University of Groningen
Mental health, education, and work in Canada, the Netherlands, and the United States
Minh, Anita
DOI:
10.33612/diss.171633023
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Minh, A. (2021). Mental health, education, and work in Canada, the Netherlands, and the United States: a comparative, life course investigation. University of Groningen. https://doi.org/10.33612/diss.171633023
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It has been estimated that half of all mental health concerns emerge by adolescence, having profound implications for education and work in young adulthood. What roles do the social safety net, the education system, and the labour market have in creating, sustaining or mitigating the risks and vulnerabilities associated with poor mental health in adolescence? To shed light on this question, I set out to explore how institutional differences between Canada, the USA, and the Netherlands impact adolescent mental health, its longitudinal patterns, and its effect on education and work in young adulthood. These countries differ with regards to the historical design of their social safety nets, education systems, and labour markets in ways that may be expected to shape inequalities in adolescent mental health and its consequences. This dissertation had four objectives:
1. Identify longitudinal patterns in the severity and frequency of mental health problems between adolescence and young adulthood, and examine the extent to which they are similar between comparable contexts.
2. Examine the extent to which longitudinal patterns of adolescent mental health are unequally distributed by childhood socioeconomic conditions in comparable contexts. 3. Examine whether and to what extent the relationship between adolescent mental
health and young adult education and work are similar between comparable contexts. 4. Examine whether and to what extent educational attainment may be intervened upon
to mitigate the pathway from adolescent mental health to NEET/disconnection from education and the labour market in young adulthood in comparable contexts. In Chapter 1, I present an overview of the literature on adolescent mental health and current knowledge gaps is presented, along with the conceptual framework that underpins the empirical research in this dissertation. This chapter introduces the life course framework and the theoretical principles that link adolescent mental health and its determinants and consequences, to the structural constraints and the historical time and place within which
individuals live. To address knowledge gaps in this framework, however, this chapter argues that it is useful to integrate a dynamic conceptualization of adolescent mental health, and an explicit conceptualization of institutional determinants. To that end, this chapter introduces concepts from developmental psychopathology, the welfare state literature (most prominently exemplified by Esping-Andersen’s Three Worlds of Welfare Capitalism), and the Varieties of Capitalism framework of Hall and Soskice. This chapter closes by linking this integrated framework to the empirical research in this dissertation. It describes the data sources used in the empirical research of this dissertation, as well as the conceptualization and measurement of institutional differences in Canada, the Netherlands, and the U.S.A, adolescent mental health, and its socioeconomic determinants and outcomes.
In Chapter 2, I present a cross-national comparative study of trajectories of depressive symptoms between adolescence and young adulthood (age 15-25) in Canada and the USA is presented. Using data from national population-level surveys of young people, growth mixture models in the cohorts from both countries converged on a four-group solution, each with trajectories characterized by low-stable symptoms, increasing symptoms, decreasing symptoms, and a trajectory of increasing then decreasing symptoms. However, the relevance of childhood socioeconomic circumstances to the course of young peoples’ symptoms differed between the two countries. In the USA, lower parental income was related to higher odds of having an increasing trajectory, and lower parental education associated with higher odds of a decreasing trajectory, but there was less support for this association in Canada.
In Chapter 3, I present a cross-national comparative study of the relationship between depressive symptom trajectories during adolescence and young adults’ position in the labour market in Canada and the USA. The outcome was defined by the intersection of their educational attainment and working status (working with a post-secondary degree, working
i.e., not in education, employment or training). Using a subset of the above cohorts, this study found that trajectories characterized by higher depressive symptoms, and particularly the increasing trajectory, were more likely to be associated with worse outcomes in both countries. Americans with higher-symptom trajectories, however, were most likely to be working with only a high-school degree in young adulthood while their Canadian counterparts were most likely to be working with a post-secondary degree or to be in school in young adulthood. In Chapter 4, I present a study of educational attainment as a pathway between internalizing and externalizing problems in adolescence and NEET in young adulthood in the Netherlands. Educational attainment was defined as the achievement of a basic qualification certificate (defined roughly as one of several upper secondary school certifications), a construct relevant to the policy context of the Netherlands. Using longitudinal cohort data from young people in the northern regions of the Netherlands, this study estimated that internalizing problems and externalizing problems contributed to higher risk of NEET in young adulthood, with larger effect sizes associated with externalizing problems. Educational attainment mediated the effect of externalizing problems, accounting for 15% of the total effect. In a counterfactual analysis in which the entire sample had a basic qualification certificate, internalizing and externalizing problems were still found to increase the risk of NEET.
In Chapter 5, I present a study comparing the extent that educational attainment mediates the relationship between internalizing and externalizing problems in adolescence, and NEET in young adulthood in the USA. This study compared two American cohorts born 10 years apart (1970-1980 vs. 1981-1990) who entered young adulthood under different macroeconomic circumstances. The level of educational attainment of interest in this study was high school completion. Across both cohorts, this study estimated that educational attainment mediated the effect of internalizing problems and externalizing problems on NEET, for between 4.3 and 6.4% of the total effect. This indirect effect was similar across the two cohorts. In a
counterfactual analysis in which the entire sample had completed secondary school, externalizing problems were still found to increase the risk of disconnection in both cohorts, and internalizing problems found to increase the risk of disconnection in 1981-1990 cohort, though the effect was lessened. However, a direct effect of internalizing problems on youth disconnection was only observed in the 1981-1990 cohort.
In Chapter 6, I provide a summary and discussion of the main findings from the dissertation, the strengths and limitations, and its implications for practice and research. Overall, the findings reveal differences by context for some aspects of adolescent mental health and its consequences for education and work. Normative developmental processes may drive longitudinal patterns in adolescent mental health problems, and the risks they present for education and work. However, the findings also suggest that a society that underinvests in resources for disadvantaged families is more likely to see greater inequality in the patterns that mental health takes over adolescence. A society that imposes more constraints to the access and availability of educational opportunities limits the education and work opportunities available to young adults. A society with a more vocationally specific education system provides a stronger link to the labour market and higher education compared with a more generalized system, but mental health problems still remain a significant challenge for higher education and the labour market engagement. Finally, young people with mental health problems are more vulnerable to labour market exclusion in poorer economic conditions; educational attainment does not differently mitigate this elevated risk in these different circumstances.
The findings from this dissertation have implications for policy, practice, and future research, as they show that institutional differences between otherwise comparable contexts may impact adolescent mental health and its effects on education and work in young adulthood. They
and labour market policy. Given the mental health and labour market impact of the COVID-19 recession, this is even more necessary. Universal mental health care and universal income support may fill longstanding gaps in the equitable provision of resources to young people with mental health problems who are making the transition to young adulthood.
In terms of future directions for research, the findings suggest a need to explicitly examine the effect of institutional determinants on adolescent mental health, education, and work. There is a dynamic interplay between the individual, developmental processes, and the broader social and political context that determine health and wellbeing during adolescence and into the remainder of the life course. In addition, future research should examine questions about who is impacted, and through what means. There is a need for greater attention to the distribution of power, bias, and discrimination that differentiate the experience of mental health, education and work by gender, socioeconomic position, and race/ethnicity. By explicitly accounting for the social welfare, education, and labour market policies in this dynamic, future research may reveal policy levers that can be used to empower young people in their transition to adulthood.
Geschat wordt dat de helft van alle psychische problemen ontstaan tijdens de adolescentie, met grote gevolgen voor studie en werk tijdens de jongvolwassenheid. Een belangrijke vraag is welke rol het sociale vangnet, het onderwijssysteem en de arbeidsmarkt spelen bij het ontstaan en het in stand houden of beperken van de risico's en kwetsbaarheden die samenhangen met psychische problemen tijdens de adolescentie. Voor het beantwoorden van deze vraag heb ik onderzocht hoe systeemverschillen tussen Canada, de Verenigde Staten (V.S.) en Nederland van invloed zijn op de psychische gezondheid van adolescenten, op het longitudinale beloop daarvan en op studie en werk als jongvolwassene. De genoemde landen verschillen wat betreft de historisch gegroeide opzet van hun sociale vangnet, hun onderwijssysteem en hun arbeidsmarkt op een manier waarvan je kunt verwachten dat dit invloed heeft op ongelijkheid in de psychische gezondheid van adolescenten en de gevolgen daarvan. Dit proefschrift heeft vier doelstellingen:
1. Identificeren van longitudinale patronen van psychische problemen tussen adolescentie en jongvolwassenheid qua ernst en frequentie, en onderzoeken in hoeverre deze overeenkomen in vergelijkbare contexten.
2. Onderzoeken in welke mate longitudinale patronen van psychische gezondheid van adolescenten verschillend zijn vanwege sociaaleconomische omstandigheden in de kindertijd in vergelijkbare contexten.
3. Onderzoeken of en in welke mate de samenhang van de psychische gezondheid van adolescenten met studie en werk tijdens de jongvolwassenheid hetzelfde is in vergelijkbare contexten.
4. Onderzoeken of en in welke mate het opleidingsniveau kan worden beïnvloed om de samenhang tussen psychische gezondheid in de adolescentie en NEET (d.w.z. niet studerend of werkend) tijdens de jongvolwassenheid positief te beïnvloeden, in vergelijkbare contexten.
In Hoofdstuk 1 geef ik een overzicht van de literatuur met betrekking tot psychische gezondheid van adolescenten en de huidige kennisleemten, en het conceptuele kader dat de basis vormt van het empirisch onderzoek in dit proefschrift. Het hoofdstuk presenteert het levensloopperspectief en de theoretische principes die de determinanten en gevolgen van psychische gezondheid van adolescenten verbinden met de structurele omstandigheden en de tijd en plaats waarin een individu leeft. Wat betreft de kennisleemten in het conceptuele kader stel ik in dit hoofdstuk dat het nuttig is om de psychische gezondheid van adolescentendynamisch te conceptualiseren en institutionele en structurele determinanten expliciet te conceptualiseren. Hiervoor worden concepten gebruikt uit de ontwikkelings-psychopathologie, de verzorgingsstaat-literatuur (met als meest prominente voorbeeld Esping-Andersen's ‘Three Worlds of Welfare Capitalism’) en het ‘Varieties of Capitalism’-raamwerk van Hall en Soskice. Het hoofdstuk sluit af met het verbinden van dit geïntegreerde kader met het empirische onderzoek in dit proefschrift. Verder beschrijft het hoofdstuk de gebruikte databronnen, de wijze van conceptualisering en het meten van institutionele en structurele verschillen tussen Canada, Nederland, en de V.S., de psychische gezondheid van adolescenten, en de sociaaleconomische determinanten en uitkomsten.
In Hoofdstuk 2 presenteer ik een vergelijkende studie tussen Canada en de V.S. waarin trajecten van depressieve symptomen tussen adolescentie en jongvolwassenheid (leeftijd 15-25 jaar) onderzocht worden. Gebruik van gegevens uit landelijke studies onder jongeren in ‘growth-mixture models’ leverde voor beide landen vier trajecten van depressieve symptomen op, een traject gekenmerkt van stabiel-weinig symptomen, een van toenemende symptomen, een van afnemende symptomen en een traject van eerst toenemende en daarna afnemende symptomen. De invloed van sociaaleconomische omstandigheden in de kindertijd op depressieve symptomen tijdens de adolescentie
