-seeking behavior for difficulties in these areas

Concepts used: mental health, mental wellbeing, mental illness

• Three different perceptions emerged in participants’ understanding of the terms mental health and mental well-being

• One perspective considered mental health distinctly different from, and more clinical than, mental well-being. Participants with this perception commonly referred to mental health as ‘serious’, ‘psychiatric’, whereas mental well-being was described as ‘feeling happy, confident, able to function/cope, feeling secure’

• Another view included these concepts as a continuum with mental health at one end of the continuum and mental well-being at the other. Students in this group tended to perceive mental health as a more severe clinical mental illness whilst mental well-being was the absence of such illness

• Participants also viewed the terms mental health and mental well-being as being the same thing, although they often appeared uncertain in this view

• Participants' understanding of mental well-being and mental health fits with the dual factor model with the clinical mental health dimension perceived as being separate from the more everyday mental well-being dimension. Moreover, mental well-being issues are related to aspects of confidence and the ability to cope with life's demands

Teng, E., et al., (2017). Crying wolf? Australian adolescents’ perceptions of the ambiguity of visible indicators of mental health and authenticity of mental illness. [27] Country: Australia

Individual semi-structured interviews

n =  16, ages 12–18, participants recruited from 4 schools that were part of the school-based program MindMatters. All participants were Anglo-European Australians

SES: Not reported

To explore how adolescents speak about mental health and illness

Concepts used: mental health, mental wellbeing, mental illness

• Expressed uncertainty surrounding mental health and illness concepts and terminology

• Negative aspects of mental health included notions of illness, such as psychological distress, traumatic experience, mental disorder, pessimism, and learning disabilities

• Positive interpretations of mental health included notions of well-being, such as self-esteem, happiness, optimism and resilience, social support, and physical health but also some personality traits such as extraversion and intelligence

• Some responses appeared to be more neutral, for example, referring to “thoughts and emotions” with no emphasis on either positive or negative aspects of mental health. Other neutral aspects included general ‘vibe’

• Mental illness included strong negative expressions

• Depression and bipolar disorder were the mental illnesses mentioned most often

• Expressed confusion over whether mental health was a positive or negative concept, interpreting the term mental health to refer to notions of knowledge and awareness

• Authenticity—difficulties in trying to discern between those with good or poor mental health. E.g., lack of “visible proof” of mental illness. Experiences of doubt about whether peers reporting mental illness were “pretending” or “exaggerating” symptoms

O'Reilly, M. et al. (2018). Is social media bad for mental health and wellbeing? Exploring the perspectives of adolescents. [44]

Country: UK

Semi-structured focus groups interviews

n =  54, age 11–18 years, 6 focus groups from schools in two UK cities (Leicester and London)

SES: The sample was considered to reflect a broad diversity of socioeconomic and ethnic backgrounds (but no closer description of this was done by the authors)

To address what adolescents think of social media and its relevance to mental health and emotional wellbeing

Concepts used: mental health, mental wellbeing, mental illness

• Many of the adolescents were unable to define mental health clearly, often confusing it with mental ill health. Others simply stated that they did not understand the term

• This was particularly the case for younger participants who generally framed it as things that are happening in your brain or in terms of specific conditions like schizophrenia or simply not knowing: “I don’t understand what mental health is”. For example, they did not believe that mental health could be positive, and others asked the moderators for clarification

Molenaar, A. et al. (2020). Language of Health of Young Australian Adults: A Qualitative Exploration of Perceptions of Health, Wellbeing and Health Promotion via Online Conversations. [45]

Country: Australia

Online conversations over social media

n =  166, ages 18–24, Participants were recruited by an Australian Market & Social Research Society-certified field house from three different International Organization for Standardization accredited panels

To provide formative information to inform future more hypothesis-driven research

Concepts used: mental health, wellbeing, mental illness

• Mental health was highlighted as an important aspect of health, often due to being personally affected by mental health issues

• The majority of participants in these analyses believed they were at their optimal health status and were therefore not largely concerned about illness or disease prevention but rather a more holistic view of health