Adolescent Mental Health and Grit

Adolescences is described as the age from 10 to 19 years old, and this is a time in an individual’s life in which is unique and developmental. Though many adolescents do not experience issues with their mental health, several physical, emotional and social changes, including experiences with poverty, abuse, or violence, can make adolescents more susceptible to mental health issues (WHO, 2018). Thus, the promotion of psychological well-being and protection from adverse experiences and risk factors that can impact their potential to thrive is not only critical for their adolescent well-being, but also for their physical and mental health well into their adulthood.

Adolescence is a critical time for developing and maintaining social and emotional habits that are important for an individual’s well-being. These habits include adopting healthy sleep patterns, partaking in regular exercise, developing proper coping, problem-solving, and interpersonal skills, as well as learning to manage emotions. Supportive environments are also important (WHO, 2018). There are several factors that determine the mental health of an adolescent, the more risk factors they are exposed to, the greater the potential impact on their mental health will be.

Risk factors that can contribute to stress during adolescence include the desire for greater autonomy, pressures placed by peers to conform, the exploration of sexual identity, and an increase in the access to and use of technology and social media. The media’s influence and can intensify the discrepancy between an adolescent’s lived reality and their perceptions or aspirations for their future. Other significant factors for adolescent mental health are the quality of their home life and their relationships with their peers. Violence and socioeconomic problems are also recognized as risks to adolescent mental health (WHO, 2018).

Some adolescents are at a greater risk of developing mental health issues due to their living conditions, stigma, discrimination or exclusion, or lack of access to quality support and services. This includes adolescents living in vulnerable settings, those with chronic illness(es), those with a neurological condition, adolescent parents, or those in early and/or forced marriages, adolescents with no guardian, and adolescents from minority ethnic, or sexual backgrounds or other discriminated groups (WHO, 2018). Therefore, adolescents with mental health conditions are in turn particularly vulnerable to social exclusion, discrimination, and stigma which affects help-seeking behaviors, education, and physical health, causing an increase in risk-taking behaviors and human rights violations.

It is estimated that 10 to 20% of adolescents experience some type of mental health condition, worldwide. However, they remain underdiagnosed and undertreated (WHO, 2018). Signs of poor mental health can be overlooked for numerous reasons, such as a lack of knowledge or awareness about mental health, a lack of access to mental health professionals, or stigma that prevents these adolescents from seeking help.

Grit, as defined by Merriam-Webster, is the “firmness of mind or spirit: unyielding courage in the face of hardship or danger,” the informal English language learner’s definition of grit is, “mental toughness and courage,” and the kids’ definition of grit is, “strength of mind or spirit” (Merriam-Webster, 2019). In their 2007 study, Grit: Perseverance and Passion for Long-Term Goals, Duckworth, Peterson, Matthews, and Kelly introduced the construct of grit in relation to success. They defined grit as, the “trait-level perseverance and passion for long-term goals” (Duckworth, Peterson, Matthews, & Kelly, 2007). Guerrero, Dudovitz, Chung, Dosanjh, and Wong, in their 2016 study, Grit: A Potential Protective Factor Against Substance Use and Other Risk Behaviors Among Latino Adolescents chose to define grit as, “working strenuously toward challenges, maintaining effort and interest over years despite failure, adversity, and plateaus in progress,” (Guerrero, Dudovitz, Chung, Dosanjh, & Wong, 2016).

The theme here is consistent, grit is a characteristic that should be strived for by all individuals. Whether in the face of hardship, danger, or adversity, those who possess grit, persevere. These are the individuals who prove against all odds that they will succeed, and if they do not, they continue onward to the path of success and continue to try until they achieve what they were after. Gritty individuals demonstrate a consistent interest in a goal (passion), and are unwavering in their pursuit of this goal, even if setbacks occur (perseverance).

Although most research on the benefits of grit focuses solely on achievement, there is growing evidence to suggest that grit may also influence non-achievement outcomes. Grit has also been linked to satisfaction with school and a sense of belonging (Bowman, Hill, Denson, & Bonkema, 2015), life satisfaction, harmony in life (Vainio & Daukantaite, 2015), happiness, and positive affect (Singh & Jha, 2008). Grit has also prospectively been linked to greater psychological well-being (Salles, Cohen, & Mueller, 2014) and decreased suicidal ideation (Kleiman, Adams, Kashdan, & Riskind, 2013). This potential relationship between grit and well-being may be particularly imperative for adolescents, who are in a developmental stage, in which they begin to develop their own individual identity and a belief system that corresponds.

The study, Grit: Perseverance and Passion for Long-Term Goals by Duckworth et al. (2007) found that grit predicted achievement in challenging circumstances, over and beyond measures of talent. It is clear that intelligence is an indicator of success in all professional domains, but less is clear about other characteristics that predict success. Duckworth et al. tested the significance of one noncognitive trait, grit. Grit accounted for grade point average among Ivy League undergraduates, retention in two classes of United States Military Academy, West Point, cadets, and ranking in the National Spelling Bee. Grit demonstrates the predictability of success over IQ or other measures of talent (Duckworth et al., 2007). These findings suggest that the achievement of difficult goals requires not only talent but also the continued and focused application of that talent over time, despite setbacks and time spent on achieving said goals. Individuals who possess high levels of grit do not stray from their goals, even in the absence of positive feedback.

Duckworth and Quinn’s 2009 study, Development and Validation of the Short Grit Scale (Grit–S) introduces a brief self-report and informant-report version of the Grit Scale, which measures trait-level perseverance and passion for long-term goals. Among adults, the Grit–S was associated with higher educational achievement and fewer profession changes. Among adolescents, the Grit–S longitudinally predicted GPA and, inversely, hours spent watching television (Duckworth & Quinn, 2009). Grit is an important characteristic when it comes to succeeding through challenges for adults and adolescents.

The study, Grit: A Potential Protective Factor Against Substance Use and Other Risk Behaviors Among Latino Adolescents by Guerrero et al. (2016) predicted that grit was strongly associated with academic achievement and life success and that grit has the potential to predict health outcomes and behaviors among at-risk Latino adolescents. What they found was that higher grit levels predicted lower involvement in delinquent behavior as well as lower odds of alcohol use, marijuana use, and fighting. Factors associated with grittier individuals also included those with an authoritative parent, parental employment, and high self-efficacy scores (Guerrero et al., 2016). It may be predicted that grit is an important protective factor against substance use and other risky behaviors among Latino adolescents.

Machell’s 2017 study, Well-Being in Middle to Late Adolescence: The Role of Grit and Life Events addresses adolescent well-being based on their environmental life events and their grit factors to predict changes in the adolescent’s well-being over a year-long span. It addresses how grit positively influences youth development, regardless of environmental life events. The researchers found that both positive and negative life events predicted the rate of change in adolescent satisfaction with life (SWL), but not their meaning in life (MIL), over a period of one year. Grit was positively related to initial levels of adolescent well-being (Machell, 2017). Results indicate that life events and grit influence the course of adolescent well-being, highlighting the beneficial effects of grit, and providing new insights into the processes that influence positive youth development.

Wang, Dai, Li, Wang, Chen, Yang, and Gong’s 2018 study, Neuroanatomical Correlates of Grit: Growth Mindset Mediates the Association Between Gray Matter Structure and Trait Grit in Late Adolescence discusses the increasing evidence that shows that the growth mindset, which is the belief that one's basic abilities are malleable and can be developed through effort, is a potential factor for cultivating grit. However, less is known about the association between grit and the brain and the role of the growth mindset in this association (Wang, Dai, Li, Wang, Chen, Yang, & Gong’s, & 2018). Overall, this study presents evidence for the neuroanatomical basis of grit and highlights that growth mindset might play a significant role in developing an adolescent’s grit level.

Sharkey, Bakula, Gamwell, Mullins, Chaney, and Mullins’ 2017 study, The Role of Grit in College Student Health Care Management Skills and Health-Related Quality of Life examines the relationship between grit, health care management skills, and adolescent and young adult health-related quality of life. What the researchers found was a relationship between higher grit with greater health care management skills, higher mental, and physical health. Sharkey et al. suggest that future research could investigate the implementation of programs that include the promotion of grit. For instance, an intervention could increase gritty behaviors, as they relate to health care, such as exercise, medication management, which would, in turn, increase perseverance across all other domains in life (Sharkey, Bakula, Gamwell, Mullins, Chaney, & Mullins, 2017). The use of the grit scale as a screening tool in college health centers may also be useful for identifying individuals at risk for poor health outcomes.

Musumari, Tangmunkongvorakul, Srithanaviboonchai, Techasrivichien, Suguimoto, Ono-Kihara, and Kihara’s 2018 study, Grit is Associated with Lower Level of Depression and Anxiety Among University Students in Chiang Mai, Thailand: A Cross-Sectional Study addresses the prevalence of Depression and Anxiety among university students. Grit, as we know, has recently been discovered as an indicator of success and well-being. However, we do not know how grit and poor mental health interact among university students in Chiang Mai, Thailand. Fortunately, this article attempts to explain this interaction. Depression and anxiety symptoms are prevalent among university students in both developed and developing settings. This cross-sectional study was conducted among university students at Chiang Mai University. Depression and anxiety were assessed using the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder (GAD-7) Scales. Grit was measured using the 8-item Short Grit Scale (GRIT-S). Individuals with higher levels of grit scored lower on the PHQ-9 and the GAD-7. Musumari et al.’s findings highlight the negative correlation of poor mental health outcomes, particularly depression and anxiety with grit (Musumari, Tangmunkongvorakul, Srithanaviboonchai, Techasrivichien, Suguimoto, Ono-Kihara, & Kihara, 2018). Meaning, as grit levels increased, the levels of anxiety and depression in university students decreased. Interventions designed to improve grit would play an essential role in the prevention of poor mental health among university students.

Skylstad, Akol, Ndeezi, Nalugya, Moland, Tumwine, and Engebretsen’s 2019 study, Child Mental Illness, and The Help-Seeking Process: A Qualitative Study Among Parents in a Ugandan Community addresses child mental illness and how it contributes to the overall health of the world. Unfortunately, many children are left untreated due to lack of access to providers. The Ugandan Ministry of Health recognized this and released the Child and Adolescent Mental Health (CAMH) Policy Guidelines. However, they had to first ensure the implementation of the CAMH Policy was successful for service users. The Ugandan Ministry of Health did this by seeking insights from parents in the Mbale district of eastern Uganda, to better understand their sociocultural factors that influenced the parental help-seeking behaviors and thus the policy guidelines. What Skylstad et al. found was that there is a discrepancy between how parents and formal health system, as presented in the CAMH Policy Guidelines, evaluate and handle symptoms and mental illness in Uganda. The researchers then suggested the increased awareness of common mental illnesses to help bridge the treatment gap. Outside of parents and policyholders, teachers should also be trained to recognize and promote mental well-being. The reported sense of weakened social security in the communities should also be further explored because this might represent a significant barrier to help-seeking behaviors (Skylstad, Akol, Ndeezi, Nalugya, Moland, Tumwine, & Engebretsen, 2019).

Yang and Link’s 2015 study, Measurement of Attitudes, Beliefs, and Behaviors of Mental Health and Mental Illness addresses the types of stigmas that surround mental illness. These types of stigmas include components of labeling, stereotyping, setting apart, emotional responses, status loss, and discrimination. This is important for measuring the level of stigma that surrounds varying mental illnesses (Yang & Link, 2015). Stigmas are a hardship placed on adolescents struggling with their mental health and thus can affect their level of grit. However, those who overcome those stigmas will likely possess higher grit levels.

Research on adolescents has demonstrated that some of the positive effects of grit on well-being are explained by an increased sense of coherence (Vainio & Daukantaite, 2015). Grit has become a defining characteristic of adolescents who have higher levels of well-being. These adolescents successfully cultivate meaning from their life experiences because their grittiness promotes the development of a comprehensible life story through their persistent pursuits to attain their long-term goals. Motivational theories suggest that successful goal achievement is key to the development and maintenance of well-being (Diener, 1994), and making progress toward their goals in valued domains is associated to an increase in adolescent well-being (Oishi, Diener, Suh, & Lucas, 1999), as well as higher satisfaction with life overall among adolescents (Proctor, Linley, & Maltby, 2009).

Recommendation

It is crucial to address the needs of adolescents who struggle with their mental health. Given the prevailing burden and impact of mental illnesses in adolescents, it is essential that interventions are identified and implemented. Interventions that promote healthy adolescent’s mental health should aim to strengthen protective factors and enhance alternatives to risk-taking behaviors. The promotion of mental health and well-being helps adolescents in building resilience and grit so that they can cope well in difficult situations. Well-being programs for all adolescents and prevention programs for adolescents at risk of mental health conditions require a multilevel approach with a use of various delivery platforms, such as school-based interventions, community-based interventions, and individual- or family-based interventions (Das, Salam, Lassi, Khan, Mahmood, Patel, & Bhutta, 2016).

School-based Interventions

Based on findings from 15 studies on the review of school mental health promotion programs, it is suggested that an approach of focusing on mental health promotion rather than on mental illness prevention is more effective in promoting adolescent and youth mental health (Omara, & Lind, 2013). It was also found that nurture groups, such as a short-term, focused intervention program that addresses the barriers to learning that exist due to social, emotional, or behavioral difficulties in an inclusive and supportive school setting has immediate positive outcomes on the social and emotional well-being of adolescents (Cheney, Schlösser, Nash, & Glover, 2013). School-based mental health interventions that focus on low- and middle-income countries suggest that the majority of the school-based life skills and resilience programs show positive effects on adolescent’s self-esteem, motivation, and self-efficacy (Mason-Jones, Crisp, Momberg, Koech, Koker, & Mathews, 2012). This evidence shows school-based interventions that use targeted group-based interventions and CBT are effective in reducing depressive symptoms and anxiety.

Community-based Interventions

Based on findings from 20 studies evaluating creative community-based interventions such as music, dance, singing, drama, etc. suggests positive effects on behavioral changes, self-esteem, and confidence (Bungay, & Vella-Burrows, 2013). Another review based on 15 other studies on community-based parent training and social skills training for prevention suggests significant reductions in depressive symptoms (Waddell, Schwartz, Andres, Barican, & Yung, 2018). Evidence from community-based mental health delivery programs show specifically targeted mental health promotion of adolescents in low- and middle-income countries have positive impacts on mental health outcomes (Mason-Jones et al., 2012). Another review that evaluated the community-based mental health programs for low-income urban adolescents suggested that person-only interventions had no significant impact on improving mental health, but person plus environmental interventions and environment-only interventions did have a significant positive impact on mental health outcomes (Farahmand, Duffy, Tailor, Dubois, Lyon, Grant, Zarlinski, Masini, Zander, & Nathanson, 2012). From this data, it is clear that the use of community-based creative activities has positive effects on behavioral changes, confidence, and self-esteem, thus an improvement in adolescent mental health.

Individual - or Family-based Interventions

The effectiveness of eating disorder programs that focused on eating disorder awareness, healthy eating attitudes and behaviors, media literacy and advocacy skills, and promoting self-esteem for adolescents was studied in a systematic review. Data from this eating disorder prevention programs based on media literacy and advocacy approaches showed a significant reduction in the internalization of societal ideals relating to appearance (Pratt, & Woolfenden, 2002). A systematic review evaluating the impact of physical activity on mental health outcomes among adolescents showed a significant impact on adolescent self-esteem. Physical activity as part of other comprehensive interventions also showed significant improvement in adolescent self-esteem. Some studies also suggest positive impacts on the social and emotional well-being of adolescents. In 35 trials it was found that the use of physical activity in treating depression compared to no treatment showed a significant impact in reducing depressive symptoms (Larun, Nordheim, Ekeland, Hagen, & Heian, 2003).

Each intervention has its own set of benefits and specific mental health conditions they apply to, this is why interventions for mental health, especially pertaining to adolescents, can be difficult to manage. Future research could build upon these current studies by exploring whether grit is a trait that is malleable or if it can be cultivated in response to these given interventions. Negative experiences seem to be particularly critical for the emergence of grit and might even be an important factor in determining who develops grit and who does not. Given the increasing interest in grit as a positive psychological trait, research must investigate this construct further to continue adding to the collective knowledge of how to best promote adolescent well-being.