Table 1 presents the themes generated and their features. It also shows how these themes and features (or subthemes) are anchored in the data. Each participant is represented by an ID formed by the letter ‘P’ followed by a number, e.g., P1. Rather than a quantitative measure of significance, the anchoring strategy shows a trace of the dialogic process between the researchers’ subjectivities and participants, and provides transparency (i.e., trustworthiness) (Mendes, 2022).
Table 1 Themes and features generated by the reflexive thematic analysis and their anchoring on the data
THEME
|
ANCHORING
|
Theme 1: “It is a big responsibility to take care of others’ mental health”: Young People’s Sense of Responsibility and Aspirations Towards Mental Health Promotion and Well-being
|
|
Feature 1.1: Young people’s contrasting views towards supporting mental health promotion
|
P1, P2, P4, P5, P6, P9, P10, P11, P12, P13, P14, P15, P16, P18, P19, P20, P21, P24, P25, P26, P27, P31, P33, P34, P35, P37, P42, P43, P44, P45, P46
|
Feature 1.2: “I feel very motivated to help my community”: views and motivations towards mental health promotion
|
P1, P2, P3, P4, P5, P6, P7, P8, P9, P10, P11, P13, P16, P17, P18, P19, P24, P25, P29, P31, P33, P35, P36, P42, P43, P44
|
Feature 1.3: “We young people, we understand ourselves but we need other people”: partnership and liaising to employ agency
|
P1, P2, P5, P11, P13, P18, P28, P32, P33, P34, P45, P46
|
Theme 2: “There are many ways to help”: Young People’s Strategies to Support their Peers’ Mental Health and Well-being
|
|
Feature 2.1: “Sharing our experiences regarding mental health”: strategies for collective actions towards mental health promotion
|
P1, P2, P3, P4, P5, P6, P7, P8, P9, P10, P11, P13, P16, P17, P18, P19, P24, P25, P29, P31, P33, P35, P36, P42, P43, P44
|
Feature 2.2: “Not judging, being empathic, understanding, listening to the other person”: strategies to offer peer support
|
P1, P2, P3, P4, P6, P7, P8, P9, P10, P11, P12, P13, P14, P16, P17, P18, P19, P20, P21, P22, P23, P24, P26, P27, P28, P31, P32, P33, P34, P36, P38, P39, P40, P41, P42, P45, P46
|
Theme 3: “They don’t believe in us”: Contextual Barriers Young People Face to Employ their Agency
|
|
Feature 3.1: “They don’t know much about life!”: feeling unheard
|
P1, P6, P,7, P13, P14, P15, P16, P17, P18, P19, P20, P21, P22, P28, P29, P33, P34, P35, P36, P42, P44, P45, P46
|
Feature 3.2: Unfavourable social norms towards mental health: fearing judgement
|
P1, P5, P14, P17, P19, P25, P26, P31, P37, P38, P40, P41, P42
|
Feature 3.3: “I can help only if the other person is open to being helped”: the other person’s lack of readiness to be helped
|
P10, P11, P12, P13, P14, P16, P17, P19, P25
|
Theme 4: “What if I do it wrong?”: Intrapersonal Barriers Young People Face to Deliver Peer Support
|
|
Feature 4.1: “I want to help but I don’t know how”: lack of skills
|
P1, P3, P4, P5, P7, P9, P11, P15, P16, P17, P24, P25, P26, P27, P28, P30, P31, P44, P45, P46
|
Feature 4.2: “I am very insecure with myself. Sometimes, I feel I am not capable to help”: lacking self-efficacy
|
P2, P9, P13, P16, P17, P18, P20, P21, P22, P24, P25, P26, P27, P33
|
Feature 4.3: “I can’t put the other person’s mental health over mine”: prioritising self-care
|
P1, P2, P9, P10, P11, P12, P13, P14, P16, P17, P19, P24, P25, P26, P27, P28, P33, P34, P35, P41, P42, P43, P44, P45, P46
|
Thematic Map
As seen in Figure 3, the themes generated belong to three distinct domains: 1) young people’s sense of responsibility and their aspirations to support others’ mental health; 2) strategies they use (or wish to use) to support their peers’ mental health and well-being; and 3) contextual and intrapersonal barriers that can impair young people’s potential to support their peers’ mental health and well-being. We acknowledge Braun and Clarke’s (2022b) critiques regarding themes’ and subthemes’ conceptions and titles that seem to be more a topic summary than “interpretative stories built around [a] uniting meaning” (p. 3). However, we also acknowledge the need to make results derived from qualitative inquiries understandable by and valuable for policymakers and decision-makers more broadly, who are more likely to engage with pragmatic and descriptive-like outputs (Mendes, 2022; Mendes & Ormerod, 2023; Tracy, 2010). In this sense, some themes and features (or subthemes) might portray descriptive-like titles to ensure decision-makers’ readership. As a remedy, we prioritised ‘in vivo coding’ for themes’ and features’ labels, with an exploration of deeper meanings within features. A youth-friendly video summarising the results can be accessed at https://www.youtube.com/watch?v=P1Cmk3SERjA (Portuguese version) or https://youtu.be/6827368TsOM
(English version).
Theme 1 – “It is a big responsibility to take care of others’ mental health”: Young People’s Sense of Responsibility and Aspirations towards Mental Health Promotion and Well-being
Young people acknowledge that supporting their peers’ mental health and well-being is a complex task, and express divergent perspectives regarding their sense of agency and responsibility in this area, as shown by feature 1.1. Notably, some participants expressed that supporting their peers’ mental health was not (solely) their responsibility:
“I do not think it is my responsibility [to support young people’s mental health] because it is a big responsibility to take care of one’s mental health. Therefore, I just feel responsible for my own mental health, which is already a lot” P33
“I will do my part as a human being but I believe it [supporting young people’s mental health] is a responsibility of the State, the society and it is everybody’s duty in the Brazilian Constitution” P26
These excerpts indicate that supporting their peers’ mental health was felt as a heavy responsibility for young people. Nonetheless, other young people recognise their responsibility and agency to provide such support:
“I always feel responsible [for supporting other young people’s mental health]” P15
“I feel very responsible for my friends (…) if I can do something to help, I will” P5
The recognition of their responsibility and agency towards mental health can also impact their motivations to engage in actions to promote the mental health well-being of their communities, as highlighted by feature 1.2:
“I feel very motivated to help my community not only regarding mental health issues but also regarding other areas” P24
“I am a more introverted person but whenever I see someone struggling, no matter if they are my friend or not, I go there and try to help that person by doing whatever I can” P1
“I have been through some struggles and I did not have support from my school, community, or health services. Hence, whenever I am able to help someone going through mental health issues, I help them” P4
For young people in this study, recognising responsibility, agency and being motivated was not necessarily enough to effectively deploy their transformative potential towards the promotion of mental health and well-being. As Feature 1.3 shows, young people expressed a need to liaise with others and to establish partnerships to employ their agency towards supporting their peers’ mental health and well-being:
“We young people, we understand ourselves but we need other people… there has to be [more people involved] to move forward [the mental health promotion]” P1
“A teacher used to support our project but, when she left the school, we discontinued the project because she was the only person who believed and supported us” P33
“I think the support from teachers and other educators within the school is very important because it is very complicated when young people are trying to do something without support” P45
These excerpts reveal that young people’s agency and transformative potential must be ecologically supported by partnering with other young people and also with adults such as teachers.
Theme 2 – “There are many ways to help”: Young People’s Strategies to Support Peers’ Mental Health and Well-being
As seen in Theme 1, young people who recognise their sense of responsibility and potential agency tended to be more likely to support others’ mental health and well-being. This theme captures the multiple and varied strategies employed by young people to support the mental health and well-being of their peers at school and in their community. Young people referred to one-on-one actions as well as actions aimed at the collective well-being. Feature 2.1 highlights strategies to enhance collective well-being:
“Sharing our experiences regarding mental health with other young people at school like a conversation circle” P6
“I am a poetess so I write some poetry and post it on my Instagram. A lot of people DM me saying my poetry made them feel good and this comforts me” P3
“I would post on social media content regarding places where young people could find help. For instance, in my city, there is an Olympic centre in which people can play sports” P7
“At my church, we have a space in which we can open up about ourselves and our problems” P35
As illustrated above, there was versatility in the way young people felt they could support their peer’s mental health and wellbeing. Young people were able to harness skills related to listening and sharing experiences in an empathic way, as well as to recognise and signpost to sources of help, using a range of creative strategies.
Feature 2.2 indicates that similar strategies are suggested by young people for direct, one-to-one peer support. For instance, being empathic and open to listening, as well as validating the other person’s feelings were mentioned as forms of emotional support:
“Not judging, being empathic, understanding, listening to the other person. Sometimes, a simple chit-chat can mean a lot to that person” P1
“Sometimes, just being gentle is helpful (…) you can turn to the other person and say “Aw this that you have done is good”... it is like making the person feel important, you know?” P10
Other young people mentioned social support strategies related to leisure, relaxing and unwinding:
“There are other ways to help, for instance: sharing a song, going out to play football, eating out, trying to have some leisure and having fun somehow” P2
Participants also mentioned more practical strategies related to helping their peers with school assignments, amplifying the other person’s social network and referring them to professional help:
“I could help him to finish his assignments if I see he is swamped with readings and assignments. It would not hurt if I help him to complete three assignments” P27
“I would try to introduce my friends to Noah [the character presented in the focus group’s vignette], people he could talk with. Also, I would try to do some activities with him and encourage him to see a psychologist” P16
Theme 3 – “They don’t believe in us”: Contextual Barriers Young People Face to Employ their Agency
Young people in this study referred to several contextual factors that could impair their transformative potential. This theme captures contextual factors that can impede or make it difficult for young people to employ their agency to support mental health promotion. According to feature 3.1, one of the contextual barriers that hinder young people’s agency in supporting the promotion of mental health and well-being was when they did not feel heard, understood or validated by others, especially adult stakeholders:
“Adults say like “young people don’t know much about life”. That is bad because young people have a lot to say, to contribute but there is not much opportunity for that [for youth participation]” P1
“When people do not acknowledge what I think, this is a barrier. Some people cannot understand me, what I want to express and this comes not only from my family, it comes from everybody” P20
“I felt I was talking, talking and nobody was listening to me” P22
According to some of the participants, adult stakeholders tended to disregard not only their lived experiences, but also their capabilities and skills to promote transformative changes:
“There is an ‘army of adults’ doubting our capabilities [to employ their agency] (…) young people are oppressed and frequently they [adults] say, “he is not capable to do that”” P15
“Just because we are young people, they think we are not capable of speaking about our own rights, we are not capable of standing for our own mental health” P14
Alongside the systematic non-validation, feature 3.2 shows that young people also faced an unfavourable context that disregarded mental health issues or instilled a fear of judgement, leaving young people faltering:
“Young people judge one another very frequently” P5
“There is the fear of being judged as mental health is still seen as taboo by some people. Therefore, I found it very difficult to talk about it [mental health]” P38
Some young people even feared they could be targeted by bullies if they decided to provide support for someone going through mental health struggles:
“I also used to struggle to get along with others and I also was bullied. Hence, I did not do anything. I did not help him (…) I was afraid to be targeted too” P25
Prejudice and discrimination related to sexual orientation and gender identity were also mentioned as prompting an unfavourable environment for young people employ their agency:
“When the people from the council city found out the project was run by transsexual young people, they started to ignore us, they stopped replying” P42
Another common contextual barrier was when the other person was not open or ready to receive support, as highlighted by feature 3.3:
“One can help only if the other person is open to being helped. Some people do not seek help or they are too shy, too introverted to talk about their issues… in these cases, it is difficult to help” P10
“Sometimes, one wants to help but the other person does not want to be helped, even though they know they need help” P19
Theme 4 – “What if I do it wrong?”: Intrapersonal Barriers Young People Face to Deliver Peer Support
This theme captures intrapersonal issues that can impede or make it difficult for young people to employ their agency to support their peers’ mental health and well-being such as self-doubt or a focus on one’s own well-being. According to feature 4.1, one such intrapersonal barrier was the lack of supporting skills. For instance, not knowing about the problem or its severity, or what kind of help one should provide:
“Sometimes, one does not help because they don’t really know what is going on. Sometimes, they don’t help because they don’t see the situation as very serious or attention-worthy” P4
“Sometimes, the problem is not knowing how to help. Many young people are willing to listen to others but they don’t know what to do. Sometimes they withdraw because they do not know how to help” P3
“I try to do this [offer peer support] but I am not a professional, so sometimes I do not know what to say” P9
Some young people expressed concerns about being invasive or disturbing their peers:
“I want to help but, at the same time, I don’t want to be invasive, to disturb the other person… I don’t want to reach out to the person to offer help, I want them to reach out to me” P5
In tandem with the lack of skills, some young people also did not see themselves as emotionally capable of offering appropriate support to their peers, as shown by feature 4.2. For instance, some of them were worried their intervention could make the situation worse:
“I was freaking out and afraid: Oh my God, what if I say something wrong and she kills herself?. I was thinking: what if I am pressuring her too much? What if I am asking too much? What if this is not the right advice?” P30
“I was anxious… I was afraid to say something wrong and make things worse” P18
Some young people just did not feel confident enough:
“I do have the will to help others but it is a very difficult task. It is very hard and requires a lot from us, young people. So the question is: am I prepared to do this? Until when can I help?” P13
“I am very insecure with myself. Sometimes, I feel I am not capable of helping. I am very afraid to approach people [and offer support]” P16
“Probably, I would try to help the person in a non-effective way because I don’t think I have that much power” P24
The lack of skills and self-efficacy can be seen as counterproductive barriers that should be managed so that young people could employ their full potential to support their peer’s mental health. However, feature 4.3 brings about an important barrier:
“I can help within my limits, I can do what my mental health allows me to (…) I cannot prioritise the other person’s mental health over mine” P14
As seen, young people demonstrate awareness of their own limits to support others’ mental health. In this sense, indicative signs of the need to refrain from helping were when young people felt overwhelmed by the situation or when the other person started becoming dependent on that support:
“My limit is when I start to feel overwhelmed by the other person’s issues. Whenever I feel like that, I know I cannot help that person anymore” P44
“When you get too involved, there is a problem because it becomes too heavy and difficult for you and for the other person you are trying to help. Hence, [before helping others] one has to take care of their own mental health” P34
“Sometimes, it becomes a little bit tiring as the other person talks a lot just because I was open to listening to them. Sometimes their stories are quite serious and heavy as well” P9
“My limit is when I start to feel overwhelmed by the other person’s issues. Whenever I feel like that, I know I cannot help that person anymore” P44
A good cue to read the situation was, as pointed out by one of the participants, when the other person started oversharing and expressing irritation whenever they were not there for them:
“[The limit for offering peer support is] when the person starts to share things I should not know and then they start to depend on me to feel well. So if they do not talk to me, they feel irritated and feel bad (…) this is the time when I have to tell the person to seek professional help” P25
Member reflections
During member reflections, the vast majority perceived the themes and features identified as highly relevant to their experiences and felt represented. Many emphasised the external barriers to youth participation; for instance, one participant reflected that “the most difficult barrier is the fact that some people still think that mental health problems are bullshit […] and therefore these issues should not be addressed or solved urgently”. A few participants referred to the fact that “young people help each other in any way they can” as a particularly meaningful result. They also offered reflections on the applied value of the results, and the importance of research that listens to young people's voices: “[The results were] super relevant, showing people how young people feel about their health is extremely important for those outside the bubble of the new generation, after all, they need to understand that the new generation has an opinion and wants and needs to be heard”. For a compilation of participants’ reflections see Supplementary material 7.